Shoreline

Hey Jen, I thought you had surgery scheduled already, Change of heart?
Physical medicine covers alot of different techniques and modalities to manage pain, everthing from trigger point injections to ESI's , PT some Physiatrist do chiropractic type manipulations, some do acuppuncture, use tens or do TINS. There are all kinds of nerve blocks to try, but these smply mask pain, they won't reduce an impinged nerve. Pain mangemnt is just that, it's simply tryng to manage your pain, It won't fix anything. If your sciatica is from an impingement nothing any PM doc does will correct it or the other bulging discs.

You let the cat out of the bag with your acknowledgement of previous history and use of meds for reasons other than pain, you can't undue this and it will follow you, there are dozens of modailties to try to manage your pain before someone deems your pain is intractable, inoperable and your only option is opiates for pain relief. Docs aren't being cruel by trying other methods aside from the one you know will work. It may even be for your own good whether you believe it or not.

Avoiding surgery nobody wants to have becaue you can find a doc willing to treat your pan has consequences. Just things you need to consider when it's hard to think of anything but pain relief. But nobody is really doing you a favor by maskng a problem that could have been fixed and leaving you in a posotion where your only option becomes pain management. Right now you have options. In a year you may have none.

The all have their own idea of what works and what doesn't. As far as any new doc or PM doc taking overprescribing, they bvioulsy want to contact your other docs to be sure they are the only one prescribing. Some believ antidepressants are the key to manageing pain, some use anti seizure meds like neurontin, toppamax lamyctyl and many others. It's al trial and error.

I do think people should have a choice regardng surgery or trying pain management, however these PM docs need to explan the possible consequences of not having surgery, trying everything under the sun , then deciding only opiates will help. You can only mask a mechanical disfunction that neds to be fixed for so long. If everything was stable and you were left in pain after surgery, that's a little different, but to put off surgery and try everything possible to prevent it, including opiates, you may miss the window in which you could have had a succesful surgery.

Acute pain turns to chronic, the gateway theory kicks in and even if the impingement on the nerve is removed, the gates that allow pain signals through are stuck open, pain is imprinted into nerve tissue and no surgery will relieve your pain even when a compressed nerve is obviously decompressed. There is a risk to not having the problem fixed surgically, and that risk may be loosing the chance of ever having it fixed and spending the rest of your life looking for a way to manage pain that could have ben fixed from the get go.
Every PM doc has a different view of opiates, there are plenty of PM docs out there from every field that don't believe in their benefit.

I know you just want pain relief, but if the answer is surgery and you choose somethig else, surgery may not be an opton down the road. PM docs need to exlpain this and the gateway theory and explain about pain imprinting into nerve tissue. What you may have fixed now, may not be an option in a year from now when you can no longer mask the pain because it's a mechanical problem that should have been fixed.

You will still have the mechanical/structural problem, simply masking it untill you feel ready could have a very negative impact on the posibility of succesful surgery or even finding a doc willing to operate.

Good luck, Dave