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I Need Advice, PLEASE?!?!?

I am a 35 yr. old male that has had back problems for 5+ years. I was working for a beer distributing company 5 years ago and herniated L5/S1 so bad that I couldn't even walk. I was basically flat on my back for 1 week until my surgery day. I had a laminectomy/discectomy and did not return to the same job in fear that I would destroy my back. After I healed I was great. Fast forward 1 year and I am doing great. On a beautiful day a friend and I went for a motorcycle ride, when I was hit on the frwy. by a car that wasn't paying attention and texting of all things (I was doing 75mph). I hit the ground at an estimated 90+ mph when ejected from my bike. I walked away, but not without reinjuring L5/S1, AGAIN!. Now i have a 6.8mm herniation and a tear in my disc and the insurance company is jerking me around after 2 yrs. I have been on Norco 10/325 - 6 X a day, Soma 350mg - 3 X a day, Diclofenac 50mg - 2 X a day, for 2 yrs, plus I have been through the drugs like Lyrica, Cymbalta, Nurotin, and so on. I am at a constant 7-8 pain with every now and then a good day would be a 5. My PM Dr, put me on MS Contin 15mg - 2 X a day, and I didn't even notice a difference. What do I have to do to get my PM to understand that even taking as much Norco, Soma, and Diclofenac a month it just doesn't work? I understand the DEA and all of the dangers related to other meds, but I just want to feel as normal as possible. PLEASE HELP.


  • sandisandi Posts: 6,302
    edited 08/28/2012 - 11:24 AM
    Most surgeons want to see the patient undergo surgery if there is nerve compression or damage that is mechanical and can be corrected by surgery and pain management is no different. Pain medications are just supposed to be one small part of a pain management program. Physical therapy to strengthen core muscles, proper lifting, bending techniques, biofeedback, swimming, ice, heat, massage and accupuncture can all be helpful as well and will help to bring pain levels down.
    Soma is a medication that many doctors are no longer using due to the addiction problems that some users have developed. Norco is a short acting or immediate release medication and taking it 6 times per day is a lot for someone who has been on it for two years. Which is most likely why he converted you to a longer acting pain medication such as MS Contin. You have to take less pills per day and long acting or ER medications provide a steadier blood plasma level, which stops the constant ups and downs that come with using short acting pain medications. You may need a dosage adjustment but most PM's in my area prefer that you give each adjustment or new medication at least a month's trial before they will adjust the dosage. In that time, it allows your body to adjust to the new medication and allows the patient to see if/how the new medication is going to work.
    I would suggest that if you have been on the new medication for a period of time and you are finding that it doesn't work well at covering most of your base pain levels that you discuss that with your pain management doctor and ask him for his recommendations.
    Good luck
  • LovetrotravelLLovetrotravel Posts: 296
    edited 08/28/2012 - 2:44 PM
    I am sorry to hear about your pain issues...

    I'm a bit confused on your comment about the insurance company jerking you around? What is this in reference to? Are they refusing to pay for treatment? Do you have a Board Certified Neurosurgeon or Orthopedic surgeon saying you need another fusion and they won't pay?

    As far as the pain meds...as the other poster mentioned...there is so much more to pain management then just continuing to tirate up the dosage of the opiates. And yes...most PM Drs. want to try a new medicine for a month or more and have you use other modalities to help with your pain as well.

    Have you gotten any cortisone injections lately? Or an epidural injection?

    How about physical therapy and/or traction? Have you done this as well for a month or more?

    Do you at least try to walk daily for exercise and do daily stretches?

    The key for chronic pain patients is living with a 5 or so on the pain scale..I am a 5-7 depending on the day and activity and haven't had a raise in opiates for more than 3 years as I would rather deal with more pain than continue to keep upping my dosages.

    The best thing to do is keep a pain journal the next weeks until you see your Dr. again. Write down everything you are doing during the day from the moment you wake up until bed. What hurts worse...what makes it better....what is your pain level after taking each pain medication...After using heat or ice....etc.

    And then bring this journal in to discuss with your DR. and just ask them what they think. This way they can decide what to do from here...If you just go in asking for more opiates...this doesn't come across well at all.

    You say you have "been through" the nerve pain meds like Lyrica, Neurontin and Cymbalta...Why are you not on one of these now? All of them...like any medication has side effects but usually after a month or so they get manageable. But anyone with disc/spine issues should be on a nerve pain medication as opiates do not work at all for that type of pain.

    And if your PM is expecting you to have more surgery soon....then I would think he wants to keep things level right now so pain management during/after surgery will be easier...

