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    Old 06-10-2004, 10:05 AM   #1
    scotty12
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    long term pain management?

    I was wondering if i should be considering the fusion surgery.its been well over a year now.the epidurals ive had did not help but the pain medication and antiinflamatories work well enough for me to function and work partime.

    my pain dr isnt pushing me to make any changes but ive stopped seeing my ortho surgeon because i really dont want to have a 2 level fusion

    i have 1 herniated and 2 bulging discs w/torn annulus and spondylolethesis L5-S1.ive been told that im not a candidate for ADR and all 3 surgeons ive seen say fusion is the answer.

    im happy with the way things are although there are days when i just cant do much but most of the time the meds keep the pain levels low enough to have some quality of life.i have a job where my hours are flexible for now anyway and unlike the first few months im getting good relief from the meds.im still taking SA meds : roxi along with vioxx and elavil.

    what im asking is because i have not had any surgery yet is pain management a long term solution.at some time will my pain dr want to end our relationship?is that something i should expect?

    anybody have any imput? : ........................scotty

     
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    Old 06-10-2004, 12:27 PM   #2
    surgicaldisaster
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    Re: long term pain management?

    Hi Scotty! Well, I would think that unless you cannot have surgery due to an underlying illness/reason that you will probably be asked to try it because it could possibly fix your problem. I know that before I went to pm, I had numerous surgeries(the last of which were 3 in 5 months). I have adhesion related disease which is extremely painful and cannot be cured. Also, surgery usually makes them worse and has for sure in my case. So for me, pain management is it. In your case though, if the pm Dr. was ever questioned on why he's rx'ing you meds when surgery has not even been done to possibly fix the problem, could end up in a world of trouble. Generally long term pain management that involves opiates is only used when "all else has failed". So, I think that at some point either you will have to have the surgery or possibly not be rx'd your meds. Obviously I don't know for sure, but I think I'm pretty much on the money here. Anyway, let us know how you are k? Is there a reason you do not want to try the surgery?(if it's in your post I'm sorry!) I know if I could fix my problem, I would in a heart beat, cuz a life depending on a Dr. to keep ya comfortable is not easy. Anyway, keep us posted and hope to hear from you soon. Surgical Disaster

     
    Old 06-10-2004, 12:47 PM   #3
    scotty12
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    Re: long term pain management?

    surg,
    thanks for your opinion.there is nothing stopping me from having the fusion.i am planning on having discography done in sept/oct and have fusion scheduled for dec.thats the only time i could take 8 weeks off from work.i drive about 3 hours on the days i do work and the surgeon told me thats a no no.i scheduled surgery with the understanding that i can only do it around december which is why i scheduled so far in advance.

    my pain doc said that the disco results may aid in treatment(ie:nerve blocks) but the belief is that the slippage is causing all the pain.

    i have always felt that if the pain is managable with meds and i have the ability to work partime and spend quality time with my family why risk the fusion.i know the longer i wait the more dependance will be an issue but i was dependent when i first started seeing spine surgeons.i know i cant go on like this forever yet im going to hold out as long as i can.

    i think im just chicken because ive researched too much about fusion.ive learned that ADR is being done now for multi level problems but not here in the us yet.i would have had surgery if any of the surgeons ive seen offered say a laminectimy or discectimy but ive been told only fusion and frankly im scared of loosing what portion of my life ive gotten back.when my pain started the first few months i couldnt do much other than lay on ice packs.

    so here i am almost 2 years later.i just feel like 80% sucess rate is too risky and i could wind up back in pain management anyway with worse pain...........

    thanks again............scotty

    Last edited by scotty12; 06-10-2004 at 12:49 PM.

     
    Old 06-10-2004, 05:30 PM   #4
    sherry47
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    Re: long term pain management?

    Hi Scotty,

    I truly understand your situation. I went through pain management for a little over 2 years. I had my fusion in January and I am back off to pain management on the 17th. I have stayed on the same pain meds since surgery. I am fusing, xrays show bone growth, but I still have horrible pain. My surgeon warned me about it. He warned me several times before surgery that this was possible. At my last visit he said, Sherry, its not going to get any better, I want you to go to therapy (heat and massage) and to long term pain management.

