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    Old 09-12-2004, 01:32 AM   #1
    rdunnit
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    Any suggestions for help with this Pain?

    Hello, I have had pain off and on for over 10 years due to some back problems. I am 6' 1" and weigh 460 puonds. I know that a lot of my back problems are due to my weight.

    About 4 years ago I went to a orthopedic surgeon for my back pain and they recommended PT and prescribed Tramadol for pain. I was unable to go to PT because of transportation issues and the Tramadol seemed to help with the pain. I was also prescribed stupid Naproxin (which eventually caused me to go to another doctor for stomach problems). This combination seemed to work off and on for the last 3- 3 1/2 years until I started getting numbness and shooting pain in my legs and especially my buttocks.

    I ended up going to 3 different doctors and a couple of ortho surgeons and heard the same from all of them. There isn't anything we can do until you lose some weight. They were downright rude too. One of the surgeons upset me so bad that I cried my eyes out and vowed to eliminate him and his whole family just to make myself feel better.

    Well I didn't know what to do and had almost given up because my family doctor would only prescribe me Lortab 7.5's and only 40 tabs a month. I would go through this in 3-4 days easily because the pain was(still is) so intense.

    I ended up going to another doctor (that was recommended by a friend) just to supplement my medications for pain. This doctor explained to me that since I was obese that I needed more than the average male due to having more tissue to spread the medication around.

    This seemed to work for awhile. (I know that this is very uncool to go to more than 1 doctor to get pain meds at a time but I was and still am in immense pain)
    Well about 1 month ago a wal-mart pharmacist somehow found out that I had been getting my other pain meds filled at a local grocery store and called my doctor( that had prescribed my Hydrocodone) and my doctor ended up telling her to dishonor the prescription and not seeing me because of non-compliance due to the fact that I had had the ER doctor and another family doctor prescribe me meds recently.

    Also during this time I had an MRI done through my PCP and it showed that I have bulging discs at L3-L4, L4-L5, L5-S1 and also spinal stenosis, some bone spurring and a bruised Sacroiliac joint on the right side.

    The bulging is especially bad at the L5-S1 disc on the right side and it is almost impossible to stand or walk for very long. It is hard to find a position to sit or sleep for that matter.

    I ended up having an epidural cortisone injection and it was awesome to be able to walk again until the next morning when the numbing meds wore off. That's when the pain started with a vengeance. The ortho that I had gone through won't prescribe anything for pain other than Ibuprofen and NSAIDS and they are killing my stomach.

    I am supposed to get another injection sometime soon and I am tired of going to the ER to get a shot for pain. It is the most horrible steady pain that I have ever felt in my life. I ended up going to the ER last Sunday and had to wait 4 1/2 hours to get seen.

    I don't know what to do. I saw my PCP Monday and he prescribed me Percocet 7.5's but they aren't even helping much at all. I am supposed to go to PT but with the pain I have it is hard for me to leave the house let alone do PT.

    At least when I was getting pain meds regularly, I was able to function a little bit closer to a normal human being.

    I apologize for being so windy but I am at a loss and starting to give up hope for a return to a normal life. It has been over 4 years since I have worked and am ashamed of being on Social Security disability.

    Does anyone have any suggestions as to what I can do?

    Last edited by rdunnit; 09-12-2004 at 01:32 AM.

     
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    Old 09-12-2004, 01:47 AM   #2
    rdunnit
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    Re: Any suggestions for help with this Pain?

    Also my PCP says that he thinks that the epidurals won't work because I have had the back problem so long and that surgery is probably my only help. But he says that I need to lose at least 100 pounds or so before they will operate.

    I have battled with weight problem my whole life and I realize I need to lose weight. I am already on Lexapro for depression and it really doesn't help. In America if you are fat then you are the worst kind of person based on my pesonal experience. I just about at my rope's end. I have a newborn son that is 10 weeks old and I take care of him while my wife is at work and it is hard to do when I am in this much pain.

