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Chronic Pain Puzzled?? Neurologist said my pain was due to the meds

CConipaCCConipa Posts: 2
edited 06/11/2012 - 8:47 AM in Chronic Pain
I am new to this site, but been dealing with pain since 2005. A brief history:

July 2006 - Microdiscectomy with partial lanminectomy L5-S1 Sep 2007 - Anterior Lumbar Interbody Fusion.
Sep 2010 - Hemorroidectomy (Int/Ext Grade 4)

My last visit was with the spine surgeon whom performed my sugery was Aug 2008, in which was not on good terms. I was asked by the PA if I was out of the military, which I was on temporary retirement. I told them I was experience back pain along with pins and needles buttocks and right leg. The spine doctor told me there was nothing else he could do and told me to seek pain management support.

I was out of meds for a month and went through severe withdrawals from Lortab 10s, Soma and neurontin. I eventually was able to get into see my primary care doctor and was placed on oxycodone 5/325 mg and neurontin 400 mg (2400 mg/daily) and finally seeing a pain management doctor.

I been taking the same meds for 2 yrs and still have ongoing nerve pain and back pain (dull ache to sharp).
I was told that I had failed back surgery by my pain management doctor. during the winter months my pain is worse than spring and summer requiring me to get epidurals.

The current pain that I experience now: Pins and needls right leg and groing (on and off), cramping testicles, right leg, right side), spasm lower back and buttocks. sharp stabbing pain upper inner thigh (think it is the L5 nerve) this happens at least once a day. My right knee pressure like pain similiar to my back pain. Numbness feeling right first threes toes, any position. I can only sleep on my back legs elevated. Can not sleep on sides because of increased spasms and pain in back).

Here is my problem now. I had my primary doctor get me a refferal to a neurologist to find out why this pain continues. I had my visit last Wednesday. He looked at the new MRI and there was nothing that appeared abnormal. He examined my reflexes and reviewed my pain management notes. After he did a little examination, he told me all my pain was because of opiate induced algesia. The above pain was mentioned to him. He asked me why I took neurontin (i told him because of the nerve pain, sciatica) and Oxycondone (back pain and tailbone pain), and Opana (to allow me to sleep since I will wake up with extreme sharp and throbbing back pain). I was speechless when he said that. Furthermore he told me he is sending a letter to my primary doctor and pain management doctor to have me taken off these meds that I currently take that are:

Sep 2008 Oxycondone 5 mg (4x/daily), Neurontin 400 mg (2400mg/daily),
July 2010 Opana ER 5mg (1x/night)

Has anyone experience something like this. Anyone have recommedations or suggestion of what I should do? I am frustrated and tired of being in pain and now onthe verge of losing my meds because of this Neurologist. I awaiting for my referral to go back and see the spine surgeon who did this surgery to find out why I am still in pain.


  • Hi CC and welcome. What I'm wondering is what prompted your surgeon to put you on these meds? Did he feel that your surgery didn't work back in 2008? ANd what does your primary think?

    My problem with the meds is that how do we know when we still need them? and when do we know it's time to make changes?

    For example I was on neurontin and skelaxin before surgery in January. I stopped everything for 3 months and then the symptoms came back so they started me up slowly on neurontin. Now I'm up to 3,600 mgs a day and it doesnt cover all the problems. So now we have to back down and try something else. But suppose my symptoms lessened how would I know it was ok to reduce meds?

    What the neurologist probably meant was that you should back off the meds and see what happens. SOmetimes we get so used to the security of a prescription that we don't want to stop. You say your meds are not covering your pain. So maybe the answer is to either find another neurologist or orthopedist or find a pain management doc to work with. A good PM is probably the best answer.
  • What about going back to your PCP and having him put in requesting a second opinion by another neurologist?

    Such a dramatic move by the first neurologist should be reason for concern by your PCP. I would think that he too would want a second opinion before acting on the recommendation of this first neurologist.

    Welcome to Spine Health,

  • I hope the doctors do not take you off "cold turkey" but wean you off slowly. It is probably a good idea to make sure that you are not suffering from hyperalgesia, but not at the risk of complications of withdrawals!

    Just to look at it this way, if hyperalgesia is the correct diagnosis, this is the only way to get rid of the pain. It's a terrible situation to be in, but at least there is a solution!

    Welcome to spine health!
  • I have to agree with HBmom there. If it is possible to wean down, and too find that your pain is actually decreasing, that would be awesome!! Keep your options open at this stage, and see how it works out. Hopefully they won't just cut the meds off...cold turkey is only good on a sandwich!! Good luck! Please let us know how it goes.

