Discussions that mention morphine

Pain Management board

Hi CPT, Every doc has their own opinion. I had one PM doc tell me I was an addict simply for asking for pain meds. I wasn't an active addict because nobody had prescribed anything other than immediate post op, but my actions were those of a "dry addict???". I've had 3 surgeries fail and docs won't admit the surgery failed until something catastrophic occurs like snapping screws and rods and pulling them out of bone. So I would go 2 or 3 years before they could actually find evidence that the complaints I was making from about 3 months post op out were actually true. The last surgery was a revision of a failed fusion and broken hardware and of course it was deemed a success buy the surgeon, right up untill the first screw broke and since then it's been one piece of hardware after another either breaking or toggling out of the vertebrae, Now they can see all the donor bone that was placed for fusion has been completely absorbed and only 1 of 12 points they tried to fuse was an actual success. But it took 3 years to reach the point where they could tell the fusion was a complete failure once hardware began to snap. Hardware wouldn’t break and becomes a redundant stabilizer once you have a solid fusion. IF you don’t have a solid fusion then the hardware is doing all the work and it wasn’t designed for that..

Being labeled an addict or told it's all in your head or any of the stuff any doc has said is just their opinion. It may very well be that the disco-gram, where they inject the dye into the discs in September will show there is a definitive need for surgery. Unfortunately after living with pain this long, relieving pain isn't even the goal of surgery, correcting instability or reliving nerve impairment like loss of reflexes, muscles atrophy, foot drop, loss of sensation or correcting any actual measurable defect is what they base their decision to call a surgery a success on. Say they replace the disc with an artificial disc. If the disc is stable and in place under flexion and extension, the surgery is called a success, despite what you report about pain. Same goes for fusions, as long as the hardware they use holds things in place and prevent movement under flexion and extension, the fusions are called a success. There is no diagnostic they can do to tell if implanted bone is alive and thriving or dead and just waiting to be reabsorbed by the body. As long as the hardware is holding you in place, the fusion is a success by medical standards.

All the things you tried that failed prior to surgery may need to be tried again one they correct the problem. Regardless of how much exercise or PT or procedures you have, it's not going to seal up a shredded or ruptured disc that is leaking fragments into the spinal canal. If you do have surgery and it doesn’t relieve your pain, you pretty much start over with all those modalities with the hopes that now that the mechanical defect has been corrected, the other methods used will now be more effective. That just makes common sense. So like I said, what didn't work before, may work at a later time . Either after the problem is corrected or when used in conjunction with other modalities. If opiates happen to be one of the modalities that's fine, you just don't want to have only one method to manage your pain.

I know Canada is different and things take a bit longer to get things done, but your still young, first time surgery has much greater odds of success than your 2nd or 3rd, You don't have scar tissue problems, you were an athlete so you know how to train and push yourself. The PT your doing now isn't a waste of time. The better shape you’re in going into surgery, the quicker you will recover after surgery. For some, surgery will be the answer you wonder why they didn't just take care of in the first place, but we base our decisions on information given by the doc based on his POV.

As far as surgery being the last step, that's a matter of opinion too, I would think determining at the age of 22 that you have to live the rest of your life dependent on opiates is your last resort, not surgery,. If surgery fails and all the other methods you tried before and try again fail, than it gets al little easier to justify the need for these meds and can jstify the consequenes of using opiates for the next 50 or so years.. The problem with being dependant on LA opiates prior to surgery is that's going to be the surgeons first agenda, to get you off opiates. The more your taking now, the farther you get from a surgeons comfort zone as far as treating post op pain.

UP untill 96 or even later, The standard post of med once you come home was 5 mg percocet “oxycodone”. 1 or 2 every 4-6 hours. Wether you had a hip replaced or a 6 level fusion or a tooth extraction. There wasn’t anything stronger they would send you home with. If you go into surgery taking 10 times the dose of opiates that a surgeon would ever prescribe for the most invasive and complex surgeries, he’s going to have a hard time managing post op pain and basically tell you that’s it’s your fault your so tolerant and depndent on opiates when you have to tell him what works for 90% of all his other patients doesn’t come close to touching your pain..

Obviously you were talking about the LA version of morphine rather than the short acting version. 30mg is the strongest SA version but MSContin and many others come in strengths up to 200 mgs per dose. There are plenty of folks that can work a dose up beyond a couple hundred mgs a day before they have ever even consulted with a surgeon, which IMO is crazy. I would never let a GP or PM doc condemn me to a life of chronic pain without being certain
there wasn’t a way to correct the problem for good. Only a surgeon can make that call.

The idea of using opiates to manage pain is to make the pain tolerable and allow you to continue rehabbing the injured area, not relieve your pain entirely. When you shoot for complete relief, you may find it the first few days of an increase but after that it takes another increase to reach close to the same level of relief you got during the honey moon from doubling the previous dose.

I know many factors are ou of your control, but you also have to realize that some docs would give you nothing before the diagnostics were complete and the potential for a complete recovery was ruled out by a surgeon, other will manage up until they have a solid DX and know if the problem can be fixed. Why make you dependant and tolerant on opiates a couple months before surgery when SA meds will take the edge off and would be much easier to taper and more in line with the meds that would be used post op if your lucky enough to have a potential cure available.

. You may not be able to work, but if the problem is bad enough to require these meds and they allow you to function on a minimal level, you have to do you part and do what’s best for you. Doping up so you don’t have to change a thing in your life does more harm than good if surgery is an option. I understand you had t make major changes in your schooling and lifestyle, but if your only getting through class by using so many pain meds, what are you really retaining from the college experience. You will remember going, but as far as actually learning, that’s a different topic.

I do wish you the best and I also wish docs would explain the consequences of their method of practice. Obviously if you have a mechanical defect, untill it’s corected, all the anti seizure meds and anti depressants aren’t going to mask a ruptured disc heal. IT would be like breaking your leg and saying don’t cast or splint it, just give me enough pain meds to walk where I need to go and I’ll just take it easy. Some people are so afraid of surgery they will make ridiculous requests like that but it only leads to one place. Every day it will take more and more to manage the pain and your leg wouldn’t heal unless it was set and stabilized.

I do wish you luck and there have been several posts about discograms that you may find interesting if you use the forum search tool.

Good luck and take it easy, Dave