    I don't know if they would have continued to rx my pain killers if I had refused the fusion. I didn't ask. I was praying the fusion would fix my pain and I would no longer need rx's on a daily basis. My surgeon knew I was expecting too much from the surgery, thats why he kept telling me over and over not to expect to be pain free after surgery. Surgical's statement about them not continuing to rx pain meds if you don't do the surgery could be true. I'm not sure. It sounds reasonable to me. Then again, we should have the choice to not have surgery and still be treated for the pain. I don't know here. I applied for SSDI and was denied because they said I had had surgery for my back and the problem was fixed so I should be able to return to work in a years time. It made me wonder if I hadn't had the surgery would they have denied because I didn't try the surgery. I wish these idiots at SSDI would understand that even if there is a successful fusion there can still be dibilitating pain. It drives me crazy. Oh well, I am in the reconsideration process now. I know this thread had nothing to do with disability, I'm sorry I got off topic.

    Anyway, think long and hard before you go through the surgery. I have been told that if the nerve has been impinged for a long time that even after they relieve the pressure, there is still pain. Something like remembered pain or something.

    I really do wish you the best. Just be prepared if it doesn't happen. I have been fighting major depression because my surgery didn't work. I thought if the stupid thing fused then I wouldn't hurt like this. I guess I just wouldn't entertain the thought of hurting like this for another 30 or 40 years. I won't do it that long. If this PM can't help me, I don't know what I will do. I have become tolerant to my breakthrough meds and now I'm having some type of allergic reaction to the adhesive on my fentanyl patches. I'm breaking out and actually bleeding from the area. Life like this sucks.

    God Bless,
    Sherry
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    Last edited by sherry47; 06-10-2004 at 05:36 PM.

     
    Old 06-10-2004, 08:07 PM   #5
    rlcowboy
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    Re: long term pain management?

    Hey Scotty I just wanted to chime in here. I have had four back surgerys in the last year and two of them were fusions so I can relate.You said that you were allready dependant on pain meds before the spinal problem? Could part of the reason that you dont wont to have the fusion done is so you can keep getting your pain meds because that sounds a little like part of it? You said without the fusion and with taking pain meds that you are only able to work part time and only have some quality of life right now. Why would you not want to do something that could give you back the ability to work full time and have back your normal quality of life? I can go ahead and tell you that no Pain Managment doctor is going to keep giving you narcotics if there is something that can fix the problem and you refuse to do it. Long term use of pain meds are for folks that have done everything in there power in order to find a solution to thier problem. Going through life being dependant on narcotics is not a way to live unless, like surgical and gibson said, you have tried absolutley everything else to fix the problem and all else has failed.Once you have the fusion you could go through a Detox in order to help with your dependance with pain meds.
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    Old 06-10-2004, 08:39 PM   #6
    Fiona_Jo
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    Re: long term pain management?

    Quote:
    Originally Posted by scotty12
    surg,
    thanks for your opinion.there is nothing stopping me from having the fusion.i am planning on having discography done in sept/oct and have fusion scheduled for dec.thats the only time i could take 8 weeks off from work.i drive about 3 hours on the days i do work and the surgeon told me thats a no no.i scheduled surgery with the understanding that i can only do it around december which is why i scheduled so far in advance.

    my pain doc said that the disco results may aid in treatment(ie:nerve blocks) but the belief is that the slippage is causing all the pain.

    i have always felt that if the pain is managable with meds and i have the ability to work partime and spend quality time with my family why risk the fusion.i know the longer i wait the more dependance will be an issue but i was dependent when i first started seeing spine surgeons.i know i cant go on like this forever yet im going to hold out as long as i can.

    i think im just chicken because ive researched too much about fusion.ive learned that ADR is being done now for multi level problems but not here in the us yet.i would have had surgery if any of the surgeons ive seen offered say a laminectimy or discectimy but ive been told only fusion and frankly im scared of loosing what portion of my life ive gotten back.when my pain started the first few months i couldnt do much other than lay on ice packs.

