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    Old 12-21-2006, 06:12 PM   #1
    Sage48
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    Went to new Pain Management Dr.

    First of all I am sorry if this is a bit long.

    Here is the result of my visit to the new pain management Dr., (my present PM Dr. referred me to major teaching hospital)...

    They examined me, reviewed MRI results from 6 mos. ago. Decided that they are not quite sure what is causing my low back and right leg pain...may be bone or muscular?????

    The said that to begin with the want me to take cymbalta...said that anyone who has been in pain for 4 years should be depressed... (ya think???)...Told them I don't really feel depressed, that I do get a little anxious some times...but don't feel depressed... Then they want me to see their Dr. of physical therapy...to set up a script for my local PT group to follow..They also said that I can continue with my oxycodone no more than 4 10/325 pills a day.

    In approx 6 weeks I go back to see the PM Dr, and if I have no relief they will do a SI injection (WHAT IS THAT, is it painful????) If that doesn't work they will do a facet joint injection...and if that doesn't work they will do a disco injection. (these will not all be done at once!!! BUT in several visits.

    BUT, they said if the cymbalta & PT are even working as little as 10 percent, they will continue on that course, rather than doing the diagnostic injections.

    I told them that I have tried antidepressents in the past, and they HATE me, I get really nasty on them, or get tachardia, which is not nice. I also asked them if Cymbalta will prevent me from driving (I drive a lot, and have to be functional, as my hubby works away from home a lot). They said it should not do any of that...said I probably won't know I am taking them, except for pain relief. Has anyone had any experience with this med???? I am very anxious about taking it, but will pop one tonight...just to see what happens...trying not to be pessimistic about it, but jeez, this is scary for me, because of all of the previous problems.... If I go into tachy, my hubby will be taking me to the ER....

    Oh well, just wanted to fill you all in on my appt. No mention about the wacky diagnostic test where they use different drugs... Just the SI & facet injections, as well as the disco injection. (which they told me was very painful, my reply was try 4 years of pain, short term 10 min. I can take, if it tells us where the pain is coming from..and hopefully give us an answer about what can be done.

    Hope you all have a Merry Christmas!!!

    Sage

     
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    Old 12-21-2006, 09:02 PM   #2
    deeannek
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    Re: Went to new Pain Management Dr.

    Well I understand your anxiety about anti-depressents they tend to make me more depressed almost suicidal. I have never tried cymbalta though. It must be a new class of anti=depressent. I have had facet jpint injections in my neck and boy do they hurt if they offer the sedation take it! They may not be as painful in lumbar region. I don't think it would be as tender. Anyway I hurt pretty bad for a couple of days after injections but my neck loosened up and the did help. I have had cervical laminectomy and some times it just gets tight and painful hard to move ... so pm decided facet injections. Anyway the worked for me but had to do them about every 3 months or so. Good luck with pt and new meds keep us posted.

     
    Old 12-21-2006, 11:19 PM   #3
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    Re: Went to new Pain Management Dr.

    cymbalta from what I have heard is a good new antidepressant with few side effects-but I am sure there are folks out there who don't like it. It will take a few weeks for it to take full effect-keep that in mind. I am thinking about taking that as well, in addition to my zoloft which I take for anxiety. We'll see though.
    I think their plan is pretty common that this point. They'll do the minimum to the maximum in that order. I wish I had more than TWO pm docs to choose from, I need a new one!

     
    Old 12-22-2006, 05:02 AM   #4
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    Re: Went to new Pain Management Dr.

    I'm not sure but I think the S1 injections are the same as a selective nerve root injection. Right ? I had both the Facet injections were nothing and I hate needles , and the S1 seem to help the pain in my legs and feet , but my back and hips still hurt.

    Hope I helped a little ???

     
    Old 12-22-2006, 06:10 AM   #5
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    Re: Went to new Pain Management Dr.

    Hi Sage,
    I've had a similar experience. In the past 8 months I've been to an orthopaedic surgeon spine specialist, a neurosurgeon spine specialist, a chiropractor, an acupuncture specialist, and a neuro-physiatrist. My pain is mainly in my right glut and follows the sciatic nerve down my right leg, sometime into my foot in my little toe. My MRI revealed MILD bulging disks in L-4, L-5.

