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Pain medication/pain management

I had a L5-S1 fusion (PLiF) on 11/26/2012. Although I have cut down quite a bit I still feel the need for pain medication 2 to 3 times in a 24 hr period. I had read prior to surgery that most patients are done with prescription pain meds by the first month. I had my first 6 week post op visit on 1/8/2013 and the doctor continued my full restrictions for another 6 weeks. I really thought this last week would be my last, but I feel like if I can't get my pain under control I can't get my walking goal met and generally am not as able to function as well. Does anyone have any input? I don't want my doctor to start thinking that I'm drug seeking or not trying to go without it. I guess I want to know what's normal? Is there a place on this forum where I could see a lot of discussion on this? I'm new to this forum stuff so any advice is great!



  • Ice728:

    Each of us are different. In January 2011 (2 years ago) I had a TLIF (L4-S1). Prior to that surgery my pain therapy consisted of a heating pad and OTC nighttime type aspirin - no narcotics.

    Immediately after my surgery I was taking percocet 10/325 (as needed for pain not to exceed 6 in a 24 hour period). About two weeks later when that prescription needed refilling it was lowered to 5/325 (as needed not to exceed 4 in a 24 hour period). For about 10 months that was OK, but I noticed that my pain always stayed ahead of my medicine. So, we increased the dosage back up to 10/325 and on some days it doesn't stay ahead of my pain.

    I am still under the direct care of my surgeon. He wants to declare me a nonfusion and redo the whole thing. I am a procrastinator, but I am either going to have to submit to another surgery or allow him to refer me to pain managment. It's not his expertise and I know that. However, I dread the process of linking up with another doctor and starting all over.

    Anyway, as I stated. Each of us are unique in our pain thresholds and sensitivity to medications. Your relationship with your doctor (general practitioner, surgeon, or pain manager) will establish the credibility of your condition. Society has cast the shadow on those who must take narcotic medications, not you.

    Welcome to the Forum, and good luck.

  • I agree everyone is different. I had my latest fusion in June was off pain meds by August. I just had to call my NS to get some cause I have a herniated L5-S1 that is pinching some nerves off and causing me some pain. I am going to seek if my NS will prescribe me something different or stronger. If you have a good relationship with your doctor, they will not think you are a junkie or pill seeker. Just explain the situation to them.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • Thanks so much for the input.
  • I am feeling like I am falling through the cracks pain management wise. I had a primary care doc for about a year and a half when I noticed my pain was increasing everyday, so we got x-rays and showed scolioisis so the primary care doc started me on Neurotin and flexeril, they worked a bit but the pain was still there so the primary wrote for 800 mg of ibuprofen (which I was already taking OTC) so that's when I changed primaryies the next primary saw me for 5 minutes and basically passed me off to The Spine Center. So the Spine doctor did his exam changed the Neurotin over to Lyrica and sent me to "interventional pain management" This new doc ordered MRI's and did trigger point injections 3 times (all 3 failed) he said because it was such a large area in the thorasic region. New MRI done when right side weakness was noted (still nothing done to control pain as far as medication) New MRI revealed cervical stenousis so pain management doc preformed a right dervical medial branch block (very painful and no results except for increased pain) now the pain management doc discharges me with Norco 5/325 mg one every 8 hours. We tried Tramadol 2 every 6 hours but no relief. Discharged and referred to a Neurosurgeon (who does not write scripts) for more x-rays and testing but nothing for the pain. Pain management doctor said for a refill on my Norco I would have to go back to my primary (who stated before he sent me to the spine doctor, I do not write for pain meds) So once again I will need to change primaries, I feel like I sound like a drug seeker but I just want something to stop the pain. Since I am currently appealing social security for disability and the state that I live in for Medicaid I feel like I am being pushed into all these tests without ANYONE addressing the pain issue. And just being passed along from doctor to doctor. I feel like an idiot when Going to a new primary, is he going to look at me like someone shopping for pain killers? I just want help!!! Tried physical theraphy and it only aggrevated the issue of pain, tried a TENS unit and even that made the pain intensify. I received a letter from the disability determination board for a mental evaluation to be done tomorrow. Am not sure what that is about, all I know is that the medical bills are starting to pile up and even though I get a discount for low income they are pricey. Any help, advice, support words of wisdom will b appreciated
    Scoliosis in t-3, t-4, and t-5, degenerative cervical/spine disease, and sensory poluneropathy
  • I have found the mental exam to be standard before any spinal electrical implants.Why they want one from you is a question.My suregon refers people to a pain management clinic after 3 months.He says he will not write for more than 3 months.I have found a pain management doctor that takes Medicare and writes what I need.For cash patients he is way expensive.Truthfully,you do not want to become dependant,it is so easy for it to happen BUT I do realize that sometimes it must happen.
  • doubleusnddoubleusn Posts: 122
    edited 01/30/2013 - 6:00 PM
    IMHO, thanks to the great fears out there, most spine patients after surgery are under prescribed.

    You want to keep patients just above the pain threshold to keep them moving, thus getting stronger, thus making their needs go down with success.

    Not doing this keeps people in pain longer and on meds even longer.

    If only society wasn't calling the shots vs good qualified pain care docs/physiatrists.

    Everybody is over concerned with claiming false victory in 3-6 months, thus they unknowingly create situations 12 months out that are still failing people.

    Hysteria over science these days, sadly :-(
    Jun 2011 -TLIF @L5-S1
    Mar 2012 -NonUnion @L5S1
    May 2012 -Multi Level Discography
    July 2012 -XLIF 2Cages @L3L4/L4L5
    Aug 2012 -All New Hardware @L34L45/L4L5/L5S1
    Mar 2013 -FBSS = Pain Management until they figure it out.
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