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  • Is anyone on pain meds for spondylolisthesis?

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    Old 01-15-2005, 11:40 AM   #1
    spondylo
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    Is anyone on pain meds for spondylolisthesis?

    Just wondering what you have found to be successfull. I am taking 2 Lortab 7.5/500 a day and Soma and either Valium and Xanax at night for muscle spasms and sleep. Hoever, the Lortab seems not to work as good lately.

    Thanks

     
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    Old 01-15-2005, 08:06 PM   #2
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    Re: Is anyone on pain meds for spondylolisthesis?

    spondy,

    i have instability issues and some bad discs.

    in the begining i really wasnt getting much relief. the first 12 months after my back pain became an everyday thing, i was taking hydocodone. it wasnt until i switched to oxycodone that i started to feel a little better.
    still on it at a higher dose.

    its been tough,im still taking SA meds but most of the time the pain stays in check.a few times a year the pain gets unbearable and i spend a week in bed.i try not to increase the dose evertime i get a flare up.

    ive since strarted taking soma and elavil.i do sleep better since starting the soma at night.ambien never kept me from waking up in pain 2 or 3 hrs after taking it.

    i was taking lorcet until i was switched to percs.have you ever benn rx'd percocet/oxycodone?
    that would be the obvious next med for your dr to try.

    my pain was so bad for so long that even after switching to percs it took 2 weeks to really bring the pain down to a managable level.i remember being very loopy the first week or 2,slurring my speech,but still terrible pain.

    i hope you feel better real soon.tell your dr how your feeling.tolerance is to be expected.

    scotty

     
    Old 01-16-2005, 07:28 AM   #3
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    Re: Is anyone on pain meds for spondylolisthesis?

    Hey Spondylo, The problem with instability and shifting of vertabrea, is that there is no amount of medication that stops the pain when things actually shift.
    I've had 3 back surgeries, the last 2 were attempted fusion, the last from L1-S1, They all failed and I've broken both sets of hardware, sheared the pedicale crews off at the bone line, the screws in my sacrum toggle in holes twice the size they were originally.

    I can be comfortable on medication or now with the pump, but when the hardware and vertabrea shifts, which it sometimes does with every step or sometimes does with slight movement, no amount of medication prepares you for the slippage and shifting, It sends a jolt throug my body that regardless of how high my pump is set or what meds are in it, It's not going to mask the pain of shifting and mechanical instabilty.

    Meds can certainly manage the pain when your sedentary and stay in the same position, but once moving I never know when things will shift or move and nothing touches that pain. It stops me in my tracks and I break into a sweat.

    Unfortuantely the only present answer for instabilty is fusion which surgeons grossly exagerate the success rate of whatever method they use, cages, or pedicle screws, postieror or global, grafted bone or donar bone, There are some new things out there I could tell you about such as new cages, new bone growth enzymes and proteins, but there has never been a statistical comaparison of effectiveness of one method versus another. Docs learn to fuse and continue to do it the way they learned.

    Some are interessted in trying the latest hardware and the latest bio agents, but again there is no data on the success rate of one method over another. There s a new cage that doesn't use donar bone, they fill it with a bone growth agent and I can get some info about that if your interested, but cages are implanted from the front after complete removal of the disc. Very invasive.

    If you have instability of L5-s1, anteror is defnitely the way to go as far as looking at it from a mechanical point of veiw. The sacrum is softer than vertabrea and doesn't hold screws as well, hence my toggling problem. the area they try to fuse from L5-S1 from a posterior aporach is like trying to glue a wing tip to another wing tip with no overlap. With what I know now, I would have gone with cages and an anteroior aproach, but hind site is 20/20.

    You can medicate to manage everyday type pain, but you can't medicate enough to prevent the pain from mechanical disfucntion when things actually shift.

    F you have already had a laminectomy discectomy, thpost laminectomy syndrome could likely be the cause of instability. They clip the spinous process off to reach the bulging or ruptured discs and without the interlocking spinous process, there isn't much to prevent movement from front to back, Your facett joints help some but they mostly prevent movement from side to side or slippage from side to side.

    Nerve blocks can prevent the slippage pain temporarily, the usually do a medial branch block as a diagnostic test to see if a full block would be helpful, if the blocks are helpful then there the option of RFA, radio frequency ablation "destroying the nerve through RF or with chemicals, however nerves grow back and can can take a different route than previously damaged by such procedures which can cause even more pain if they can easily become trapped or impinged by instability and movement. There isn't an easy answer and several surgeons would likely give several different opinions based on the method they learned.
    Good luck, Dave

    Last edited by Shoreline; 01-16-2005 at 07:33 AM.

