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My Dr. has me second guessing if my pain is real

lowlevelrebelllowlevelrebel Posts: 12
edited 06/11/2012 - 9:03 AM in Chronic Pain
Hello all,

I'm new here. I know no one is a Dr. here but I've been having a lot of neck/upper back pain. I've tried PT, Cervical ESI, and medications. My Dr. suggests no treatment but to lose weight. I am very large. I understand the risks in spinal surgery and it seems I have a lot going on. I know no one can give me a dx but here is the text from my Cervical, Thoracic, and Lumbar MRI's. I'm in a lot of pain everyday. Currently I am taking Butrans 10ug/hr patch and up to 4 Norco 5/325 a day for my pain. My pain management Dr told me that they think prescribing any stronger medication would be a "huge disservice" to me at my age. I'm 38. I'm struggling to deal with the pain and weakness. I'm to the point where I'm questioning if I'm crazy and really shouldn't be having so much pain with what I have going on. Most of my pain is in upper thoracic, neck , shoulders, arms and hands. I'm sorry to post all this information but I would appreciate any insight someone who knows more about this can give. Thank you so much in advance! Bob

Mild flexion of cervical spine
C3-C7 The cervical spine is developmentally narrow.
C2-C3 mild left foramnial stenosis
C3-C4 mile left and severe right foramnial stenosis
C4-C5 moderate left and severe right foramnial stenosis
C5-C6 mild left and moderate right foraminal stenosis
C6-C7 mild left and moderate right foraminal stenosis
C7-T1 moderate bilateral foraminal stenosis
T1-T2 severe right foraminal stenosis mild left foraminal stenosis
T2-T3 mild left and right foraminal stenosis
Right curvature of upper thoracic spine measuring 13 degrees
Superimposed focal left paracenral disc protrusion 5-6 mm indenting the thecal sac
Additional right paracentral disc protrusion 3 mm indenting right side of thecal sac
T3-T4 Small broad based left paracentral disc protrusion 3mm
T4-T5 Disc bulge asymmetric to the left indenting left thecal sac
T7-T8 Left paracentral broad based disc protrusion indenting the ventral thecal sac 4 mm
Curve to the left of 13 degrees of lumbar spine centered l2-l3
Congenital narrowing of the canal and shortening of pedicles
L1-L2 mild disc bulge
L2-L3 mild disc bulge mild bilateral foraminal stenosis
L3-L4 mild disc bulge and lumbar spondylosis and facet joint arthropathy mild to moderate central canal stenosis
Bilateral foraminal stenosis
L4-L5 disc bulge and facet joint arthropathy. Mild naorrwing of central canal and lateral recesses
Mild foraminal stenosis
L5-S1 mild facet joint arthropathy
Mild bilateral foraminal stenosis


  • Hello Bob,
    Have you been referred to either a board certified spine neurosurgeon or a board certified spinal orthopedic surgeon for a consult?
    You do seem to have a lot going on, most of it appearing to be congenital ( meaning from birth) but that doesn't mean that it isn't significant for your condition.
    If I were you, I would either ask for a referral to a board certified ortho or neuro surgeon for a consult and see what they tell you as far as whether or not you are a candidate for surgical interventions and maybe another consult with a different pain management center, for interventional treatment, PT, injections, etc...
  • I agree with sandi.

    Your age has nothing to do with pain control. If you are in pain then it needs to be treated.

    Your weight could well play into all the bulging discs as our spines were not designed to carry it.

    You need to get busy on finding more/another Dr, especially in the pain department. They could be not wanting to treat you because of your size which is wrong but does happen.

  • Sandi. Thank you so much for your suggestion. I never thought about any difference in neurosurgeons. There are 6 ns in the group that my Dr. is in. The group has 2 board certified neurosurgeons but my Dr. is not one of them. I wonder if my Dr. would be upset if I asked to see one of the board certified surgeons in the group? Thank you so much for a place to start. I'm in way over my head here.
  • Yes...Board Certified Neurosurgeons are at the top of the training for spine issues.

    And I know it's hard to hear...but being overweight...even by 15 to 20 pounds can put such stress on our spines so anything over this a DR. is going to push for you to lose weight before any type of surgery is offered. (Unless there is emergent issues with possible paralyzation)

    You are on a decent amount of opiate pain medication so the key is finding other modalities to help lessen the pain. So I can see why they are not anxious to raise your dosage until they see what your pain level is at an appropriate weight.

    The goal for pain management is to get you to a 5 or so on the pain scale with a comprehensive plan.

    So all the other modalities are:

    Daily exercise
    Physical Therapy
    TENS unit
    Aqua therapy
    Cortisone treatment

    And then other medicines like a muscle relaxer and nerve medication....Are you on either of these?