    Where do things stand on that front?
  • Yes, as far as the insurance, they are not wanting to pay for any more treatment. I have been through PT and seems that it didn't do much good. As far as being on nerve meds, I couldn't tell the difference with or without them. I have had 2 ESI's and they only last about 2 weeks. My PM was talking about doing an implanted neuro-stimulator, but that's like $50K, and here we are at the insurance company again. I have a desk job, and I do get up and walk/stretch every 45 min. or so. and also do mild exercise, walk, and swim ro help. I guess my PM just hasn't got me dialed in yet. I was hurting so bad one day that a guy I know that was injured bad on the job gave me 1/2 of one of his meds that he uses for breakthrough. I know it's not good to take unprescribed meds, but when you are nearly in tears and can't hardly move, you get desperate. I took 1/2 of an Opana 15mg and withing 10 min. I was almost pain free at like a 2-3. I was amazed, but didn't take anymore in fear, since it wasn't prescribed. I am going to have surgery in the future, but how far off is unknown (Ins. Co.) I don't want to tell my PM that I took that, but how do you explain to them that, "WOW", I was almost pain free for at least 8 hours. If I tell my PM they may discharge me, and I can't handle that. So, what to do? I have another appt in Oct. and I will keep a pain log untill then. I hate taking all of these meds, not to say the cost of them. I just wanna feel normal again, but don't all chronic pain patients...
  • While I appreciate you being honest about taking your co workers medication...just please know that it is actually a felony to do this. For both you taking an illegal drug and him giving it to you. It's also extremely dangerous as you could have had an allergic reaction or a serious side effect....And if that was an Opana ER....it could cause both you or he an overdose with the medication as those are not allowed to be split into two.

    And lastly....if your PM Dr. called you in for a random urine test as they are allowed to do....if they found this medication in your system...then you would be dismissed immediately from their practice and a mark on your medical records that you abused prescriptions and would likely not find another DR. to ever prescribe opiates again...

    I'm not trying to be a jerk here, and again..I appreciate the honesty...I just need for you, and others new to PM who read this, to know just how serious and dangerous it is in so many ways and can ruin someone's future.

    If pain is that bad for you....then you need to call your Dr. immediately and go to the ER....Believe me...I've had excruciating pain and have been living with chronic pain for 11 years now.

    It seems like if you have insurance...then if there is something that needs to be done like a procedure or treatment...if your Dr. writes to the insurance company then they should cover it...What have you tried to do that they flat out refused?

    As I wrote...start keeping a pain journal and then you can take this into your Dr. at the next visit...(why is it all the way in October? Can you call and put yourself on the cancellation list to get in earlier?)...you can then discuss with him your journal and he can see that your pain levels are not being handled well.

    You can ask him what he recommends you both can do to help it get to a level 5 or so. The main thing is not asking for a higher dosage of opiates. It's about being open to whatever he suggests and this may be part of it.

    How long did you try each of the nerve pain meds? If it's been years since you tried them...then I would try them again as your nerve pain may be getting worse and that's why your pain is getting harder to handle. Again...most everyone who has spine issues is on a nerve pain med as I wrote...an opiate does not touch that type of pain. There is no way the insurance company will ok a SCS unit if you aren't even taking any nerve pain meds.

    And if you've been on the Soma for awhile...then try rotating to another type of muscle relaxer. As I mentioned...since I've been in PM for so many years...my Dr. and I rotate medications every few years so that we don't have to keep upping the strength.

    I really think that if you are a candidate for surgery that a Board Certified Neurosurgeon you are seeing or a BC Orthopedic surgeon would be able to show the insurance company you need surgery or other treatments.

    I wish you luck...

  • TaurianTTaurian Posts: 8
    edited 08/29/2012 - 12:42 PM
    I didn't realize that could be a felony for taking his meds, now I know and won't do that again. It wasn't the ER on the Opana, it was IR, but worked. Anyways, I will have insurance in a few months as I had to switch jobs due to my pain, I was working retail and all of those hours on my feet killed me. I have had a L5/S1 laminectomy/discectomy 2 yrs ago, but now Dr. is talking a fusion, which I heard isn't good at all. I know it sounds crazy, but I'm just leary when it comes to surgery on my back (horror stories). I will definately keep a pain journal, as a #1 priority. I am always open and honest with my PM and we have a good patient-Dr. relationship. I'm just glad that I found a forum where people care more about how to help with pain issues than just talk about getting stoned off meds. I wish I didn't have to take 1 pill. My wife wonders why our sex life is in the tank and why I seem depressed, but I guess pain will do that. Oh, the last time I took nerve meds was about 3 months ago, we went through all of the major ones. Maybe I will ask my PM to put me back on some to see if it will help. I just wanna be normal again, but I guess thats not possible after hitting the ground @ 90+mph from some stupid illegal that didn't even have a DL. Gotta love the USA for that...