     
    Old 01-16-2005, 07:30 AM   #4
    spondylo
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    Re: Is anyone on pain meds for spondylolisthesis?

    Dear Scotty,

    Thank you so much for responding to my post. It was very encouraging. I have been suggested to try Elavil by two different doctors and I think I am ready to give this a try now. Maybe this will help with the nerve pain in my leg and with sleep.

    I am not ready to ask for the perc/oxycodone yet, though I know this is probaby in my future. I do get some relief from the Lortab and will likely go up on my dosage since I am still taking a relatively low dose. I have a distant (25 years ago) history of drug abuse (pcp, sopors, etc.) so I am very cautious about the pain meds.

    What are SA meds? I probably know this, but can't think of it.

    Have you had any surgery?

    Thanks again. I really appreciated your thoughts.

    Karen

     
    Old 01-16-2005, 07:37 AM   #5
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    Re: Is anyone on pain meds for spondylolisthesis?

    SA= short acting meds, versus long acting meds for round the clock pain management. If you can get by on SA meds and function, I would stick where yur at. Once on LAmeds like OxyContin, MScontin, Duragesic and methadone, physical dependnce is inevatable, IT doesn't have to equate to addiction snce your reason for using them isn't psychologically driven, but even with agressive use of LA opaites "long acting" instability isteslf won't be slved and there is price a to pay even though it's simply physical dependence which can be resolved with a slow taper.
    Good luck, Dave

     
    Old 01-16-2005, 07:42 AM   #6
    spondylo
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    Re: Is anyone on pain meds for spondylolisthesis?

    Dave,

    I did not see your post before, but I want to thank you. That was very informative information and really helped me to understand what is going in my spine and what the surgeries are all about. I have had this for nearly 30 years and managed it mostly with just exercise, ice, and "gritting my teeth." However, I am tired of gritting my teeth and my spondylo has slipped from grade 1 to grade 2. I am just started the pain med route and have not experienced the excrutiating pain that you and others describe, just mostly constant, chronic pain. I have not had any surgery as of yet.

    I will save and print out your post so I can read it over again. I have seen some of your posts and you seem to know a lot about these things. Do you mind me asking how old you are and when you had your surgies? Are you on disability?

    Thanks again for taking the time to explain all this to me.

     
    Old 01-16-2005, 08:26 AM   #7
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    Re: Is anyone on pain meds for spondylolisthesis?

    Spondy,

    If you try elavil,give it a couple of weeks as it does take time to work.Dont expect miricles but it does help with depression and neuropathic pain a little.in the beginning it will make you tired.i still get sleepy 2 hrs after taking it and if im laying down its very easy to fall asleep.

    As far as your history goes,when i was in high school and my early 20's i used drugs recreationally but never had any problems stopping.
    The way i look at it is,i would not do anything to jeopardize my relationship with my pain dr or put up any red flags.I believe you only get 1 shot at pain management and controlling the pain is a priority that gives me the ability to function as an active member of my family and work partime.

    dependence is dependence so if switching from 40-50 mg of hydrocodone to 35-40 mg of oxycodone helps control the pain better,then whats the difference.if the DEA reclassifies hydrocodone to a class II med dr's would probably write more rx's for percocet then sticking with vicodin if it was not working well.

    I do agree with Dave as far as sticking with SA meds if you can.the ups and downs do suck but if you ever have surgery it'll be asier to taper down before/after surgery.

    I havent had surgery yet.i found a surgeon Im comfortable with but im looking at a 2 or 3 level fusion,L3-S1 most likely.All 3 surgeons ive seen agree that if im not having constant leg pain and am able to work partime than by all means hold off.i have a grade 2 slip at L5_S1 and the 3 discs above are in bad shape.the only healthy lumbar disc i showed on my last MRI was L1-L2.

    take care and feel well,scotty

     
    Old 01-16-2005, 09:48 AM   #8
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    Re: Is anyone on pain meds for spondylolisthesis?

    Hey spondy, I was 27 when I had my first back surgery, I had ruptured the discs at
    L3-4 and 4-5 and had fragmants impinging nerves at the outlest called the foramen. Surgery wasn't by choice, I had so much nerve damage a speed bump would cause incontinence."sp?" trying not to be to graphic with words I know how to spell..

