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CzechchickCCzechchick Posts: 9
edited 06/11/2012 - 8:40 AM in Lower Back Pain
I recently visited my doctor to discuss my low back pain. It originated from boot camp, Marines, in 2000, so I have been in this pain for 8 years. I get all medical care for my back through the VA. I left the appointment feeling like they didn't believe I had a valid reason for pain. Now, to explain even more, I am on Fentanyl 50 with oxycodone for breakthrough. The biggest reason I am on Fentanyl is that I have had reactions to most other medications, including morphine, and methadone. The patch does work well for me as I have zero side effects, including no spaciness, no constipation, no sexual issues (I know this has been a big issue on these boards, and I guess I am the lucky few that has not lost that to medications), just absolutely nothing.
Their argument was that if I build tolerance too fast, there will be nothing left that will help me. And I do understand that, I am on a strong med at a relatively high dose. I was on the 25 for one month and on the 50 for two, and really wanted to move to the two day schedule instead of the three. Their other argument was there was no severe central canal stenosis. But I feel I am justified because my mris have revealed the following: disc dessication at l1-l2 and l3 to l5. L4-l5 have moderate type 2 endplate degeneration. L3-l4 is a mild proffuse disc bulge, with a posterior annual tear. L4-l5 is trapped in scar tissue, narrowing the right l5 nerve root, following a discectomy in 2003. Also at this level disc material and fact arthropathy produce moderate left neuroforamina stenosis. A more recent mri (2009) echoed the same, adding that there is spurring at t11-t12 with moderate narrowing of the disc space. There is also a new herniation at l4-l5 which impinges on the intradural portion of the left l5 root. Also new: degenerative disc disease at l3-l4 with the annular tear still present. I know you are not doctors, but with my extreme back pain, which feels like my spine is about to explode, also buring in hip and lower back at night, and an inability to get up in the morning due to extreme pain. I also cannot stand or walk for more then five minutes without extreme pain, causing me to bend over forward constantly. I have one of those balls for stretching and just completed pt which gave me more stretching which I do. I am frustrated with my doctors reponse as I cannot understand how with all of this the don't seem to acknowledge my pain. I am young and have two small children to raise, and I am sure most of you can understand my frustration with this. Sometimes you get tired of fighting. Do I have reason to seek out more relief or are my injuries not enough to justify any more? I am confused as to what I should do. Also I finished a course of prednisone to see if that would help, but no luck. Any opinions?


  • I'm sorry you're having so much pain. Have you seen more than one Ortho or Neurosurgeon? They usually refer you to Pain Management for conservative therapy and may do further testing to see the cause of your pain. I've been to 3 Spine Specialists so far and had 2 opinions for Pain Management Drs. and waiting for a 3rd Pain Management Clinic at the hospital to help me with my pain. Keep looking for someone to help you. Your Primary Dr. has to refer you to these Surgeons. I hope you find someone to help you. 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
  • The best advice I can give is to keep trying other doctors.

    I have had similar problems to yours, though (thankfully) I can walk for longer than 5 minutes. I have degeneration and herniation in disks L3-S1. I have been to so many doctors it is getting ridiculous. The main problem is that they say I shouldn't be in the amount of pain I'm in. And then there's my favorite excuse - you're too young to be in this kind of pain. I am 30 years old and have had increasing pain for 3 years now. I use Vicodin to control it though I should probably be on something stronger - the problem is I need to be alert and focused on the job.

    The doctors either tell me they can't help me or tell me I am too young for surgery and try to send me back to a physiatrist. I am on my 4th physiatrist (the previous 3 felt they could no longer help me). I completely understand your frustration. I have two more appointments next week and hope that one of these doctors will help me, though I am not pinning all my hope on it as I have done on the past.

    Anyway, just keep trying as many different doctors as you can. It is frustrating but sometimes it's the only option. A lot of them have hang-ups about doing anything drastic with a younger patient. If I didn't have an understanding primary care doctor I doubt I would even be able to get Vicodin....
  • I would look for a second, third, even more opinions... Just because this one Doctor is not acknowledging you pain, it does not mean that you are not in excrutiating pain! I hate Doctor's like that!! Grrrrrrrr!
    And when it comes to the Fentanyl patch, you still have several Mg's that you can go up if you create tolerance, so that is BS on his part. Also when you run out of Mg's of Fentanyl to use, maybe they can fit you with an Intrathecal Pain Pump so that way you can live your life.

    I am not a Doctor or a Nurse, but I think that for what you are saying, you have a lot of issues in your back that can cause all of the pain that you are in plus more! So yes, go find a another Doctor and see what his opinion on your issues is. Good luck to you and I hope that you will find a more sympathetic Doctor soon.

  • I agree with the other responses above that you should get another opinion. I am far from being an expert but it sounds like you do have narrowing of the canal or stenosis and/or nerve impingement which is painful in addition to the bulges, spurs and tears.