    so here i am almost 2 years later.i just feel like 80% sucess rate is too risky and i could wind up back in pain management anyway with worse pain...........

    thanks again............scotty
    Scotty,

    Believe me I can relate to the fear of surgery. I went through the same thing prior to my fusion on May 25. I was diagnosed with DDD, and a collapsed disc at the L4/L5 levels. My procedure involved a discectomy, Titanium instrumentation, and bone graft. Also I was experiencing nerve compression which was verified by an EMG, which my surgeon felt would become permanent nerve damage. I realize their are no guarantees; but believe it or not I am three weeks post-op and am already taking less pain medication than I was taking pre-surgery. I realize we are all different and we get different results from fusion procedures. But, one thought would be to continue to do all the research you can and also (if you haven't already) read the Back Pain Forum. You will get a great mix of people who have had successful fusion procedures and those that are still struggling.
    Also, the other question would be; are you completely comfortable with your surgeon? I know if I didn't have 100% confidence in my surgeon and the lengths he went to make sure I had all the necessary tests prior to the surgery, eg; an EMG, I would not have had the surgery. So, maybe that's another reason you are feeling the apprehension -- maybe seeking another opinion is in order. Again, I know the decision of surgery is very much a personal one; so I don't want to presume to tell you either way. But, what I can say, in these months you have to think about it; research, research, research.. and ensure you are getting many perspectives.
    Jo
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    Last edited by Fiona_Jo; 06-10-2004 at 08:54 PM.

     
    Old 06-11-2004, 04:36 AM   #7
    scotty12
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    Re: long term pain management?

    thank you all for your opinions.

    i have thought about the surgery for a long time and i dont doubt that i will call it off when the time comes in december.im on SA meds and i have cut down in the past to see what my true pain levels are like.i wake unmedicated every morning with terrible pain.i normally go 10 hours overnight between my last and first dose of the day.waking is not a good way to judge how i really feel,the pain is always worse after sleeping.
    i
    have spoken with my pain dr about my fear of the surgery and have been open with him about how i feel regarding being pressured into having surgery.even my surgeon said that as long as the meds offer relief and are not abused then why rush into the surgery.im fairly sure itll be atleast from L4-S1 as there is very little disc space below L4.

    I have never abused the meds yet i know dependence is an issue that has the ability to cloud my judgment.a big issue is that i had built up a succesfull business over the past 10 years and i have people who work for me just as long who depend on me.none could take my place while recovering from surgery and i dont want to risk failing to fuse by driving 90 min to work which i know is what ill be doing.8 weeks is long enough to lose what i have got

    anyway,thats my story and i thank you guys for keeping things in perspective for me.........scotty

    Last edited by scotty12; 06-11-2004 at 05:55 AM.

     
    Old 06-11-2004, 06:27 AM   #8
    scotty12
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    Re: long term pain management?

    ricowboy,
    youve had 4 surguries in the past year?god bless you.thats my point.it seems to me that those who fail to fuse just start down a road of many surgeries and pain thats much harder to manage.

    i worry about not fusing but the ddd is something that scares me.my pain dr has told me he relly cant do much about that and strenghthening is the best i could do to slow down the degenerative changes.my disc spaces from L3-S1 are pretty bad if not fused now will most likely be fused in the near future if i just had the L5-S1 fused where the slippage is.even my surgeon told me that he is concerned with the disc spacing and most likely would atleast be fused on 2 levels if not more.said i would gain about 1/2 inch after surgery.

    im sure i can think of many reasons to avoid the surgery if i want.i have always felt guilty about living on pain meds to avoid the surgery until my wife went with me to my last appt with surgeon and raised the issue.my surgeon told her that the meds im on were safe long term and not to worry.i could always have the surgery and many of his patients couldnt take the leg pain thus theyre reason for going ahead with the surgery.i havent had leg pain since the first few months..........
    4 back surgeries in a year is alot and there is no way you could ever fully recover.thanks again and hope the future holds better days for you.may this year be better than the last.........................scotty

     
    Old 06-11-2004, 05:12 PM   #9
    Fiona_Jo
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    Re: long term pain management?

