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Old 08-02-2017, 06:54 AM   #1
erfan
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No changes

I have the following impression

Multilevel degenerative change...slight progression from prior.

Thecal sac narrowing is noted at multiple levels of note. Severe thecal sac narrowing at L2-L3 and moderate at L1-L2, L3-L4 and L4-L5.

Multilevel Foraminal Stenosis Severe on left at L2-L3 L3-L4, and L4-L5. Moderate at other levels described.

I have been on Percocet 10/325 bid and MS Continue 60 bid for many years with little help. Any suggestions?

Alan

 
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Old 08-02-2017, 12:54 PM   #2
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Re: No changes

Perhaps a surgical consult? Not sure what your asking for suggestions regarding. If it is regarding meds, none of us are qualified to make suggestions regarding meds.
With narrowing or compression, typically surgery can be done to relieve symptoms and pain, so if I were you, getting a surgical consult would be my choice.

 
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Old 08-03-2017, 07:19 AM   #3
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Re: No changes

I am not surgical since I don't have any open levels for a fusion. More than one doc has assured me of this.

Alan

 
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Old 08-03-2017, 05:28 PM   #4
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Re: No changes

I assume you see a pain management specialist? If so, another pain doc opinion wouldn't hurt. Maybe even another doctor at the same practice. If not, than another practice. [Just as a consult. Don't accept any meds or sign any contract. Don't cut any ties with the current doctor/clinic.]

Every doctor usually has a slightly different way of doing things, different meds they prefer, etc. Are you doing anything else for the pain besides the opioids? A good pain management plan incorporates a mix of daily meds, as needed meds, alternative therapies, lifestyle changes, and more. It usually takes a combination of those to obtain some good pain relief; 50% is a common reasonable goal. You should discuss tangible pain management goals with your doctor. Some like numbers (such as pain reduced from X to X out of 10), but many find it more clear when a patient says their pain prevents them from doing X, Y, and Z.

However, unfortunately the climate is moving away from using opioids for noncancer chronic pain. We are lucky to be getting anything nowadays. Therefore even though your dose is low, it is unlikely that a different doctor would give you a dose increase, despite that an increase in tolerance is very normal. People are having their doses decreased (it happened to me - by 2/3) or even being taken off the meds. My doctor has basically told me no more dose increases ever, so eventually it may get to the point that the opioids aren't even worth it anymore.

I can say that MS Contin is a poor pain med for many folks, so if you haven't tried multiple other long acting opioids and returned to that one, it is worth specifically asking to try something different. In addition to reminding them about your continuing high pain levels, mention any other issues, such as the dose wearing off early or side effects.

Through some trial and error I found that one pain med gives me a lot more effectiveness than anything else for an equivalent dose. Despite there being standard published dosage conversions, everyone is slightly different, and we also may not have complete cross-tolerance to other meds. Due to that, even back when they were doing dose increases due to tolerance, when a patient said the med wasn't as effective, they would usually try switching it before they would consider increasing the dose.

Also, many folks take MS Contin 3 times a day, so if the dose wears off early for you, tell your doctor. However, unfortunately it looks like it only comes in 15, 30, & 60mg, so you couldn't do an easy swap from 2 to 3 times a day, but 30mg 4 times a day might be an option. Also, there are two other long acting morphine formulations that come in capsules instead of pills and will actually last a full 12 or even 24 hours, Kadian and Avinza, which both have generics. It looks like those come in more dosages too (although with the longer dosing, you could probably just stay at 60mg bid). In short, definitely ask your doctor about trying something else. Ideally a different long acting med and some adjunct therapies, but at least swapping the MS Contin dosing and/or formula to ensure you are getting constant coverage.

Note that having good constant long acting med coverage is important so the short acting med can actually be for true breakthrough pain, not taken on a schedule to fill in gaps in pain relief between long acting med doses. Yes, we can't really be suggesting specific treatments, but hopefully this general advice was helpful. Best wishes.
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Old 08-05-2017, 04:26 PM   #5
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Re: No changes

I appreciate the response. Physical therapy made matters worse and injections didn't help. I know that I'm lucky in the current environment, but Who wants to live like this? I just don't want to move.

I do have a full time job I do from home so there is that. I just feel that those of us with legit pain issues are getting punished by the actions of others.

 
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Old 08-05-2017, 04:56 PM   #6
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Re: No changes

I'm so sorry for your pain, Alan.

 
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Old 08-08-2017, 05:15 AM   #7
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Re: No changes

Quote:
Originally Posted by erfan View Post
I just feel that those of us with legit pain issues are getting punished by the actions of others.
Yeah, it seems tougher than ever right now. However, these types of changes are also in our interest. If a pain patient's doctor has issues with the DEA, that hurts both the patients and the doctor. I'd rather get something than nothing.

Keep trying different specialists and see if any have some new and different ideas. Or, sometimes just a new combination of treatments. Hang in there! Best wishes.
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