    I have tried Percocet, Hydrocodone and all of the others, VIOXX,BEXTRA and etc with not much help other than stomach problems.

    What can I do about this pain??

     
    Old 09-12-2004, 09:18 AM   #3
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    Re: Any suggestions for help with this Pain?

    I don't know what to suggest for you. It sure sounds to me though that you are being undertreated for your condition. Can you speak with your doctor about putting you on timed release meds such as mscontin or oxycontin, something that will last more than 3-4 hours at a time?
    About the weight I have a cousin that was really overweight. She tried every diet I'm sure with no luck. She finally ended up having some kind of stomach stapling done and she lost a pile of weight. She did have trouble finding a doc that would do the surgery though. Good luck I hope you find better pain relief soon. Welcome the the boards by the way.
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    Old 09-12-2004, 12:00 PM   #4
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    Re: Any suggestions for help with this Pain?

    Hey Rdunn, Unfortuantely I have heard docs tell patients they won't operate untill they loose wight about as often as not touching you untill you quit smoking. Smoking is a little easier to hide. or discontinue for a couple weeks. Even if the tested for niciotine, it only stays in your syetem 2 days. Up front, I will tell you I shoot from the hip and won't candy coat things to make you feel warm and fuzzy.

    As far as bigger people needing more pain meds, that's really only true when it comes to anesthesia. Just because your twice as big as someone else doesn''t mean you should be given twice as much pain mededicine for chronic pain.

    I've seen 98 pound women take 800mgs of morphine a day and a 300 pound man knocked cold by one percocet. It has more to do with previous exposure, tolerance and your level of pain.

    As cruel as it may seeem. Operating on someone that is that overweight really does have lower odds of success, and failed back surgery usually leaves you in a worse position than you are prior to surgery. Imagine beng worse and having a pain management doc say he won't help untill you help yourself.

    You got cought doc shopping, which is major no no but rarely prosecuted unles you altered or forged or stole script pads. It happens. It happens to pain patients that are undermedicated. Most knowledgable PM docs know the difference between psuedo adiction and addiction. Psuedo meaning showing certain behavors like doc shopping but it's done out of a patients need for pain relief rather than a need to get high.

    The bottom line is you have to loose weight, even if you find a surgeon, it may releive you leg and nerve pain, but you back will be a mess without some major changes. Have you talked to your wife and investigated gastric bypass, the ring thing, the pouch, there are several techniques that will drop weight fast. They are risky, you could die from these procedures. But you could die tomorrow from your health issues brought on by being morbidly obese.

    My personal choice would be better to die in the OR trying to improve your chances at living a healthy life than eating a bullet from depresion and pain. The depresion is pretty normal and goes with being in pain. But when you weigh all your risks, Including the future of your newborn, You have to be around for him and your wife.

    The loss of weight may even take enough presure off your spine to ease the pain. I know it's a risk. A friend of my moms died 20 years ago from gastric bypass with the ring thing. Hopefully techniques have improved in 20 years. There are many succcess stories out there and you could be one.

    I understand being mad at the docs for not helping you, but you will be madder if your end up worse off than you are now and trust me, it can happen to anyone but when the odds are so against you from the getgo, It's like trying to roll a 7 with one die.

    I've had back surgry 3 times, I ws 6ft weighed 165 all 3 times, the last 2 were fusions and because the fusions failed, the hardware snapped or the screws just toggle in the wholes. If I can break hadrware at 165, I'm sure you can too.

    I'm trying to be politically correct but I'm not the most elequent person you will ever read a post from, but I won't BS you and I won't say things just to be cruel.

    Your not just obese, you are morbidly obese, which means you will die at an early age because of your weight. All back problems aside, that's gotta be the most important thing. To be there for your child and to take care of your health. Because you life is in danger, I doubt medicare would consider this elective or cosmetic surgery. The morbid part kind of takes it to a different level.

    If you would have back surgery to relive you back pain, why wouldn''t you have GP to save your life? The GP may even improve your back condition and you may find you don't need surgery after loosing 200 lbs.