  • I agree...this is a great forum where we all understand what it's like living with chronic pain..

    I have had 3, two-level, cervical fusions..The last one they went in from the front of my neck and then turned me over and went in through the back to really shore me up with lots of titanium plates, rods and screws...

    I still have severe herniations in my lower cervical/upper thoracic and two in the lumbar area but will not do another fusion unless it's an emergent situation.

    Just keep in mind that they are thousand upon thousands of people who have had fusions and are doing just great and pretty much pain free or very limited pain and out living their lives. What you find on the internet and boards like these are obviously people who have had issues with surgeries or other health issues that cause chronic pain. So....if a fusion is needed for you...then just make sure you have a great Board Certified Ortho or Neurosurgeon and hope you will be one of those with a great outcome!

    I am one of the stange ones that when I was married or in a relationship after my divorce....I've always kept sex as a priority and a way to release great endorphins to help my pain! LOL...We just found ways that it wouldn't injure my spine in any way....I have asked my PM and Neurosurgeon and they said just be careful but keep enjoying it!

    So I also think it would be good to maybe even get checked for low levels of testosterone as this can happen as well with taking medications. And obviously I do understand that there are times you may not feel up to being intimate...try to work with your Dr. about this to do safely...

    And if you need to...you may even need to seek out counseling for the emotional toll that chronic pain takes on you. (collective you). I went after my divorce but stayed on for 6 more months working on ways to come to terms with my pain. This is how I learned, working with my Neuro...to make sure I didn't do things that could injure me further...but to not curl up and hide inside or from life as laughing, loving, and doing things that bring us joy are so important for our well being. Some people even need to go on an antidepressant for awhile as depression is very common with chronic pain..So please address this issue if need be and know you are not alone.

    Same thing with making sure you don't smoke, don't drink except rarely, don't drink a lot of sodas (even diet), or lots of caffeine...but drink lots of water each day. As well as eating well and maintaining a healthy weight. My Neuro won't even do any surgery on those who smoke!...

    That may all not apply to you..but just thoughts in general to try and help...

    I truly hope that you can talk with your Dr. and he will work with you on your pain levels..
  • Bro, I hate to tell you cause I am in the same position. I injured the same disc and had a micro that did not help at all. They never listened to me when I told them I was in pain and the meds were not helping. I have now had my second surgery( a fusion) and I have just traded one pain for another. I started on lortab 7.5 and flexaril, then lortab 10, flexaril and gabapentin and now I take percocet 10, oxycontin 20mg, flexaril, gabapentin, zanaflex, cymbalta. That is what I take now but I have tried everything under the sun to get relief and like you I found nothing. Truth is, the doctors cant just prescribe the strongest meds right off the bat for you because your condition(and mine) are not considered that serious in the "big picture". The DEA makes it difficult for doctors to do their jobs now and this is what we have to deal with.
    I know it is a big deal to you just like it is to me, have they mentioned surgery because it could be a good option for you. I was able to rid myself of most of the nerve pain after my fusion and now I deal mainly with the back pain, sometimes I can deal with it and sometimes it is pretty bad but we paly the cards we are dealt.
    The pain killers can only do so much, you are on a good amount and I dont think more will really help. I stopped going up in doses of mine because everytime it increased, I did not notice any relief. I do not want to end up a zombie and completely dependent on the medication so think about it before you go up in amount too much. I am not saying you do not deserve to be pain free but some of us will never be pain free and mass doses of painkillers only mask it. Sorry you are dealing with this.
  • LovetrotravelLLovetrotravel Posts: 296
    edited 08/30/2012 - 8:49 AM
    Are you still on all those medications? Both the Flexeril and the Zanaflex (muscle relaxers) as well as the Gabapentin and the Cymbalta (nerve pain meds)? I'm not sure why you would be on two different nerve pain meds if you say you don't have nerve pain anymore after the fusion...

    Same thing with being prescribed two muscle relaxers at the same time...That is very unusual for a Dr. to do and along with two strong opiates....this is where people can accidentally overdose because of 4 medicines that cause respiratory supression. I hope you also aren't on any sleep medication that you take at the same time...