    They did a large laminectomy where they removed the lamina and the spinous process to get to the globs of disc fragments. The surgery instantly relieved the leg pain and resolved all the other problems. I Did the PT thing and was back at work in 10 weeks. Unfortuantely 6 months later I blew the same discs and the L4 shifted back, grade 2 Spondylolisthesis which means it shifted 50% out of alignment and L3 shifted forward, grade 1 retrolisthsis. It pretty much looked like a 1 year old tried to stack blocks and didn't do very good job.
    Grade 1 is a 25% slip,
    grade 2 is A 50%
    Grade 3 is 75%
    Grade 4 is 100% and
    grade 5 is complete toppling of the vertabrea where it's shifted completely off and will lkely cause spinal cord damage,nerve root shearng, strethcing or cord compression. The retro seemed worse, it impinged my spinal cord and I lost alot of contrlol of things from from the waste down.

    Because this started as workmens comp, they were not in a hurry to tell me anything else had gone wrong, I went through more PT, then PM bootcamp/work hardening back in 94 when PM meant PT and antiD's. No such thing as OxyContin back then.

    The whole comp thing dragged on, after boot camp I was cured like everyone else that went through, was retruned to work but could barely walk. Treated like crud like many folks, drug seeker, all in your head, etc etc. I finally went to Duke and paid for an IME myself to find out what was wrong and that's where I was DX with spondy and retro. The first surgery was 7/93 the next was 2/96, a very long time to live like that and be called a drug addict and every other reason I couldn't return to work.

    They fused me from L3-4-5 with 6 screws and 2 rods 2/96. I never felt right but the docs insisted everything was fine. I was sick of comp controlling my life and took a crappy settlement, not that their are any good comp settlements unless injury is caused by neglegence in my state. Took a year off, did some side work and bought and sold a few cars then went back to work in a different field where no lifting was involved but was on my feet all the time.

    By the beginning of 99 I couldn't take it anymore and just went to GP fort an Xray to see if everything was OK and I had broken 2 screws and bent a rod, the fusion failed and I went back under the knife in 4/99, I was 33. It was supposed to be a simple revision and take 3-4 hours and started at 8am. When I woke up It was dark outside and I knew something had gone wrong. Wife was crying and I was hurting. There had been complications, the discs above and below were rupured, a vertabrea fractured when they put a screw in and I ended up fused from L1-S1. I spent the next 9 months bed wridden except PT and got the same drug speeches from surgeon, yada yada .. and Havne't been able to work since.

    In betwen surgeries I went to a dozen PM docs, 3 PM clinics tried everything they asked and then some I asked to try.

    By then I was 33, and Insurance cut off any further PT, I wasn't making gains, Had more Xrays, this fusion failed, I broken screw after screw and started PM with a doc that had always been arund but nobody wanted me to see this doc because I was such drug addict even though I hadn't had any meds in months or years betwen surgerries.

    Anyway, I started the SSD process in Novemeber of 99 and was turned down, then turned down on apeal and eventually a judge overturned the previous decisions a year after waiting for a hearing. I got my first SSD check in aug 2001. They aren't quick to aprove 33 year olds for physical problems. If I was nuts or had real adiction problems and was in and out of rehab the SSD process would have been easier.. But they believe physical problems can be overcome and I could still find meaningful employment. Their definiton of meaningful employment was any job that grossed $600 a month, not a typo, 600 a month was meaningful to them.

    It took about 6 months of tinkering with LA opiates to get the hospital bed out of my den. It's hard to see improvement from month to month or even looking back 6 months at a time, But as the years have passed I'm certainly more functinal and have learned to somewhwat except things although I'm always looking ahead for what's new and inovative or some possible way to patch me back together without removing ribs and running a bar from hip to hip and extending the fusion up 3 more levels.

    I do 90% of the housework and cookng, became Mr. mom which was cool being home with my daughter as she's grown up. My wife went back to school and because I had medicare we only did cobra on her insurance. After years on meth I was tired of feeling the meth blahs and hoped the pump would offer more function. That took about 2 years and several trials to convince me it was the right thing to do and I had that implanted back in june. It took about 6 months to get back to where I was pain wise but my head is much clearer with the pump and my personality, labido and the color in life came back.

    I've seen surgeons that wouldn't touch me and one that has a new monster surgery he would like to try, but I'm not up to a complete overhall. Some of the new technology looks promising if I could find someone to adress the worst problems rather than redoing the whole thing. I'll post that info on the latest cage and bone growth stuff on the next page.

    Sorry it was so long. As far as knowledge, I've basically spent the last 5 years on he computer looking for an answer, watching clinical trial progress and have seen some things that look promising that were not options 12 years ago.
    Whew, that was long, but 12 years is a long time. I'll be 39 in a few weeks.
    Good luck, Dave
    check out the Open LT-CAGEŽ with INFUSEŽ Bone Graft on next page.

