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pain management appointment today

so, i had my 3 month appointment with pain management today, i always just see the nurse practioner. they had me take a urine test right when i came in. so after that the nurse practioner comes in, and proceeds to tell me that the doctor has reviewed my file, and they will no longer treat me, because there is a solution for me, the microdiscetomy that the neurosurgeon i saw about 2 years ago recommended. she explained to me that narcotics, are for a last resort, usually after surgery, and nothing else has helped.
i understand that, narcotics are not good for me, i take 150mg of nucynta er every 12 hours, they started me at 50mg. i also take 300mg of gabapentin 4 times a day, and 1 200mg of celebrex a day. she said i could talk to my regular doctor, and see if he would prescribe the nucynta, or switch it to vicoden, otherwise they will just wean me off. i told her i am scared to death of surgery, because i have a physical job, and must lift things at work, i would be very worried of reherniating. i do stretches every morning for about 45 minutes to an hour. i also bought and take vitamin b gummies. also i rarely sit, i either stand or lay. i feel very good and have for some time. i do not know if its the nucynta er, the stretches, or all of the above. but i feel well enough, that i dont need the surgery as of now. i explained to my wife the whole situation, i will not lie, i was upset, and in tears. and she just tells me i must be addicted, by the way i am acting, being upset. i will say it again, i just do not understand why the pain management, has done all of this for me for around 2 years, and now they just say we are basicly don with you. also they did do the injections, a total of 4 in the beginning. i do not feel like an addict, just a person that has come a long way, and has been feeling much better. sorry to go on for long, i just feel some people on here have been thru this. i know they are cracking down on pain manegment, i am just upset, and worry about the pain coming back at full force. i guess i shall see.
thanks to this forum, it gives me a place to vent.


  • I can understand feeling the way you do, but what you were told is correct. If there is a surgery that can repair the problem, then surgery is the best fix- and once it heals, the risk of reinjuring is minimal if you follow the surgeon's restrictions and limitations.....once you recover, and you are back to normal, then you can safely resume your life.
    Pain management is tightening down and avoiding surgery to persue pain management is not the standard and should never have been. Pain management is not meant to do that and never was. I think that doctors who do that are doing their patients a huge disservice in allowing it. It is one thing if surgical options are postponed due to family emergencies or some other crisis, but it is not meant to do for the long term as a means to avoid surgery.
    If I were you, I would consult with the surgeon again and have an updated MRI to see how that disc is now......if the surgery is an option, it is one that you should consider carefully.....and if not, then maybe going off the meds is a good idea, see how you are since many times, herniations resolve on their own over time, even without surgical interventions.
    Did they provide you with a tapering plan? If not I would at least give the tapering plan a try....you might find that you really don't need those meds any longer. Wouldn't that be freeing?
  • their idea of a tapering plan, was to for me to ask my primary doctor to switch me to vicoden, if he would not give me the nucynta. i see what you are saying, but also have read on here many times, that surgery is not to cure pain, but to stabilize the spine. also almost every week, or couple of weeks, i read on here about people that had a microdiscectomy, have reherniated. if the surgeon can guarantee i can go back to work, and lift up to 75lbs at times, then i would get surgery. to me i think any and all things that are working, should be a means to prevent surgery. over the short time i have been a member on here, i have read about so many problems with the microdictomy, that i almost think it is set up for failure, and should not be an option for back surgery. that may sound ridiculous, and i know there have been a few on here with good outcomes, like paul, and ben, but there were way more with worse outcomes. and i know the good outcomes do move on. sometimes, i wish i would have never found this site, then i would have never found out so much information, that would discourage me. but i wanted to learn as much as possible.
  • i also re read your step by step to treating chronic pain, and number 3 pain medications,narcotics is above number 4 surgery, kinda disagrees with what you are telling me, maybe i am confused.
  • I do understand..the very idea of having surgery is frightening. If it was not, then I would be worried about someone who is not concerned. There are other options beside microdiscectomy and you honestly do not know if the disc situation has resolved itself or not. Many times, given enough time, the disc will resolve on it's own. Microdiscectomy has gotten a bad rap, but in large part it , those outcomes come from doing too much , too soon and not allowing the surgery to heal, before jumping back into activities that they have not been cleared to do.
    Once you injure an area, there will always be some 'weakness' so , we all have to learn to make some adjustments in how we do things and maybe not do things that we once did........ you can't lift 75 pounds now can you? So what is the difference in at least going ahead and discussing the tapering plan with your doctor and giving it a try. Go make an appointment with the surgeon and get a new MRI, see where things stand now- surgery may not even be necessary, or if it is, talk to the surgeon about other options , and in the meantime, take each day as it comes.
    I do empathize with you, and can feel your concerns, and they are all legit, but on going pain medications is not the answer either.......
  • yes i lift that everyday, several times, a day. i know the disc has not healed, as sometimes, i will feel the burning sensation, but not very often, certaintly not enough for me to feel i need surgery. thanks for responding, but again you list meds, before aggresive surgery, on your step by step.
  • catfishmanccatfishman Posts: 185
    edited 10/01/2013 - 7:56 AM
    i have also been feeling so well, that i have been doing alot of much needed work on my house, to get it ready to sell if i find a different one for me. those pland will all change now i guess. oh well
  • but if you read it, it does not say opiates, it says medications and those include things like muscle relaxers and neuropathic meds in the discussion of medications.
    It also says somewhere in there, that some steps may be disregarded entirely due to the findings of your doctors.......it is a general discussion of the usual steps, but based on the findings of individual doctors, and their exams things may or may not be included.
    I sense your frustration and am only trying to help, so I hope that you will feel a little better about things in a few days, once things have had some time to settle a bit. If you want to talk, my pm box is open.