    To be honest, many docs do psych exams prior to back surgery, they only want the best candididates with the best chances of succcess. When you walk in, they have to wonder what's going on that you have let yourself become so large. If you let this happen, would you walk every day as part of your post op recovery, would you go to PT, how hard would you push to recover? Or would you simply ask for lots of meds to mask you pain and think you need more than a smaller person. . A 400 pound man that has never taken opiates has the same tolerance as a 100lb woman that has never taken opiates. So needing more because yourlarger really isn't acurate when it comes to manageing pain. There are some things that it makes a difference but not pain management.

    You have to show them the different person that you can be, take care of yourself first and a doc is more likely to take care of you. Although your disabled, you have too much to live for, But trust me , when your unable to walk through the zoo with your child because of back problems or weight, then it really sinks in as far as your lmitations and changes you want in your life.

    Even with visably broken hardware and failed fusiions, I went through years of PT and pain management without opiates between surgeries. As I have been told, by several surgeons, nobody dies from back pain. If you can walk into their office, they aren't concerned about your spine slipping out of whack and paralizing you if they refuse to help because of a weight issue.

    If your in a wheel chair, then they will likely assume it's weight related and not so much spine related. many people with bulging disks and arthritis still walk without pain meds or surgery.

    I know this isn't what you wanted to hear, but it's just the way things are. I really don't think another doc in another country would be doing you any favors by operating on you. So your options are find a PM doc that will medicate you untill you are dependnet on meds or treat you with other modailities. Or do what you can to loose the weight in order to live a normal life. Then if there is somthng you can't fix, perhaps a surgeon can fix your back.

    I think you may have to accept that the weight is the major issue.The back stuff can be resovled but not when you life is at risk every day due to your weight. You may be able to find a PM doc willing to prescribe huge doses of pain meds. But if you remain sedentary, your tolerance will grow, your weight will go up, surgery will never be an option and your life will not change other than being dependnet on opiates.

    If the opiates allow you to start an excercise program and you can do this and control your tolerance, except that no med will relieve all your pain, that may be a viable option. I was bedridden after the last surgery untill they gave me enough meds to actually walk without my legs buckling.

    If your thinking I'm some skinny guy that doesn't no squat. I do know that your life is more important and being there for your daughter is more important than manageing the pain if someone puts morbid infront of your diagnosis. I had a heart attack at 36, If it can happen to a skinny guy it can happen to you and you have more to live for now probably than ever before with a newborn in this world.

    I have nothing against larger people, But your situation is similar to an alcoholic that won't stop drinking but needs a new liver. What are the odds of a new liver improving the quality of his life. Or a smoker that needs a heart transplant that won't stop smoking.

    Docs want to take care of the life threatening stuff before taking care of the comfort stuff. That's really about all there is to it. There is a real risk of you dieing under anesthesia during a non essential operation, that is reason enough to say loose the weight first.

    If you needed bypass surgery, they would do it regardless of your weight. But this may be resolved by simply loosing wieght and your odds for succesful surgery right now are so low, no surgeon wants to cripple you or make your worse than you are now. Your options are somwhat limited but should start with some way to manage your weight.

    I really hope I haven't offended you and I have explained things in a way the docs didn't bother too. I hope it makes sense, and you have a fullfilling pain free life. But you do have to do your part and docs will asume that's not going to happen because of your present physical condition.

    Heck, loose 200 lbs and if your still in pain docs will think your the most motivated, best candidate for surgery hey have ever met. I understand hurting to much you can't walk even 1 mile a day. That's why I would suggest something like gastric bypass to jumpstart and change your life around to where you can find treatment for your back.

    Good luck, Dave

     
    Old 09-12-2004, 04:02 PM   #5
    rdunnit
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    Re: Any suggestions for help with this Pain?

    I am 37 years old. When I was 16 (in 1982) I had a stomach staple surgery and ended up developing peritonitis due to a hole in my stomach. I spent 3 months in intensive care and ended up having 2 more surgeries to repair the damage to my stomach.

