Request advice on Vicodin use, Avinza, chronic back pain, therapeutic drug use - General Health Message Board

scubamom · 05-26-2006, 02:09 PM

I'm a 35 y/o married mother of 3. I quit working Dec 03, took a year off, and Jan 05 had a stoke. During the stroke a spinal tap was unsuccessfully performed which caused back pain, which was finally (about Mar 05) diagnosed as not a result of the puncture but of degenerative disc disease with a bulge, a tear, and a cyst on S2. At that time I saw a neurosurgeon who did not qualify me as surgical candidate, and who also discouraged physical therapy as to not aggravate further my condition. In May of 05 I started seeing a pain management dr. After the unsuccessful epidural shots, he recommended IDET, which my insurance company promptly denied, although they will cover a fusion/disc replacement.
Here's where I'm at and my questions are:
- I take Norco, 10/325 3x per day.
-My dr wants me to take Avinza (morphine-ish) time release which scares the bejeebies out of me.
-My pain mgmt dr has also stated that if I don't choose the disc replacement or pay for the IDET out of pocket, that he will discontinue seeing me.

There are minimal ill effects from the stroke, mainly short term memory, but otherwise I'm in generally good health. Although I do have high bp, started during my last pregnancy, it's controlled with meds, and I do have to take a blood thinner for stroke therapy.

Is there any reason why I should be held hostage to have surgery when I really feel that it's not yet necessary? There's a strong family history of back and osteo disease and although I'm certain it will happen eventually, does it have to be now? I have 2 teenagers and a 5 y/o. Although my youngest will go to school this year I'll still need to get her to and from and care for her otherwise. My husband supports us nicely but we can't afford a housekeeper or nanny. I've explained to the doc that even though I don't feel it's yet necessary, the timing is also particularly poor. That aside though, I function perfectly normally using the medication. Doesn't mean I'm not dependent, but that's not addiction. I feel the doc's request to move to Avinza is an increase in the drugs and a drastic move. So all these factors examined, what's the problem if I continue taking this medication for a few years? Am I missing something?

Thanks anyone for your comments.

BrittleBones · 05-26-2006, 03:25 PM

Hi and Welcome Scubamom! Wow...it certainly DOES sound like your current doc is holding you hostage! Refusing or choosing not to participate in an invasive procedure with all of your health issues sounds to me like the very best decision you could make at this point. Especially if the surgery isn't absolutely necessary. But maybe I'm confused...you say that your doc wants to up your current med to something stronger, namely the Avinza; yet he says he/she won't give you any meds if you don't undergo the surgery. Is that right? Your nuerosurgeon gives you the medication? Or does your Pain Management doc write the scripts? There should never (in my opinion) be negative consequences to a patient's decision to opt out of surgery. My pain management doc had me scheduled for a nerve ablation (sp? - burning the nerves) for my back. I got all the way to the pre-op room and was sitting with my little gown on when I had a serious change of heart. But I told the nurse that I was afraid if I didn't go through with it that the doctor would be very angry and probably not continue to treat me with medicine. Well, she went to get him and explained the situation. He marched right in and told me that he would NEVER force a patient to go through with a procedure that they didn't feel 100% sure about. He also told me that he doesn't "punish" his patients by withdrawing their medication or cutting them off.....or lowering their dosage because they disagree with his recommendations. As far as the IDET goes: I don't know what those initials stand for - I probably should, but I don't. Is it possible to fire your pain management doc and find a new one who is willing to treat you with meds for the near future? Don't know what the availability of pain management docs is in your part of Florida. There are other folks on this board with much more experience and better advice than I have and I know they'll be along very shortly to help you out. In the meantime, I'm glad you are here and hope you continue to use this board to get and give help and support. All the best - KathyMac

ARANGER · 05-26-2006, 11:18 PM

Hey Scubamom, welcome to the boards!

I agree with Kathymac about the procedures. You should always be allowed a second, third, or fourth opinion. And in the meantime, you should not be punished. Your doc as already confirmed that you have pain obviously by suggesting invasive treatments. BTW Kathy, IDET stands for Intradiscal electrothermic therapy.

As far as the Avinza or any LA med. Its not such a bad thing. If you have chronic pain and are taking shortacting meds like Norco which has Tylenol in it. Over time this can be bad for your liver and with SA meds, you don't get complete coverage. These meds spike rather quickly and then start to drop of. Which equates to multiple dosing. With a med like Avinza you don't have these ups and downs. Many times you are able to cut back or get off the SA meds like Norco and only use them for break through pain. LA meds you usually don't feel like SA meds. Its a much smoother release.

If your doc is pushing a surgery on you, I would consider getting a new doc that gives you options. Or at least go get other opinions. With that said, if the generally feeling is that you need to get something done, you may find it difficult to find a doc to continue to treat you with meds only. But there are other options before going to surgery. There are steroid injections, PT, and some other minimal invasive procedures. Let your doc know your apprehension regarding surgery and that you want to try some other things first to see if you can get a few more years out of your condition before going to surgery

Anyway, thats my opinion. Good luck

wrenegade · 05-29-2006, 08:29 AM

Hi Scubamom! I am in SW Florida and have a very good pain management doctor in the Port Charlotte area. I know we cannot be too specific on the boards, but if you doctor is trying to force surgery on you, I would definitely look around for another doctor.

KathyMac, Bless you for your courage in taking control of your situation at the last moment and what a blessing to have a doctor like you described. He sounds like an exceptional person.

wren