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Breakthrough Pain

I saw my PM this week. He got the letter I sent asking him to reconsider his policy of not giving breakthrough pain medications. He thanked me for feeling comfortable enough to approach him with my concern. Long story short, he will not change his policy.

I'm limited to maintenance medication only now. To try and calm my back down, I've done two rounds of cortisone. I am scheduled to get facet join injections L1 - S1, both sides. Roughly ten shots at one time. He does not pre-medicate anyone for injections so I just lay there and take it. I've had two levels at one time and it was ok. But, I've never done 5 levels at one time.

If anyone else has, please respond and let me know how much discomfort to expect. I have a lot going on at work right now and I need to go back after I get the shots (if I can move!).


Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2


  • When ever I got the shots , I always called my PC doc and she gave me adivan to relax me.They also numbed the area before they gave the shots.Good luck I hope the shots work. kathy
    Kathy B
  • I actually just posted about this on another thread- I have had L/2-S/1, both sides, done at once without sedation. It was not near as bad as when they did the RFA's without sedation or drugs, but it still was really painful. I think it also depends on your Dr. Obviously those with more experience are better at understanding the patients anxieties, and tend to be more gentle. It also depends on how sensitive you are, and if you wiggle/shake/etc.while they do it. That has been just my experience, of course. I will never understand why some Drs won't use sedation! Drives me CRAZY!! It would make their job easier in cases like mine, where I already have a condition that causes shaking and jerking. Had I been able to relax, they probably wouldn't have needed the extra 3 people to hold my 115lb body still so he could stick me in the right spot!!

    I hope you have great success, and that it isn't any worse than the others you have had! Good Luck!
  • I have a pretty high pain threshold, but I don't like being in pain when I don't have to be. I am going to call my PM and ask for a small "cocktail" for the event and if they say no, I'll just wear my Superman under britches and man up;)

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • RangerRRanger on da rangePosts: 805
    hey Keith,
    I would really hope they would numb you up good before they inject your facets. A little more than 2 years ago I had facet block injections to my cervical spine. I do have a high threshold of pain but halfway through the procedure she could see I was tensing up and asked me if I wanted some more shots to numb the area. I think it is hard for the Dr to administer the injections if we are all tensed up. Not a bad idea to leave the "sallypants" home Keith and grab the Superman spandex.
    Good luck, hope you get some good pain relief.
  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 118
    EMS Guy, if I were you, I would find another PM doctor. From your posts, it sounds like your PM does not consider his patients and their comfort. There are plenty of PM docs out there they will help you but I know it is a real pain to find a new PM doc and get back into a regime with him or her. My new PM doc had some pretty nasty things to say about the amount of pain meds my prior PM doc had me on. Of course, the new guy is talking about a lot of the baloney stuff like bio-feedback, etc. I'm way too logical to pretend with that stuff. So far though, I have had some tough days and nights but I'm going to see how well he does with helping me manage my pain before I think strongly about a new PM doc.

    If you let us know where you live, there may be someone in your area that can recommend a PM doc for you via personal email as the pain board controllers are overly aggressive with deleting your posts if you provide names. Good luck in finding a new PM doc.
  • He actually was just published in a medical journal about prescribing less medication with more interventional procedures. He also is just about to be named the President of the Greater Louisville Medical Society. He is a highly respected doctor in our area. KY just passed a major medication reform Bill. PM's are being heavily scrutinized and face major fines for both prescribing to many meds AND too few meds. So, the problem is finding the happy medium.

    Laws like this happen when lawyers play doctors and some doctors do stupid stuff like running pill mills instead of real offices.

    I get a 5 level round of facet joint injections tomorrow morning. Hopefully, that will help!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I'd find a doctor who would help you control your pain, not just what he thinks needs to be controlled. I would be freaking out because without breakthrough, no more work for me. Titles and awards are great but who are they helping? Doesn't sound like you.
  • I had my procedure and thank goodness they gave me some Versed. Even with it, it hurt like crap. I got both epidurals in L1-L3 and Facet Joint Injections L1-S1.

    Then, they tell me I'm coming back in two weeks for the second round. Holy Crap, I didn't know this was going to be a series of shots. I will say I am feeling better. I'm not taking as much medicine as I was before the shots.

    I'm going to the mountains tomorrow, so this will be a real test as to how good they are going to work. I'm keeping my meds in my fanny pack to be on the safe side! No serious hiking, just a couple mile walk on fairly level ground. No sense pissing my back off all the way right after getting round one done.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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