     
    Old 01-16-2005, 09:55 AM   #9
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    Re: Is anyone on pain meds for spondylolisthesis?

    This cought my eye as a way to get L5-S1 fused and stop some of the crunching and toggling of screws.

    Introduction
    Anterior lumbar interbody fusion (ALIF) is an effective treatment for patients with chronic low back pain resulting from single level arthritic conditions. Lumbar spine fusion procedures that do not interfere with the posterior spinal muscles have some significant advantages in the surgical treatment of low back pain. The anterior approach to the lumbosacral spine enables the surgeon to expand the disc space and re-establish the normal anatomic alignment and relationships of the lumbar vertebra while at the same time avoiding injury to the lumbar spinal muscles. The anterior approach also avoids scarring of the nerve roots.

    Stand-alone ALIF procedures using autogenous bone grafts alone have been associated with a high rate of non-union and poor positioning of the spinal elements. Addition posterior fusion surgery has been advocated to stabilize interbody grafts and increase rates of fusion. Recently, cylindrical threaded intervertebral fusion cages have been shown to stabilize a lumbar vertebra and promote fusion. The use of fusion cages has lead to high rates of fusion and to improved clinical outcomes.

    In animal studies, recombinant human bone morphogenetic protein 2 (rhBMP-2) applied to an absorbable collagen sponge carrier (INFUSEŽ Bone Graft) has been shown to promote fusion after ALIF. Recently, this technique was used in a small series of human patients who underwent stand-alone ALIF with tapered fusion cages. In these patients, the use of rhBMP-2 applied to a collagen sponge was also shown to promote fusion. To further evaluate this method, the clinical and radiographic outcomes at two years of 279 patients who underwent a single level ALIF were studied.

    Study Design
    In a multi-center, 2-year study, 279 patients who underwent a single-level anterior lumbar interbody fusion with the LT-CAGEŽ fusion device were evaluated. These patients were place into two groups by random selection.

    One group (136 patients) received autogenous iliac crest bone graft. The other group (143 patients) received recombinant human bone morphogenetic protein-2 (rhBMP-2) on a collagen sponge carrier (INFUSEŽ). The objective of the study was to determine the clinical and radiographic outcomes in patients treated for single-level degenerative lumbar disc disease with a stand-alone anterior interbody fusion using tapered threaded titanium fusion cages with autogenous bone graft or rhBMP-2 and an absorbable collagen sponge carrier.

    The patients' clinical outcomes were assessed by their neurologic status, work status, back pain, leg pain and disability questionnaires. Plain radiographs and computed tomographic scans were used to evaluate the progress of the patients' fusion.

    Study Results
    Mean operative time (1.6 hours) and blood loss (109.8 mL) was less in the rhBMP-2 group than in the autograft group (2.0 hours and 153.1 mL). At 24 months, the rhBMP-2 group's fusion rate of 94.5% remained higher than the autograft's at 88.7%. New bone formation occurred in all patients treated with rhBMP-2. At all postoperative intervals, the average disability, back pain, and leg pain and neurologic status were improved in both treatment groups compared with the preoperative status. In the autograft group, 8 adverse events related to harvesting of the iliac crest graft occurred in 8 patients (5.9%). At 24 months after surgery, 32% patients still reported graft site discomfort and 16% were bothered by the appearance of graft site. Of course, no patients in the rhBMP-2 INFUSEŽ group had any graft site pain of complications.

    Study Conclusions
    The rhBMP-2 INFUSEŽ treated patients had shorter operative times and less blood loss. At 24 months, this group of patients had a fusion rate that was nearly 6 percentage points greater than the autograft group. Overall results show that the use of rhBMP-2 can eliminate the need for harvesting iliac crest graft for successful lumbar fusions.

    Key Points From the Study
    ˇ Fusion rates for both treatment groups were high at all studied intervals. At 24 months, the average rate of fusion for patients treated with rhBMP-2 was nearly 6 percentage points higher (94.5% vs. 88.7%) than for patients treated with autograft.

    ˇ The average operative time was 1.6 hours for patients treated with rhBMP-2 compared with 2.0 hours in the autograft group. This difference was statistically significant.

    ˇ Blood loss was less for patients treated with rhBMP-2 than for patients who underwent iliac crest bone graft harvesting.

    ˇ At all postoperative assessment intervals, patients in both treatment groups showed improvement in disability scores, in neurologic status, and in relief of back and leg pain.