    Also too of course, Welcome to Spine Health!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    This was from the result of a Google search on opioid induced hyperalgesia ... I hope it helps explain his clinical recomendation(s)

    Background Opioid-induced hyperalgesia is a clinical phenomenon, characterized by increasing in pain in patients who are receiving increasing doses of opioids. This Fast Fact reviews the clinical findings and treatment options. See also Fast Fact #215 on opioid poorly-responsive pain.

    Clinical features of opioid hyperalgesia:

    ◦Increasing sensitivity to pain stimuli (hyperalgesia).
    ◦Worsening pain despite increasing doses of opioids.
    ◦Pain that becomes more diffuse, extending beyond the distribution of pre-existing pain.
    ◦Can occur at any dose of opioid, but more commonly with high parenteral doses of morphine or hydromorphone and/or in the setting of renal failure.
    •Physical Examination
    ◦Pain elicited from ordinarily non-painful stimuli, such as stroking skin with cotton (allodynia)
    ◦Presence of other opioid hyperexcitability effects: myoclonus, delirium or seizures (see Fast Facts #57, 58).
    Proposed mechanisms:

    •Toxic effect of opioid metabolites (e.g. morphine-3-glucuronide or hydromorphone-3-glucronide).
    •Central sensitization as a result of opioid-related activation of N-methyl-D-asparate (NMDA) receptors in the central nervous system.
    •Increase in spinal dynorphin activity.
    •Enhanced descending facilitation from the rostral ventromedial medulla.
    •Activation of intracellular protein kinase C.

    •Reduce or discontinue the current opioid.
    •Change opioid to one with less risk of neurotoxic effects: fentanyl or methadone (see Fast Fact #75).
    •Add an infusion of a non-opioid NMDA receptor antagonist such as ketamine (see Fast Fact #132).
    •Add a non-opioid adjuvant such as acetaminophen or an NSAID.
    •Initiate epidural, intrathecal, regional or local anesthesia and taper/discontinue systemic opioids.
    •Increase hydration if clinically appropriate.
    Conclusion Opioids can lead to a paradoxical increase in pain. Opioid-induced hyperalgesia should be considered in any patient with increasing pain that is not responding to increasing opioids. Referral to pain/palliative care professionals is appropriate to help develop a management strategy.

    Also known as opiate resistant pain ... I have been done this road a couple of times over the past 5 years. Had a medically supervised detox .... only to need to be placed back on opiate based meds again.

    Doctors with many types of patientd and varied conditions sometimes advocate a "drug Holliday" (Drug free) that is. This process allows us to reset our mu opiate receptors that are "saturated" after a period of useage of high level or long periods of time. After this break ... opiates become more effective again.

    I hope this helps explain where he is comming from.

    Personally ... I have been there ... done that ...

    Hoping for solutions for you,

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • Sorry to hear you asked for a Neurologist and he said
    your meds are causing your pain. I had another MRI when my pain had changed in my lower back and was sent for an EMG/nerve test because of the numbness and weakness in my leg and foot. I also had flexion/extension x-rays to make sure my spine was stable. I hope your Surgeon can give you some answers. Best wishes. 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
  • well now down is up and up is down and black is white and hard is soft
    typical crap from doctor who does not know about pain management.
    the new excuse now, and dr drew on celebrity rehab used this, is to blame the pain drugs for your pain.
    crapolla crap crapo el crapo
    it is b.s. and crap
    i guess you know where i stand on this. this guy out to be sued and lose his liscense.
    just mho
    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.
  • Except that Dr. Drew didn't make it up, it's a known phenomenon.
  • That first so called Neurologist I saw is a joke, he sent letters to my PCM and PM providers detailing that my pain was caused by chronic use of "very low" dose of Percocet and Opana ER that was causing my pain. He called it Opiate induced Hyperalgesia and suggested I am taken off the medication. Well I stopped taking the meds, while I was resting from my hemmeroid surgery and the pain became mild until I went back to work in October. I ended up with severe pain and had to get more epidurals and spent time off again from work. Also I discus this hpyeralgesia with both my PM provider and Spine Surgeon they both disagreed with that neurologist findings.
    I was consulted to a different Neurologist that actually listen to me and he notice that I showed signs of scolosis (head tilts slightly and right shoulder is slightly higher). He ordered a C and T spine MRI and here are the results:
    (Note: I have to wait until 2wks into Jan before I can get to see the Neurologist and Spine Surgeon).
    C Spine:
    Findings: Pre- and postcontrast MRI imaging of the cervical spine with additional sagittal and axial T2 Flair sequences to assess for demyleinating disease.
    Comparison cervicqal spine radiographs 12/2/10.
    Anatomic aligmnent: Normal vertebral body height, signal and contour. Crainiocervical junction and spinal cord unremarkable. Specifically, no evident white matter lesion to suggest demyelinating disease.
    Trace C4-5 disc space narrowing without associated annular tear, diswc bulge or stenosis.
    Trace c5-6 disc space narrowing, early disc dessiccation and very shallow broad posterior disc bulge causing no significant stenosis. Very subtle annular tear is suggested.
    Very shallow broad based posterior disc bulge of C6-7 with very subtle annualr tear suggested.
    Reamining cervical disc levels are unremarkable.
    Apart from very subtle enhancement of the posterior disc at C5-6 in the region of the suspected posterior annular tear, visualized enhancement appears physiologic.
    1. Very early two level disc disease without evident associated stenosis.
    2. No evidence of demyelinating disease at visualized craniocervical junction and cervical spinal cord.
    My guess the C spine just shows some early signs that may have to be dealt with far in the future.

