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Not sure what path to take with chronic back pain . . . advice is appreciated!

AnonymousUserAAnonymousUser Posts: 49,900
edited 06/11/2012 - 8:24 AM in Lower Back Pain
Hi,
I was diagnosed with a herniated L5-S1 disk 20 years ago. The odds of recuperation through surgery was 50/50 so I opted to live with the pain. When I hit 50, I noticed either tremendous lower back pain accompanied by pain in my left buttock down the left side of my leg. Two MRI's later, I went to visit a neurosurgeon and same story. I am now 56 and decided to start the conservative route starting with 3 epidural steroid injections. #1 was almost a miracle, #2 put me in pain worse than before the injections and #3 put me at a pain level between #2 and no shots. On the "pain scale", I was at an "8". I went 4 months and the pain returned to its original state so the surgeon recommended a micro-discectomy. I was very hesitant but read many articles about those who experienced less pain. 3 months ago I opted for the disk surgery which went well but the post-op recovery was unbelievably painful for a week. Slowly I began the physical therapy route and for a few weeks, I would say my pain level was at about a "6". To make matters worse, my career dictates I sit for long periods of time and on top of that, I travel via air several times a month. The dilemma I am now in is my pain is back up to about an "8". The surgeon prescribed hyrdocodone 7.5/325 which if I take as prescribed (1-2 every 4-6 hours) , it appears to bring the pain threshold down to around a "3-4". I am able to function normally on the prescribed amount but have heard all the "additive" horror stories surrounding the pain killer. I meet with my surgeon again this week for follow-up #3 and the last time when I spoke of the pain; he mentioned the possibility of a fusion type of procedure. I work with quite a few people who went through similar surgery - one now has some sort of patch she wears for pain management after 8 years, another had fusion which led to a 2nd and 3rd fusion including an artificial disk which later cracked and required a rod and screws to stabilize the disks above and below. I have yet to find someone who has had fusion and hear them say they were pain free. I’m not a pill freak at all but I’m at the point I would rather take a lower dosage of hydrocodone (5/325) on a fairly frequent basis. I plan on retiring in 10 years and can't afford this pain to worsen to the point where the lack of mobility affects my job security. Now is not a time to even consider surgery because the unemployment rate and current state of economy is working against me. My question is, how do surgeons feel about pain medications when there are few options available? I've been told by the folks I mentioned above that they been aware of how bad the pain became post-fusion, they would have stuck to some sort of pain medication. Let's face it, life is too short and I don't want to spend my "golden" years in constant pain.
I do not abuse or take more pain medication than prescribed and I do not drink alcohol or smoke. Has anyone out there with a similar pain threshold been able to reach a happy medium with your doctor(s) where they accepted your decision to choose pain medication over the unknowns of a disk fusion? I looked through this forum for similarities but run into the "you don't want to take pain meds all your life - you'll become addicted" and I attribute those comments to those who "might" have abused their prescribed dosages. I am quite disciplined and now that I have been taking hydrocodone for 4-5 months, there is and never was a "high" I felt other than feeling great not to have pain all the time. Any suggestions on how to approach my surgeon do they all push for surgical procedures? I realize they will make pretty decent $$$ if I elect surgery but I come from the old school of; "it's my body and I know how I feel". Right now, all I want is to keep my pain level around a 4 or 5. These 8-9's of pain without pain meds makes sitting and walking unbearable. By the way - I stopped pain meds for around 2 weeks to measure the pain level and I was pretty close to being back to square one. Any suggestions? As an FYI, the surgeon also prescribed Valium for muscle spasms post op for 2 weeks and Valium just about knocked me out and I lost time from work. Maybe I am one of those few individuals that all hyrocodone does for me is what it's supposed to. Dull or stop the pain.
Thanks for any advice - I am at a loss and very frustrated about the thought of questionable fusion surgery which could lead to stronger pain meds that could affect my on the job abilities.