    Over a period of 8 months, I've had a shot of cortisone in the trochanteric bursa, (when they suspected bursitis in the hip); about 8 sessions of acupuncture; went to a deep massage therapist 8 times; had weekly chiropractic adjustment; went to PT.

    Then I was referred to a neuro-physiatrist, pain management MD. She began her treatment over the last 2 1/2 months. She has done: 6 or 7 trigger point injections; one ineffective epidural; and one ineffective SIJ injection; and three shots in the facet joints.

    The epidural, the SIJ (sacroiliac injection, given right into the sacroiliac joint) and the facet joint injections, were all done under local anesthetic (each take about 10-15 minutes, so I was only under for that period of time). They are also done under guided fluoroscope. I didn't feel a thing. The 'shots' are a way of determining a diagnosis, and for some the shots alleviate pain, and sometimes eliminate the pain for an extended time. Two of my friends have been pain free, each for about 2 years, both having has severe sciatic pain. I wasn't so lucky, my pain is still here.

    Initially the physiatrist also recommended an antidepressant, Lexapro. She told me that the same nerves that cause depression, also are related to pain. She said that they've had a lot of success in 'breaking' a pain cycle using antidepressants in conjunction with other meds. I took the antidepressants for about a week, but I was nauseous constantly, so I stopped taking it. I tried it again, and had the same problem so I stopped taking it again.

    I still don't know exactly why I'm having the pain. Yesterday the neuro-physiatrist kind of dismissed me, saying that she felt that she had done all that she could do. Once again she reiterated the same as the orthopaedic surgeon, that I am definitely not a surgical candidate.

    I'm going to 'pick up the ball, and run with it' on my own for a while. I'm going to try light exercise, yoga, massage, and take the meds that she's now prescribed, Celebrex and a muscle relaxant.

    I'm taking the Celebrex. Took 2 (200 MG each) yesterday and 1 this morning. I think I feel some relief. Also, I still have hope that the facet injection (that I had last Monday) combined with the Celebrex may still somehow 'kick in.'

    Oh, Sage, I'm also in Florida, St. Petersburg..

    Again, to all, have a pain free holiday, and I wish everyone a healthier New Year!!

    Last edited by judyswrite; 12-22-2006 at 06:15 AM.

     
    Old 12-22-2006, 12:48 PM   #6
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    Re: Went to new Pain Management Dr.

    [QUOTE=shawley]I'm not sure but I think the S1 injections are the same as a selective nerve root injection. Right ? I had both the Facet injections were nothing and I hate needles , and the S1 seem to help the pain in my legs and feet , but my back and hips still hurt.

    Hope I helped a little ???[/QUOTE]

    Since I had some confusion about all this when I had my epidural (what the nurse called it) / selective nerve root injection for L5 (what the doctor called it), I asked the nurse yesterday when I went got the injection. She said the selective nerve root [I]is[/I] an epidural, it's just the steroid is injected close to the suspected nerve causing the problem. She mentioned epidural is more of a "general" area and it's mainly used for women giving birth (duh).

    I also asked her what the SI injection is (since that's the shot I got the last time that only lasted two days). She said the steroid gets injected into the Sacroiliac Joint rather than the nerves.

    [b]sage48,[/b]
    The SI injection wasn't painful for me...I do have a pretty high tolerance for pain, but still the only thing you really feel is the first time he sticks in the needle for the anesthesia and that's not all that bad. It helps, I'm sure(!), that you're face down and you don't see the doctor coming with the needle, but he did give me a warning just before giving the shot. Those 2 days were nice. Hope you get more relief than that!

    Last edited by ktnap; 12-22-2006 at 12:52 PM.

     
    Old 12-22-2006, 04:17 PM   #7
    Sage48
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    Re: Went to new Pain Management Dr.

    Thank you everyone for your help!! I do believe that the Cymbalta is a fairly new anti-depressent...and supposed to help with pain...and depression.. I really don't feel depressed!! I get anxiety once in a while, and mad!! (usually have a pity party after I have been to the PM Dr....but get over it pretty quick..)

    I have had problems in the past with antidepressents which were given to me for the same reasons...to help the pain...but, they just did not like me, side effects, that is why I am leery of any of them.. I decided to start taking it after Christmas..because I don't want to have any problems during the holiday. Will see what comes of it then.

    I haven't had facet of SI injections...sounds like you guys have had some of them, if not all....and different reactions to them. Do they put you to sleep for the SI injections??? The facet joint injections sound easier for some reason.