    I have looked into the gastric bypass surgeries and even contacted several doctors but no one will touch me due to complications in my previous surgery.


    I have been on almost every diet known to man. I am ashamed for "letting myself get this way".

    I am sorry to have bothered you with this Shoreline

    Thanks

    Robert

     
    Old 09-12-2004, 05:47 PM   #6
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    Re: Any suggestions for help with this Pain?

    It's understandable what you are going through Robert. I know you are in a bad situation in many ways.
    As far as the medication situation, unfortunately you did do something innappropriate, going to more than one doctor, which has resulted in the stop of medications. I know that's difficult to accept but it is done for a valid reason. It's not to single you out by any means, it is the law and is there to prevent abusers. It doesn't sound like you are an abuser by any means but I am only explaining how it is.

    As far as your obiesity, it is a problem with the back. While I am not obese by any means I am overweight but I have family members and friends who are morbidly obese such as you. One good friend of mine is currently on a well known diet that is quite healthy and has lost nearly 75 lbs since January. He was pushing 400lbs in weight and is doing good.

    A former sister in law had the bypass surgery, and it has been sucessful. What type of complications did you have with prior surgeries?

    There are many medications that can help you to loose weight but you also must do that in conjunction with proper diet and exercise. I know you are thinking with the amount of pain you are in exercise is a no go. You need to be doing water aquatics, it is non weight bearing so that is going to mean no more pain than you have, or if you do by very little.

    One of the primary reasons doctors will not operate on someone obese when it comes to any part of the spine is not only the anethesia as indicated but the amount of fat there is getting to the spinal cord. I watched a recent video regarding ACDF's and this was brought up on more than one occasion. If the doctors have a difficult time getting to the spine it means you will be under anethesia for a much longer period of time and you do run a higher risk of complications.

    Add to that the extra weight added to the spine currently, fixing the spine with that same weight simply spells a failure in surgery. Quite honestly it is the exact same situation with folks who need a hip replacement at an early age. Most doctors will not do it if you are obese since it will wear the hip out very rapidly or the hip could fail completely within a short amount of time.

    I realize you are ashamed of yourself but you really do need to address the weight issue immediately. Loosing the weight probably will not stop your pain, in fact it wont bases on your DX, it may elieviate some. But what it will do is put you in a place where if you do need surgery then that is a viable solution. Obviously right now it is not and no doctor will operate and if they did I would honestly question their ethics unless it were a life or death situation.

    As far as PM, not sure what to tell you there since you broke the golden rule, most PMs will probably not help you at this point and I know it is sad. You can try some alternative therapies such as water therapy, bio feedback, meditation and the like as well as getting involved in a Pain Management class which usually runs about 6 weeks. THese do not involve medications and are viable options overall.

    Best of luck to you and don't give up. The help is there but you really have to help youself first and understand it from the side of a doctor as difficult as it seems.

    Barbie

     
    Old 09-12-2004, 06:05 PM   #7
    KateInAustralia
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    Re: Any suggestions for help with this Pain?

    Robert,

    Shoreline is just following up on your first statement-

    "I am 6' 1" and weigh 460 pounds. I know that a lot of my back problems are due to my weight."

    He's not trying to upset you, he's just answering your question by offering some suggestions. You asked for advice to treat the pain, he's just saying what the dr's are saying and what you are saying- that your pain level may decrease if you didn't weigh 460pounds.

    And to say its "not cool" to shop around for doctors is an understatement- its simply not right, and ruins it for the rest of us that try to keep within our allowed levels of opioids and other pain meds.

    It is much better to stay with one dr and do the right thing, otherwise you'll find they will cut off ALL your pain meds and you will be classed as an addict. You are shopping around to get more meds than you are allowed, there's something wrong there. I understand you want pain relief, we all do, but breaking the rules is not going to help you in the end, it'll make you worse. And it will make it worse for the rest of us.

    If the Lexapro doesnt' help, ask your dr to suggest another antidepressant. There are many different ones. I found Lexapro didn't help me, so now I'm on a different one that has made a huge difference for me.

