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hedycarter1 03-17-2004 10:38 AM

Question for Shoreline or anyone else that can help
 
I had my first epidrual injections 2 weeks ago Monday, I have had the worse pain in the last year from the next day until now. I called my doctor, he is sending me in for another MRI on Friday.

Here is my question:

He had me on Vicodin 5/500 1 - 2 Tabs every 6 hours as needed. I had to take 2 every 6 hours to make it to work. Anyway, i called him again and expalined that the pain meds only worked for around 3 hours and then I was in agony again was there anyting else he could do. He called me in a prescription for Vicodin es witch is 750/500 1 tab every 6 hours. Isn't that less hydro?

So far this morning i am okay, I took one as soon as I got up, my pain usually gets really bad in the afternoon as the work day wears on. I am at a desk job for the most part and do a lot ot typing. It seems to inflame everything. I do Ice and strech, and try to change positons as often as possible.

My last MRI showed:

DDD, DJD or the c-spine, Opteophites in c6/7pinching a nerve, I now also have bulding disks in c6/7. Formnal narrowing. Sorry for the spelling, I am going off memory here. I know is said something else but cannot remember what it was.

Anyway, Could me increase pain just be from the buldging disk or the bones spus getting worse? I have not heard of anyones pain increasing for this long after an ESI.

I appreciated any responses...

Thanks

hedy

Shoreline 03-18-2004 06:07 AM

Re: Question for Shoreline or anyone else that can help
 
Hi Heady, Vicodin ES has 7.5mgs of Hydro and 750 mgs of Tylenol, Meaning you can't take 2 at a time without risking liver damage from the tylenol, It's called apap on your bottle. Yes that is less hydro than taking 2 5/500 vicodin . My suggestion would be to take onetablet every 4 hours, By the 6th hour you pain can wind up so bad you can't bring it back down. You might want to double check what he gave you, If hge gave you Lortab 7.5/500 then you m=could take 2 at a time but you may run out early. But switching you to a med you can't take 2 off and decreasing your intake from 10mgs of Hydro every 6 hours to 7.5 mgs is a 25% decrease in anyones book. Are you sure he gave you 7.5/750 or 7.5/500, You can take up to 1000mgs of apap every 4 hours, but no more than 4000mgs per day short term..

ESI's can cause pain if you don't have a lot of space in the epidural area, They pretty much inject the same amount of fluid into everyone and if you have less epidural space then someone else you can certainly have pain from the pressure. The last Meylogram I had done, went very smoothly and the doc commented on how large the epidural space was he was injecting into, becase there was plenty of space it didn't cause any pressure and was pretty painless. As the meds are absorbed the pain should lesson, but there really isn't a way to spead things up. A little heat from a heating pad may help it disperse faster but it may just take some time.

Your not gettng a terrible spinal headaches that make you vomit when you stand upright are you? The spinal headaches are a possibilitry if they nick the dura and you loose spinal fluid, It's a risk of having an ESI, The only way to patch the hole in the dura is with a blood patch. They draw blood from your arm and inject directly into your spine near where they think the nick is, this way when the blood trickles out of the nick and the whole created for the blood patch it clots and seals both holes.

Spinal fluid doesn't have clotting ability on it's own ,when you loose spinal fluid you brain sets down on your skull whoich is the worst headache you can imagine. The blood patch not only clots the hole but tops of the spinal fluid and relieves the headache. You didn't mention headache so it's probably nothing to worry about.

Hang in there, You will likey wake up one day soon feeling much better, then think carfully before having another ESI done if this one did nothing but cause pain. Take care, Shore

hedycarter1 03-18-2004 09:05 AM

Re: Question for Shoreline or anyone else that can help
 
Hi Shore,

yes you are correct, he gave me vicodin es,it is 7.5/750. I thought that it was less hydro. I did not undrstand his thinking. So I cannot take 2? If I take it every 4 hours I will run out early but I have to be able to work.

My pain is still very bad, it has almost been 3 weeks now, I also have pain running down my spine by my sholder blade which is new.

Is is possible that he hit a different nerve than c7?

I am back to taking the 5/500 2 every 6 hours because I get better relief although it still only works for around 3 hours.....

I will not have anothe ESI, it made me worse.

What would be your suggestion to speak to him about next. he is a spine specailist, phisiologist (sp?)...

