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pain managment- reasonable goals?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:31 AM in Lower Back Pain
I am new to the world of chronic pain, but am actively pursuing all options open to me and experiencing very little pain augmentation despite my good intentions. I find that my primary care doctor doesn't have much time for me, even though I see her at least every two weeks. She likes to refer me to other people rather than discussing my condition with me, which means I have lots of bills but very little in the way of coherent, cohesive information. I have two disc herniations at L4 and L5, plus 'tears' that I haven't gotten any clear info on. I have tried everything suggested to me and everything I have read about online that I can get my hands on, including (suffice it to say that I have done all things short of surgery if you don't want to read the list): Heat, cold, acupuncture, chiropractic medicine, TENS, bed rest, walking, physical therapy, a steroid epidural, Tylenol, Ibuprofen (both in high doses), naproxen, asprin, Donnes, Icy-Hot, Arnicare gel, dietary changes, weight loss, soma, flexeril, amytriptyline, Prozac, Torridol, Tylenol with Codeine, Tramadol, Vicodin, Norco, and Dilauded. Narcotic pain meds are sadly the only thing that gives me consistent, reliable results. My doctor has told me that, after 1 month taking Norco at 10mgs every 4-6 hours that my main goal should not be pain relief or a return to my daily life, but getting off the Norco. I have no history of drug addiction or dependency, nor has she asked me about any of my past medical history in this sense. I am constantly bedridden with discogenic, non neuropathic pain which has completely halted all my daily functions. I cannot hold a job and am having a terrible time getting to my classes (I am a 25 year old grad student). My surgeon told me surgery is not an option unless I am in this pain for at least a year because he has never performed multiple fusions on someone so young and is hesitant to do so. The docs who administered my epidural said that there is little in the way of solid evidence for the treatment of discogenic pain. My tears and herniations are not putting pressure on my nerves, which rules out a lot of treatments and makes a lot of my options dependent on idiosyncratic results. I don't want to go against my PCP's wishes, but none of the specialists I have talked to seem concerned about my narcotic use, considering its the only thing that has worked so far to get me out of bed consistently and put me back on my feet, literally. I have had many doctors ask me if I have tried a higher dose of the Norco to help with my symptoms, which suggests to me that my doc is being a bit negligent. My question, which I apologize for taking so long to get to, is what my expectations should be in treatment? What are other people's experiences with dealing with docs and their approaches to pain management? When I take the Norco I am able to walk, do light cleaning, etc, but still can't sit for longer than about half an hour without stabbing back pain. This is a pain level I am willing to live with until I can get work (which I desperately need, living as I do right now purely on grad school loans), which I have communicated to my PCP. But is it ethical to ask a patient to be bedridden when they could be active, especially with a condition that requires exercise as a means to getting better? I will be seen in a pain management clinic in a month, and am also wondering what to expect there. I assume they tend to be more helpful than PCP's, but can they refer me for non surgical, non drug treatments? Anyone have good results with something I have not tried? I am very confused and would appreciate any help that can be offered me. Thank you so much for your time and consideration.


  • I should also include that I have had three pain flares over a three year period. One flare three years ago and two flares in the past six months, with about three weeks between them.
  • regarding pain control.its sad that you doctor seems not to have time for you ,,but i know some doctors are like that {my doctor is not thank god} many doctors want a quick fix ..they want you out of the door with a prescription and dont want to see you again ..back ache is a doctors nightmare because there is a good chance that you will need to be coming back to see him time and time again ..there is only so many things that he or she can offer you ..like you have mentioned you have been there and got the tee shirt !.like yourself my pain is managed with narcotics .{but i use my TENS too}.i have also found that gentle regular swimming helps .as for pain clinics i have found them to be a waste of time .i think that the people that work in these places think that we are all drug seeking slobs!.that's the way i amd many more have been treated in these establishments.i do have a nice pain consultant but even she has come to the end of the treatment line .i have had epidurals /facet joint injections various pills etc.and two lots of surgery ..i have just refused a fusion as i dont want any more surgery .a reasonable goal for pain control would be to be able to sleep and get through the day without being in too much pain .i can now manage 4 hours sleep in my bed and i have a window of about 3 hours during the day in which to go for a swim or shop but then i need to return to my recliner to rest .{before the back problems i was super fit i looked after my poorly grandparents worked /shopped swam and walked my dog 3/6 miles a day ..so i have had to adjust my life somewhat since the operation.it has taken me 18 months to be able to start to enjoy life a bit .and for me that's a result .some people want more ..and i think that they are setting themselves up for a fall ..IE they want to run before they can walk ..you will never be as well as you were before you had any back problems.even if your operation went well and you are in no pain .you have to make sure you have enough pain killers to get you from one month to another and just do what you can when you can .and dont over do anything that would be my advice on pain control..{i have been in pain for 15 years }
  • Would you mind saying if you are in the U.S. or the UK? I am in the U.S. and have a lack of understanding of how the NHS works.

    Are you able to make appointments with any specialist or must you be referred by your PCP? Have you had a MRI or how were your disk problems diagnosed?

    Have you explored options through your university health services where you are a grad student?

    I am not personally familiar with discogenic pain as all my pain has been referred nerve pain, but I have often read that surgery is not a cure-all for discogenic pain.

    It sounds like you need to figure out a way to bypass your PCP as she does not sound like your advocate. I would think a physiatrist (an MD whose specialization is in physical medicine and rehabilitation) or a interventional pain management doc who did a fellowship in the spine might be your best bet to figure out what can be done to help you.
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