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Pain Specialist has run out of options for me. What now?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:34 AM in Pain Management
Hi Everyone,

I hope I'm posting this in the correct forum. :)

A brief history:
I had a laminectomy (L4,L5 & S1) in December 2008. Initially my pain subsided for a few weeks only to return with a vengenance. After I completed post-surgery PT without any improvement my neurosurgeon referred me back to the Pain Clinic. Overall, I have been seeing this Pain Management Specialist for almost a year (I had seen him prior to my surgery). Since March I have done PT, an EMG, cortisone inj, and an epidural inj. At my epidural follow-up the Pain Specialist said he doesn't feel there are any other options for me. He will not discuss a SCS with me as he feels that if the injections didn't help neither would a SCS. However, he will prescribe me as many narcotic painkillers as I can stuff in my purse. #o Since day one he has been pushing me to take high level painkillers. I've explained to him that I am not comfortable taking those type of pills. Has anyone else had this problem or am I the exception?? I am in the process of trying to get a referral to a different pain clinic in my area. Hopefully that comes through soon.

I still have daily moderate to severe back/leg pain. My pain is worse at night - it feels like my back is breaking! My right leg is numb below the knee. Occasionally I'll have sharp twinges of pain in my leg but more often than not I feel nothing. I feel like a prisoner in my own home. I can't go anywhere more than a few miles because I can't tolerate the drive. I can't go shopping because the walking is too much. I didn't think my pain would disappear 100% when I had surgery but I didn't expect to be in just as much if not worse pain afterwards.

My questions are:
What is the next step after pt, surgery, more pt, emg, and injections?
Is inquiring about a SCS the appropriate next step?
At what point do you just accept you are going to be in pain everyday?

Thank you everyone for taking the time to read my post & offer advice.



  • Your current pain management doc isn't trying to steer you wrong about the SCS. In most cases, it does nothing for back pain and the primary target for an SCS is radicular pain. Since your problem as you describe is primarily back pain with numbness in the leg instead of radicular pain, chances of an SCS helping you with anything is slim to none.

    There's nothing wrong with seeing if you can get a referral to another doc. Just keep in mind, that although it may seem that the grass is greener on the other side, it might not be once you are there. If you have a doc who is willing to medicate you well to keep your pain managed, that's awesome. Have you considered instead of trying another pain management doc, trying to get a new evaluation from a different neurosurgeon or ortho spine specialist?

    Hope this helps.

  • In my personal opinion, you need to see a different ortho spine surgeon or neurosurgeon for another opinion from a new doc. When was your most recent MRI? Maybe I missed that in your post, but if you have nerve issues, I would think an MRI would be appropriate to see what's going on.

    A SCS is a last resort for patients who are NOT surgical candidates. It seems a little premature to be thinking of that. I've noticed a lot of PM docs push them on patients(personal experiences) but you have to make sure nothing else can be done first. There very well be something else that can be done surgically, then again, maybe not. I worry about your leg issues more than your back pain(it may hurt more, but I'm thinking of permanent damage if you wait too long.)

    Please consider an outside surgical opinion with a recent MRI done shortly before the appointment. I don't think there's anything wrong in taking pain pills if you hurt, but I understand what you're saying. I really feel like you need another surgical opinion before you are just written off to a life of a purse full of drugs and an SCS.

    Please post an update so we know how you are doing!
  • dilaurodilauro ConnecticutPosts: 9,859
    there are always options. Sometimes you have to have the right doctor(s) that will work with you to explore them.
    Many people may NOT benefit for additional surgery and options such as the Pain Pump or SCS might not even address the situation.
    There are so many conservative treatments beyond the ones that you have already done.
    Acupuncture, Massage Therapy, Ultrasound, Passive Traction are just some options.
    Then there are those that may be considered Alternate Style treatments, such as work done by hands on Osteopathic doctor, Cranial Massages, Aroma and Music therapy which basically falls under Relaxation therapy.
    So please never give in thinking that you do not have options. But it is up to your doctor to recommend them to you. A fair question to your current doctor would be: None of the treatments you have given me to date are working for me, What OTHER options are available?
    If they offer none, then I would definitely seek other doctors.
    Pain medications, narcotics have a bad rep. But many times they are the only way to manage and control a person's pain. As long as there is valid pain, narcotic pain medications should always be considered.
    Search yourself, research, dig into articles, etc to find other options and make sure you get a fair and honest discussion with your doctor about other options.
    Good luck.....
    Many of us have been down your road and so many have found the correct path to take
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I was scratching my head over the reasoning your PM doctor has about ESI's and neurostimulators- if the ESI don't work, neither will the SCS? That's like comparing apples and oranges...it makes no sense to me, and it's coming from me experiencing this first hand.

    Everybody who replied has made excellent points. If something can be fixed by surgical means, if it were me I'd go for that option first. It could be the option that will help get you on your feet again, who knows?

    For now I'm not a surgical candidate but I am hoping to have a pain pump put in to help with my chronic back and nerve pain. My back pain ratio is a bit higher than the leg pain, and my surgeon told me that a pain pump would help me more than an SCS. I did go through a stim trial long ago but it didn't work out for me.

    I also take a lot of strong medications to deal with my pain. I feel fortunate because others do not have access to pain mgt or doctors who are willing to prescribe narcotics on a long term basis. I have been offered a variety of treatment options at my clinic and not just meds. I go to a multidisciplinary practice that offers a great range of services.

    I do agree that SCS and pain pumps are last resort options when no more surgery can be done. Some say spinal fusions are too. It depends on who you talk to. Whatever you and your doctor chose to do, remember that it's never the end of the road. Take care
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