The neurotrin that I take is not longer working.

By the way, do I have to wean off the neurontrin or can I just stop taking it? I have bad side effects,(dizzyness, headaches etc.) and it is not really helping my nerve pain anymore...

thanks,

hedy

hedycarter1 03-18-2004 04:32 PM

Re: Question for Shoreline or anyone else that can help
 
Bumping it up for Shore to see...

Backsahurtin 03-18-2004 09:21 PM

Re: Question for Shoreline or anyone else that can help
 
[QUOTE=hedycarter1]Hi Shore,

yes you are correct, he gave me vicodin es,it is 7.5/750. I thought that it was less hydro. I did not undrstand his thinking. So I cannot take 2? If I take it every 4 hours I will run out early but I have to be able to work.

My pain is still very bad, it has almost been 3 weeks now, I also have pain running down my spine by my sholder blade which is new.

Is is possible that he hit a different nerve than c7?

I am back to taking the 5/500 2 every 6 hours because I get better relief although it still only works for around 3 hours.....

I will not have anothe ESI, it made me worse.

What would be your suggestion to speak to him about next. he is a spine specailist, phisiologist (sp?)...

The neurotrin that I take is not longer working.

By the way, do I have to wean off the neurontrin or can I just stop taking it? I have bad side effects,(dizzyness, headaches etc.) and it is not really helping my nerve pain anymore...

thanks,

hedy[/QUOTE]

Hi Hedy,

I know I'm not Shore, but thought I'd tell you that they weaned me off it when I took it last. I was on 2700 mgs a day (3-3x's a day). The pm doc had me do a gradual taper and it took several weeks, but I'm glad I did it that way. From what his office staff told me, I could have been high risk for seizures had I just quit taking them. They are considering trying me on it again to see if it'll help, but I'm not quite sure I want to do it since my memory from the time period I was on it is rather vague. I've also had 2 seizures, but they are from unknown origin (one was while I was in the dentist office, the other I was talking to my hubby when he said my eyes rolled back in my head and I started shaking all over, he said I didn't fall down or anything, just this tremendous shaking that scared him really bad). Haven't had any others that I know of though I do feel like this 'internal' shaking once in awhile. Give your doc a call and ask how he'd want you to stop.

Shoreline 03-19-2004 05:31 AM

Re: Question for Shoreline or anyone else that can help
 
Hi Heady, Backs a hurtin is correct, You do need to taper off anti seizure meds, The drop in medication could actually cause a seizure, So you do need to taper. If your taking the 300mgs pillls and this would be for 900+ mgs per day as long as you decrease no faster than 300 mgs every 3-4 days you should be fine. I did a very rapid taper of neurontin without problems.

Now if you have had a seizure before that changes everything and you really have to taper slowly and if you have always taken some kind of anti seizure med to control seizures it would have to be replaced with something else to prevent seizures. I'm not sure why docs think patients are morons and can't figure out that their dose has been dropped when you go from 10mgs of hydro to 7.5 mgs. Duh..
If your back on the 5's you may find you get smoother relief by taking one tablet every 3 hours instead of 2 every 6, this way your pain doesn't wind up to the point of not being able to bring it down. These meds do not last 6 hours, I can't think of a single short actning med that does, You take a vicodin, wait 45 minutes for it to work and your lucky to get 3 hours of relief after that. You are not unusual, That's how they work and if your Physiatrist doesn't know any better you probbaly need to find a PM doc that has an anesthesiology background and a better understanding of opiates.

I wouldn't want a physiatrst "physical medicine doc" doing my epidurals, It's not like they are anesthesiologist and have done thousands in a maternity setting, Physical med docs practice on their patients and hopefully get better with time. IMO
Take care, Shore

hedycarter1 03-19-2004 08:41 AM

Re: Question for Shoreline or anyone else that can help
 
Hi backsahurting,

Thanks for responding. I was wonderig about that, I had heard that I could not just stop taking it. I am on a pretty low does but I do notice that if I don't take it I feel very tired and achy...Did you experience this? Ihave been on it for year now....

