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When strong opoids should be introduced

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:37 AM in Pain Medications
of course when severe pain is present, but what about if the patient was an active 18 year old with 5 monts plus with severe L5 S1 pain/siatica withought a disk herniation? i am that patient. and i feel like my pain fits this cagtegory of medicaiton but i also see why i would be denied becuase of my age. can anyone tell me how i can either convince my doctor or an alternative option? please i need advice i dont no where to turn? is it time to go to pain management again?? thank you all


  • Has your doctor/specialist determined the cause of your pain?
  • Hi hon - just thought I'd chime in...

    Normally, doctors will not just jump in to the strong opiod medications... And each and everyone of us here who are currently on these opiods will say that at first we were tried on NSAIDS (anti inflammatory meds), then a mild pain reliever, coupled with PT, massage therapy, maybe an epidural injection, nerve block etc. I was undergoing treatment for a few years, and had surgery before I was given a prescription of Oxycodone. The doctors will not prescribe strong medication just because a patient says they hurt. There has to be documented evidence to show a reason why the patient is in that much pain.

    Hoops? You bet. Unnecessary? Some times. Did I comply with my doctor's suggestions, treatment plans and jump through all those hooops? You betcha sweet bippy I did. But, my ultimate goal was not the strong meds... I was hoping one of the suggestions would reduce my pain...

    What happened to cause your pain? I agree, you are young, but that's neither here nor there. Your doctor should be running tests (xrays, MRIs CT, lab work, etc) to get to the cause of your pain.

    Were you in an accident? Do you have a family history of arthritis, lupus, fibromyalgia? Do you play sports? What is the specialty of the doctor who is treating you? General practitioners (family doctors) don't like to give prescriptions for narcotic pain medication very often. That is usually reserved for Pain Management doctors. Maybe your doctor could refer you to one?

    SCSoccer - good luck, hon. I hope you can find a doctor and a satisfactory treatment plan. You are way too young to be in so much pain. Keep us posted?

  • As said above. I came to this realization when I went for minor surgery, and the Dr was tossing me T3's for it at 10-12 per day.

    I told him that I did not need them for the surgery, but they sure helped make the back pain let off a bit. At the time, I was realizing that I had the "flu" all of the time. And that had been going on for YEARS. That was the first basis of the chronic pain diagnosis.

    That began 5 - now 6 years of searching for an answer and rolling through a long list of NSAIDS and analagesics. Most were codiene based for a couple of years. I researched the issues with Tylenol and liver failure and gave that to my Dr and he switched me to the next level of World Health Organization - meds.

    From there I had 3 trips to the ER and they prescribed stronger IR meds. On the basis of that and some time studies and my own pain chart, we agreed on a Extended Release meds and Break Through meds.

    I also ran through a list of Trycyclic meds, as they affect pain as well, and can provide relief, and give you sleep when the pain intefers.

    It is not a short journey, at least it was not for me!

    Cheers - C45 -
  • i would get to your PM Dr and let him know the pain you're having. My Primary Dr. has handled my pain meds and had to return to her frequently to get a slow release med that helps me get through the day. Have you seen a Spine Specialist yet? 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
  • You asked: is it time to go to pain management again? Well, the answer has to come out of your doctors mouth, but it is definitely a question to ask them. With no bulging disks or anything that could be even remotely improved via surgery, pain management (i.e. phys therapy, home exercise, and or meds) is the only logical answer I can think of that may help you.

    Your age is less of a burden for you than is your actual situation. The fact that you have this severe pain present, with nothing on your MRI to back it up creates tough decisions for your docs. Is there anything at all that showed up on your MRI that you didn't post? I'm curious...

  • the mri was normal with a slight slight slightttt disc buldge at L5 which they deemed unimportant.. it was like 1.5-2 mm but i have no stenosis so i guess they have a point. but i mean they cant find the cause of the pain.. they just said it was chronic. its been 5 months with no releif.. and the epidural injection i have had for pain in fact was injected into my s1 nerve root made my leg useless.. and pain persisted.. its really not fair
  • What drugs have you tried already?
  • 2 norco 10/325 for pain every 4 hours.. it was a slighttttt relief and i stress slight. but apparently the spine specialists who perscribed it said that it was the strongest they could perscribe????? also i took diclofenec *sp* gabapentin soma methlypredisolone.. nothign major yet.. i had to go to the urgent care when i ran out and got a shot of nubain.. but right now i am drugless.. and its hell!
  • They said they didnt find anything on MRI. Have you had any other tests? Radiofrequency lesioning? Injections? How about discogram. That is the only thing that showed what was causing my back pain. I had tears in three discs. PM me if you wish.
  • It tok a discogram to diagnose my annular tears which are extremely painful. It sounds like you may need a new doc that is willing to get to the root of your problem.
    Also. it took me 4 years to get to the strongest meds. You don't want to start out strong if you can help it because you will build a tolerance and need to have meds increased.
  • I'm sorry you're having this pain so young. I can understand how frustrated you are with inconclusive tests and no real answers for your pain. Sometimes it takes a long time to reach a diagnosis and it will require additional testing like the ones mentioned above- discogram and possibly a ct/myelogram. But it all depends on your doctor.

    What type of doctor are you seeing at the spine center- Ortho or Neuro? I went to a spine cinic and was started on Norco, Soma, and Neurontin as well as PT and epidural injections. I ended up having surgery for the disc herniations I had. I suffered complications and was sent to pain mgt where my meds to bumped up to Fentanyl 25mcg patches, Norco for breakthrough pain, and Neurontin for sciatic pain. I had a 2 level fusion later on and I went up to 100 mcg every 2 days of the Fentanyl patches in a period of a year. I was changed over to Ms Contin 180mg's daily plus 60 mg a day of the short acting morphine, and now I take 80mg of Oxycontin a day and 60mg daily of Oxycodone. Yes, I went through 2 surgeries, more PT, more epidurals, more tests, etc and it was in a span of about 2 years. My problems have gotten worse during all of this and that is why I'm on so much medication (see sig line).

    Unfortunately it may take a long journey similar to mine in order to get a clear diagnosis and treatment. Mercifully my problems were seen right away from my first MRI and that is why my treatment moved on so quickly. I know it's not easy to be patient and go through hoops when you're in pain. You may even have to find another doctor if you're told there is nothing else to do for you. You have to keep going until someone finds an important clue as to why you are having so much pain. Meanwhile, don't give up..keep researching and keep looking for a doctor who will truly listen to you. Take care
  • i had to have mri's cat scan. nerve tests and disography on 2 disc before strong meds were given. i started out with methadone percocet, then disc was so bad i went on 20 mg of oxycontin then went to 40 mg of oxy with percocet ir breakthrough then 40 mg of oxy with fenatly suckers for breakthrough this with injections also. then when i got strong meds i had to sign a contract. problem was that my pain dr retired and had to get a new one. i asked my old one for reference so that made it easier. new one tired subtly to get me off my meds but i convinced him that i needed that med and dosage and now he never hastles me
    you just don't go in and mention you want strong narcotics
    major red flag and they will show you the door
    i saw a guy in wheel chair show up and say it has b een a couple of years bu the dr gave me a time release pill and i don't know name but i want to try it. needless to say they showed him the door. don't even bring up subject of narcotics. inho drs give out naisds because they don't wnat to give out narcotics
    remember take 2 aspirin and call me in the morning
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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