    There are so many factors of chronic pain that we can't control. But I know in myself, if there is something I can change to make my pain ease, then I will do whatever it takes to change that and get that pain relief. It seems your weight is your problem. I understand you've tried everything, but giving up is not going to help you. You have to keep trying. The internet is a great way to find a dr who will help you. Don't give up, its so important for your health and for your family that you do lose the weight and ease the pain.

     
    Old 09-13-2004, 02:13 PM   #8
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    Re: Any suggestions for help with this Pain?

    Hi Robert, I am sorry if I made you feel worse about your weight. The more eloquent posters have done a better a job at explaining why docs do the things they do.

    Surgery is really invasive, if you watch the discover channel it's more like watching Bone mechanics, they use the same cordless drills, rodding, fusing, cages. The docs do know what will decrease the odds for success and if your not a good candidate a reputable surgeon won't operate. If you go to enough surgeons, You probably could find someone willing to operate. If your spine was broken in a car accident, they would do back surgery if they thought it helped.

    Aqua therapy is a great idea, After my last fusion, L1-S1 I couldn't walk without the plastic turtle shell except in water for 6 months. It is virtually non weight bearing but you can create as much resistance as you want simply by moving faster.

    As far as meds for treating CP with opiates, when there are no other options, I absolutely agree, I think folks should be given a second chance too. If your pain was properly treated you likely wouldn't have been in that situation.

    Are there alternative therapies to opiates. Yes, they do work for some people. My first and second surgery was before the invention of Oxycontin. PM docs didn't use opiates that I knew of so I can tell you all the alternatives and I don't feel it's a waste of time at all. Take what's useful and toss the rest. But if something simple like acupuncture would work, It would be crazy for anyone to want to have spine surgery.

    Antidepressants are commonly used for treating chronic pain, they believe it's more than simply treating the depression, they believe they actually relieve pain.

    IF the present AntiD isn't working, I'm sure there is a pain management doc out there that will listen, understand and go through the process of trying different meds. Honestly, there aren't many I Haven't had to try at some point in the last 11 years.

    I'll do a quick list of everything I have tried prior to or to prevent another surgery. PT, obviously there are many methods of PT, The Mackenzie, myofacial release, trigger point and some PT's do chiropractic adjustments. Then there are the relaxation techniques that do help while your actually doing them for me, and other get longer lasting relief. Self hypnosis, guided imagery, biofeedback, yoga breathing techniques. I've also used TENS, TINS, Acupuncture, Nutrition can play a role. Tomatoes are known to increase pain??? I've done a work hardening program, and 2 PM clinics not to mention all the ones in private practice.

    You reach a point if these don't work, you are willing to take the crappy odds just for a chance at surgery relieving the pain. I begged to have nerves severed , instead I had nerve blocks, ESI, Trigger point injections, then there is trigger point pressure, plain old chiropractic where there are several different techniques.

    I learned all these and tried all these and more over time, For nerve pain like burning leg pain, the antiseizure meds can help some people too. Everyone is different when it comes to treating pain.

    When other methods don't work, Opiates are an option. I've talked with my doc about treating people with histories of abuse or addiction, his thought was even a heroin junkie can get hit by a bus. Why should he have to continue to self medicate. He would try and help them and keep a tighter reign on the opiates. He believed everyone deserves the benefit of the doubt as far as history. He would likely treat you and just be more cautious using tools like UA's, pill counts, more frequent visits and shorter supplies of meds. That's just the nature of legitimate use of opiates.

    Everything needs to be documented and justified and a lot of us have Pain management contracts that spell the rules out. What other doc makes you sign a contract to only use one pharmacy and tells you that you may be asked for a UA or pill count at anytime. But we put up with all the hoops in order to have some quality of life.

    My suggestions for help with pain is to start the process over. Tell your doc you want to see a PM doc, make a list of everything you have tried, take Xrays and radiology reports and you will find some docs that will tell you they don't think they can help, you will meet some that don't use opiates but have many of the tricks I tried up there sleeve.