    As well as possible Antidepressant and/or sleep medication.

    And then counseling/therapy to deal with chronic pain.

    Including a healthy diet and absolutely no smoking (if applicable).

    Again...I know it's frustrating to hear..but you are very lucky to not need immediate surgery and doing everything you can to get as healthy as possible will not only help your spine issues but health overall.

    A strong core (stomach muscles) will help prevent further damage...

    And truthfully....if Drs. were to take a random 100 people off the street and do MRIs....You would see many spine/disc issues....Our spines do this naturally with age. Some people have many things on their MRI with no pain...and others have a lot of pain without any type of herniations...

    So, it's not about your pain being real...It's all about working with your Dr. to use as many of the modalities I mentioned daily/weekly/monthly, as well as getting to a healthy weight to help get your pain to a decent level...

    Good luck...
  • I can't tell you how much I appciate the time you took to share. I can understand that my weight is killing me. Since about 12 I've had bad sciatica and leg weakness when I walk. I was a very active kid before that.. but anyways chubby. Well as I've gotten older I've allowed pain and stiffness that movement causes and mental issues have to let my weight become totally out of control. I'm 5 ft 9 and weigh 420. I've lost 30 lbs in the last two months. I'm also in counseling and being treated for my metal health. I can see why no surgeon would want to touch me. He's recommended gastric bypass but my insurance doesn't cover it. I'm also finding it harder and harder to work my desk job because the sitting kills my neck and back. It's good to know that a 5 is acceptable for pain. That's about where I stay. I think I'm too sensitive because it still seems unbearable. I know my weight is going to kill me if I don't continue to lose. I need to push myself but haven't done a good enough job. I guess I've felt stuck in that I really can't exercise much. But I've also done my share of feeling sorry for myself these last 2 years since the pain got bad. Your post called out the fact that it has to be me and me fighting to have a chance. I'm not sure where I'll find the will... but I know I have to. Bob
  • I appreciate your honesty and sharing...My mom has struggled for many years with her weight as she is 5'5 and was over 300 pounds a few years ago. So far she has lost over 70....and she just turned age 70 last year! She gave up smoking almost 20 years ago and drinking close to 25 years!

    So I applaud you for wanting to work on this as hard as it is with the spine issues and pain. Because yes...it would be risky surgery with your health...but also because you may find that with the weight loss that your spine becomes a non issue or at least much more manageable...

    The biggest things my mom did included aqua therapy. This way it didn't put any pressure on anything and was easy on her back and knees. It was something she actually looks forward to doing!

    So even something as simple as this or just walking in your home even in 5 or 10 minute increments..Start as slow as you need and gradually build up...Every little bit helps.

    As well as I got her to switch to eating all Organic. This has helped with her weight loss as well.

    And yes...living with any type of pain can seem unmanageable some days. Chronic pain can really wear on us emotionally. That is where I've found boards like this as well as seeing a counselor to work through the emotions.

    Again...start with baby steps and we will cheer you along the way!!

  • I was severely overweight when I injured my spine (three ruptured discs, which eventually involved some DDD, spondy, and some scoliosis. Fortunately, I had already begun the process for gastric bypass surgery before I had the spine surgery. I lost a total of 85 pounds before having my spine fused. At first, it really helped the pain. I got almost two years from time of injury until I had no alternative but fusion because of the weight loss. I think if I had not lost the weight, I would have been forced into the fusion much sooner and would not have had as good of an outcome. I've gained back about 15 of my pounds, but I've been at this weight for almost three years now, so this is probably where I'll stay. My spine is stable, and I'm able to move fairly freely. A bit stiff, especially as regards bending over, etc. I'm careful not to re-injure myself as I never want to have another level fused. I also am very careful with my diet, as gaining even a few pounds adds stress to that fusion. I can feel the weight before I even step on the scale.

    Trust me, I know losing weight and keeping it off isn't easy, but if you can manage to reduce your weight you'll be doing yourself a big favor. I'm a lot older than you (approaching 58) and I only manage through exercise (basically a lot of walking) and I don't eat refined carbs. Just protein, fruit and veggies. That's it for me.

    I wish you all the best. Pain just plain sucks, and being large and in pain is absolutely no fun at all. I've been there.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Hi Bob,

    I'm new here and haven't officially introduced myself yet, but reading your post i just had to reply. I know you said your insurance wouldn't cover the gastric bypass surgery. Mine doesn't either unless a doctor specifically states it is medically necessary. I was wondering if perhaps you can ask your doctor to appeal to your insurance company and write them saying that it IS medically necessary for you and your situation, it can't hurt to try, all they can do is say no.

