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PCP advice.

ashtonaaashtona Posts: 55
edited 06/11/2012 - 8:46 AM in Pain Medications
Disclaimer: This is kind of a long story, but I will attempt to be as brief and concise as possible.

I am a chronic back pain patient. I don't remember the exact discs but they are in the L region. 1 is slipped and 2 are bulging then there are various others that are minor but starting to go.

My PCP sent me to a neuro surgeon. My last MRI was in February. The surgeon stated that he wanted another MRI. My level of pain did not seem to mesh with what he was seeing. Cut to July, my new MRI shows that disc to be significantly worse.

My PCP had me on 60MG MS-Contin and 15MG MS IR. This was doing nothing to ease my pain. Meanwhile, the surgeon told me that they realize the pain is bad but that they really think, because I am young, that we should try one injection before we do surgery. I agreed to this.

This whole time, I have been out of work, my family has been taking shifts at night to care for my son, I can't walk etc... I went to my PCP a couple of times and told him that these meds are not working. His response was he doesn't want to work with any more meds.

Cut to my injection. I get home, I am in more severe pain than when I went in. I call him up and he tells me to "bear with it." I ended up at the hospital where they could only give me Vicodin. I declined because if Morphine isn't going to help, Vicodin certainly won't.

Yesterday, my fiancee and I go to my PCP. I go in and tell him that this was unacceptable. To be told "bear with it" was not what I would expect when I pay nearly $400 a month for health insurance. My wedding is also next week, I have a 2 year old and a job I have to get back to. I want my life back and I cannot get it back with this constant pain.

I told him that if he is not comfortable treating me, let me know and I would be happy to collect my records and find a new Dr.

The end result, he increased the MS-Contin to 100MG's and refilled the 15MG IR's. So far, this is a little better. I am back to work. Walking with a limp but at least walking.

The problem is, just like last time. I know that this will cease to work after a couple of weeks and I again, will be in pain.

I have done research and have heard that MS-Contin is not the best medication to use in this situation for a lot of people.

My question is, what would you do? Do I stick with it and see? Maybe this time it will work. Or do I change Dr's?



  • If your PCP isn't doing enough for you look for other one.I went thru a few before I found the right one. Just remember Its your body If you dont fight for it .Who will.

  • Thanks, Jim!

    I did just that. I went on a 20min long tyrade of how being treated that way was unacceptable.

    The pain is managed well for now. I just have a feeling that the 100MG MS-Contin is going to do the same thing as the 60MG. Eventually, it will cease to work.

    Do most people here have to fight for care? Is this common? For a Dr to wait for me to get upset, my fiancee in the room crying because of how hard our home life is right now?

    My son told me he hates me because I am unable to play ball with him..

    Just confused.
  • For starters 100mg of MS-Contin is a pretty hefty dose. If it's working for now, be happy you have that much. It serves no purpose to wonder what will happen in a couple of weeks. Try to limit BLT (Bending, Lifting, Twisting) while you navigate your condition. Sometimes an injection can make things worse before it gets better. Unfortunately, having issues with your back takes time to figure out whats best. Are you doing any Physical Therapy?

  • Not at the moment. This has thus far been a 6 year long battle. Physical Therapy 8 or 9 times within that period. This is my 5th injection.

    But this is also the first time I have been referred to a neuro surgeon. All of my past Dr's basically scripted me percs every month and told me to stay in bed.

    This is the first Dr I had that actually started to be proactive about chasing down every option.

    The problem I have is not so much with the meds, I realize that 100MG CR MS-Contin is hefty and right now, it has gotten me up and mobile again. I changed my sons diaper for the first time in a month yesterday. I know, it doesn't seem like much but to me, that was the best thing ever!

    My problem was with my Dr. What Dr tells a patient: "I am sorry, but you are just going to have to bear with it." What Dr waits till the point where I am angry, my fiancee is in tears before he helps.

    The questions are, is this common? And do other people have an issue with Morphine working but what seems like a short time later, ceases to work?
  • Ashtona,

    I don't have kids, but I know that had to tear at your heart when he said that. *hug* Sorry it is getting to that point!

    As was said already, "you have to fight" because no one else will. Unfortunately *some* doctors are just plain jerks! Like all of us though, we come in all sort of personality 'flavors'. I sometimes look at doctors as any professional "I employ"..(contractor, designer, mechanic), if it isn't a good fit, it isn't, and I get another. Doctors are mechanics of the body, and so if it isn't working out for you, then I would look around to see who all is out there that might be better. With pain control, surgery, overall care, you have to have a confident and comfortable feeling with your doctor(s). Please let us know what the NS says. Take care - hug your son, and that wonderful fiancée.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks, Brenda.

    It did indeed rip my heart out. I am a grown man, I have been with my fiancee for 6 years now and have never cried. When he said that, I was crying like a baby. I know he is only 2 1/2 and doesn't know what real hate is, but to see him so upset because daddy cannot play, well, it's extremely difficult.

    An hour after I took the 100MG MS-Contin, I was able to get up and move so I spent the whole day just playing whatever he wanted to. It was nice.

    Here is to hoping it lasts a while until the surgeon and I come to terms with a long term solution.
  • Your post brought sympathetic and then happy tears to me as I read it! What is good and scary about kids say... under 7 or 8, is they pretty well express what they truly feel - makes it even harder. If a teen child had said that, most would go "yeah, whatever!", but a toddler....

    My happy tears where from you being able to spoil his little heart with *him* being the focus! If you're anything like my husband, it takes TONS to make you cry, and that in itself lends to how hard your heart felt that day. I wish you many more 'play days' with your son! Bravo to ya!!!! :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Had you tried the vicodin, you might have found that it worked for you- the thing is to try different things and see if they work for you, because different narcotics work on different receptors. It is not about one medicine being stronger than the other, but about narcotics working differently for different people.

