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    Old 01-18-2006, 11:47 AM   #1
    mdp3
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    Question anyone with fbs going to pain managment

    Anyone Going To Pain Managment Doctor For Failed Back Syndrome And What Kind Of Relief From Pain Are You Getting What Meds Work And Dont Work Or Procedures That Work And Dont Work I Have An App. With One On Friday 2 Back Sugeries And In Constant Pain 24hrs. A Day I Take 7 To 8 Percocets A Day And They Do Not Work Any Advice Would Be Great Thanks Mike

     
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    Old 01-18-2006, 12:32 PM   #2
    ltedeschi
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    Re: anyone with fbs going to pain managment

    I had a posterior one level fusion with a cage. It shot out into spinal column on day three. They found it at six week check up. Surgery to remove cage two months after first surgery.
    Fusion failed. One year later posterior/anterior two level fusion.
    It fused but I had terrible back pain and my legs were bad.
    Diagnosed with RSD in legs.
    Had a Spinal cord stimulator implanted.
    It helped the legs but the back is still horrible.
    I am considering removing the hardware the doc says just call when I am ready.
    I take 60mg of ms contin three times a day.
    Zanaflex( muscle relaxer) twice daily if needed.
    Motrin 800 mg as needed
    Hope this helps good luck!!
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    Old 01-18-2006, 12:35 PM   #3
    onyxgates
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    Re: anyone with fbs going to pain managment

    I am at a pain mgmt doctor for my back. Not the same issue as you but have you considered asking your doctor for a LA medication? I am currently on 30mg Avinza. It is nice because I don't have to worry about where I am going to be at when I need to take my medicine because I only have to take it once a day. If I were you, I would try and get a long acting medicine. My one concern is that I still get break through pain and my doctor doesn't allow for break through medication . I would verify with your doctor to make sure he allows for break through pain. It happens, I think everyone on this board can attest that it does exist.

     
    Old 01-20-2006, 11:14 AM   #4
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    Re: anyone with fbs going to pain managment

    Hey Mike, PM can be anything from trigger point injections, epidural steroids and anti-depressants. Every doc has their own opinion on using opiates long term and if they use opiates they may or may not use bereak through meds, medication for pain that breaks through your regular long acting dose of pain medication. But pain medication is just one form of pain management.

    Nobdy can predict what is worth trying and what isn't. The only sure answer is, If you take stronger longer lasting pain killers you will likely get more pain relief. Percocet worked at one time so they can simply increase the dose or change to a different longer acting med, Like a long acting morphine product, methadone, the LA version of oxy "OxyContin" or Fentanyl pathces. There are also implantable morphine pumps that can deliver morphine, Fentanyl or dilaudid or the new cone snail toxin called Prialt. An SCS may be the right option if you have a lot of leg pain still.

    Although stronger opiates will likely reduce your pain, There is a cost to using opiates. You do become physically dependent, not addicted, but dependent. Where one day of missed meds causes withdrawal. You eventually become tolerant to whatever works today. You get every other docs opinion on your med use, which you may get tired of the opiates are addicting speech. You have to deal with all your friends and famly members opinion on your med use. Everyone becomes a doctor and wants to tell you the little they actually know about narcotics.

    Times have definitely changed in the last 10 years. Prior to 96, there was no long acting OxyContin, morphine and Fentanyl were only used on cancer and surgery patients and methadone was only for heroin addicts. So the fewer people that know what you take, the fewer opnions you will have to deal with. The few that abuse the meds make it tough on everyone. People have their meds stolen by friends and family and some are victims of crime outside of pharmacies. To think there is no cost if meds are your only choice is very foolish.

    I've had 3 failed surgeries, 2 were fusions that failed,The last was L1-S1, I've broken the last 2 sets of hardware and will live with pain the rest of my life. I saw dozens of PM docs, tried dozens of non opiate methods to learn to live with and manage my pain. There are plenty of PM docs out there that don't believe in using opiaits. Every doc is different. If your present prescribing doc is tired of prescribing percocets and the scrutiny it brings by the medical, and pharmnacy board along with law enforcement and th DEA, he may be turning your entire care over to the PM doc.

    If he doesn't use opiates, you may get your first experience with withdrawal. It's a crappy situation to be in and I dn't know what else you have tried aside from surgery and PT. If there is something you haven't tried and the doc offers, be willing to try anything.Why have to deal with the hassle that goes along with opates if acupuncture works for you, or any of a couple dozens methods aside from opiates work.

    It's the trial and error that gets old, but opates will always be out there and there will always be some doc willng to prescribe them if you look hard enough. Just look for pain relief, you never know what may work or not work. Some people swear by ultram, it doesn't do crap for me, but why go staright to oxycontin if Ultram works. Chiropractic may work great for you, there is just no way to predict what will fail or work to relieve your pain.

