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Advice needed please

Hi all

i have had chronic low back pain for the last 5 years after i had a l4-l5 l5-s1 disc herniation(only diagnosed during the summer gone), i have been on a various amount of anti-inflammatory's that have not helped one bit, sometimes i get sciatic pain down my left leg,(but has started on right leg recently too) for the last 3-4 years i am taking tramadol and lyrica for the pain every day. current dose is 300mg tram and 325mg lyrica daily. have had plenty of anti-inflammatory and local anesthetic injections without relief, also have no break threw pain medication
over the last month i have had a pretty bad flare up, i have been to the doctors looking for local anesthetic injections in the hope of some relief. i am due to see a pain management doctor in feb coming for the first time. but the last time i was at my doctor i was literally in tears with the pain, she now wants me to come off opiate painkillers and try an anti-depressant, i have tried cymbalta before for the pain but again no improvement. she is worried i have an opiate dependance, which i do(as you would do taking them for the last 3-4 years every day.) i understand she is only a family doctor and is running out of options to do from her qualifications. but why now does she want me off tramadol when she knows il be going to pain management in feb? i said i will try it out for a week, she prescribed me diazapam to cope with droping the tramadol dose, i managed to get to half dose but i dont think its working so i am back to normal dose now, i will let her know on monday when i am back to see her.
i guess im just looking for advice to see if anyone has been through this situation before and have some advice on what to do? or say to the doctor?

by the way i am 23yo male

thanks in advance


  • I'm not a doctor, but I think you should see a back/spine specialist, be it an orthopedist or a neurologist. Have you had a disco gram of your back to see where the worst pain is coming from? To tell you the truth, I'd be more concerned about the effects of 3-4 years worth of anti-inflammatories on your liver than I would be about opiate dependence. And, if she's worried about dependence, diazepam is really not the way to go -- that's one of the most addictive drugs there is! As I say, I'm not a doctor, but sometimes I think doctors are so misinformed that they end up throwing the baby out with the bathwater, or just make a problem they foresee worse without helping anything. If you need a referral, tell your doctor you want to see a back or spine specialist. If you don't need one, make an appointment before going to pain management. Some pain management places are great, but when I went, all they offered me was a spinal cord stimulator. I've not heard very many good outcomes with those and there was no way I was letting anyone implant one in me. Sometimes, you have to be the manager of your own care, as if you leave it to a busy GP, you get lost in the shuffle.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • to visit a back specialist. I see why the doctor does not want you on medication too long. Your body builds tolerance and is only masking the pain.

    I would recommend visiting a neurosurgeon or orthopedic spine specialist.
    They may send you to a physiatrist and may end up with same course of treatment but I think you need someone who really can tailor the treatment to your diagnosis. It's always good to get a fresh set of eyes.

    Good luck.
  • Scooby, Hang in there. A lot of us have been where you are. I battled doctors over and over as they made bad diagnoses, prescribed useless medications and so on . I am no doctor, but I can tell you this. If you have a pinched nerve, you might need stronger medications. I had a pinched nerve before my PLIF - "Lumbar fusion", and I needed more more powerful pain killers and antiinflamitories. I would see a spine doctor. Take care.
    Left foramina stenosis of L3/L4 (retrolisthesis)
    L2-ilaic revision fusion ( loose screws) with a laminectomy at L3 (cage at L3-L4)
    (PLIF) -@ L4/ L/5 - S1 (cage at L4/L5)
  • thanks for the advice!! appreciate it!!

    i was at the doctor and now she has said to me she thinks its all in my head!! i was never so insulted in my life by a doctor, to be in pain and have a scan prove my case and the doctor to turn around to me and basically admit she doesn't believe me, and then she said to me "Do you not think its the case somewhere in the back of your mind" I was so gobsmacked i just looked at her and said no, i don't. and that was the end of that visit.oh by the way she has said to me numerous times before that she believes it will heal on its own,so I'm beginning to think she never believed me. I'm sure their are plenty of you out there that have been told the same, what did you do? next time I'm going to her I will be demanding to refer me to a specialist .
    i got so angry tho! to be 23 in constant pain for the last 5 years is hard enough, but then for your own GP to turn around and say that is insulting to be honest and i think I'll be looking for a new GP.
  • sjoboyssjoboy Posts: 25
    edited 12/30/2012 - 7:07 AM
    Every day I see more cases of how mismanaged pain is and how many misinformed doctors are around there! Telling that all is in your head does not help a bit. Even if it were (and I'm not saying it is) that's not helpful at all, you are in pain.