    I personally haven't had it but I've known people who have had it and the difference was literally life changing.

    And like others have stated i will be your personal cheerleader, regardless if you have to lose the weight on your own or are able to get the bypass approved. Good luck and God Bless!
  • I had to show some cyber support for you! I know you can do it... day by day, step by step.
    Do it.. for YOU!!!!
    and you have an amazing cheering section for ya Bob~!
    All the best
  • I had to show some cyber support for you! I know you can do it... day by day, step by step.
    Do it.. for YOU!!!!
    and you have an amazing cheering section for ya Bob~!

    i also wanted to share about isometric exercise. check it out.. maybe google?
    I can do stomach tightening, butt tightening, calf stretching exercises from my chair. no range of movement needed...and I find it only benefits!!:)

    All the best
  • Obviously you need to loose weight to take a load of your spine and to decrease numerous other health issues that may arise, but this should have nothing to do with being treated properly by doctors and in being prescribed strong enough pain meds to treat your pain. Age and weight should have nothing to do with you getting help for pain and due to your weight you will need a higher dose of medication to get relief than if you were 200 pounds lighter. With weight considered I would be careful saying that that you are now being prescribed is a high dose of narcotics, this should be between you and your doctor and the true measure should be how it relieves your pain.

    As far as your statement of you being at a pain level 5 but then you state that it still seems unbearable to you makes me wonder if you are possibly downplaying how much pain you are really in. I of course have no idea, just food for thought with this one.

    I am also in the process of loosing some weight and I'm in the same position as you in that I really cant do much in the way of exercise due to severe pain. The food part of the equation is by far the biggest part in loosing weight. What you gain by a moderate workout for an hour can be accomplished by cutting out a few hundred calories (soda and small snack), so we can do this even with moderate exercise off the table (pun intended). I would be very careful being too hard on yourself and making loosing weight more that it really is, its going to be a life long process of eating healthy and putting too much emphasis on loosing weight fast and right now can be counter productive. Its been many of years getting to where you are now and its going to take some time to get to where you want to be.

    What I'm doing and seems to be working very well for me is I cut out all soda and pretty much all juice (juice can have more calories as soda). I stopped all fast food and have changed all possible carbohydrates to a more complex form when possible (brown rice instead of white, hardly any bread and very healthy at that, as little sugar as I can. I eat lots of veggies and a fair amount of fruit. honestly with eating this way I find it hard to get enough calories many days and I have to make sure I eat lunch or a snack in order for me to not get too hungry later on and want to eat something I shouldnt.

    Hope you are doing well and I wish you the best of luck....Mitch
  • How did you do that !

    That is fantastic, I wish I could do that tell me what you did, and how I could do the same.

    30lbs in 8 weeks, what is your next goal !

    Take care and thank-you.

  • First off I have to say that I'm absolutely amazed by the number of great people on this site. Thank you so much for your information and thoughts. Above all thank you for all the encouraging words. I've never been on any kind of online forum and I can't express my appreciation enough. It's great to have a place where people understand the impact that the pain and limitations on activity can have.

    It's been a crazy week. Sunday night I woke up several times with an intense pain along 3or so of my right ribs. The next morning I woke up and that pain was radiating into where my gallbladder was. That was taken out about 2 years ago. Since the pain wasn't typical for me I decided to stop at a local urgent care that I've been to for ear infections and things. They've always been great there. I really just wanted a quick checkover to reassure myself. Since the pain was in my upper right quadrant they said they couldn't see me and referred me to the local er. Well I went even though I thought it was a bit crazy on my part when I was just in pain ... not doubled over or anything. I had a great er Dr. They ran blood tests. Took x Ray and did an ultrasound. Everything came back normal which I was thankful for. She said it was likely nerve pain radiating from my thoracic spine. I didn't ask but she wrote a script for some lortab to take ON TOP of my normal pain meds. I felt mostly stupid for going to the er. I just get nervous when I get a new type of pain. This afternoon I attempted to bbq for my mom and dad and I got a buzzing in my upper back like I had a tens unit on. That's not ever happened either. No hospital this time though. Ha ha. I am nervous that I'm having these new types of pain and things happening. Is that normal to feel nervous about? I have an appointment with pain mgmt nurse on Monday. My pain is better with the lortab but that won't be ongoing. I feel it's kind of pointless to keep telling the Dr that my pain is not under control. I guess the energy to try to convince them that the butrans patch gives out after 4 days and the Norco 5/325 helps take the tiniest edge off is just gone. They've made up their minds that I'm ok. But.. I'm keeping my head up. Going day to day. I just don't like these new pain sensations showing up. I try not to worry.. but it's hard not to. Thank you all again so much for being so awesome.
  • Thanks for updating us....Sorry you have had some extra pain...

