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Pain Management Doc sold me on SCS; second opinion says I am not a candidate!

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:39 AM in Chronic Pain
My pain management doc gave me a sales pitch about having a spinal cord stimulator implant, handed me the St. Jude DVD & brochures to go through and sold me 100% on it.

I have four bulging lumbar discs, spinal stenosis, and an L3-L4 spondylolisthesis, and for the last 1 1/2 yrs. have been getting treated for back pain with 4 epidurals, physical therapy, a TENS unit, and meds - that included neurontin, which drove me nuts. I asked my pain management doc for an antidepressant that would also treat my pain - like cymbalta - he didn't want to do that because then he wouldn't know if the epidurals were "working" - that he planned to do (another round of 3), but my insurance denied everything submitted after he did one (my 4th) epidural.

I have gotten worse in the past few weeks with constant sharp, burning lumbar pain and within 30 minutes of driving a car, my right leg starts having calf & thigh pain, with numbness and throbbing in my right foot. My right foot also gets "heavy" after very short amounts of walking - and wipes me out; but I can walk on my tippy toes and heels. I don't want this to keep progressing.

The staff and PM doc seemed so disorganized I told my orthopaedic spinal surgeon I wanted to go to someone else, and I did. I have never had a back surgery. I told the "new" pain management doctor about the pain in my right foot and leg after he'd reviewed my MRI's. I said my original PM doc offered me an SCS. The second opinion doctor said, "no way are you a candidate for that; you've never had a failed back surgery." He followed that news with the fact my medical insurance company was tough on approving anything, and would never approve an SCS for me. Second opinion topped it all off by handing me back my co-pay check and said, "I'm sorry, but there really is nothing I can do for you; you have multilevel problems."

The second opinion doc recommended I see a neurologist and get a second opinion; adding that I probably needed surgery. I told him my orthopaedic spinal surgeon didn't want to do surgery unless I had "drop foot". Second opinion said "that's extreme."

Why would a Pain Management doc offer me something like an SCS that is really NOT an option??? I figured if my surgeon didn't want to do surgery, the SCS would be a "good thing".


  • First of all, I find it odd that PM #1 wouldn't try Cymbalta because then "he wouldn't know if the epidurals were working". Huh? Maybe then he would know if the Cymbalta would work. There are so many ways to approach pain management. It sounds like PM #1 just wants to do procedures. They are the most lucrative.

    As far as surgery goes, its tough to proceed if "you have multilevel problems". I was told by a non-surgical spine specialist that I had alot wrong with me, so it was hard to tell what was really the source of my pain. When I eventually saw a surgeon, he thought my problem was pretty straight forward; did a laminectomy and fusion and it didn't help my pain. I've read that the biggest reason surgery fails is poor patient selection.

    I now have a spinal cord stimulator and I've asked whether I could have gotten it without going through the surgery (which was brutal). I don't remember what I was told but I think its kind of unusual. At least with a SCS, you really can't come out of it worse off. You will, however, be unable to have any more MRIs.

    A spinal cord stimulator is considered a treatment of last resort. You certainly should try Cymbalta and the other nerve drugs before you go that route. How would PM #1 think a SCS would impact his learning how the epidurals are working?

    I think you should run, run, run from PM #1 as I believe he is thinking of his own pocketbook rather than your best interest. Susan
  • Keep in mind that all these treatments, implants and surgeries are somewhat subject to the individual doctor's interpretation. The spinal cord stimulator was originally designed to be used as a last resort to interrupt the pain signals, when no surgical procedure was left to be tried. However, with the rise in popularity of pain management specialists, it is not always used as a "last resort" any more. This will vary from doctors to doctors as you have found out.

    Did the 2nd opinion want you to see a neurologist or a neurosurgeon? The neurologist can perform an EMG test and a nerve conduction study to see if any of your nerves are being affected. The neurosurgeon would provide a diagnosis of your spinal problems and offer a treatment plan, surgery or referral.

    When a spinal injury or mechanical problem is not absolutely clear cut, different doctors will have different approaches to dealing with it. Some will not do back surgery until it is their definition of "bad enough." Others will recommend surgery more quickly. There really is no one "right" approach. There are too many variables involved. This is one reason why it is always a good idea to get several opinions prior to agreeing to any surgery. In your case, it is time to keep looking until you find a doctor who can help you.

  • You can not trust the emgs trust me i had to broken peek cages in my back an had a emg that showed nothing . Then had a thin slice c/t to find out that the peek cages were broken an when i had the surgery to fix them ny neuro Dr said i also had calcium depoits an bone spurs an that he no longer would rely on emgs ?????
  • Hi gwennie17. The second Pain Management doctor wanted to send me to a neurosurgeon that he said "was the best in the area." I checked out the neurosurgeon's credentials a bit on line and he is affilated with 10 hospitals, as well as teaching at a university. The neurosurgeon sounds like someone I should at least get seen by for a second opinion.

    The second Pain Management doc also told me some doctors will perform an SCS implant on someone who has not had a failed back surgery, but he does not. After talking with PM #2, it sounds like I should really find out what is causing my pain, since it's affecting my being able to drive a car at this point.
  • Thanks for your reply Susan! PM doc #1 did hire a Physician's Assistant and the last time I was there I saw the PA, who actually did a brief neuro exam on me and I did ask her (the PA) to start me on cymbalta, and she did - but at what I kind of thought was a low dose - 30 mg once a day. I called Lilly pharmaceutical and spoke with a nurse on Lilly's patient call-in line, asking what the recommended dose of cymbalta was for treating depression and pain. Turns out the dose was 60 mg daily, so I called PM #1's office, left a message, and actually got a call back from the PA. The call ended with an agreement to try 30 mg for a few days and then go up to 60 mg/day of cymbalta.