    You said you were diagnosed two disc herniations last summer. How were you diagnosed? Weren't you referred to a specialist then?
  • i was diagnosed with a ct scan in a private hospital in croatia, had a mri scan here in ireland first and "nothing" showed up... i suspected something was still wrong and got a ct scan in croatia, i was with a translater and when i was been referred to the neurosurgeon she told them i was going home the next day so i didn't get a chance to see him, i was raged she had said that to them but i was delighted i got a diagnosis
  • Unfortunately doctors won't believe you until tests show a condition. Somehow they fail to consider that there may be conditions that current tests under-report. Aren't you able to get the CT scan report and pass it to your GP?
  • would be to NOT return to this doctor at all. Unless you are in some sort of HMO/managed care program, I'd avoid this person like the plague, as she seems to be just about as beneficial to your health. You also don't need her providing disbelieving chart notes to a neurosurgeon or orthopedist.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Scoobyrob, hi.

    You seem to be tolerating the Lyrica. You are on approx half of the maximum dosage. I had pain at half dosage too. I went to 300 mg twice daily and after a couple of days the pain went. You know about the side effects already I expect.

    Do you have a copy of the scans? if not, Get a copy of them and report from the scanning company. They are yours and should be provided for free. The report may actually say more than 'nothing wrong'. Research and find a good spinal surgeon and ask for a referral there. See the link, 'Finding a good surgeon', in the FAQ which is near the top of this page.

    Suggest you start a pain journal, recording your pain description, intensity, pain location, time, what you were doing beforehand, etc. whatever doctor you see in the future will benefit from this and provides evidence that is hard to blow off. They may find valuable clues in it.

    Also, you (as do all spinal patients (unfortunately, its just the way it is)) need to educate yourself with the knowledge available here to be able to describe and discuss the symptoms and options with physicians (and us if you want) in a knowledgable manner. They do not have time to teach you. Spinal patients should go there prepared. Yes, that's difficult when one is in pain, but we are lucky, we have knowledge available to us.

    Do you have numbness, tingling, burning or weakness in leg? Any abnormal walking gait?
  • My Dr. is very cautious with opiates, gives me enough for a month then off them for a month. I see a lot of Drs but only my primary care prescribes pain medication. The more you take the more you need. I'm in my 50s and have been told by Drs that my pain tolerance is extreme. Nurse told me I was the 1st patient he had seen come out of a 3 level laminectomy and not ask for pain medication.
    Pain is your friend, lets you know something is wrong and you need to back off. I ignored the pain and ended up in emergency surgery for cuada equina syndrome. I've had multiple spine surgeries and now dealing with brain tumor. T4,5,6,7 fused due to injury sustained during extreme skiing days. That pain never goes away. Last year 3 level laminectomy at T9-11 to remove tumor on spinal cord. Stumble around on crutches but happy I can still get on my feet! Once you accept that the pain will never go away you learn to tolerate more as time goes on. And having a dog that never leaves your side makes things easier.
  • Very sorry you're going through this. I would certainly say this is not all in your head. I would agree with your primary that you should be looking at non-opiate medications but don't think she is the person you should be working with. What you need to do is get a group of specialists working with you. I hardly ever see my primary anymore who told me to take holistic meds when I fractured my back at one point.

    It's good you're getting into a pain specialist as well you should be looking at a neurosurgeon. Have you tried any physical therapy? I take it you haven't had surgery yet. Once you get to the right people you should hopefully get better answers. You really don't want to keep pumping tramadol or other opiates to mask the pain but get working with the right people on how to fix the cause of the pain.

    It's definitely a long road but when oh get to this new specialist I'd make sure you get names of who he recommends for a neurosurgeon, physical therapist, etc. A specialist would know much more than you general doctor.

    Good luck to you!
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