    Quote:
    Originally Posted by scotty12
    thank you all for your opinions.

    i have thought about the surgery for a long time and i dont doubt that i will call it off when the time comes in december.im on SA meds and i have cut down in the past to see what my true pain levels are like.i wake unmedicated every morning with terrible pain.i normally go 10 hours overnight between my last and first dose of the day.waking is not a good way to judge how i really feel,the pain is always worse after sleeping.
    i
    have spoken with my pain dr about my fear of the surgery and have been open with him about how i feel regarding being pressured into having surgery.even my surgeon said that as long as the meds offer relief and are not abused then why rush into the surgery.im fairly sure itll be atleast from L4-S1 as there is very little disc space below L4.

    I don't want to sound like I'm the board proponent for surgery. I just want to make sure you look at things from every angle. Has your surgeon confirmed there isn't nerve damage occurring? I know that is what really pushed me into surgery; when I was informed the extent of nerve compression that would inevitably become permanent. I was getting to the point where I had foot drop, almost complete leg weakness and basic functioning was difficult .. even with the pain meds. The reality when we are in pain our bodies are telling us something .. there is a problem. I realize their are many people that are on long-term pain management for various conditions (I myself have Lupus and EDS), which are very painful conditions in themself and the reality there are no "cures" or surgeries for these conditions. I just have to live with the pain every day. I do have to agree with others on the board who have said that pain management could be potentially "cut-off" if it gets to the point where your Doctors don't feel you have done everything you can to help your condition. The reality is we are the ulimate "owners" of our health. Also, you may have told us .. but has PT been an option and if so how did that go? Remember, we are here to support you.

    Jo
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    Old 06-11-2004, 05:41 PM   #10
    carol632
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    Re: long term pain management?

    If there is anything I have learned in my 4 years of research and reading and interaction on pain boards, it is this: Surgery, particularly fusion, should be the absolute last resort. It should not be done to relieve pain, as often it doesn't. It needs to be done if there is nerve impingement that will lead to permanent and serious damage, or if the spine is unstable.

    If conservative treatment, and that includes meds, are keeping your quality of life at a level you are content with, then I don't think you should have the surgery. If things change, you can always have it done, but once it is done, you cannot undo it. It is likely that ADR is going to be approved within the next year and if you can wait til then, I say "go for it"! God, if only it had been on the horizon for me, what a difference it would have made in my life.

    I have been fused three times....2 lumbar and 1 cervical. The cervical and the first fusion were total successes. The second lumbar fusion failed...I had to have the morphine pump put in to control the pain.

    Please understand that this is just my opinion, derived from my own research.

    Good luck, whatever you decide to do.

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    Old 06-11-2004, 06:26 PM   #11
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    Re: long term pain management?

    Quote:
    Originally Posted by carol632
    If there is anything I have learned in my 4 years of research and reading and interaction on pain boards, it is this: Surgery, particularly fusion, should be the absolute last resort. It should not be done to relieve pain, as often it doesn't. It needs to be done if there is nerve impingement that will lead to permanent and serious damage, or if the spine is unstable.

    If conservative treatment, and that includes meds, are keeping your quality of life at a level you are content with, then I don't think you should have the surgery. If things change, you can always have it done, but once it is done, you cannot undo it. It is likely that ADR is going to be approved within the next year and if you can wait til then, I say "go for it"! God, if only it had been on the horizon for me, what a difference it would have made in my life.

    I have been fused three times....2 lumbar and 1 cervical. The cervical and the first fusion were total successes. The second lumbar fusion failed...I had to have the morphine pump put in to control the pain.

    Please understand that this is just my opinion, derived from my own research.

    Good luck, whatever you decide to do.

    Carol
    I completely agree; that was my concern -- that if there is nerve compression/damage occurring surgery is necessary. My situation was such that I was deteriorating almost daily; believe me my surgery was nothing I entered in lightly; especially given my other health conditions that place me at high surgical risk. I had to have an egocardiogram just so I was cleared for surgery! But I couldn't deal with the reality that I everyday I was risking irreversable damage. That is the only the area I really caution people people back problems .. make sure there is not nerve damage occurring. (If it wasn't the case with me; I would have definitely gone the more conservative non-surgical route.) That it was I posed the question about PT. It wasn't an option for me; but I know it helps many. Anyway just my thoughts.