    ˇ The use of rhBMP-2 in anterior lumbar interbody fusion procedures eliminates the complications of iliac crest bone harvesting including postoperative pain and scarring.

    rhBMP-2 has recently received clearance from the Food and Drug Administration (FDA) for specific uses. Consult your surgeon to learn if you are a candidate.

    Good luck, Dave

     
    Old 01-17-2005, 06:30 AM   #10
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    Re: Is anyone on pain meds for spondylolisthesis?

    Let me just say YIKES,Dave.wow, only 39??i cannot believe all that you have gone through and are still here to talk about it.No wonder you sound like a PM doc.It ALL makes sense now.It just goes to show you that no matter how bad you think you have it, there is always someone out there who is worse than you.I am glad you use all of your knowledge and experience to try and help all of us.I have learned soooo much from you Dave,and just wanted to say a big thank you to you for that.I wish things were going better for you.Marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 01-17-2005, 08:43 AM   #11
    spondylo
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    Re: Is anyone on pain meds for spondylolisthesis?

    Scotty & Dave,

    I just want to say thank you again for all of your helpful information. I am printing it out so that I can study it all later. My pain seems almost insignificant after reading what Dave has been through and some of the others as well. Still, we are all different. My pain is not excruciating, but has been chronic for almost 30 years.

    I see my pcd tomorrow and am going to talk to him about some things.

    I will write more when I have a chance. I am blessed to still be able to work and to work from home setting my own hours, so I do have to get to work.

    Again, I agree with Marcia in feeling very sorry that Dave has been through so very much and so young. And sorry Marcia that you (and Scotty, too) has had to suffer so much.

    I don't believe in pushing my religion on anyone, but I do want to say that I have found the Lord to be good and powerful in spite of my trials. I believe His promise to someday dry every tear and His promise to create a new earth where "nothing will hurt or destroy." That is my hope and what keeps me going. And I know it is not a false hope.

    My heart goes out to all on these boards and thank you so much for taking time to help me in my need as well.

    Love,
    Karen

     
    Old 08-09-2005, 12:41 PM   #12
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    Re: Is anyone on pain meds for spondylolisthesis?

    Hello Spondylo,
    I have the same problem that you do and the ambien never keeps me asleep all night so I usually end up taking more pain meds which I don't want to do.
    My best sugestion at this point would be to get on a diferent sleeping med so that your body can repaair itself during the night.
    Stay away from too much tylonol as we all know it is not very good for your liver and kidneys. I wish the best for you.
    Nikitan

    Last edited by nikitan; 08-09-2005 at 12:44 PM. Reason: left out part of sentence

     
    Old 08-10-2005, 01:47 PM   #13
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    Re: Is anyone on pain meds for spondylolisthesis?

    Hello all, I went back and re-read this as my original post was back in January. Nikitan, if you hadn't have answered it, I would have lost track of it. Wonder why my name now reads "wrenegade?" I was spondylo, but forgot to add the "LO" when I tried to sign in (as spondy). Hence, I thought it was all messed up and re-registered as wrenegade. . . sigh. . . A lot has happened since last January.

    I am now on 10 mg of oxycodone 3 times a day with 500 mg each time of tylenol, i.e., the equivalent of three 10/500 Percocet a day. Still taking Soma and I am now taking 1/2 to 1 Klonopin at night with one of the Soma which works great for sleep for me.

    I re-read what Dave said about the slippage and how not much hope of resolving the pain with meds. I was eligible for Duragesic's patient plan and tried the patch, but it gave me a headache and made me nauseous. Yesterday, I went to try again. I have found I can leave it on 2-3 hours and take it back off. I usually do this after lunch as this is my "problem time." Mid-morning meds have worn off and if I take the oxy just before or with lunch it slows down absorption and I am in pain until around 4:30 p.m. (After my lunch has digested enough, then I take the afternoon dose). Anyway, the short-acting meds aren't cutting it anymore. I am trying for OxyContin which I really didn't want to do.

    In the meantime, I have found out that Vocational Rehabilitation will pay for a fusion for me, but I am concerned as to what type of care I will get going through the government? I have also been told of a doctor that has a foundation within driving distance that I will check out. I don't have many other choices as we are broke as can be with no insurance, noneligible for Medicare or Medicaide.

    I never thought I would even comtemplate the surgery, but I do hear that some people have good success.

    I have a little osteopenia. Anyone think that will interfere? Any ideas about the Voc Rehab and surgery?

    Thanks again for all the input. How you doin', Dave?

    wren (aka wrenegade aka spondylo) LOL

     
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