Thanks
Hedy

hedycarter1 03-19-2004 09:14 AM

Re: Question for Shoreline or anyone else that can help
 
Hi Shore,

I posted before I saw your response. Thank for the advise. I am going to start taking 1 every 3 hours and see if that will help. I am goin in for another MRI this afternoon becuse my physiatrst does not undertstand why my pain is worse. So do go back to my PCP and ask for a referral for a Pain Management Doctor?

I was told that phisical medicne doc are the ones that do the injections. The title on his card is
Minimally invasive treatments for the spine
Pain Management

What does that mean, pain management? Should'ne he be trianed in meds?

Thanks,

Hedy

Backsahurtin 03-19-2004 11:00 AM

Re: Question for Shoreline or anyone else that can help
 
[QUOTE=hedycarter1]Hi backsahurting,

Thanks for responding. I was wonderig about that, I had heard that I could not just stop taking it. I am on a pretty low does but I do notice that if I don't take it I feel very tired and achy...Did you experience this? Ihave been on it for year now....

Thanks
Hedy[/QUOTE]

Hi again Hedy,

I did notice feeling more tired when we made my first attempt at tapering, so the pm doc had me go back to my original dose and we tried it again about 2 weeks later and I had no problems at all. Unfortunately, I didn't get to do a rapid tapering like Shore did, but the slow tapering worked for me. I think it depends on the person, the dosage, and length of time you've been on it for how they'll do the tapering for you if you're ready to come off it.

I hope you can do a rapid taper and wish you the best of luck with it! I'll keep you in my prayers!

Back...

Did y'all gain weight while you were on it? Just curious.

hedycarter1 03-19-2004 11:22 AM

Re: Question for Shoreline or anyone else that can help
 
Hi there,

i did not gain weight but I cannot seem to lose any either, summer's a comin and I cant seem to drop the last 10 lbs...

another side effect that I don't like...

Backsahurtin 03-19-2004 11:39 AM

Re: Question for Shoreline or anyone else that can help
 
[QUOTE=hedycarter1]Hi there,

i did not gain weight but I cannot seem to lose any either, summer's a comin and I cant seem to drop the last 10 lbs...

another side effect that I don't like...[/QUOTE]

I didn't know if the weight I'd gained was from it or the prednisone I was on for so long. I'm off it now too, came off about the same time I started Meth so wasn't sure which is responsible for my weight loss (have gone from 202 to 179 since Sept). I did completely lose my appetite for awhile (during the holidays, lol) but am now eating kinda reasonably, but still not right yet. Just don't feel hungry very often and when my tummy says it's full, I stop or I'll end up sick which I know is not good for the back. Was actually adjusting to being about a 5 on the scale but am at 8 right now due to something not agreeing with my tummy. Guess I'd better quit the salami at 2 am huh? lol

I wish you luck with the last 10 lbs. You can do it!!!!
Ang

hedycarter1 03-19-2004 11:46 AM

Re: Question for Shoreline or anyone else that can help
 
Hey Ang,

I would think that the weght gain is from the pregnizone (sp?) I know that when my mom was on it she swelled up like a baloon. Why were you on it? for Pain?

I am having a very hard time with feeling sick to mmy tummy as well, about an hours after I take my vicodin I get very sour tummy...

Yes, quit the salami t 2 am..hehe...

Heather

Shoreline 03-19-2004 01:30 PM

Re: Question for Shoreline or anyone else that can help
 
Hi Hedy, Your physiatrist claims to be a pain management doc. The reason why I say claims is because anyone can claim to be a pain management doc. There is no internship for PM docs, An internship for pain management would be very similar to the internship for neurology and physical medicine. However anesthesiologist also practice PM.

Maybe a nicer way than saying a doc claims to be a PM doc is the doc has devoted their practice to patients that need pain management and everyone's needs are different and every doc has a different philosophy on the usefulness of long acting opiates. Some docs will prescribe LA opiates but think BT meds are the road to addiction.

Without a curriculum, without an Internship or fellowship in pain management, there is no cross the board way to manage pain. Just as there is no absolute right way to fuse a spine. If you see 5 different ortho surgeons, they may suggest 5 different ways and approaches to spinal surgery.

It all depends on who they trained with and what their philosophy is. In actuality, a med student receives 3 credit hours of pain management training which is simply training for management of acute pain, injuries or post surgical. There is no Internship for pain management and intervention where docs receive additional training in the use of long acting meds or intervention procedures. That's why PM are usually Neuro's, Physical med, psychiatry or anesthesiology. My pm is a Neurologist/Psychiatrist His partner is a DO/anesthesiologist that did an internship in general surgery so he can do pump implant and management.

