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  • too much pain/cant take much more

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    Old 02-17-2004, 10:38 AM   #1
    scotty12
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    Unhappy too much pain/cant take much more

    hi all,
    it was a good few months where the meds were really helping but the past few weeks have been horrible.i just dont seem to be getting nearly as much relief as before from percs.i cant go on like this.next appt. with pain dr is in three weeks and if he wont help im scheduling disco and i think ill have the fusion.i might try a new pain dr 1st but i just dont have it in me to look too hard for a new dr.
    my pain has returned to as bad as its ever been.im back to ice packs and hot baths a few times a day.anything just for a few minutes of extra relief as the meds just arent cutting it anylonger or the pain has worsened.i told my pain dr about all this and he told me to take extra medsif i have to (i have extra because of monthly appt.s being earlier)and that i will have bad days and just have to hang in there.i just cant do it anymore.im getting depressed again.....any positive thoughts?i hate to rush into a probable 2 level fusion when i had had a few months where i really thought things were improving........scotty

     
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    Old 02-17-2004, 12:07 PM   #2
    Shoreline
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    Re: too much pain/cant take much more

    Hey Scott, I know alot of us have been where you are now. Pain can certainly make us except less than favorable odds when surgery seems to be the only alternative.

    What I can't figure out is why a PM doc is trying to manage your pain that he knows isn't going to improve with short acting meds. I'm sure you have heard that it's easier to keep pain in check then it is to bring a high level of pain down. That's pretty hard to do with a med that you have to wait 45 minutes to start working and then might get another 3 hours of relief from. The first sign of tolerance to the meds is shorter duration of relief.

    Dextromathorphan may be able to help along with a change in your dosing. Instead of taking 2 pills every 4 hours, You might try taking 1&1/2 every 3 hours, this way your pain won't spike as high before it's time for your next dose. The dex can help in prolonging the action of the meds and help with your pain tolerance. It's OTC , and the Dexalone capsules are nothing but pure dex, so your not taking additional un- needed meds. It would certainly be worth a little trial.

    Because you did get relief for several months that's actually a good sign, your pain does respond and can be managed by opiates. For some folks, no amount of pain meds will touch nerve pain like leg pain or radiculopothy. That's the one good thing about all 3 surgeries I had, I awoke from surgery without the leg pain. My backs a mess but no amount of pain meds relieved the burning leg pain.

    It does seem like your doc should be steering towards a long acting med. Honestly with all the contreversay and the argument about 12 hour dosing and rapid tolerance, I would ask to try an LA morphine product rather than OxyC. In my state, Purdue gave us a grant to create a tracking system of every patient and every script a doc writes for oxyContin. I don't like the idea of being part of a data base of opiate users and my doc doesn't want to be part of a data base of oxy prescribers.

    My own doc, as agressive as he is, won't prescribe oxyC for these same reasons. I wouldn't ask for it If he did other than using Roxicodone for BT pain that the long acting meds don't cover. As far as long acting meds, and I've tried them all except Avinza, I would prefer Kadian. There is no contreversy, most people don't even know what it is and you won't have to argue about how long it lasts. It certainly lasts 12 although 24 hours is debatable. I took it 3 times a day. This way when I woke in the morning, only 1/3 would have been wearing off and 2/3 of my previous days dose was still going strong. I never felt a dose wear off or kick in. Super smooth continous relief once titrated to the proper level.

    Methadone is another option but most docs won't use it as a first line drug because of the titration process and lack of understanding of how to prescribe this med. But it is an option.

    I rememeber being told they would fuse and refuse when I could no longer stand the pain. What a position to be in. It leaves you wondering should I have been stronger, tougher , whatever...But untill you have experienced that kind of back pain/leg pain it's a choice other people can't fathom.

    Have you asked to move your PM apt up? 3 weeks of intractable pain could make you decide on something that could otherwise be managed. There are so many different ways to fuse a spine and so many different aproaches and sets of hardware it really is tough to know if your making the right decision or going with the right doc.

    Personally, Having endured a 5 level disco gram, I don't see why it would be neccesarry in your case. If there is any question about the disc above the area he wants to fuse, I would say go ahead and fuse it rather than face being in the same position a year or two from now trying to decide whether to extend the fusion. Disco's are the most barbaric tests I have ever heard of.

    When they did mine they inserted 3 steel catheters into 5 different discs. They went through nerves on the majority of them and then they inflate the discs with die through each of the caths placed in each disc. They usually do a test disc above and below the suspect area and it's the only thing in my life that ever made me cry out in pain. I thought people would pass out at that level of pain but I was wrong. The purpose of a disco is to reproduce your worst pain. If it does and they can see tears they know they have a bad disc. BUt they only need to do this test if they can't figure out why your still hurting and other diagnostiocs don't show the problem. It's sounds like you have a definite problem at L5-S1 and L4-5 is questionable. A few years of pounding on that disc and it will be fused too. So why do a disco if you have decided to have surgery.

