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  • What is pain management?

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    Old 01-04-2007, 09:17 PM   #1
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    sara313 HB User
    Question What is pain management?

    Basically, I'm not clear on what the full treatment plan of pm is. Is it mainly drug therapy?

    Here is my story as I'm new to this forum. I'm a 33 year old SAHM and wife with a 18 month old daughter. During the summer of 2002, I suffered a fall on my lower back which resulted with chronic Spondylolisthesis. I had months of PT with little or no relief and had my first epi injection in the spring of 2003. It was a miracle for me. It worked the first time and I was great until the birth of my daughter in June 2005. Labor was difficult and completely ruined my already bad back to the point that in addition to the Spondy and disc degeneration, I now have a tear in my spine. I decided to see a Chiropractor this time. This was a big waste of time and money. After about 7 months I went back to see my original ortho and scheduled another injection in Nov 2005. Relief lasted one month. I have to pay out of pocket for the shots so I waited for another one until May 2006. The relief lasted until Sept. I then had another shot in Oct 2006. NO RELIEF at all....except in my knees and ankle which are also very painful. I went back to my spine specialist last week and he thought I shouldn't be having so much pain and scheduled another MRI to see if he missed something. MRI showed no change in my condition and he recommended continuing as we have been. Keep in success rate with injections has been 50/50 at best. I explained that I couldn't continue this way as I'm paying out of pocket for all of these shots and I'm basically throwing money down the drain because I'm not getting much relief. Plus, I'm taking Darvocet and Lortab in fairly high doses to ease the pain because they work and they are cheap, but I'm going down a dangerous road. What I didn't tell him was that I'm also getting meds from my PCP since I'm needing more for relief. He symathized with me and agreed to schedule me to meet with the surgeon. In the meantime I'm also trying to meet up with a Neurosurgeon to get another opinion.
    Phew...have you made it this far? SO....if nothing pans out with these surgeons I'm thinking of seeing a pm clinic. My doctors won't give me anything stronger than Lortab and/or Darvocet and they only work in higher doses and for only a few hours at a time. I can't afford more injections so I'm thinking I need to get on a drug regime that would be more helpful. But, what else can I expect?

    I'm in a miserable place because of this pain. I think the people around me are so sick of hearing "my back hurts"! I know I'm sick of saying it!

    Thanks for any insight or information you can provide. I've already learned a lot from you all as I've been lurking for a day or two.

    P.S. What does the abbreviation b/t mean?

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    Old 01-05-2007, 12:54 AM   #2
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    Re: What is pain management?

    Hi Sara, Pain management means anything that helps someone learn to live with and reduce their chronic pain. You can spend years trying non opiate methods of pain management like Bio feedback, self hypnosis, guided imagery, electric stim, acupuncture, chiropractic, trigger point injections and release, myofacial release and massage, nerve blocks, epidurals, nerve ablation , use of numbing agents or Botox. Antidepressants and antiseizure meds have a role in PM for some.

    I came from a different generation of pain management though. No doc would prescribe opiates, not even PM docs unless you had exhausted all other avenues, Now some docs will write you a script for the most potent meds available on your first apt. Is that a good thing? I don't know. At some point you have to look back and say did I try everything I could before I traded pain relief for dependency on opiates and the doc to keep prescribing.

    If you haven't tried anything other than the max number of epidural steroids a doc will give in a year, there are dozens of modalities and treatment methods many docs use alone or in combination with opiates. Even now, not all PM docs use opiates , some people do benefit from counseling and learning relaxation techniques or antidepressants and antiseizure meds provide enough relief. Some people swear by acupuncture or chiropractic.

    I pretty much had to try them all before long acting opiates were even invented or used for anything other than cancer pain. I was offered pain meds after I was bed ridden from 3 failed back surgeries and 7 years of pain management without pain meds.. However my medical record is 2 charts about 3 inches thick of every other method of pain management I have tried. My doc doesn't have to worry about being audited and the DEA asking did I try anything else before I was handed a script for morphine or oxyContin. It took 7 years, 3 PM clinics and a dozen PM docs to actually try everything I mentioned and the other couple dozen methods I tried.

    Pain management isn't about strictly relieving pain though. Any doc can prescribe opiates. If your pain is severe enough to require these meds then a good doc is going to look at the big picture, What's your mental health status, are you depressed, what other coping skills do you have aside from reaching for a bottle of pain meds?

    Having nothing but scripts written for pain would be like someone with a major mental illness receiving only medication and never speaking to a shrink or counselor. Meds alone are no more effective at treating depression than counseling alone. However when you combine the two, the results are more than twice as effective, the same stats apply for chronic pain.. The more tools you have to deal with pain and the more coping skills you have the better off you will be. If you chase total relief with medication, it's no different than an addict hoping to get the same high as their first hit after 5 years of abuse. Along with physical dependence on opiates you also develop tolerance. To sustain complete relief you would have to increase the dose of meds on a pretty regular basis.

    Even with implanted morphine pumps, which I have, the best they shoot for is 50% pain relief, and that's about the best I can get without the meds causing too many side effects and leaving me impaired.

    BT means break through, short acting meds to be used when a base dose of long acting medication just isn't working. BT meds are used for break through pain. Someone with a patch on may have pain from activity or have greater pain at night. Rather than increasing the long acting dose of meds or the strength of the patch to manage your very worst pain, short acting meds are used sparingly to treat those episodes of BT pain to bring an increased level of pain back down to a tolerable level a long acting med or other treatment may provide.

    The goal of pain management is to improve function and quality of life. If narcotic pain meds impair someone more than they restore function, it becomes hard to justify continued use of those meds. You don't have to remove someones pain completely to improve their ability to function or improve their quality of life.

    Some PM docs use opiates as a last resort when all other methods fail. Some don't use them at all, Some PM docs are rather loose and reckless with opiates and there are PM docs everywhere in between. Some use BT meds and some only use long acting meds and want you to use a non opiate method for BT pain. If a relaxation technique, stretching, Ice, heat, acupuncture or Yoga or whatever can reduce your pain, why increase your level of tolerance and dependence on opiates.

    Dependence just means you will experience withdrawal if you stop using a med abruptly, It will occur with anyone using long acting or short acting pain meds around the clock for a continued period of time. It doesn't mean addiction and all the negative aspects associated with addiction. It's simply a physiological response and a price you pay if the only thing that allows you to function is opiate pain medication.

    Good luck and welcome, Dave

    Old 01-05-2007, 02:55 PM   #3
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    Re: What is pain management?

    What is pain management?

    When doctors can't fix you.

    Old 01-05-2007, 08:14 PM   #4
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    sara313 HB User
    Re: What is pain management?

    Originally Posted by thylantyr
    What is pain management?

    When doctors can't fix you.
    LOL....that just a sad fact isn't it?

    Thank you Dave for all the wonderful information. I'm going to continue to lurk and read up on everyones experiences. I'll post again after I meet with the surgeons.

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