    Jo
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    Old 06-11-2004, 06:57 PM   #12
    scotty12
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    Re: long term pain management?

    i went for p/t for a year 2-3x per week.after insurance cut me off i joined the gym program and just did stregnthening but no heat/stim or ultrasound.pt helped not so much with the pain but i became more capable of lifting.i dont mean i was moving furnitue but just a gallon of milk or everyday things made the pain alot worse. to this day i still stretch every day but have slacked off on the stregnthening.
    i went for accupuncture for a few months.it wasnt covered by insurance and i was only getting 2-3 hrs relief after 12 visits so ive recently stopped.

    my wife is a physical therapist,she made sure i gave it a fair shake.
    a good freind of mine just had a fusion in jan(she was in a bad car accident and told by a few surgeons she would wind up paralyzed if she didnt have surgery)and she hasnt been doing well since.she never took pain meds reguarly til after surgery so i am a bit apprehensive


    so even though ive done most conservative treatments i just am not ready to dive in to the OR just yet.thanks guys................scotty

    Last edited by scotty12; 06-13-2004 at 11:22 AM.

     
    Old 06-12-2004, 12:04 AM   #13
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    Re: long term pain management?

    Quote:
    Originally Posted by scotty12

    so even though ive done most conservative treatments i just am not ready to dive in to the or just yet.thanks guys................scotty
    You are totally right to be cautious. If the extent of nerve compression/damage wasn't going on; I definitely would have gone a more conservative route. Take care of yourself .. and keep us posted on how you're doing!

    Jo
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    Old 06-12-2004, 06:13 AM   #14
    scotty12
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    Re: long term pain management?

    jo,
    ive been told by my surgeon (and the other 2 i saw prior)that as long as im not experiencing the leg pain any longer,no prmt nerve damage to worry about.also w/o leg pain i wont have much luck having more epi's..........take care ,scotty

     
    Old 06-12-2004, 10:26 AM   #15
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    Re: long term pain management?

    Wow Jo,

    We had the same surgery, and I must say, I am honestly impressed that you are on the computer at less than a month out from surgery. I had my fusion on Jan. 22, 2004 and I am still pretty much immobile. The surgery did stop my nerve pain from running all the way down my right leg. Now, it stops in the buttock area. The problem is, I have extreme pain in my left hip and leg. (They took the bone grafts from my left hip). So in my opinion, the surgery just traded pain from one side to the other. But, I was at the point that I had to try it. I was in so much pain that I took the odds the doctor gave me. He gave me 60 percent odds of success. The bone grafts are growing so they pretty much consider my surgery a success even though it has left me with more pain. I think its a very personal decision as to whether or not to have surgery. When you get to that point that you just have to try you will know. I don't regret trying. Now, my surgeon is sending me to a new PM on the 17th to set up a lifetime regimen of pain management. I have tried everything, so now we are left with trying to manage the pain with opiate therapy. I'm seriously considering the intrathecal pump like Shoreline(Dave) had implanted. I think it would be nice to not have to keep up with changing patches and disposing of them and breaking out from the adhesive and all that other good stuff that goes along with it. I also think it would make the relationship with a PM easier as they KNOW you are not abusing your meds. I have been pretty much lucky with PM so far. It has been almost 3 years and I have always been compliant. It's just that no matter how compliant you are when you walk in that office you know that the least little thing could cause you to not have your meds.

    Scotty,

    Just remember, this is your decision as to whether or not to have surgery. I think you will Know when the time comes. When you can no longer deal with it and the possibility of success is enough for you. Even if you have a successful fusion, you can still have extreme pain. I am finding this out now. But I had to try. Thats why I say I think you will know when the time is right for you. If you don't feel right about going into surgery, then by all means don't do it, because if it fails you will feel horrible. I wish you all the best and I know how you feel.

    God Bless,
    Sherry
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    Last edited by Administrator; 03-26-2014 at 01:07 AM.

     
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