    At best, some docs use a short acting med to sedate you for the placement of the caths,and then wake you for inflation of the discs, but I had no medication at all untill it was over with. There really is no way to describe a disco other than imagine pain that will make you scream. It sounds like the only purpose of doing a disco on you is to determine whether to fuse the top disc now or in a couple years. Not exactly a good reason to go back to the middle ages.

    I would call the PM and say what can you do to save me from having a fusion and ask why your using a short acting med for pain that doesn't relent. You need round the clock relief, not just relief when you are ready to eat a bullet.

    I wish there was a simple answer other than a surgeon wanting to see how much pain you can endure before begging him to operate. The alternative is agressive pain management. use meds, use other modalities, Get some feel good PT , message, heat and e-stim at the very least. They can make you more comfy. It's just a matter of finding a PM doc willing to work with you to find the combination of meds and modalities to help.

    Another good test as far as knowing if fusing you will help is a good brace. When I had both post op turtle shells made and fitted,"The plastic shell you wear for 3 months post fusion" I didn't want to let go of them after the final fitting because it felt so good to have my spine held in place. If I hadn't gained 30 pounds I would break one out on the bad days just for comfort. The suport was fantastic but docs don't want you to become dependent on the brace because your other muscles will weaken.

    Talk to your PM about having a brace made or purchasing one that's not the kind you buy off the shelf and wear when you work at HQ or Lowes or the giant hardware cities.Even one of those may help. If bracing helps, Then there is a pretty good chance fusing may help. But there are no gaurentees for succesful fusions. But there are things they could do now to relieve your pain more than what your experiencing now.

    I'm sorry, I don't want to freak you out, but it's a huge decision and I wish I had been given an alternative to waiting untill you can't stand the pain and nothing being done to manage it. I know better now and know there are things that will help you now. Call the doc and tell them it's an emergency, you can't catch your breath, your ready to be admitted to the nut hut, whatever you need to do to get in to see the PM doc asap .
    Good luck, Shore

     
    Old 02-17-2004, 06:37 PM   #3
    wastefulltick
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    Re: too much pain/cant take much more

    hi scotty
    i was where your at about 13 months ago i moved to nc and at the time i was on 3 percs a day and the pain from pinched nerve in c7 started getting worse to the point i did not leave the house for days at a time i coudnt find a pm doc there and could not get any local docs there to fill my script let alone add to it it was a small town in the mountains and there were very opiate naive so i ended up driving back to fl once a month to my pm doc there i was afraid to ask him to increase my meds as i thought that he might think i was drug seeking one night i was in agong and went online to see if i could find any info on what i was going thru and happened across heathboards and this was a blessing not only did it give me info i was looking for i found out the i had become opiate tolerant so that nite i took 1 1/2 percs instead of 1 and found it reduced my pain to where it was next visit to pm in fl i told him what i had been going thru and what i did and he agreed that i had become tolerant to the dose i was on and even became angry with me that i did not tell him about the increase in pain so that he could adjust my meds which he did right away he put me on 15 mgs of roxicodone 3x a day and 5 mgs of roxicet for any breakthru pain i had 3 x a day and made me promise to tell him the next time that the pain got out of hand note he also sent me for new mri to be sure there was no futher damage of the disc c2,c3 c4 c5 c67 to this date my meds were increased 2 months ago to 15 mgs roxicodone 4 x day and 5 mgs roxicet 4 x day for bt so my point being you might want to dicuss this with your dr to see if he is willing to titrate the doses or increase the mgs and quanty and maybe give you something for breakthru if he is unreasonable about this i would find a new pm doc also i want to add that after reading shorelines post on dextromorphan i have tried it 2 nites in a row with my roxicodone and much to my surprise it has made my meds last an extra 2 hrs which makes me happy because i dont have to get up at 5 in the morn in pain and take my meds i cann sleep till 7 am yahoo!!! sorry for the long post hope this helps
    bob

     
    Old 02-18-2004, 09:58 AM   #4
    scotty12
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    Re: too much pain/cant take much more

    well i was up very late last night weighing the pros and cons or more like the knowns and unknowns of my choices and i want to thank you again shore for bringing to light what the future may hold.here is what i put down on paper:

    SURGERY:

    discogram to determine condition of L4 and also L3 which also shows a bulge
    possibility of winding up fused from L3-S1

    8 weeks out of work (currently working as much as i can)

    stress of single level fuse on L3 and L4

    results of surgery unknown (85%-90% sucess rate)

    possible failure to fuse

    loss of flexibility

    fuse and live happily ever after

    PROPER PAIN MANAGEMENT:

    known:respond well to opiates
    physical dependence
    tolerance and proper tiration
    liability of med use


    with all the possibilities the answer should be pretty simple.atleast seeking proper pain management i know what the future holds.i have no neuropathy to justify the risks of fusion surgery.
    thanks for the help shore and please,if i put up similar post to this one remind me again why i should hold out as long as i can.....scott

     
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