    When I was in your situation, I asked my doctor to refer me to pain management, because it was clear that the dr. was uncomfortable working with such large doses of narcotics. Also, pain medicine doctors use non-narcotic medicines such as lyrica and cymbalta to create kind of a "cocktail" to try to decrease narcotic dosage, since tolerance is always an issue. For example, because I take Topamax and Cymbalta, I'm able to keep my Ms-contin to 45 mg a day and I use Norco for breakthrough.

    You are right, you should be able to change your baby's diaper. When things were really bad for me, my PM doctor gave me a fentanyl patch- that really knocked out my pain (knocked me out too! I asked to back off of it, but the point is that he's willing to step up my meds when I ask).
  • I was on MS contin 60 mg for awhile before I told my Dr. it only lasted for 6-7 hours and she increased it to 4x a day which I was on for 2 years then switched to something else. While you're getting relief now and enjoying time spent with your son, still try to keep walking everyday to build up your muscles. I have to see my Dr. monthly for refills so let her know how the meds are working. I'm glad my Primary Dr. gives the meds as I've seen 3 PM Drs and all I've received is injections. Good to see you're back to work and having quality time with your son. 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
  • Interesting that you bring up the receptors. I asked my Dr to change meds.

    My exact words were: "I am not trying to increase my dose, I am just letting you know that the Morphine is not working. Maybe we can try something different at a lower dose?"

    His response was: There is no difference between narctoics, they all act on the same receptors and therefore Percocet, Oxycontin, Vicodin, whatever makes no difference. The key is to find the right dose.

    I agree with you, though, HBmom. I should have tried the vicodin but I was also afraid due to my contract signed with my PCP. But I also think that different medications can react differently.

    For instance, low doses of Percocet may provide better pain relief than extremely high doses of Morphine.

    I am no Dr, it is just in my research I have seen people have great relief from just 10MG's of Oxycodone Vs. 135MG's of Morphine.

    Well, right now it is working. I need to get through my wedding next week and then go from there.

    Thank you to those that wished me well with my son and stuff. I really like this place. Very supportive! :)

  • dilaurodilauro ConnecticutPosts: 9,835
    There is no question that your first priority is to be able to manage your pain so that you can continue moving on.

    But, be aware, no pain medication alone is going to eliminate your pain. For many patients its a combination of different medications that can help.
    But only your doctor would know what is appropriate for you.

    It sounds as though you have had MRI's done, I dont see where any doctor has suggested additional conservative treatments or even surgery.

    You indicated that your PCP is handling your situation right now. I would definitely look into seeing a spine specialist to get more details and another opinion regarding your MRI results.

    When it comes to doctors, it is important to remember that they base their decisions on test results and physical review. What they are looking for is the problem to match up with the pain level indicated. Many times that does not happen. That does not mean the doctor does not know what they are doing.

    It is so important to establish an effective two way communication relationship with your doctor(s).

    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
  • Conservative treatment is years gone now. It all started with Ibuprofin 800MG's, Flexeril, Physical Therapy 8 or 9 times, Valium, Gabapentin, Oral Steroids, 5 injections, 6 or 7 MRI's, 4 Dr's etc...

    I am not sure what conservative treatment there is left.

    I am referred to a neuro surgeon now. They did my latest injection because they really felt it was a good starting point.

    I am 36. They feel that I am too young for surgery even though they have admitted my condition warrants it.

    The extrusion is bad and has gotten worse since February.

    I am a very confused pain patient, that is for sure.

  • dilaurodilauro ConnecticutPosts: 9,835
    Age really has no bearing on if you need surgery or not. I had my first at 28, because it was necessary, I was not able to walk due to severe nerve impingement.

    If anything, being young is on your side. You should be in better over all health and should be able to recover quicker.

    As far as conservative treatments, the list goes on

    - Physical Therapy
    - Aqua Therapy
    - Passive Traction
    - Ultra Sound
    - Heat/Ice therapy
    - Acupuncture
    - Spinal Injections
    - Osteopathic treatments
    - Relaxation techniques
    - etc

    I've tried them all, some are very effective in managing the total situation.

    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
  • And conservative treatment isn't something you do once, it is what you do continuously to reduce your dependence on narcotics.

    Heat, ice, a comfortable chair, non-narcotic medications, therapeutic exercise, relaxation therapy, massage, and so on are all pain management techniques that you rotate through continuously as a chronic pain patient.

    Keeping a healthy weight and finding a really good physical therapist is also key.

  • Well now that my pain levels are reduced to a 2 or 3 with the Morphine increase. I have been doing stretching excersises with my fiancee at night.

    I am not overdoing it, because I know the meds are masking it. But I am trying to get a little more active each day.

    That entails playing indoor games with my son. Not a lot of movement but enough.

    I took him out for a short walk last night.

    Trying to walk as much as possible while I can.

    The longer I walk or stand, though, the more I feelt that pin point pain start to cut through. That is when I rest.

    Just trying to keep it simple for now so I don't do a crazy amount of damage.

    Oh, and I will be the first to admit that I need to drop a few pounds. No question about that. Work in progress. :)
  • Maybe you can get a second opinion from a different NS? It seems useless to do another injection on such an old extruded herniation to me. Ask you PC for a different referral you have waited long enough. Once your feeling better you will walk and loose weight.

    I have to ask my NS for injection referrals right now. He doesn't believe in them. I need them for limited pain releif on my T spine. Any relief- however temporary is good for me.

    Hang in there,

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