    I can't beleive this doc is not seeing this. I would keep pushing for other opinions from spine specialists until you find someone who will listen to you.

    I'm also young. I'm 32 and am disabled already cuz I'm having more pain after my fusion 1.5yrs ago. Before surgery I dealt with the pain for atleast 6-7 yrs but have always had some back pain all my life. I'm a married mother of 2 children so I understand about taking care of kids while being in excruciating pain.

    I wish you the best of luck and please keep us updated.
  • I appreciate the encouragement a lot. To Charry, yes, I have seen specialists in the past, but not recently. I really feel I should see an ortho, who could clarify to my doc the issues I have as they seem to really be structural, disc degeneration, arthritis with bone spurs, etc. I think that my doc simply does not know enough to treat me, her knowledge is just limited. Seeing a specialist will probably be my next step. It's a little harder though, because I have to jump through the hoops that the military sets up, as I am on military disability and get my care through the va. I will push for some change with my meds, I figured the same, that there is a lot above the level I am at and I just really need to get them adjusted until I am comfortable. Life just really sucks like this. I have actually also been to the pain clinic, where they gave me one injection, which was a total bust. The procedure was extremely painful as they couldn't seem to find the right spot and dug around for a while. It was terrible and didn't help. Their further suggestion was to stay on morphine, which gave me night sweats and made me feel like crap. Unfortunately for me the military pain clinic was a terrible experience and didn't help at all. Anyway, once again, I thank you all, and will take your advice to heart, and keep pushing. What else is a person to do? Thanks for the advice and encouragement.
  • I can understand why you are so frustrated and I'm sorry that your back hurts so much. I was in my early 30's when my back problems started and it disrupted my life as well as my husband and children. I couldn't do this or that, go here or there, sit, stand, walk, etc. The pain is nonstop and severe. I had a total of 3 spinal surgeries and the last one was to put in a pain pump.

    Has anyone recommended surgery to you? If you currently have nerve impingement it might be an option so it's very important to get in with a specialist ASAP. You don't want to risk permanent nerve damage and only can the doctor assess your risk of that. I took too long getting to a OS because my family doctor dropped the ball big time, and I ended up with nerve damage in the right S1 nerve.

    Anyways, I also was on Fentanyl patches for a while and I was started on 25mcg every 3 days. After my fusion it was increased to 50mcg and then it went to every 2 days. A few months later I got up to 100mcg every 2 days. For breakthrough pain I started with Norco and went up to the 10/325mg every 4 hours. I grew tolerant to those and I was switched to Percocets. I did well on the patches and didn't have any trouble with side effects, even at my highest dose.

    I really feel that you should seek a second opinion because there might be a possibility that you may need surgery to decompress that nerve, and only the doctor can evaluate you and decide what is best. Maybe they will adjust your meds so that you get better relief too. Yes there are some that think age is a problem and no way could someone young have back pain. Not so, it doesn't discriminate at all and I've read about 19 year olds with herniated discs or DDD. If the doctor won't listen or just blows you off, leave and find a better one. You have medical records and films that show that you have painful conditions so I'm sure they will work with you as far as pain medications is concerned. No one should suffer just because they are young. Please keep us posted as you continue to look for another doctor. Take care
  • I have been fortunate to have GP,s that although not specialists in back issues were wise enough to point me in the right direction. My doctors have been humble enough to say they are not sufficiently experienced, my local doctor went out of her way to suggest an appropriate specialist, a professor in the big city. He told me what I needed to know, it was not what I wanted him to say; it took some guts to look someone between the eyes and tell them the truth, rather than an ill-conceived fantasy of what might be possible.

    You know you have pain and at times that has to be sufficient for us to keep fighting, take your medical evidence to where someone has more experience and may be able to give you some additional clarity.

    As you will see here, many even with the relevant evidence this is just the start of the improvement process, we all have to realistic in what may help and much expectation is placed at what is possible irrespective of the reality for some. A categoric diagnosis is vital in moving onto the next progressive step where we move from a known underlying origin to a logical next process.

    Any shots will only mask those underlying symptoms and are not the route for and long standing improvement, attempting to find a second and continual opinion that agrees with you is not what you want, we are not doctors and need to have confidence in a diagnosis that reflects what we do have, not what we think it might be.

    Second opinion are useful to confirm an initial diagnosis, we must be careful in not having many second opinions so diverse it just confuses us rather than reiterates a good sound clinical diagnosis. With your current medical history it would not seem complex for you to get an appropriate assessment that is proving so difficult at this time.

    I am now in my 20th year and that waiting is never easy and many before and after continue to find problems in acquiring that initial relevant diagnosis that seemed so simple at the start. Please do not place too much credence on the comment of this initial diagnosis, as in the future the reality of your plight will come into view given time, we all have experience of those initial assessments being less appropriate as time goes on.

    Take care and do keep fighting, for now at least.


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