Infochondriac
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Comments

  • You may want to find a good pain management doc. They are much better at treating pain than a surgeon would be. I would not be in the least bit concerned about the addiction possibilty. Chronic pain patients may become physically dependent on their meds in order to relieve the pain but that is totally different than someone that is an addict and takes the meds for the high. There are lots of folks here, including myself that depend on opiates for pain relief. I find that they are extremely long lasting, do not cause damage to your organs and are much safer for long term use than the shorter acting meds that contain acetaminophen or the like. I do not get any "high" what so ever from my pain meds and function quite normally. I do get very good pain relief. A pain management doc is much more familiar with the meds and I think that would be a much better choice for long term medicated pain relief. Good luck to you and please keep us posted.
    BTW- You are not one of the few that only experience pain relief from the meds but rather one of the multitudes. When you see us speak of not liking to be on pain meds forever it is probably because of some of the side effects that we may experience.
  • It's been since February and I've been off work due to leg weakness and pain and no longer able to do my job. I'm on pain meds and I feel no high at all because I'm taking slow release narcotics. I think it would be okay for you to continue with meds but it could get worse and if you have any numbness or tingling nerve damage could happen. Try to build up your core muscles and get 3 surgeons opinions because scar tissue could be worse. I hope the pain goes away without surgery for you. I'm still hoping I will heal also without surgery. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Hi charry,
    It is never easy dealing with pain and no perceived solution, I as you had to cease my current job and for me surgery was an option although unsuccessful, you could view your situation in that is does not warrant surgery and that does nothing to relieve the pain you are in and dealing with a feasible outcome.

    Surgery for most is successful and do not be put off, if the best option for you at this time is PM then you will have to embrace that until your condition worsens and makes PM ineffectual and the tenure of your overall capacity diminishes and the possibility of future surgical intervention become an additional option at that time.

    It is logical to surmise that your pain is being caused by something and to that extent OT or the continuance of PM infer the development of stoicism, rather than any reduction of the pain itself just of your concept and behaviour in how you react and deal with it.

    PM is not the panacea of a remedy and only intended for you to manage your condition more effectively, the alternative is not to embrace this and develop additional traits as a consequence, that will then need addressing when they have developed in your manner or psyche.

    We all have that momentary loss of direction and overwhelmed by the information we are receiving and do not know what to do for the best, irrespective of the viable options or lack of them. We have all been where you are and most of this is up to you now, for the moment seeing that an invasive option is not correct for you at the moment. You need to develop what works for you, as an individual and this will take time and patience and much painful effort, once that initial transition is overcome, maintaining, monitoring and evaluation will become the watchword of your future.

    Good luck to you.

    Keep posting.

    John


  • Oh the joy of hearing your experiences! Advice and suggestions are plentiful but when one connects with someone unknown who understands pain, it is true wonderment!

    I met again with my surgeon who pulled a 180 degree turn on me. He still is keeping fusion in the picture for mid-2009 but this time said; "you originally came to me because of lower back pain and shooting pain/numbness in your left leg. You now say the pain/numbness in your left leg is gone and that is what I treated you for - I am now suspecting beyond the obvious disk damage observed on your MRI, I am suspecting you may have problems with your hip . . ." I said, my hip??? The pain radiates from the center of my lower back to the left about 8 inches. He replied; "that's not your back if the pain radiates outside of your spinal area - we're looking at an issue with your hip and/or pelvis and I am recommending I refer you to a pain medication doctor to get cortisone shots in your hip area".

    Time for that 2nd, 3rd, and 4th opinion if it takes that much. The odd fact is my neurosurgeon is one of those considered by his peers and patients as the best top 5 in Texas and has performed neuro-surgery on Lance Armstrong. The memorabilia in his office is overwhelming and includes a huge framed personally signed picture of he and Lance, Lance's bicycle seat (signed) and his racing jacket (also signed). Hmmm . . . I am not an athlete by any means. I am an information technology manager for Dr Pepper Snapple group who simply wants to get through the rest of his life without this agonizing pain. I would love nothing more to be able to sit in a chair for more than 30 minutes without pain that increases like a storm developing momentum.

    I thank the media and addicts for the bad advertising pain meds get and it is a shame and borderline inhuman that those of us with that "8-9" level of pain are often looked at with doubt. I am going to get my additional opinions from orthopedic surgeons. Right before the surgeon ended our visit, he ended with; "Sir - in my business I see the extremes - those without pain and nothing but numbness, and those with extreme pain and agony. You are the patient - we do not have a "painometer" and you are correct - only you know your body better than anyone".

    He prescribed Celebrex, Flexiril, and Lyrica and indicated he would continue with hyrdocodone until we visit again next spring to assess disk fusion. And by the way, he also told me it may take up to 4 weeks to feel "some" added relief from the newly prescribed meds.

    I am adding a pain management doctor to my list of people to get opinions from. I am fine with the dose of hydrocodone (7.5/325) I take several times a day. I don't want to kill my other organs with additional meds.

    Thanks again for listening and most importantly, providing cautious but significant direction and options. I will stay in touch!

    John in Texas and pain . . .
  • Sounds like things are looking up for you. Please do keep us posted.
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