    I do have to ask if you immediately contacted your Dr. to make sure they are ok with you taking the Lortab the ER prescribed...

    Even without a specific contract....this can get you into real trouble with them and dismissed from the practice altogether as it looks like "Dr. Shopping"....

    Obviously we know that is not the case....But any Dr. prescribing opiates/narcotics are under strict guidelines from the state and the DEA. Most Dr.s are having their patients sign Pain Mgmt. Contracts...

    This prohibits getting any more narcotics without notifying them first and asking permission...

    Usually someone will call the office or have them page the on call Dr. if after hours. The patient would then tell them that you are having severe pains to where you need to go to Urgent Care/ER...and ask them what to do. They sometimes decide to contact the ER/UC where you are going and work with the DR. on the narcotics issue. Other times they just say to call them when you get back home and if you got a new prescription. But either way it's contacting them immediately about the situation.

    Did you at least give the ER the information to contact your Dr. and tell them about the medication that you are already on?

    I gather that this happened last Sunday? So hopefully you have already talked with your Dr. and let them know about this ER trip and they know about the new prescription of Lortab...

    Almost all states now, 44 I think, have the Prescription Monitoring Program that is tied statewide to your name/identification to monitor every prescription you get anywhere in the state. This is one more way to keep people from Dr. Shopping...(Again...I do NOT think this is what you did)

    Just trying to help as I would hate for you to get kicked out of the practice you see now and have a permanent red flag on your record.

    Unfortunately with getting older and having spine issues....we have aches and pains all over the place. I have had 1 foot surgery, 2 knee surgeries, 4 laproscopic abdominal surgeries, 3 cervical fusion surgeries, and a pituitary brain tumor. So I get pains all the time that may be bad for a few days..I just rest...use ice/heat...and it goes back down later...

    Spine issues can cause these really sharp nerve pains that yes...shoot from the back to the front...down our arms...or down our legs...or as in your case...into the abdomen.

    As I wrote in my first post....It's really about working with your Dr. to use all the other modalities in addition to any pain medication. You can't rely on those to be the only way to reduce your pain unfortunately. No Dr. will continue to do that.

    So it's using all the things I listed as well as said...continuing to lose weight (congrats so far!)...

    And then...once you get to a healthy weight...Then they can see where your spine is at that point and if it still requires pain mgmt.

    Keep us posted!

  • Hi there. Yes, I called my pain management Dr's office to let them know I had been prescribed Lortab by the ER. They said they were fine with me taking them as directed. I also told the E.R. all of my medications and strengths, etc. I definately DON'T want to be red flagged. It's such a balancing act. On one hand I have my Dr telling me that any pain that is not normal should be checked out asap. On the other hand I can't be going to the Dr./ER everytime something random or new happens. I guess maybe I'll develop a rule that absent of paralysis, doubling over, or a bone sticking out of my back...maybe I should just ride it out. :) But yes, I did contact everyone to make sure they were in the loop on what was happening. I hope you all are feeling as well as we can today and that we all enjoy our Sunday!!
  • I am SO glad that you followed all the appropriate steps and contacted them....As I said...I would hate to see something happen to you inadvertantly...

    And yes...it's finding that fine line if you think there is something emergent and such severe pain that you need to go get it checked out...then most all Drs. will suggest going to the ER/Urgent Care.

    Or knowing what certain twinges or types of pain that are caused by the disc issues and if there isn't any type of high fever...fainting...or emergent....then learning how to get through the rough day or couple of days when the pain is higher with using the modalities of which I spoke.

    Since I have had my 3 neck fusions...I have had some close calls and bad events. I have an almost 80 pound dog that I've had for 9 years...and just a few weeks ago I was walking him and he saw a cat underneath a car and ran at full speed which when it got to the end of the leash it yanked my arm and neck so hard I came crashing to the ground on my left knee.

    So I had some extreme pain over the next week with my neck...as well as my knee was swollen up like a softball for two weeks and could barely put any pressure on it walking!..

    So I just used lots of ice...resting....elevating my knee....I didn't go to the ER or anything as I still had all feeling in my arms so that I didn't rupture another disc...And I figured that my knee was probably really strained/sprained but wanted to wait a few weeks to see if it calmed back down if I needed to tell the Dr. But it was some excruciating pain for awhile...

    Again...it's really a personal choice along with talking to your Dr. if you feel you need ER/Urgent Care.....

    So glad it all worked out for you and you were able to enjoy a BBQ with your parents..

  • Just wanted to check in and see how your doing lowlevelrebel?
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