    If you do have surgery, You have to make it a point to get to PT. Excuses are easy, I have a kid, job, can't afford it etc. But if a doc does surgery or prescribes meds, he does expect you to do your part. It may be simply learning some techniques and doing them at home if it's just not possible to go to PT 3 days a week.


    I had my hardware replaced and fusion revised but the discs above and below were crushed and they ended up fusing me from L1-S1. After 9 months of being bed ridden except for going to docs and aqua therapy, I found a PM clinic that used pain meds, PT, Biofeedback, nutrition, psychology, what ever suited each patient best. I had the pain managed to where I wasn't thinking about checking out but I was still disabled by it. Then this set of hardware snapped and obviously the bone hadn't fused.

    So I started seeing more surgeons. I saw 3 very good surgeons at great schools with great reps. They all told me 3 surgeries have failed, what makes you think a 4th would do the trick. I don't fuse for whatever reason. Surgery wasn't an option then. So I have lived with the help of opiates but lost so much I still think about a cure. I'm 38 too.

    There are devises and techniques now that were not available 5 years ago. I saw a surgeon that believed he could properly redo my fusion and really had some great mechanical ideas as far as stabilizing the crunching and squeaking. But I'm not quite as desperate as I was before, when nobody was prescribing any actual pain meds. I I would not try to roll a 7 with one die now. I can wait and see what develops in the future.

    As far as what can be done. There is a lot that can be done by trained PM docs that may or may not use opiates. Opiates may be part of the equation to get you moving if gastirci bypass isn't an option do to adhesions or scarring. But have you checked in the last 5 years? Do you research what's new? That's part of doing something about it, doing research.

    I'm not a mean person, I just won't blow smoke up some ones backside. If you hadn't mentioned the weight, My advice would be find out why you are not a candidate for surgery. Every doc has a different opinion. But knowing part of why you were told what you were, I understand the reason for a surgeons decision and really was just trying to explain, not make you feel bad. Many of us are not a candidate for more or any surgery.

    I can guarantee nobody that I have met on this forums intent would be to make you feel bad about being overweight. It may be a painful subject, but when you ask good people for advice, ignoring a huge health risk and just bashing jerk docs really doesn't help you.

    But if you know gastric bypass is not an option, then the next step is to see real PM docs, not just GP's that give you 30 Lortab once a month. That's not pain management.

    But there is a right way to manage pain with opiates and a way that is going to set the patient up to have highs and lows, doc shop because they are undermedicated, experience withdrawal from using meds too quickly and running out early.

    A real PM doc can be a Neurologist, Psychiatrist, DO, Physiatrist "Physical medicine" or an anesthesiologist. Anesthesiologist usually do more interventional work but also have a better understanding of medication than your average doc. Pm docs usually prefer Long acting meds that don't have the highs and lows that short acting meds do.

    Some docs believe in using limited break though meds, some go hog wild and some won't use break through medication at all and want you to use some technique you learned and stick with your base dose of meds. Break though meds are short acting meds for when the long acting just isn't working.

    There is no way to ensure opiates or avoid treatments you don't want to try. You can always say no, But if that doc does prescribe opiates he may only for patients that nothing else worked for. So by not trying, you could shoot yourself in the foot.

    I know you have been in pain a long time but you didn't mention any formal pain management, just getting by. I was hoping to explain a little about what you will find in the PM field and what to expect.

    Stick around. In a couple weeks nobody will think of your weight unless you bring it up. If your getting ready to try something new, this is a great place to find info.
    Take care and congrats on your newborn. Dave

     
    Old 09-13-2004, 05:37 PM   #9
    rdunnit
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    Re: Any suggestions for help with this Pain?

    Thank you very much for the reply Shoreline. I will heed your advice and have my PCP send me to a PM doctor.

    I realize my weight is my biggest problem. I see myself in the mirror everyday and realize that if I keep this up I won't be around long enough to see my two kids grow up.