    I think it's pretty safe to say that you could go from one PM doc to the next consulting untill you find one that believes in opiates, but are you doing yourself a favor by not trying everything else first? Taking a pain pill if your in pain seems like the obvious answer, but if this is something you have to deal with the rest of your life, the more tools you have to manage your pain the better off you will be. The more you learn about what's available and the more things you try the more likely you are to find relief. I wouldn't say there is any thing that isn't worth trying, How can anyone say something won't relieve your pain.

    If you imagine everyone with chronic pain on a bell curve, The people on the far right may have some discmfort which is managed well with antidepressans and excercise. Move ot the top of the curve and likely you have tried many other methods to manage pain, like chiroractic, acupun****ure, PT, have a TENS unit, tried TINS, learned self hypnosis, bio feedback, guided imagry and yoga breathing techniques to manage excutiating pain. They may have tried enough things to say the benefit of opiates outweighs the negative aspect. If the meds restore function, reduce pain and allow you to return to work and don't impair, don't cause ED, Don't destroy relationshps, that's great.

    Move on down to the far right of the curve and everything I mentined and twice as much more has been tried, Long acting meds have been used at doses 10X what your taking. An scs may provide some relief, a morphine pump may provide some relief. But the goal of pain management is to improve function. Although there is no ceiling on the amount of pure piates they can use, meaning you will become acustomed to the respirtory suppression if you slowly raise the dose and allow you body to accomadate to that dose, 600 mgs of morphine to me isn't a lethal dose, to an opate naive person it would kill them or put them in la la land. You also become acustomed to the impairing effects. The only thing that realy limits a dose is the side effects. Most peple will develop tolerance over time but that can be controlled various ways too.

    I have a pump that delivers a healthy dose of dilaudid. If it dilivered more it would just impair and sedate me. Delivering meds to the spine where you have far more opiate receptors is the most efficient way to deliver meds, But even then, at best I get 50% relief because I still crunch and grind when I walk or stand.

    So everyone falls somehwere on the curve. Nobody knows what will relieve your pain, it's all trial and error. Even increasing your dose or changing your meds is just a guess, It may take several adjustments to find a dose that helps but doesn't leave you zonked. With a pump the goal is 50% relief. 50% relief to me means I don't need somebody to help me stand when I shower, It means I can walk for 20-30 minutes and can sleep for 2-3 hours straight before I move and everything crunches and wakes me up.

    This is what I have to be satisfied with after trying every other method you can name to manage pain. Dozens of PM docs, 4 different PM clinics that lasted 3-4 weeks. Round after round of PT,and the best they can do for me, even with high doses of opiates in a pump is allow me to walk, and contribute around the house. It takes all day to knock out what my wife can in a couple hours, but at least I can do it.

    Nobody can really say, what it's going to take to ease your pain and how functinal you will be. You may be able to go back to work and be in moderate pain, you may be able to simply stand for a half hour before your legs start shaking. If you don't try something, you are the one that misses the opportunity to find something that brings relief without the heavy price that stronger longer acting meds carry.
    Some of the prices we pay are:
    1, They are outragusly expensive, if you lose insurance you won't have many choices
    2, your become physically dependent
    3. you get treated like an adddict by docs and pharmacists that still think opiates should only be used by cancer patients and post op, and many still do.
    4, you have lots of pleaseant side effects to get used to or learn to deal with. Yes stronger pain meds will bring more relief, but how much before they become impairing or you can't pee or is too constipating. You may have to change shirts 3 times a day from sweat.
    5. Every time you drive with opiates in your sytem you take the chance of landing in jail for DUI or DWI, whatever your state calls it.

    There is a huge price to pay, there are limits on how much pain the meds can reduce, Docs don't shoot for 100% pan relief, they are just trying to improve the quality of your life. 50% is a pretty reasonable goal and what they shoot for with pumps and spinal cord stims, but how much function that brings is completely individual.

    Being pan free but nodding out in the lazy boy isn't their goal and is no way to live, even when your on the far right of the curve.

    Managing pain is all trial and error, whether it's with a medication or a technique or procedure. Long acting pain meds are X,Y and Z in the order in wich a responsable doc is going to do the trial and error,. Obviously not every doc knows A-Z or believes in everything in between. So you may end up changing docs several times if the docs methods don't help "YOUR" pain. Hopefully the new doc has something different to offer as far as technique, knowledge, his opinion about meds or even having the touch to put a technique to good use.

    I wouldn't be surprised if they try a long acting med since your already on percs, but you may meet a PM doc that flat out doesn't use opiates and wants you back in PT, wants to do trigger point injections and try acupuncture. Then learn a relaxation technique.

    You have to take what works and move on if a doc can't provide you with a level of relief you can live with.Under what conditions are you being sent to PM. Does the refering doc expect him to take over your entire care from that point on. Often when surgeons and GP'sget tired of prescribing meds they aren't comfortable with or the lenght of time they simply pass the buck to PM docs.

    OH well, way more info that you probably wanted. But nobody can tell you how much relief you will get, and from what or what is or isn't worth trying. Everyone is different and responds differently to medicatioin and modalities.

    Good luck, Dave

     
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