Discussions that mention morphine

Pain Management board


Hey BB, I saw your other post and the idea that the guy is just running a block shop really isn't accurate. Block shops or PM clinics that do nothing but blocks don't use opiates in conjunction with any procedure they can talk you into. The idea of a block shop is that you’re in so much pain and being offered nothing else that you will do anything for relief including blocks you may or may not need.

Here is an article and it also explains the risks
http://etherweb.bwh.harvard.edu/pmc/padmin/celiac.html
The risks are really no different than any other type of block near or around the spine. You have the aorta that runs down the spine to avoid, the potential for damaging the spinal cord, the potential for the denervation agent migrating into the spinal cord or epidural space.Infection from any type of injection can lead to death and piercing a nerve hurts like hell, but I haven’ met or seen or heard about anyone dieing from a nerve block in the last 15 years. Unfortunately I can’t say the same thing about people dying from opiate abuse. I know 3 personally and have read about several on the net where the patient only wanted their pain relieved but never tried anything other than opiates.

They were told or felt entitled to these meds because somene that new nothing about their history told them if they had pain for more than 6 months they should be on long acting opiates. That blanket statement is about as far left as opiate phobic docs that only use them on terminal patients are far to the right. So really, where is the greater risk. People dye from simple spinal taps on occasion and because there is the potential risk they must inform you of the risks.

It's not the anesthesia, because they don't use a general, you have to be awake enough to be able to report success or failure. They give you light sedation like versed if your lucky, use local numbing agents and other than that it's no different than any other nerve block or nerve ablation procedure or spinal injection. This type of procedure is done by anesthesiologist and surgeons, not your general physical medicine doc or neurologist turned PM. Anesthesiologist and surgeons are the needle guys and gals with the absolute most training. Women trust their lives and babies lives every day when having an epidural for child birth and an epidural carries the same risks that a nerve block does. Fortunately anesthesiologist do thousands of spinal injections throughout their career and should use fluoroscopy to guide the needle to reduce the risk of piercing your spinal cord or aorta.

There really is nothing that doesn't carry a risk, I found that article under minimally invasive techniques. Invasive is when they slice you open from L1 to your but crack and break out the power tools, a needle or injection is minimally invasive. You can dye from a tooth extraction or having your tonsils out so If you base your decisions to have or not to have a procedure that may bring relief based on potential risk, there aren’t any procedures that don't have some risk.

If there is the potential to isolate a diagnosis or bring relief through a 15 minute procedure it's certainly better than spending the next 10 years dependent on opiates with your tolerance growing and the meds becoming less and less effective. Nerve pain doesn't respond to opiates the way somatic pain does, It takes a multi faceted approach and if you start dictating terms of treatment you will never find relief.

Medication really isn't all it's cracked up to be and anyone that has lived with intractable pain would jump at a chance to try something to relieve it. This is the philosophy the doc is going to have if your describing pain so great it requires more pain meds than most post op patients will use during their entire recovery.

A doc that does nothing other than write scripts is the kind of doc that gets busted and goes to jail. There is a lot more to PM than opiates. I've had dozens of spinal injections, nerve blocks, diagnostic tests that require dye to be injected into the epidural space and I've yet to have a reaction other than loss of spinal fluid that can be corrected with a blood patch.

10 years ago all the meds you read about on this forum were not even available and morphine was only used long term to treat malignant pain. It was the last option after everything else had been tried and failed.. Using opiates has more consequences than all the non opiate methods combined. I've yet to see someone’s spouse leave because there other half had a nerve block. I have seen dozens of relationships end over the use of opiates though. I've seen friends and family cut the CP patient out of their life do to opiates, I've seen folks loose their jobs, security clearances, driver license, homes and none of these things are risks of non opiate methods of managing pain. I hope those risks were explained..


As far as risks from a block, I would bet more people have died or paid a much greater price from their pursuit of pain meds and the negative consequences that go along with opiate use, than have ever come close to dying from a nerve block.. You may hurt a little more the next day from a block, but to deny participating in anything that has a risk and to not see the risks involved with opiate use isn’t rational. It’s OK to be scared, but to deny yourself an opportunity to get better without having to be dependent on opiates isn’t a rational choice.
Take care, Dave