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Chronic pain - Frustration

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Old 05-25-2009, 08:41 AM   #1
Join Date: May 2009
Location: Fort Mill, SC. USA
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ABlueMenace HB User
Chronic pain - Frustration

Hi - I am new to this. I am a 46 year old, married for 20 years and a father of 3 teenagers. My wife works, and we have health insurance. It is costly and we struggle financially.

About 9 years ago my left pinkie finger began twitching involuntarily at odd times. Doctor visits and an MRI revealed a lesion directly impacting pressure on my spinal cord, in the neck, about C5. I was rushed to a neurosurgeon and operated on within the week. It was a dangerous and intensive operation requiring the slicing of many layers of tissue, muscle, and the removal of certain portions of the spine deemed unnecessary. Within a few months the scar tissue had built up to the extent that another operation was scheduled to remove it. While in there, the neck was fused at the C4, C5, C6 area. I was left with chronic pain.

In constant pain and unable to reliably work, I applied for disability from Social Security. (a nightmare) I had to get a lawyer, see many "experts" all to confirm the obvious. Finally, following a hearing and over 3 years waiting, I was confirmed as qualified for Disability.

I tried spinal injections, but the area was simply too narrow and the Doctor advised against this approach. I was put on Morphine (MS Contin)

I am very frustrated. The tolerance to morphine has escalated every year. I take 2700 mg of M.S.I.R. monthly, and 200 mg of MS Contin every day. I have asked and asked and asked my doctor to alter the morphine to ANY of the other compatible medications. He refuses.

The reasoning is simple. We live in a "VERY" conservative state, SC, where one is lucky to be treated with pain meds at all. I have a University Degree and am not stupid. The general presumption is that those who take pain medication are either addicts, or "going to be" addicts. Since Morphine has been a "safe" pain reliever in war for decades, it is acceptable to be addicted, under Doctor supervision. Oxycontin, Oxymorphone, Hydromorphone, and Dilaudid, are all "reasonable" to switch to for 6-8 months. Yet the general feeling here in the deep south is "you are lucky to get anything at all !" My Doctor won't budge as these other medications are perceived as more "pleasure inducing", and therefore morally unjustifiable.

My question is simple. How can I properly provide literature to him so he might comprehend that altering medications is more effective as it affects different pain receptors ? I'd also like any advice from those who might have been in a similar situation.

Thanks - From SC

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Old 05-25-2009, 11:26 AM   #2
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Re: Chronic pain - Frustration

hello. sory to see you here in this forum. reading your post i know how you feel and SUFFER more than your doctors. i've been through a whiplash almost 4 years ago and suffer from chronic pain in the neck 24/7. non stop. so it's probably the SAME pain you have cause it involoved tendons, ligament and muscles damage(it's been totally streched during the accident)plus 2 bulging disks(though they have never operated on me)but i have this feeling this is the same impact my accident and your operation, so i think me and your suffer on the same level. it's called severe nerve pain.
i'm taking only half a percocet 5/325 a day. not allowed to take more than that. been taking that for already half a year and now it does almost nothing. i asked my doc to increase the dose she said NO NO NO. she also don't want to switch me to another pain meds. she calls pain meds nonsesnse cause they are not for treating pain. how interesting. i was also told i will be an addict! you are not the only one!. but it's impossible to live without pain meds. i'm to the point i cannot function anymore.(check out my other posts). did you try lyrica? it helped me a bit but i stopped using it. there is another drug with the name cymbalta, i think it's for neck pain. (ibuprofen does nothing for me)
listen, the only thing you can do now is to look and look for another doc and if you don't find in SC you will need to go to another state and then check out with another clinic and get in touch with those 2 doctors, you understand what i mean? that's just an idea.
all right, my friend, i'm writing this and i really know how much you are suffering 24/7. i'm so so sory i'm so sory it happened to you.

Old 05-25-2009, 06:53 PM   #3
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Re: Chronic pain - Frustration

Originally Posted by ABlueMenace View Post

My question is simple. How can I properly provide literature to him so he might comprehend that altering medications is more effective as it affects different pain receptors ? I'd also like any advice from those who might have been in a similar situation.
Hello and welcome to Healthboards. Many here have a wide variety of experiences and thus, can provide a lot of support and guidance.

I'm sorry to hear about your situation. This is a tough one. I'm afraid to say that I'm not sure there is a lot you can do to influence this Doc. You could try to print off some information you find about opiate rotation, but in all honesty, I doubt it will work. In general, PM Docs get locked into certain philosophies and don't change much. Those who are conservative stay that way, and those who prescribe freely, typically do so for all their patients.

A lot of what influences a PM is how he / she is trained, and what "type" of Doc they are. PM Docs usually fall into one of four buckets....Anethesiologists, Rehabilitative / Occupational Docs, GPs who have a sincere interest in PM and / or dedicate a portion of their practice to PM, and then GPs who treat their patients who have pain.