    Not a baby about this stuff, have had several epidurals, and most of them with no additional meds...just the numbing and then the injections... BUT, not looking for a medal either!!

    Again, thank you for you help. Really appreciate it..

    Sage

     
    Old 12-23-2006, 03:23 AM   #8
    ktnap
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    Re: Went to new Pain Management Dr.

    [QUOTE=Sage48]I haven't had facet of SI injections...sounds like you guys have had some of them, if not all....and different reactions to them. Do they put you to sleep for the SI injections??? The facet joint injections sound easier for some reason.
    Sage[/QUOTE]

    Hi Sage, I wasn't put to sleep for the SI Injection.. It's very much like the epidural (some call it selective nerve root), but I had [I]more[/I] "sensation" from the epidural when the steroid was injected.

    I'd say the SI injection is a bit less stressful(?) (for lack of a better word) than that one.

    Also, I had a driver for the SI but it wasn't even required. A driver [I]was[/I] required for the epidural...

    (edited to add: I just re-read your post and I wrote this message thinking you had already had the epidural... I'm sure if you are very leary about it and think you'll be too anxious about it, you could get your doctor to prescribe a valium or something to get through the procedure...but you definitely will need a driver in that case. At any rate, the shot is really not all that bad and I was only in the room where they do the procedure for about 5 minutes at the most. I spent about 30 minutes in the "intake" for blood pressure/heart rate monitoring and then they keep you about 15 minutes afterward monitoring your vitals.)

    Hope this helps,
    Kat

    Last edited by ktnap; 12-23-2006 at 03:30 AM.

     
    Old 12-23-2006, 05:16 AM   #9
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    Re: Went to new Pain Management Dr.

    I was 'put under' for all three injections, epidural, SIJ, and facet joint. All three were done under 'guided fluoroscope.' All three were unsuccessful in relieving my sciatica, but my pain wasn't worsened by the injections, and I didn't have any residual pain after any injection. Because I was given an anesthetic, I did have to have someone drive me home. Also, I took an antibiotic (Keflex) as a precaution to guard against infection, for a week after each injection.

    Good luck!

    [B][COLOR="Red"]Happy New Year to all![/COLOR][/B]

     
    Old 12-23-2006, 05:34 AM   #10
    Sage48
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    Re: Went to new Pain Management Dr.

    Thank you Katnipped & Judy for your replies...

    I have had several epidurals & a couple of nerve blocks..(nerve blocks & 3 epi's for my cervical area - which I finally had fused 3 years ago) After the neck was "fixed" I then have been concentrating on getting the pain removed from my lower back & leg... 5 more epi's & 1 transforminal injections..which didn't work that well, the Transforminal worked for a few weeks, but then started acting up again. (these were done during an 8 month time period, and yes, I did develope adrenal insuffiency..which is finally resolving, thank goodness.)

    My "primary" PM Dr., never mentioned facets or SI problems...he was concerned with not giving me anymore steroids, so basically for the last 1 1/2 years, I have just been on pain meds. That is why I was referred to the teaching hospital in Jacksonville, to see what they might be able to do. Wow, they now have several plans, step wise from least invasive to invasive to see what might help, and hopefully diagnose what the problem is. Like all of us it is very frusterating from not getting a reason for the pain, and suffering from all of the medicatin side effects.

    I just keep trying, I get discouraged...as we all do, but I need to get this resolved...one way or the other...just for my peace of mind. If I have to live with the pain, so be it. (after 4 years, I guess I am at the point where I have to not worry too much..just go from day to day, but some days are sooooo bad...and I do have pity parties that last two or three days...but I do get over them. )

    This new PM Dr. seems to have listened to me..and at least he is willing to try different things to see what the problem is..rather than just leaving me on the medications. So, I have hopes for the New Year..

    I am not really afraid of the pain from injections, just want to prepare myself..so far you all have given me the information I need...doesn't sound to bad. I thank you for taking the time & for all of your help.

    Wishing you all a wonderful holiday!!!

    Sage

     
    Old 12-24-2006, 06:20 AM   #11
    judyswrite
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    Re: Went to new Pain Management Dr.

    Hi Sage,
    You said <<<they now have several plans, step wise from least invasive to invasive to see what might help, and hopefully diagnose what the problem is>>>

    Since I have run out of methods to rid my sciatic pain, I would be so grateful if you would tell us what their <<<several plans>>> are as you are introduced to them, and the effect.