    I called back multiple times, leaving messages asking for a refill when I was running out of cymbalta (since I was now taking two pills a day instead of one), faxed PM #1's office twice with that same request, and no one called.

    So I went to my family doctor and he wrote the script for cymbalta as well as an Rx for wellbutrin because the one side effect of cymbalta that bothered me was anorgasmia. I read on-line somewhere wellbutrin might help that problem.

    I was on neurontin and that was making me REALLY depressed and moody. The cymbalta actually did make a BIG dent in fixing my depression and mood problems, I weaned off the neurontin, but the cymbalta has not decreased my pain.

    PM #1 wanted to see if "two more" epidurals might solve my pain problem; at least for a while. THEN, his plan was to do a trial SCS. PM #2 told me because I am "young and active", the SCS would be "really invasive" because the paddles would have to be implanted in my back and secured in place by my spinal surgeon for the permanent SCS - which required cutting open my back. PM #2 told me "you have an L5 problem" when I mentioned my foot/leg symptoms/complaints.

    PM #1's office WAS supposed to schedule me for the SCS "class", and I was told a St. Jude rep would contact me - it never happened, surprise, surprise.

    What's really weird is that PM #1's office called in a vicodin prescription for me. My pain increased dramatically after PM #1 did his first (and only) epidural on me. I was taking 6 tabs a day of vicodin 7.5/325, using a TENS unit throughout the day, and also taking an anti-inflammatory med. I left messages for a refill and faxed in a request for more vicodin - which did get called in for me. Problem is, when I saw the PA and she did the neuro check, it was once again time for a vicodin refill. I told the PA how much vicodin I was taking and she couldn't find any documentation anywhere to support what I was saying, and I got an Rx for less. I faxed in the pharmacy sheet for the vicodin prescription that was called in and never got a response. Finally, I called my spine surgeon's office and they called in an Rx for vicodin after I informed them of ALL the hassle's I was getting - being given dates for procedures that were never scheduled by the staff, having multiple cancellations for a second epidural, and when that second epidural was denied - I didn't find out until I called my health insurance company. I also asked the orthopaedic spine surgeon's office to call PM#1 and let them know my vicodin Rx was refilled - keeping things on the up & up, since I have ALL my pain meds written by one doc, and filled at the same pharmacy.

    Tomorrow I'm going to try and find a local Pain Management doc - I was traveling almost an hour and a half to see PM #1 because my spine surgeon (who sent me to #1) was recommended by a friend. I am going to try and get seen by the neurologist PM #2 recommended. Along with the leg and foot pain, I am losing motor control and range of motion in my toes on both feet.
  • You really should get that 2nd opinion as she pointed out different doctors will have different ways to approach the same problem and honestly from everyone I have talked to that an SCS is really a last resort not this early in your process.

  • In my experience, neurosurgeons will often take on problems that orthopedic surgeons won't. The first doctor I saw after I had the MRI that revealed my problems was an orthopedic surgeon and he actually physically moved across the room from me after looking at my films. I'm not sure if he was consciously aware of physically moving away from me, but it certainly punctuated his unwillingness to touch me surgically.

    The best thing that ortho doctor did for me was to refer me to the neurosurgeon that has done all of my surgeries, except my SCS implant. And, the neurosurgeon that did my SCS implant left me even more thankful for my regular one. ;)

    One thing you need to remember about the SCS is that it just covers the symptoms, it doesn't correct the problems. If you have confirmed 4 herniated discs, in my opinion the SCS would be a lot like putting a band-aid over a stab wound. It might address the problems in the beginning, but eventually there's going to be more damage than the SCS can deal with and once you have the SCS, surgeons aren't as excited about dealing with you because you become a high-risk case.

  • Certainly a second opinion by a surgeon and not a PM doc would be a smart course of action. It is foolish to recommend an SCS trial or even consideration when there are unaddressed structural issues as Michael pointed out.

    For the record, there are very few instances when a person is an SCS candidate without having had surgery, and that is for someone suffering CRPS which cannot be helped with surgery and may not be the result of surgery.

    I agree with Michael about being cautious with Cymbalta. I took it fine for several months and then it began to backfire on me with waking nightmares and urinary retention.

    Be careful with all that you read when you research things on the Internet. Anyone can write anything they want and make it sound credible and factual, when it may be nothing more than someone angry at a person, an institution or a company.

    Best of luck,

  • The second Pain Management doc - the one who actually seemed to care about how he treated people, told me point blank the issues I was having with my right leg were from a nerve root problem... and that he couldn't help me. I did get an appointment to see my orthopaedic spinal surgeon this week and sent all the MRI & epidural reports I had to the neurosurgeon's office in hopes of getting an appointment and a second surgical opinion.

    I still can't figure out why PM doc #1 gave me the sales pitch for an SCS. Second PM doc was familiar with my health insurance plan and said my insurance would pay for back surgery before they would pay for anything else, and that an SCS was out of the picture.

    I will let you know what happens.
  • Like BionicWoman, I felt that I needed to emphasize that the SCS does not cure anything, it might help mask the pain, but eventually the damage will be to advance to do anything but surgery to correct/cleanup the damage. Don't get me wrong though, I have a SCS and it is the only thing that allows me to get out of bed in the morning and have a productive day. I have actually had five different SCS units. I currently have a rechargeable unit, before that I was having a revision at least once a year because of the power demands. For me it absolutely works, but in your situation there is something that appears to need correction first. If after this you still have the pain then an SCS might be a potential aid, but again it does nothing for the underlying problem, it just helps mitigate the pain.
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