    I had some success with the Atkin's diet in the past and I am really going to try it this time. I used to smoke weed for depression and pain but quit 5-6 years ago. Marijuana has less side effects than most of the other drugs that I have taken for pain but it is highly illegal.

    That is another topic not needed to be talked about here.

    I had my second epidural injection today and now I hurt worse than I ever have. It has really knocked me for a loop. I couldn't even hardly walk without stumbling. I am hoping that it will be more effective than the last.

    I really do appreciate everyone's responses and I am sorry if I sounded like I was feeling sorry for myself. I really didn't intend to sound that way. I came here because I was at a loss and needed direction from someone that has been through a lot of what I have been through.

    I found direction and for that I am very grateful.

    This forum is a blessing. Even if sometimes what you hear is not what you would like to hear.


    Thanks Shoreline and everyone else.

    Robert Dunn

     
    Old 09-14-2004, 07:21 AM   #10
    KateInAustralia
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    Re: Any suggestions for help with this Pain?

    Hi Robert

    I hope you get some pain relief from the epidural blocks.

    By the way, I just thought I'd mention that here in Australia they are pushing for marijuana to be made legal for chronic pain. One of the major Premiers (Head of State) is trying to get it legalised, as he's seen the benefit it has for people and said on the tv this week that if one of his family members was in the chronic pain that some people live with daily, he'd go out of his way to get them pain relief. He just needs approval from the Commonwealth (England) for it to be legalised.

    I've thought of it before, but don't want to break the law, its not worth it in the end. But this current affairs show on tv showed people with chronic pain who use it now and get instant and immense relief, without the "druggy" effects that people who use it socially get.

    Good luck with your quest for treatment, Robert. Let us know how you go with a pm, won't you.

    x Kate

     
    Old 09-14-2004, 07:44 AM   #11
    twisten
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    Re: Any suggestions for help with this Pain?

    Hi Robert. I'm glad to read you are going to try to follow some advice you received here. I sure hope the injections help you more also. I'm trying accupuncture again and its agony!! Those needles hurt me so bad!! I'm going to try a few more sessions and if it still isn't helping for long then I'm not going to put myself through it anymore. They are legalizing marijuana up here in Canada also. I have never been one to smoke pot, even as a teen, so I don't know if I could do it now. I am considering looking into it a bit farther though. Anyone good luck and keep in touch with us so we know how you're making out.
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    Old 09-14-2004, 10:34 AM   #12
    Shoreline
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    Re: Any suggestions for help with this Pain?

    Hey Robert, It's pretty normal to feel worse after the numbing agents wear of from an ESI. The pain is usually caused by the pressure the meds create in the epidural space. As the meds disperse ind infiltrate the area the pressure is relieved and hopefully you will benefit from the anti-inflamatory action.

    They normally limit ESI to 3 a year. Steroids really aren't good for you in the long run but have there place. I'm a little tainted about steroids because my wife has steroid induced osteo perosis and has had almost 40 stresss fractures and compresion fractures in 4 years. Not an exageration. All she has to do to brake a bone in her foot is step off the curb.

    IMO If the first 2 ESI haven't helped there really isn't a need to subject yourself to more steroids. There are several types of steroids they can use in ESI's, The worst is depo-medrol. It has polyethelene glycol "Antifreeze" as a preservative. It can cause arachnoiditis. Infalamtaion of the sub archnoid layer of the dura around your spinal cord and can damage the mylan sheath that protects nerve roots. But these are the risks involved. Even after the Burton report was released that discuses these things, the doc that wrote the report said he would continue to use ESI as a tool to manage pain. I guess it benefits more than it hurts, percentage wise.

    Hope your feeling beter in a couple days and get some eal relief from the ESI.
    But if the ESI doesn't work there are still dozens of modalities.
    Acupuncture and trigger point injections aren't a bad idea, However you have to find a doc that has the touch with the needle and can find the exact spot.