Anesthesiologists tend to be the most aggressive in treating pain. They normally use the full arsenal of meds available as they are the most advanced trained. Anesthesiologists are primarily trained in drug therapy, thus, they tend to be aggressive with meds....It's what they know best.

Rehab / Occupational Docs tend to focus on "healing" or getting people back to work or as functional as possible. Thus, they tend to be fairly conservative in their approach, and like to do a lot of procedures. They also are usually big into alternative methods such as biofeedback, progressive relaxation, and creative imagery. These type of Docs will often use a multi-dynamic approach and use many different methods, combining meds with other other theories.

GPs are a mixed bag. Some are fairly aggressive, but most are not. Most GPs just don't understand PM and are more concerned with the DEA and don't routinely use the more powerful meds. GPs also tend to be heavy into the SA meds whereas anesthesiologist are more into LA meds.

I'd be curious to know what type of PM your Doc is. Once a PM Doc gets entrenched in their particular philosophy, they rarely change. I've read stories here for example where people have been treated by GPs and are having trouble getting the right amt of med (strength wise) and use a local PM as a consultant to the GP, and even after the PM recommends to the GP to use a particular regimen, the GP still is reluctant to go there. Thus, if some of these Docs won't even listen to other Docs, then a patient bringing in information probably won't work either.

However, if I were suffering and in a lot of pain, I would do whatever it took to get the treatment I thought I needed. If you do some in depth research and present it to your Doc, all he can say is 'no.' You might even explore using another PM as a consultant, if you guy is just a regular Doc. You could also consider a new Doc. Not sure if this is a feasible option or not, depending on where you live, other options in the area, and etc. Also, the main hurdle with going to a new Doc would be trying to explain why you left the other one....But, this can be done. You have to think through what you'll say, however, so it doesn't appear you're all about meds.

Best of luck with this, and I'm sorry you are having trouble. Nothing is worse than being under medicated.

Take care.



Old 05-26-2009, 09:14 AM   #4
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slipperyslope HB User
Re: Chronic pain - Frustration

I sent you a private message. thanks, SS

Old 06-16-2009, 11:21 AM   #5
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tinabean34 HB User
Re: Chronic pain - Frustration

I think a lot of us have been through what you are going through with your doctor. Plus if you see someone else then you may be accused of doctor hopping and that is a sign of an addict??? Anyway, I say never give up! I haven't, I do whatever I have to do to function. The internet is a wealth of information on chronic pain. Since we all have different causes of that pain there is a lot of different opinions and information. Look at your problem specifically. You can even find posts on this board that will give you some background to present to your doctor. You can tell them that you understand where they are coming from but you want to live your life and be functional in it. Say you are grateful for the help they have given you but you feel it is not working as it originally did. Sometimes a break with other medication will allow you to go back on the original later. Something else may work better for you, or ask if there is anything you can add like Lyrica or Ultram or Cymbalta (this is an anti-depressant that is supposed to help with pain, I take it and haven't seen a difference).

If they refuse to anything to help, ask if they can refer you to someone that will help, that is their obligation. Myself I say I will drive anywhere it is that bad. Go to a pain management center, they will work on the right combination for you, you may have to sign a contract but it's worth it to not feel like you are a pain to your doctor.

I hope you get the relief you need. I always research whatever they tell me is wrong and it has been one thing after another for the last 5 years. Get your information together, go to the doctor and see if you can be a partner in your therapy not just the patient.


Old 06-16-2009, 02:58 PM   #6
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brianpain33 HB Userbrianpain33 HB User
Re: Chronic pain - Frustration

Since you have nerve pain, ask your doctor to try you on one of the medications used to specifically treat nerve pain. Here are the list:

anti-convulsants - Lyrica, Neurontin(gabapentin), Trileptal, Tegretol, Topomax

anti-depressants - Cymbalta, Effexor

atypical opiod - Ultram (tramadol), Ultracet

These are all non-narcotic except for the Ultram and that is a very weak opiod and not even a scheduled medication like the morphine is. The opiate/opiod medications tend to not work very well for nerve pain. Nerve pain is very difficult to treat and I have seen doctor after doctor not use any of these medications which completely blows my mind. These should be one of the first medications to use since they usually help more than opiates and they are non-narcotic. Why wouldn't a doctor want to use these?

You could print this out and maybe some information on each of these drugs and ask if you can try one of them and if the first one doesn't work then keep moving down the list. I can tell you that I take Lyrica and Trileptal and I have been on Ultram and Cymbalta in the past. Any of these could help you alot. Keep us posted.


Old 06-30-2009, 01:38 AM   #7
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Nelee HB User
Re: Chronic pain - Frustration

Quick Change,
Your problems sound much like mine.
My doctor is an anesthesiologist. He prescribes "agressively" (See above)
It still doesn't work .... but it helps.
If he wasn't helping me, I'd go somewhere else.

Also, like Executor, I don't think any patient can change a doctor's mind. Just can't be done. Doctor's have strong minds. It's better to change than trying to move a mountain. : )


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