    Obviously I am not a Dr...but I've been in PM for over 11 years now and had 3 fusions. I was on Cymbalta for a few years until I weaned off as I was also lucky to not have any more major nerve pain. So that is why I'm surprised if you are still taking two meds when you say you don't need to...
  • After going to my GP Dr. he told me I needed to see a rheumatologist (spelling), because of some previous blood work. My cousin, wo is 40 yrs old has RA and now I'm finding out I may have it to. Maybe explains my hands, knees, and ankles hurting. I just thought it was from nerve damage from my motorcycle wreck. This seems to be a game changer for me, not sure what to think. Would RA increase the pain level in my back? And what is the outcome for RA? I know I have seen my cousin where she couldn't get out of bed before. Kinda scared now. Anyways, I understand about the DEA stuff and all of the pill mills that open up. My PM Dr. has been around for 25+ years, and does other things than just meds. He has done 2 ESI's on me with no really good results. I guess I realize I am on alot of meds, but whats the use in taking them if they don't help? Sometimes I just wanna drive my car into a wall so they will fix me when I'm broke, but then what good would that do, I might die. Tjats just how bad the pain is, and I'm not even that bad to some ppl here, but everyones threshold for pain is different. I am at a constant 7-8 most of the time and with all of my meds maybe a 6. If I could get to a 2-3 I would be happy, but don't know if I'm asking to much.
  • Did the Dr. say that they saw the markers for RA in your bloodwork? Even then...RA is is pretty hard to diagnose as there isn't one definitive test...Kind of like Fibromyalgia which you could have as well..

    There are all different levels of this and many different types of medications or treatments so try not to get too far ahead of yourself or compare yourself to your cousin. This will only stress you out which causes more pain..

    For anyone with chronic pain....yes...taking enough meds to get to a 2-3 is not as realistic...I live with a 5-7....5's are the good days and then the 7's are bad ones...

    I have stayed on the same dosage of medication for the last 3 years....As I mentioned....pain management is all about a complex approach and if I were to take more to get to a 2-3....then not only would that be where I couldn't drive safely and it would be where my tolerance would be so high I'd have to keep upping the dosages all the time.

    With chronic pain....pain is just part of our lives...you find ways to adapt and still live a great, fulfilling and joyful life..

    As I wrote in my other post...you may want to seek out treatment for the emotional side of living with chronic pain...

    And if you are staying with this PM Dr...then either try to get into an appt. earlier by a cancellation or just wait to speak with him about your pain levels then...

    Again...try not to worry too much about the Rheumatologist....

    Along with my previous fusions and severe herniations I have now, I also have a Pituitary brain tumor, a Morton's neuroma again in my foot which I've previously had surgery on. I have terrible knees that have had many surgeries, as well as 5 laproscopic abdominal surgeries removing my appendix and numerous ruptured cysts that cause excruciating pain. This has caused terrible adhesions...

    My point is....many of us have more than one pain issue....and you just have to work with the Drs. to find the absolute best comprehensive approach that goes beyond medication to live a good life. Seeking out counseling is very helpful to get mentally adjusted if this is going to be your life and being more realistic on what a long term pain level goal is...

    I do feel for you...it's not easy!...Hopefully you will find some fun things to do this holiday weekend and enjoy yourself:)
  • Great thread,Thank you to all those who posted...., keep them coming
  • I have been doing research on why the MS Contin isnt working, which alot of people say. I found that some people say the Opana ER is more effective and lasts longer (from what I have read). I am going to ask my PM if this is a med that I could try and see if it works, if she says no, then so be it. I just wanna be able to sleep and live half way normal, as do we all. I am not a "pill seeker" just want something that works. Since Opana is fairly new maybe it will work? I will just be up front with the PM and see what happens. She was gonna put me on some patch that stars with a "B", but insurance would not cover it, $400+ for 1 month supply, thats why she did MS Contin.
  • If you have not already. He/she will make sure the at fault driver pays, as well as your personal insurance. I just went through that after a MVA in 2010 two months after my second fusion surgery I was T-boned. My health insurance refused to pay any of the medical bills till it settled this spring.

    Be honest with the pm that the meds are not strong enough. Simple. He should bump your dose.

  • An attorney, that is. We are at a deadlock with the ins co. they dont wanna pay anymore, and my attorney is on top of it, but u know ins co's. The pain is horrific! Strange, it feels like the inside of my knee is gonna explode, especially when its cold, along with my back, all the way to my toes. It's like nothing I have ever felt! But u know what I mean...
  • You may need to see a different dr. Perhaps a NS over a OS and ask about a different nerve pain med. I know all about nerve pain. Sorry it really sucks. Maybe you will be a candidate for surgery eventually- when you get new insurance and it settles?

