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Old 08-22-2012, 10:23 AM   #1
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Can extruded discs heal? And PM questions.

Hello. I am a new to this posting on this board.

I've been a PM patient for the past 10 years. My neck issues started after a car accident 21 years ago.

5 years ago my new (and current) PM doctor said I was half way to needing surgery. In an attempt to avoid the knife, I've run the gauntlet of conservative treatments; PT (many rounds), chiropractic, massage and neuro-muscular therapy, heat, ice, various injections. I took Neurontin for years before starting with this PM. He prefers Baclofen. My pain has been treated with cervical facet injections 1-2 times a year, Lortab 7.5/500 and 10mg Baclofen - both 3X a day. Well, this isn't cutting it anymore.

My pain is largely left sided. Neck, shoulder, upper arm. Also pain in upper back and clavicle area.

My last MRI indicates:
C4-5: mild disc bulge and moderate facet degenerative changes.
C5-6: Right central disc osteophyte complex, focally narrowing the right anterior canal and producing right sided foraminal narrowing. Mass effect upon the right anterior cord is present.
C 6-7: Left central disc extrusion entirely filling the left root exit zone.

I know osteophytes don't go away, but can disc extrusions heal on their own? My doc doesn't think I need a new MRI unless I develop new symptoms. Is increased pain considered a new symptom? The end of June I had facet injections at 4 levels and the relief was not what I used to get from them. I've been on the same dose Lortab for the last 8 years. Yes, 8 years! For whatever reason I haven't built up a tolerance to this dose or maybe I'm just stoic and stubborn. What will my PM think in regards to me being on same meds for so long and suddenly asking for something stronger? .

Over the years when pain got unbearable, PCP would Rx a small amount of Oxycodone. It got me through bad flare ups and then I'd just go back to the Lortab. I have not had to sign a contract, do pill counts etc. I don't want to create any issues.

But now this is no longer adequate, having more bad pain days than ever and am scared to death to ask for something stronger. I am seeing him on Friday and don't know the right adjectives to use to get better pain management. When I had my last injections I asked him if there way anything else I could do and he said "No, other than surgery. And there is no guarantee surgery would relieve all my pain". Woud PT be of any help at this stage?

Sorry, I'm scattered and rambling.... Pain is bad today. Just wanted to introduce myself and get started posting. I know the stronger meds question gets asked all the time here, but I'm really at a loss for words. I need some support from those who understand chronic pain and the associated PM pains.

Thanks in advance for ny replies.

Kay

 
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Old 08-22-2012, 08:27 PM   #2
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Re: Can extruded discs heal? And PM questions.

Welcome! Sorry you are dealing with more pain. It is definitely reasonable to need a med/dose change after 8 years. I would have a heart to heart with your doctor that the last injections didn't have you the same relief they have before, you are noticing the Lortab has been managing less and less of your pain, etc. If you can, give a percentage or 1-10 scale increase in pain. Tell them what it has prevented you from doing which you used to be able to do.

Ask what they suggest. They should have some sort of idea/option for you in addition to wait until its worsened enough for surgery. I'm not an expert, but if your condition hasn't changed (only potentially worsened), and nothing new is going on, it doesn't seem worth re-trying treatments that didn't work. Maybe someone else can chime in on if you are missing a type of treatment for this condition. I see that you should have a lot more options for medications, both narcotic and non-narcotic. There are other adjunct pain meds similar to Neurontin, and other muscle relaxers besides Baclofen.

I think increased pain can be a new symptom, but then again, its expected for treatments such as injections and narcotics to lose effectiveness over time. It depends on how much you trust your doctor's opinion if they say you don't need to repeat it. I would not be afraid of "creating issues". You deserve treatment for your pain. As long as you are not asking for meds by name/dose, insisting on getting more pills before you leave your appointment, etc, you don't have cause for concern.

Your doctor doesn't know how you are doing unless you tell them. Even if you fill out an intake sheet when you go into your PM doc (a lot of them do that), they may not recognize you rated your pain higher than last time unless you point that out. I think it is very reasonable to need a stronger med after all this time, and may even be time to consider a long acting pain med.

If you have had constant pain for this long and have been taking the Lortab around the clock, a long acting med can give you much more even pain control. I'm shocked that you have been getting by with only three times a day as well, as for most folks, Lortab wouldn't last more than a few hours. Best wishes.
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Old 08-22-2012, 09:24 PM   #3
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Re: Can extruded discs heal? And PM questions.

Tortoisegirl-

Thank you for the reply. . And the Welcome!

I've read many of your posts and you always give such thoughtful advice. I really appreciate it. .

You are right that the Lortab doesn't last more than a few hours, about 3-4 for me. Until I found this board and started reading posts I didn't realize that a daily roller coaster of pain was not the norm. Well duh! Even though I have known for some time that my pain wasn't being adequately managed, I thought this was as much relief as anybody gets from PM.

Thanks for all the suggestions. I feel a little more validated and not as afraid to talk to him about it. I've learned here not to ask for particular meds by name or dose. I just need more relief, even if it's not in the form of a pill. I don't like how irritable the pain can make me and I really miss being active.

My pain seems insignificant compared to what many others post here. Sorry for all the pain & conditions you live with. Your posts seem to indicate you have a good PM doctor that truly tries to keep you comfortable. You deserve it. You are truly an asset to this board.

Thanks again. -- Kay

 
Old 08-22-2012, 09:39 PM   #4
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Re: Can extruded discs heal? And PM questions.

hi, its late and I just kinda scanned over the posts and I didnt see where anyone mention radio frequency ablation. This is done sometimes after facet injections stop working. You may want to ask about this as well. This is where they go in and burn the nerve off causing the pain and it does come back eventually but you usually get a lot longer relief. cj

 
Old 08-22-2012, 10:38 PM   #5
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Re: Can extruded discs heal? And PM questions.

Quote:
Originally Posted by no34evr View Post
hi, its late and I just kinda scanned over the posts and I didnt see where anyone mention radio frequency ablation. This is done sometimes after facet injections stop working. You may want to ask about this as well. This is where they go in and burn the nerve off causing the pain and it does come back eventually but you usually get a lot longer relief. cj
Hi CJ -

Thank you for this suggestion! I will definately ask him about this on Friday.

Many years ago - with a different PM doctor - I went through a trial of injections and then kept a 24 hour pain diary that I faxed to him. It gave me very little relief so he said that indicated I wasn't a good candidate for RF. I think that may have been the procedure you are talking about - but I'm not sure.

BUT, that was like a decade ago and frankly I never got as much relief from any of his injections (various ones tried) as I have with my current PM. I always attributed it to difference in technique or skill between the 2 docs.

Yes, it is late but I don't sleep very well with this pain... And the Lortab keeps me awake if I take it too late in the evening. Awful way to live, but what do ya do!?

Anyway, I'm adding your suggestion to my list for my appointment.

Thanks for giving me some HOPE! -- Kay

 
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