Well its been a long time since I have been here, nice to see some old names & surgery buddies still around. Not much new here, pretty much have hit my plateau as far as improvement and pain goes, and I am blessed to have a good pain management physician.
One thing that did come up with me recently however, that I think is probably under-recognized, is the frequency of adrenal insufficiency that can occur when individuals take chronic opiate pain medication OR regular steroid injections. After my second fusion I weaned off of the fentanyl patch to the oral equivalent of about 1/3 the narcotic dose - but was still experiencing more and more fatigue and brain fog. I had to figure things out for myself - all my docs were very, very quick to say "Ah, but you still take some"...when I knew lowering my medication by two-thirds should not be making me dumber and more tired!! A 9am cortisol and ACTH level revealed I did have secondary adrenal insufficiency, and yes gee surprise, surprise much of my energy & brain function returned when I started hydrocortisone replacement. Unfortunately, we still aren't in a perfect world, and I have had some complications of the steroid replcaement therapy.
When I brought up the issue of adrenal insufficiency with my pain management physician, he mentioned that he was aware pain medication can affect male testosterone levels but didn't realize how prevalent adrenal insufficency can be from opiate medication (he also didn't think it was from quarterly steroid shots which my endocrinologist felt differently about). When I researched it on my own it seems to be pretty prevalent though. Anyway, since this site is about patients providing insight to each other on how to improve their quality of life...I just though I would add it might be something to look into if you are on less and less meds but feeling more fatigued or brain-dead. The diagnoses is done with a simple blood test drwan at 9am.