    Findings: Pre- and postcontrast MRI imaging of the thoracic spine with additional axial and sagittal T2 Flair sequences. Comparison dervical spine enhanced MRI 12/07/10, thoracic spine radiographsw 12/02/10 and enhanced lumbar spine MRI 9/7/10.
    Very mild levoconvex spinal curvature. No evident spondylosis or spondylisthesis. Mild endplate spondylosis at T9-10 which associated disc diseasem detailed below. Additional multilevel shallow disc bulges predominantly of the mid throacic spine, adjacent cephalad levels, detailed below.
    The visualized spinal cord demonstrated normal course, contour, caliber and signla; specifically, no findings to suggest active or quiescent demyelinating disease.
    Visualized paravertebral soft tissue are unremarkable.
    T1-2 through t3-4: unremarkable
    t4-5: very shallow central/left paracentral disc protrusion minimally contacts the ventral thecal sac but causs no significant stenosis.
    t5-6: unremarkable
    t6-7: very shallow central posterior disc protrusion with probles associated central posterior annular tear marginates the cord ventrally and indents the thecal sac ventrally, but causes no significant stenosis.
    t7-8: Posterior annular tear and shallow broad based central/left paracentral posterior disc protrusion indents the thecal sac ventrally and marginates the spinal cord, causes minimal left lateral recess stenosis but no evidnent nerve root impingment.
    t8-9: Very subtle left paracentral shallow disc bulge minmially flattens the ventral thecal sac but causes no significant stenosis.
    t9-10: Mild endplate spondylosis. Right posterior lateral annualr tear with broad based right lateral ecentric disc bulge whic caues mild narrowing of the right lateral recess and milde right subarticular foraminal stenosis.
    T10-11 through t12-L1: unremarkable
    1. Multilevel predominately mid throacic dis disease with trace to mild associated stenosis.
    2. Mild dextroconvex spinal curvature.
    3. no findings to suggest demyelinating disease.

    I have to wait until Jan 10 until I can get answer from my doctor. However, I got an appointment with my PM hopefully can tell me what this all means.
  • if this is a well known phenomen then i must be in horrible pain NOT
    i have been on strong pain meds for over 10 years and have not experienced this at all. Just another example of research papers drs etc trying to stop pain meds. i don't care who what or where says it is going on imho it is a bogus statement by drs who don't want to use pain meds. why are not most of the people on this site complaining about this if it is true. it might happen in a small minority but for all of us not not not not
    bogus bs again
    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.
  • What a load of garbage. The doctor should lose his license! As far as dr. Drew, he is some dufus doctor wannabe that is on reality t.v. for fame and fortune. Sounds like you might be seeing his brother, that is a shame. I hate to see anyone suffer because of some doctor.
  • now lets test the logic of this statement
    pain meds are for dulling pain, correct. they have been used for centuries for this, right. were also used in civil war, ww1 and 11 and other wars, correct. why would a dr give a drug that makes your pain worse when he is supposed to be helping you? just the logic of this statement makes it unrefutable. so hospitals all over the world are giving pain meds to patients knowing that hey make your pain worse. yea and i have a bridge in brooklyn to sell you also. your are right mouse, dr drew is a wanna be dr who does not know what he is doing. he hurts people not helps them. just show biz. he ought to be sued and brought up on charges for pushing this garbage. this is another example of media going ape over the use of pain meds. this is why we have to be careful when going to drs and asking for them. this garbage puts more pressure on legitimate pain drs and legitimate pain patients. too many people around trying to get pain meds when they don't need them legitimately which hurts all of us who use them legally and legitimately.
    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.
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    I agree!
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
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