    Again, my pain is sciatica, beginning in the glut and going down my leg into my foot. Over eight months: I've gone to physical therapy; I've had a series of acupuncture; deep tissue massage; chiropractoer adjustment; trigger point injections; one epidural; one SIJ injection; and three facet joint injections. None of those treatments have worked for me. I wonder what's left? I'm not a surgical candidate.

    I'm eager to hear about your 'new path' to rid you of the leg pain.

    Thanks,
    Judy

    [B][COLOR="Red"]Hope Santa is good to all![/COLOR][/B]

    Last edited by judyswrite; 12-24-2006 at 06:20 AM.

     
    Old 12-24-2006, 07:38 PM   #12
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    Re: Went to new Pain Management Dr.

    I have been on Cymbalta for almost a year now and it has worked wonders for my neck pain.

    I have 2 very prominent cervical disks compressing my cord and the neck pain and crepitus was unbearable. I also have a disk at t7-8 that is herniated with disk material up against but not compressing the cord.

    My doctor started me on 30mg Cymbalta and then upped it to 60mg. He moniored me at 6 weeks at first, and then every 3 months.

    You have to give this drug time to work, however. It took about 5 weeks before I saw any improvement, but once it started, it continued to improve for several more weeks. I seldom have ANY neck pain now.

    I have learned to take it the same time every day and to be mindful not to skip a day.

    As far as depression, it has gotten rid of the worse of the symptoms, though not all of them.

     
    Old 12-25-2006, 12:38 PM   #13
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    Re: Went to new Pain Management Dr.

    Sage,

    Haven't you been on Neurontin or Lyrica or Topamax? I believe that out of the three Lyrica is the most effective and Topamax the least effective of the three. Lyrica is like Neurontin with less side effects. Nerve pain does not respond that well to narcotics. The anti- convulsives are proving to be quite beneficial. I am unable to take the antidepressents as they give me tachycardia. As with all medications what is great for one person does not help another but if you haven't taken any of the anti-convulsives please give them a try.

    Merry Christmas
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    Old 12-26-2006, 04:23 AM   #14
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    Re: Went to new Pain Management Dr.

    Katnip , thanks that really help me out with that question , I did have epidurals and I'm not preggo , I'm a guy ..lol I know they give it for back pain..hehehe...well where they gave me the injection really helped me , but i can tell it's slowly comming back..Time for another one...

     
    Old 12-26-2006, 02:22 PM   #15
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    Re: Went to new Pain Management Dr.

    Hello everyone, thanks for all of your messages....

    I'll try and fill in some of my missing information:

    Yes, I have been on neurontin...that stuff is dangerous....made me so stupid I went through a red light...saw the light turn green for the straight ahead traffic & turned left...oops...that arrow was red.... I had been having stupid moments a lot when I was on the neurtin...but that one was soooo bad, that was the last day I took the stuff...

    I am going to take the first Cymbalta tablet tonight..gulp....I have tried anti-depressents in the past, and my body just didn't like any of them....had problems with side effects & could not stay on them. I explained this to the Dr. & he said "oh, these are different"...ok, so I'll try them, but I told him that I have to be "functional", as I am alone a great deal & have to drive...I can not be dizzy - I also explained that I get tacacardia (and major PVC's - like A-fib...) and that I don't want to encourage that to start up again. He said I should be ok...so ok, I'll believe him...BUT, if that starts up, I will not be able to take this medication.

    I have an appt. with a Dr. in physical therapy on Jan. 11...to get a script of whatever PT exercises he wants me to do..which I will then have to take to my local PT place...

    So far, the first step is to take the Cymbalta, then do the physcial therapy, I then have an appt. with the PM Dr. on 1/30...he said if these steps work, even a little we will continue on that course. If they don't work we will go on to injections....SI, Facet Joint, Discogram...and I heard piriformas (WHAT IS THAT??). I think that was the order that he stated...
    Ok, I will keep you all updated on the type of treatments, and how they work.

    Wish me luck on this new med. tonight....I am really afraid of it, especiall if it starts the tacacardia up...that is no fun at all..

    Have a good night, and thanks again for all of your replies.

    Sage

    Last edited by Sage48; 12-26-2006 at 02:25 PM.

     
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