There are a couple other physical med docs at the practice and a psychologist along with a couple nurse practioners to manage the stable cases. I don't think a single doc at my clinic has the same credentials but they all practice pain management.

Perhaps your physiatrist/PM doc only use opiates in certain cases. Asking for a referral to another PM doc is really just asking for a second opinion. As far as the meds she prescribes, those are the ones she's comfortable with. She may not be comfy prescribing the long acting meds where dependence is an excepted and unavoidable risk.

It actually makes sense to try less potent opiates and some other modalities like trigger point injections, epidurals, prescribing TENS units and PT. Not everyone that needs pain management needs to be on Duragesic patches or morphine. The doc should prescribe appropriately for the condition and use a multi faceted approach when other methods haven't been tried.

The anesthesiologists tend to know more about opiates and aren't afraid of the long acting ones. Physical med docs can prescribe anything they want, however her philosophy may not be pro extended use of opiates. Just as every patients needs are different and will respond to different modalities, every PM docs Philosophy is different and his method of pain management may be different from the PM doc down the street.

Prescribing potent long acting meds draws a tremendous amount of attn to the doc and they have to be able to justify the use of these meds. Diagnosis is important but documenting other methods to manage pain that have failed is even more important for a doc to be able to justify his prescribing practices. Before my doc prescribed anything, I saw the psychologist, Took the MMPI which is a 3 hour psych test, did a UA and had a complete physical. I brought him a list of every other PM doc I had seen and the contact info, a list of every modality I have learned or tried, the effectiveness of each and the contact info, A list of every surgery and the radiology reports and contact info for the surgeons, and a list of every med and the effectiveness of each.


Why go right to a Duragesic patch if physical therapy hasn't been tried. Unfortunately pain management is booming and many folks just won't except the fact that they have to live with some level of discomfort. Some people will consult and consult with PM docs until they get the meds they want without having to try any other method of pain management.

I don't think people need to suffer but if someone is looking for complete pain relief so they can go back to riding bulls at the rodeo, they have no business taking these meds. If you can ride a bull, I would say your not exactly living with intractable pain and that's what these meds are designed for. If Vicodin or Ultram drop your level of pain from a 8 to a 5, you may have to except that, just because you know morphine would give you more relief, doesn't mean a doc should prescribe it.

Being dependent on these meds carries allot of baggage and creates allot of heart ache. Without the meds, I would be bedridden and couldn't stand long enough to shower. My needs are not the same as everyone else's. I was completely bed ridden after 3 failed surgeries, the last was a 6 level fusion with 12 screws and 8 rods. 2 of the new screws have already sheared the head off. These aren't little screws either, they are more like hex head lag bolts almost 3 inches long.

Even with all the meds I take, I haven't seen a pain level under a 6 in years, I haven't slept through the night in 5 years. But I have to except this.The number system is a horrible way to gage pain. I have had to adjust my own pain scale with every surgery. What I thought was terrible pain prior to my first surgery is more like a 4 on my pain scale now.

What was once unimaginable pain has become very real, So if a 10 is the worst pain you can imagine, that 10 is only based on what you have personally experienced. A doctor can't look at me and say your obviously at a 10 and look at someone else and dismiss their pain because they haven't ever had surgery. A nerve compression can hurt just as bad as anything else, But it's based on subjective experience. What type of pain have you experienced that your comparing your level of pain to now.

Increasing my meds would decrease my ability and motivation to function, so I have to except what I can get as far as pain relief. I am doing another pump trial next month, But PM is different for everyone and every PM doc should treat each case as a separate and unique case. Someone with DDD may be able to drop their pain level down to a 2 or 3 with Ultram. Ultram won't do a thing for me. Norco doesn't even touch my pain, My BT meds are stronger than some peoples entire day supply.

Just as my pain requires X amount of meds, There are people worse off than me. I know one person that takes 160 mgs of methadone 4 times a day. I know another that needs a combination of Kadian, Methadone, and he wears 4 100ugh patches. His case is unique too.. They attempted to fuse him and he had advanced osteo perosis. As soon as he stood up after surgery half the screws pulled out and his spine totally shifted. He can't walk to his mailbox and he takes 10 times the dose of meds I do.

