Discussions that mention morphine

Pain Management board

Hi Hope4U, I'm not up to covering 13 years of history, but I worked up until the last time they tried to revise my fusion.This was to replace broken hardware and redo a fusion that faioled to grow at L3-4-5. I woke up 12 hours later fused from L1-S1 and that failed to grow too. Since then screws have toggled out of holes, screw heads have sheared off, I've developed a significant slip at L5?S1 "spondyliotheisis" where the vertebrae shift out of alignment and could potentially topple off. I crunch and squeek when I walk and wpretty much did all the stuff you talked about, PM clinics, injections, coping skills, etc.

I had a pump implanted 2 years ago and the biggest change is the mental clearity from going from oral pain meds to intrathecal delivery.

As far as side effects, of course there are side effects, but they are usually dose dependant. If your not having side effects now it won't mean you won't have side effects as they increase the dose down the road. That's pretty much inevitable when the problem isn't stable. Meaning it's pretty much a given that your spine is going to continue to fall apart. What works now may not when the next disc goes. As far as never having surgery again you can never say never. There are less invasive ways to remove disc fragments than lengthening you old fusion. With rapid degeneration, I wouldn't expect to be getting the same relief a year from now without an increase in dosage.

Doses can be increased and meds can be changed but eventually you will reach a level of side effects you won't be able to tolerate or that leave you impaired. Side effects of IT meds are pretty much the same as side effects seen from high dose oral use with long acting meds. Constipation, Urinary retention "can't pee" hormonal changes like low testosterone, ED, sedation, restless leg syndrome, etc. etc. But that's when you reach whatever your threshold is and whatever you consider intolerable.

I really didn't catch that your pain had been aggressively managed with oral meds prior to the pump, meaning long acting meds like OxyContin, MSContin, Duragesic or methadone. If you went from basically minimal pain meds to a pump, I would think what your experiencing is somewhat of a honeymoon. 50% pain reduction is the goal of pumps but 50% means different things to different people. Just like rating pain, what's a 5 to me, may be an 8 to you and a 3 to someone else.

Personally I have had to reset my pain scale with each surgery , when the unimaginable becomes your reality, you need to come up with something new to call a 10. Which is supposed to be the worst pain you can imagine. Once you experience more pain than you can imagine you need to drop that down to a 9 and use 10 for something worse than what you know now. Trust me, things can get worse. 50% reduction in pain may mean someone can go back to work, or it may mean someone doesn't need help walking or standing in the shower. 50% relief means I'm not bed ridden and can take care of the house. It takes me 4 times longer to get anything done but it’s important I contribute something. If 50% relief means you can resume golfing or your fun activities, then the decision is purely financial.

Only you know if your able to work. I was mid level management not that it matters because I can't go 4 hours without soaking my clothes in sweat and having to lay down. I can't sit in a booth selling cigs for 8 hours or travel the eastern seaboard training people.

It cost us our house, fortunately we were able to sell and walk away with the remaining equity after paying off the second it took to make it through the 2 year process of social security determination. It cost us our credit, had to go BK, and we live a very different lifestyle in a very different neighborhood. Our daughter just turned 13 and there are times when she’s the glue that keeps us together. I wasn't happy with my new role as House B#%# and this wasn't the ride my wife had signed up for either.

It's tough on wives and relationships. Fortunately my wife is dealing with things but she was working when I was inured so it's not like my housewife suddenly had to get a job. I imagine if that's the case it would create even more tension. Not being able to work or losing your identity is little tougher to deal with then retiring early. I'm 40 and would love to work, I miss the interaction, the mental stimuli, I miss everything I can no longer do, But I'm supposed to be grateful I can still walk although that's limited.

Having little to talk about other than the housework you accomplished that day also leaves a bit to be desired. It's awkward and uncomfortable going to a Christmas party or family reunion when you can put on a happy face for an hour or two because nobody knows what my life is really like. They can't see 12 screws , 8 rods, failed fusions and a pump that allows me to fake it for a few hours. On a good day I get about 50% relief, I still use short acting oxycodone when the pump isn’t cutting it. If you set the pump to manage your worst pain, you would be over medicated the rest of the time. I also have my pump set to deliver a higher rate at night and the am.

I'm at the point where side effects are limiting increasing the dose. I could switch meds again and hope for less side effects and better relief, but given my prognosis, any great relief would be short lived.

I assume your talking about private LTD benefits offered by your company or purchased through a private plan. Those plan benefits usually decrease over time rather than stay the same, so in addition to the LTD you would likely apply for social security disability unless you were a fed, state or postal employee which have their own plans that are better than what's offered in the private sector or SSD.

SDD has a max benefit and someone making 300Kk doesn't get more than someone that made 50K.

If you do have to apply for SSD, you have to do it within a certain time frame or you won't have worked recently enough to have the work credits to be eligible . Credits are worked quarters. IN 99 you must have worked 5 out of the last 10 years, normally the 5 preceding your disability. If you have great benefits through a private plan, you should still apply for SSD before 5 years passes. Not that going out on LTD has any effect on your eligibility for SSD.

SSD is very different than private LTD. It doesn't matter if you were a top level exec making 300k a year, Disabled means unable to perform any type of job. If you can sit in a booth selling cigs at a gas station, you can work and wouldn't qualify for SSD.

There really is no average dose, as far as high doses, compared to who and what. Which med are you talking about. Morphine, Dilaudid, fentanyl or Sufentanyl. I'm at 6 mgs of dilaudid a day and increasing my dose would mean more side effects and impairment than I'm willing to live with and more than I want my wife and daughter to see.

It sounds like going out will end your marriage, That's a decision only you can make. If you're close enough to retirement, maybe losing your identity isn't as big an issue as it is at 40. If you could travel and enjoy yourself, it's a different set of circumstances. There is no dose that will get my life back. I think you will be surprised how fast you loose strength and endurance if you have to live a sedentary life to keep the pain manageable.

Anyway, I'm bouncing around now too thinking about my life. If I forgot something please ask or someone else may catch it for you. IMO IF your employer will allow you to come back to work and you are physically able too, I would fight to stay working untill things get worse. I don't know what 50% relief means to you. I was already disabled when I had the pump implanted and although I knew it was just a tool, I guess I hoped in the back of my mind it would make a big enough difference to return to work. The biggestl improvement is the clarity of mind from not using high doses of oral opiates.

Welcome and good luck, Dave