    Any doc can learn the the basics of where these injections should be done but it doesn't mean every doc has that touch and can pinpoint the spot and get the job done. I've tried TP injections and Acupunture from sevral different docs and it can be amazing how some never hit the spot and don't offer relief and others can nail it right on the head and break up a muscle spasm in a single session.

    Some docs will pepper an erea with TP injections which simply contain a numbing agent and some use steroids and some use natural NSAIDS. It really just depends on the doc. In all I proabbly have seen well over a dozen docs when you consider there are 5 in the practice I see now, I saw 10-12 in the 8 years before I even found this clinic I go to now.

    Is your pain mostly back pain or mostly nerve pain, radiculopothy down the leg or the slang term sciatica. Many people use the term sciatica for any form or leg pain, It's not always used acurately because the sciatic nerve is a specific nerve and you have nerve roots that come from L1 all the way down to S3 that can effect the legs that are not the sciatic.

    You really have to stick with it and not let one doc fail at relieving your pain and believe you just have to live with it. When the doc says you have to learn to live with it , It's time to change docs. You do need to do it the right way, cancel any refills the old doc may have out, Make sure the day supply is up on a pain med if the next doc gives you the same one, But say doc # one that has given up prescribed Vicodin, If you still have some Vicodin left from him by the time you see another doc and he changes your med to a stronger version of Hydro or uses oxycodone or another med. The new prescription over rides the old and you haven't done anything wrong by simply changing docs and excepting a new script.

    Just be upfront, If you still have 10 vicodin left and it should last 3 more days, the doc may write the script to be filled when the other one has been completed. Each time you get a script filled , a day supply is assigned to that script. If your given 20 pills , and the directions say take one every 6 hours, the day supply "5" is entered into the pharmacy computer and your insurance.

    You wouldn't be able to fill the same med with the same instructons untill the day supply is completed or 90% complete. But if it's an entirely different med, that overrides the old.

    So if you are switched from Vicodin 5/500 to Norco 10/325, the Norco is an entirely different med/script and the new directions and days supply over ride the previous script. We walk a very fine line, even the apearence of non compliance or doc shopping means risking your relationship with your doc and the pharmacist.

    I have a pump and oral dilaudid prescribed by my PM doc. Printed on the back of each presccription are, directions , policies and It specifically tells me and the pharmacist that if I have a surgical or dental procedure , do not use your CP medication to treat this pain, have the treating physician prescribe pain medicine and notify the clinic.

    I had a tooth pulled today and was given 10 percocet. What do I need percocet for when I have dilaudid? because my PM doc doesn't want me running out of dilaudid early trying to manage the pain of a surgcical procedure, that was not the intent of th dilaudid. I'm given X amount and it has to last 30 days, so additional pain caused by dental or surgical procedures could easly have me run through my CP meds when the doc should have prescribed somethign himself.

    Unfortunately there are docs and dentist out there that think because you have a pump or because you take opiates for CP, They shouldn't have to prescribe any more opiates. But the meds My PM doc prescribes are not intended to treat that pain. So finding surgeons and dentists that understand this can be important down the road.

    MY pump implant was done by an OS not in my PM practice. The doc in my practice that does pump management used to do the surgery himself but is now too buisy with pump management and refills and he's the guy that does all the procedures like Nerve blocks, ESI's, Infusions etc. So I had this pump put in on a thursday and was discharged on friday with no additonal pain meds. I gues he thought the pump was going to manage all the post op pain but that's not what the pump is designed for. I had a lot of incision pain the pump didn't touch.

    Long story short, I had surgery and was given nothing for post op pain. I did run out of short actng meds given by my PM doc about 5 days early but he understood the circumstances. I just didn't want to get into a confrontation with the surgeon over Pain meds when he just did the pump and knew I had meds at home. Unfortunately it was near the end of the month and refill time and I had very few meds at home. So I did suffer because docs don't get it.
    Anyway, good luck and keep at it untill you find what works for you.
    Take care, Dave

    Last edited by Shoreline; 09-14-2004 at 10:59 AM.

     
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