There are people that would truly kill themselves rather than face their pain without meds, not because they are weak, but because their pain is that debilitating.

Some people are able to continue to work with the help of meds, Some people no matter how much you give them they will never work again. Opiates aren't miracle cures. It's simply palliative care. Treatment to make your life more tolerable.

There are many down sides to opiates though,I know people that have family members that won't speak to them because they have no understanding of opiates and pain management and think the person just wants to stay high all the time. First off, when you have been in pain for 11 years and taken LA meds for 4, you don't get high, there are no pleasant side effects and it's simply a trade for the ability to function and contribute in some way to the family, even if it's just doing the dishes and some laundry. I take care of the house but it takes me all day to complete 2 hours worth of work..

Continued on next post

Shoreline 03-19-2004 01:32 PM

Re: Question for Shoreline or anyone else that can help
 
However, not everyone that goes to a PM doc needs long acting meds, An ESI may calm things down for 6 months and then another may do the same. If the condition worsens, which things aren't exactly up hill as you get older it's nice to know there is something out there to help you deal with pain.But if you start your PM journey on high doses of long acting meds before you have ever had surgery to try to correct it. How well do you think surgery will go when the surgeon is afraid to add anything for pain to what your already taking for fear of overdosing the patient.

It's not likely. Surgical pain can be treated just like breakthrough pain but some docs aren't comfy with their patients needing something more than 600mgs of morphine per day.

There is a huge difference between Intractable disabling pain and discomfort and annoying pain, they both don't need the same level of intervention. That regulation about making pain the 5th vital sign has people going haywire thinking that the docs are breaking the law if their pain isn't managed to their satisfaction and they can sue the doc that wouldn't give them a shot of morphine for their pain in the ER.. That's not how it works.

That regulation simply means that while a patient is in the hospital they must ask you what your level of pain is. If the doc prescribes Motrin then he has asked, evaluated and treated. It's not a guarantee for morphine for all.

With any doc who wants to play PM doc being able to hang Advanced pain management on their door, It doesn't mean that everyone that has DDD should take morphine or that doc is going to prescribe a narcotic pain killer. You may get elevil and Neurontin. Everyone over the age of 30 has some degree of DDD. It doesn't mean they are going to relieve 100% of everyone's pain and turn every patient into an opiate dependent patient that must return every month for refills or they go through withdrawal.

Your present doc is a PM doc, you just need to communicate your needs, your level of pain and if she isn't able to make your pain manageable, then consult another PM doc and see if he has something to offer your first doc didn't. The goal of pain management with opiates is never 100% reduction in pain.

PM docs that believe in using these meds usually shoot for 50-60% because they know that patients expecting complete relief will never be satisfied and will always need an increase. Every visit will be the same, I still hurt, can't you do something more? This makes a patient the worst candidate for opiate therapy because their expectations are not realistic.

There are some folks that think they have to feel the meds, if they aren't warm and fuzzy they don't consider their pain being managed, another bad candidate that will always need an increase.

Take care, Sorry I was long winded, That's twice I couldn't keep my post to 10,000 characters.LOL Shore

hedycarter1 03-19-2004 01:58 PM

Re: Question for Shoreline or anyone else that can help
 
Wow Shore,

Thanks for all the great information. Yes, I agree, I do not want to be on long acting meds at this point, I have very bad pain in my eye but nothing as compared to your I am sure. The vicodin still works for me most of the time. I have been on it for ovr a year now at pretty much the same dose. Perhaps I just need to go to norco.

I am doing PT, Acupuncter,I try to swim 2 times a week. And now the ESI's.

I do like my doctor he is nice and I think that he is worried about my pain. Its really only been since the last ESI that I had such bad pain, besided that I was usually between a 4 - 7 every day. Since the ESI I have not been below a 7 yet even with the meds.

I tryed 1 vicodin every 3 hours like you suggested today, I still have not been below a 7.5 today. The nerve pain that I am having along with the stabbing pain in my neck just dont want to go away.

Anyway, off I go to Another MRI.. I geuss the doctor wants to know more about the new disk buldges and why I am having increased pain

THanks again for the wealth of information, I feel better prepared for my next doctor visit.

Hedy


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