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My PM and my Ortho differ on SCS...

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:37 AM in Pain Management
If anyone could possibly shed some light for me my surgeon who just performed my 3rd lower back surgery in April thinks that even though my back pain is unbearable and my nerve pain is still just as bad as before surgery because of my age(32) I should still wait before considering a SCS because he feels in 3-5 years alot of my pain might not be present and for me just to rely on meds until we can wait and see.However, my PM thinks im a perfect candidate for a SCS system and should give it a try...Im not sure what to do considering I haven't worked for over 6 months and since 2005 Ive averaged a back surgery every 18 months 2 of which were Fusions to my L4L5 and L5S1


  • I would have to agree with both of them then. Think about it, if an SCS can help you now and help reduce the amount of scripts you have to take and reduce your pain , sounds like a good move when the appropriate time comes. You're just 5 months out from your last surgery, which in spinal surgery recovery isn't a long time. If the ortho is right, in 3-5 years you can stop using the SCS and have it removed. I would still give it a little more time before I traveled down the SCS path.

    Just my two cents.

  • Both my surgeons were recommending SCS for me and were pressuring me to try it. They kept saying that having the trial was a great way to find out if it would help. If it does not, then you know that, and move on. You're not really out that much for trying.

    I agree with Dave though in that five months is still very early in the game. I probably wouldn't try it until a year has passed.
  • I would wait a little longer also. Five months isn't very far out. But if the pain is still there when you are getting closer to a year then I would go ahead and do the trial. I am doing it right now.

    My neurosurgeon actually sent me back to my PM Dr. since he couldn't do anything else for me. My PM Dr. argued to me that me still being in my 30's is a reason for me to try the SCS and that if I kept on the pain meds it would eventually wear out my organs. The good thing about the permanent SCS is that it is removable as opposed to fusions. So if something else better comes along in the future it may still me possible. For me I just saw a road that lead to evetually higher doses of pain meds that worked less.
  • Im gonna hold off for now just because it won't solve my chronic back pain so its only gonna help one of my two problems.I use a great liver cleanser to help with my body but according to both of them im gonna need meds regardless of the SCS so you cant win for losing...
  • I've said this before.. and I'll say it again.. ;)

    Whether or not it's "too soon" depends on the nature of your problem(s) and your clinical presentation.

    I wouldn't look at it as a matter of which doctor is "right" about the whole thing, but rather is there more value for you in waiting versus going forward now? Do you think you can live with the pain/drugs involved for 3-5 years without obliterating your life in the process? Are there other procedures that might give you the relief you need to get through that time? Are there any other surgical interventions that might resolve/relieve your issues in the future?

    I'm only a few years older than you and my issues are primarily in the lumbar area. For me, the main issue was (and continues to be) scar tissue encasing my nerve roots. Since there's no surgical intervention for that, my neurosurgeon referred me on to my first pain doctor at 4 months post-op from my last fusion. That pain doctor presented the option of the SCS about 2 weeks later, after he did some further diagnostic testing.

    I had some issues arise with that first doctor that couldn't be resolved, so my trial was delayed until I could find a new doctor. If I had been able to go forward with my trial at 5 months post-op, I absolutely would have. For me, the only thing waiting accomplished was to put me through hell and a whole lot of ineffective drugs.
  • My situation sounds alot like yours as far as the scar tissue and such.We are gonna re-evaluate the options in 2 months after he gets my med doses right but im probably gonna atleast give the trial a go cuz if I can atleast get rid of some of the nerve pain then all I'll need the meds for is my back pain which will probably always be there after 3 surgeries.Let me know how your SCS trial goes if you dont mind and thanks for the input!
  • Oops.. part of my last post wasn't entirely clear.. that's what I get for posting when I'm tired.

    I've already had my trial and my permanent implant was placed over a year ago. I couldn't be happier with the outcome. My SCS covers everything from my bra line (your avatar doesn't look like you're wearing a bra, but you get my point ;) ) all the way to the bottoms of my feet.

    I do still require medication along side of the SCS, but the doses I'm on now are nothing compared to the doses I was on prior to the implant. For me, it's the balance between the SCS and meds that works. I use an ER med that brings my baseline pain down a notch or two, then the SCS usually takes over from there. I also have BT meds I can use for spikes that break through the SCS.

    The most important difference is that prior to my implant, the meds weren't controlling my pain, even at super-high doses. Now, my normal balance of meds/SCS actually works and keeps me completely pain free for about 90% of my day.

    I'm at the point now where my biggest challenge is recovering my body from the debilitation that came with the limited physical activity while recovering from the various surgeries and waiting for the next round. That's one of the reasons I suggested you consider how long you can live with your pain while you wait, and exactly what you will sacrifice in that process.

    For me, the 9 months I spent waiting for the SCS trial was the time I saw the biggest physical decline in my body. I gained a ton of weight during that time and lost a huge percentage of my muscle mass, both as a direct result of inactivity. I'm much more active now, but it's taking a lot more effort and much longer to rebuild the lost muscle mass and drop the extra weight, which are the two things I need to do to get my "real" life back.

    For you, it might be an entirely different situation and you may be able to remain active enough to avoid the problems I've run into, in which case waiting may not be such a bad idea.
  • SCS is not a cure...it is a tool to help manage...that being said. I would go with my gut feeling...only you know what you can live with. I couldn't live knowing I was taking so much pain medication...so there was no question. I did have to do to two different PM's before SCS was offered. My primary doctor couldn't give me enough medication and saw me several times when I was in the worst pain...so she knew first hand what level my pain was. When she touched my hip I gasped and when she applied pressure to my stomach the sould that came out wasn't a yell, more of what I call an intense pain and am immediate holding of my breath because breathing made it hurt. I am very small and the increasing of my pain med made me lose more weight. Basically I was dying...becoming too thin and in pain all the time. My primary doctor search out PM's until she found someone that would listen to her about my level of pain. Now I can't talk about back pain as that is not my issue...but a pain managment doctor does exactly that manages your pain...I assume, forgive me if I am wrong, but surgeons don't deal with anything but surgical pain and not daily pain. That is just my two cents. Only you know what is right for you. Trust your instinct.
  • I am also 35, looking at the pain infusion pump, PM introduced it to me and have me scheduled, I just saw my ortho and he states it is a last resort option and will not do the wing fusion until I am 45. I cant imagine pain medications being able to be effective for 10 years yet the device clearly has its issues too. I wish there was a guidebook for this. I have very limited mobility and diminished quality of life. I am comepletely homebound with a 4 year old son. I see my PM tomorrow and preadmission for the medtronic trial. I wish the answer would fall into my lap but I just so afraid of making the wrong decision. I also have MS. If the infusion pump or scs were a last resort why are we offered it at 32 -35??
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