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What do you consider adequate pain management?

Hi all. I am just wondering what you each consider adequate pain management? Is it the ability to do specific things, how you feel, etc ?
I have another appointment scheduled with the pain management clinic because I do not feel my pain is under control. I know I will never be pain free, but I would like to be able to do basic daily activities without crying. My pain management goal is to be able to get an adequate amount of uninterupted sleep, be able to do basic grocery shopping, and sit comfortably for 45 minutes. Reaching these basic goals seems almost impossible at this point in time. Am I setting my goals too high or expecting too much?

I am currently taking: hydrocodone 5/500 3 times daily, Flexeril 10 mg nightly, Nortryptiline 20 mg nightly, Prozac 20 mg nightly, Ibuprofen 600 mg 3 times daily, nabumetone 500 mg 2 tabs twice a day and benedryl 25mg nightly. I have to take the benedryl because I get a histamine release reaction at night with all of my meds and it makes me itch like no tomorrow! I feel like I spend so much money on prescripion medications and I am getting no traction. Grr, ok I will quit ranting and look forward to seeing the different perspectives on what is considered adequate pain management.
DDD & spinal stenosis L4-S1 since 2001
30+ injections, PT, massage therapy, accupuncture, TENS unit, meds, etc but no surgical intervention
I am not a surgical candidate


  • dilaurodilauro ConnecticutPosts: 9,841
    edited 08/22/2013 - 4:14 PM
    and it will vary from person to person.

    But by pure definition of what pain management should do:

    Improve the quality of life for those living with pain

    As you can see , that is a pretty broad statement. To me, pain management should include all the various forms of medical treatment to help a person to be able to do the day to day activities they did before. That could include everything from Physical Therapy, Acupuncture, Injections, Traction, Tens, Aqua therapy and more. All the conservative treatments available. So will even incorporate some of the Eastern medical ideas such as Deep Tissue Massage, Aroma Therapy, Meditation, etc.

    I look at the pain management discipline as the vehicle to allow a person to function and to also provide a path in which the person can reduce or eliminate pain medications as a way to function.

    Like I said at the beginning, its a difficult question
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • sandisandi Posts: 6,343
    edited 08/23/2013 - 3:20 AM
    Have you had surgery yet? What is the cause of your pain? I usually have some idea of everyone's story, but I can't remember yours at the moment. Proper pain management goals are usually a reduction of 50% of your unmedicated pain levels.......now, depending on if you've had surgery, how long ago or how recent it was, alters what would be considered reasonable goals for now.
    What would you consider your daily pain levels to be at their best and at their worst?
    Sleep is one of those things that tends to suffer a lot , when dealing with chronic pain but there are things that you can do to help yourself, and really is not a part of 'pain management'- melatonin is an over the counter, naturally occurring substance in your body , and is available in the dietary supplement section of any store...melatonin helps you fall asleep and stay asleep and doesn't suppress your respiratory function. You can take up to 10 mg, and it does not give you a morning after fuzziness or lack of awareness that comes with using sleep aids.....L-Tryptophan is another naturally occurring substance in your body that helps you sleep. It is found in turkey and other food stuffs and is what causes people to take a nap after TDay dinner (LOL). L-Tryptophan and Melatonin can be used together to help you sleep better and longer.

    Sitting times and increasing your endurance, depending again on whether or not you have had surgery usually comes from slowly increasing your time spent sitting by a few minutes each day......at first I couldn't sit for more than 5 minutes at a time, but slowly, over time, I made myself sit a bit longer each time I sat and slowly I noticed there was a bit of improvement in the length of time that I could sit without making the pain levels shoot through the roof..especially if you have had surgery, this tends to improve as time goes on and there is little that the doctor can do to increase that using medications. A comfortable chair, a foam pad or soft blanket/chair pad all might be something worth considering to see if you can find some way to make sitting more comfortable and increase your time sitting slowly.
    As far as grocery shopping, slowly increasing your time spent walking, will help, using the shopping carts to lean on( I looked like a 150 year old woman at first- and still do on some day only now I look like a 90 year old......LOL) helped me to increase my stamina and slowly I was able to get the grocery shopping done without having to take someone with me all of the time. It's not to say that some days I don't need someone or that these things work all of the time but they do, combined all add up.
    As far as pain levels go, a reduction of 50% of your unmedicated pain levels is considered to be good pain management. The rest comes from learning to live within our new limits and pushing back against them some, to try to get back some of our life as we knew it before our physical problems began.
  • Thank you for all of your input! I have a 14 year intermitent history of low back pain and sciatica. My most recent MRI shows I have degenerative disc disease with nerve root impingement at L4/L5 and L5/S1 with spinal stenosis, loss of disc height at L3/L4, L4/L5, and L5/S1 and i am beginning autofusion at L4/L5 and L5/S1. This flare started 02/2010 and just hasn't stopped. My pain flares used to be very random and would last 2/3 months max. I guess I am just wondering if I am expecting too much pain control. I have had physical therapy, massage therapy, use a tens unit daily, stretch daily, try to walk as much as I physically can, I am trying accupuncture, medications, etc. I wasnt sure what is considered to be adequate in the pain management arena. I am well aware I will never be pain free. At this point I will settle for somewhat functional and being able to get some good sleep!
    DDD & spinal stenosis L4-S1 since 2001
    30+ injections, PT, massage therapy, accupuncture, TENS unit, meds, etc but no surgical intervention
    I am not a surgical candidate
  • sandisandi Posts: 6,343
    edited 09/21/2013 - 6:42 AM
    If you have nerve root impingement and stenosis ( canal or foraminal?), has surgery been suggested/recommended?
    What about injections? Swimming? Yoga? Anti-inflammatories might also help some....
    Depending on the severity of the nerve compression and stenosis and it's effects determines whether surgery is warranted or not. If it is recommended, you might want to consider it since some of the pain could be resolved by relieving the compression/stenosis....
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