    Feel better,

  • LovetrotravelLLovetrotravel Posts: 296
    edited 08/31/2012 - 7:11 AM
    Taurian said:
    I have been doing research on why the MS Contin isnt working, which alot of people say. I found that some people say the Opana ER is more effective and lasts longer (from what I have read). I am going to ask my PM if this is a med that I could try and see if it works, if she says no, then so be it. I just wanna be able to sleep and live half way normal, as do we all. I am not a "pill seeker" just want something that works. Since Opana is fairly new maybe it will work? I will just be up front with the PM and see what happens. She was gonna put me on some patch that stars with a "B", but insurance would not cover it, $400+ for 1 month supply, thats why she did MS Contin.

    I'm not sure what you mean when you say "people" have said MSContin doesn't work? You have to realize that a lot of what you read online is people complaining about things....From medication, to having surgery, to new cars or refrigerators.....you will find close to 92% negative opinions...People who are happy with things usually don't go online to post.

    So...morphine has been around since the 1800's....And most every synthetic opiate is derived from it. Opana is one of them and is not a "new" medication. It's been around since 1955.

    MSContin works well for many people...including myself. I have been on MSContin for the last 3 years and haven't had to up my dosage in all that time.

    I know you are really pressing the Opana here because you took that pill from your co-worker and were "pain free" for a bit...As I mentioned earlier...this is not what chronic pain management is about...It's not about pain free...

    It's about being at a 5 or so and using every single one of the modalities that I mentioned. It's not about seeking out an opiate that will be the way to bring your pain levels down. By solely relying on this...your tolerance will be so low you will need more and more and stronger and stronger dosages...

    Opana is exactly the same time release as the MSContin..8-12 hours..And it is dosed every 12 hours or every 8 depending on the DR..So it doesn't last any longer...

    You can certainly try and ask your Dr. about Opana...but it is going to raise a red flag that you are asking about a specific medication out of the blue and why this one as it's similar to the MSContin....She may even suspect that you have taken this without a prescription and that is why you are wanting to be put on it....If she asks you, "Why are you choosing that med?"....What are you going to say? My PM and I are friends outside of our appts. and this is one of the red flags he mentions about patients when they come in asking for specific narcotics....

    I'm really not trying to give you a hard time but we've been trying to help you by providing a lot of information about pain management...you seem to be a bit too fixated on the opiate part of this which is just one of dozens of modalities for treatment.

    Obviously your choice....I am just trying to help you get the best possible treatment long term...
  • TaurianTTaurian Posts: 8
    edited 09/01/2012 - 4:01 AM
    I appreciate the help, I really do. I talked to my PM over the phone and I explained the situation. What she said was that the Norco 10/325 probably isnt working cause I have been on it for so long. When I go she will switch me to something else. I didn't realize living with a 5 is like a normal thig. I do swim alot for a no impact exercise, which helps some. As you have advised I am not going to ask for a specific med, just see what happens. I have been through PT/Chiro, but the chiro adjustments seemed to increase the pain. I tried to move my date up, but they are booked and he has procedures scheduled, so I have to make an appt way in advance. I will ask her other things I can do to help other than pain meds, and hope for a 5. I just cant live with a 7-8 all of the time. I am also going to go to therapy for "livin with the pain" and see how that goes. I will update when I go to Dr. Again, I thank you for the help, it is greatly appreciated.
  • LovetrotravelLLovetrotravel Posts: 296
    edited 09/01/2012 - 12:31 PM
    I'm thankful that you realize I truly am just trying to help..I apologize for being blunt at times...I would just hate for you to accidentally get yourself into trouble by doing something and ruin your chance at getting good pain management...It's hard typing things online, especially when we all don't know each other...

    And your Dr. may very well raise your dosages or change to another opiate once you explain that you are not getting out of being in a 7-8 on the pain scale after trying everything in addition to the medication.

    I know it's so hard to get adjusted to living with chronic pain...when we have an acute injury....we expect to have treatment and have our pain go away completely...It's a totally different beast dealing with pain 24/7.

    That's why so many people end up in counseling for awhile and/or on antidepressants to help manage the depression that happens to lots of us.

    Personally I wouldn't include the Chiropractor into my treatments with having spine/disc issues. It's pretty dangerous with even the tiniest adjustment that could damage your nerves permanently. Again..certainly your choice...but my own Neurosurgeon has said that he is so glad I never went as I could have been paralyzed since my herniations were so severe..

    Swimming/aqua therapy is definitely a great thing to do, as you mentioned, being low impact.

    I really think that if you approach your Dr. as a "team" player in that you are looking to do anything and everything else in addition to your medication to help lessen your pain, that you will get the best response.

    Look forward to hopefully hearing a great update from you after your appt.:)
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