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Back pain and pain management

Good day everyone. Ok long story short I was a professional Wildland firefighter for 15+ years. I suffered a broken back at work and have been in horrible pain since. I had a break at L5-S1 in 2011 and have been fighting constant pain ever since. In February 2012 I had a spinal fusion (partial disc removal w/cage installed, screws and rods, the works I guess) and I've also had a Rhyzotomy procedure to reduce pain with little to no success. I felt somewhat better after the fusion surgery, but in the past few months pain has steadily increased as have my medications. After surgery I could get around ok with a 50 mg Tramadol or 2 after about 4-5 months of healing. Well that turned into 5/500 Vicodin, then to 7.5/325 Vicodin, 5 mg percs then 10 mg percs and now I'm on 25 mcg Fentanyl and Tramadol for BT pain. Well as of about 2 months ago the Tramadol is a no go for relief anymore (now realize I needed the Tramadol and Fentanyl daily for ANY kind of relief daily, no longer using the Tramadol for BT pain, I need it along with the Fentanyl, and something stronger now as Tramadol is not working). I have tried both the Tramadol 50 mg and the Tramadol 200 mg ER along with the Fentanyl to try to minimize my opiate intake since I'm only 35, but I'm running out of ideas and guess I need to step up to the hydro or Oxycodone along with the Fentanyl.

My question to the forum is this, should I be looking to increase the patches to a Fentanyl 50 mcg since I always need another drug with it for pain relief or would it be better to stay on the 25 mcg patches and up the BT drug to something higher? Up the patch and BT drugs?

Also I'm under the care of a PM doctor for all this medication nonsense ( for the past year) and he has talked about a small implanted stimulator that "could" help with pain relief? Anyone have any experience with these devices? I'm open to about anything as I'm honestly nervous about being on meds this strong at age 35, since opiate tolerance only increases and the drugs will need to get stronger over time and I don't want to be on 100 mcg patches and 10 percs a day in 10 years.

Thanks much for your time, Chris


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  • First , one huge thing that I want you to take into consideration, is that I have been doing this pain management thing for many conditions over the last 20 years, so what I say comes from experience and not from anything other than that......
    I'm sorry that you are injured and that you are experiencing pain......but the reality is that once you are injured, there is no such animal as pain free ever again. The injury will always exist and there will also be some level of pain that we have to learn to make adjustments to, that we must learn to make accomodations for, and develop other ways of doing things that we always did in order to make it easier for ourselves and to learn to live with chronic pain.....notice that I said learn to live with it, because it will be there....
    The problem becomes one of how to manage what will amount to the next 30, 40 or 50 years of our lives, while allowing us to be somewhat okay. Pain management is there to help but it is not the end all , be all when it comes to how to live with this. It is a small part of the puzzle. The goal of any pain management program is to have you functioning at the best level that you can, while giving you various tools to cope with the pain levels....medications are one tiny part of that. Pain reduction is part of an overall, comprehensive pain management program. If your unmedicated pain levels are a 6, then medicated the goal is to reduce that pain to a 3.......but that is using more than just medications to treat that level 6 pain....
    Physical therapy, injections, rfa, TENS. ice, heat, massage, accupuncture, and tons of other options are all incoporated to give mulitple tools to put into your toolbox to help..
    They must be used every day, every flare up, in order for them to become effective tools. Just as you can't fight fire without the proper tools, you can't fight the pain without them either.
    The problem that I see right away is your pain medication consumption is far too high for someone who has only been in this chronic situation for two years.. What happens in another 5 years when you are at a much higher dose of fentanyl and no doctor wants to write for those meds?
    Your body will adjust to a baseline pain level- it produces endorphins to help ease pain but those are waylaid when we come to rely on opiates to treat pain.....and already you have gone from tramadol to vicoden to percocet, to fentanyl- fentanyl is the strongest pain medication out there today..what happens when that no longer works? Where do you go from here? Those are questions that you need to answer, not only for doctors but for yourself, because you are the one who will be left dealing with escalating dose increases and ultimately no doctor will write for high doses of meds when a patient shows up in their office....
    I included a link to the steps to getting chronic pain treated in my first post to you, and I hope that you will read it and think about what I said in it.....
    Your current dose of fentanyl is , while not considered technically a large amount, you are already asking about adding 'breakthrough ' meds to your dose or raising it by double...that's not a good sign.
    Breakthrough meds are only supposed to be used when the pain is spiralled out of control and all of the other modalities have been used , and failed. Taking breakthrough meds on a regular basis, whether it is once a day or several times a day only increases your tolerance (the amount of medication that your body expects to have constantly in it's blood stream) and makes the use of them totally ineffective, for those times when you really do need them.
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