  • it does say opiates on number 3 above surgery number 4. not trying to argue, but i looked at it again
  • catfishmanccatfishman Posts: 185
    edited 10/01/2013 - 8:13 AM
    i just dont understand why they wasted all this time, i have been seing them for over 2 years now, they are the ones that had me on vicoden at first, then they switched it to nucynta, then to nucynta er, why try all this for so long, then say, well this is not the right thing, makes no sense to waste my time, and i also had to have my mother pick up my hand written prescription every month, because their office hours and my work hours, so i wasted her time as well.
  • They allowed you to go with the use of opiate medications because you didn't want surgery. With the recent changes to how extended release medications must now be labeled, more and more patients who used the medications to avoid surgery are going to find themselves in a similar situation. They most likely offered you medications in the beginning to help ease the pain while you waited for surgery, and once you decided not to go ahead with surgery, then they treated you as a patient who needed further treatment because of the claims of increased/ongoing pain. After time, any patient who is going to be on opiates for an extended period of time , policies demanded that the use of long acting doses be used, rather than short acting versions of those medications, which are more likely to be abused,and or misused. Recent changes to labeling of long acting opiates has changed the labeling from for use in moderate to severe pain requiring 24 hour dosing to severe pain requiring around the clock dosing and as such, will change the way that many PM s are willing to write for medications now.......
    ..As I said before, some of the steps to getting back pain treated are solely based on the exam and imaging findings, so , it is a general step by step guide and your individual condition and doctors expertise may alter some or all of the steps taken.
  • catfishmanccatfishman Posts: 185
    edited 10/01/2013 - 10:13 AM
    well i guess i will see how it goes, i feel i have a strong tolerance to pain, so if i have to hobble at work a little, that is ok with me. i will not be able to just quit my job, i actually really like where i work, get a ton of respect, from all the bosses, and co workers, plus the pay is pretty good for me, and the benefits are excellant. thanks for your input sandi, but i still disagree with the way things are, if taking nucynta er every 12 hours, makes my pain go to zero, that is better than cutting me open. i also think it is one of the weaker pain meds, for instance i work with a guy who is on oxycontin, and he slurs his words all day long.
  • I don't know if this will help in your decision any but my ex-husband had a microdiscectomy in 95 and in his words, "it cured him!!!" I gather from your screen name that you are an outdoor kinda man, so is he. He is able to hunt, fish, go out on his boat, climb and sit in deer stands, walk around in the woods scouting for hours and rides his 4-wheeler. If or when my dr tells me that he can do a surgery to end or help my back, leg, hip and foot pain I would gladly take that chance. Any pain would beat this pain even if I had to settle for different kind of pain for awhile. Just think of how ur life would change if the surgery worked (it will take time and alot of work on your part) you could be out of pain and no more taking pain meds!!! And your life could get back to normal again!!! I would see the surgeon again, get another MRI & go from there...If your disc has healed then I would start a tapering plan with your dr.
  • catfishmanccatfishman Posts: 185
    edited 10/02/2013 - 12:03 PM
    thanks taren, the thing for me is i am not in pain right now, and have not been for months, once in a while i feel the numbing in my leg, but no pain. and yes i know i dont feel it because of the meds, and the stretching, and the not sitting for long. i will wait it out and see how bad the pain comes back, i feel i have a strong tolerance for pain. i guess i would be able to drink after all the meds are out of my system, have not drank in a long time, dont really care for it, plus i had to many alcoholics in the family.
  • I am confused, why is the idea of tapering off medications if you are pain free now such a huge problem? Is it that you fear the pain will return? Or are you using the meds as a crutch 'just in case'? If you are pain free now, then there would be no need to persue surgery, or continue pain management?
    If the pain returns, then you may in fact need to fix the problem, rather than medicate it........and you can address that if it comes, but the idea behind pain management has never been for a patient to continue lifting 75 pounds while taking opiates , so that they can be 'pain free'.
    Nycunta has a two fold effect , in that part of it's effects make a person feel 'good', more energetic , and overall more content/happy/satisfied and I get the feeling that that might be part of where your concerns lie, not so much as the fear of the pain returning. If that is true, then getting off nucynta is definately the right move. It has been marketed as a milder pain medication but it's effects on the brain chemicals is far from mild, and the euphoric / effects on mood and energy have caused major problems for some people taking it.......
  • i only fear for the pain to come back at full force, i personnaly do not see what is wrong with having to take medication, to able to stay working to support my family. but i guess it is fine for the people that no longer work, that have had surgery to stay medicated, makes no sense whatsoever.
  • i also really do not feel (good), super energetic, or any other different sensation, certainly no high type of feeling. i work at the same pace i always have for the past 27 years.
  • I think that you are misunderstanding my questions somewhat. In your posts, you mention being pain free and at the same time, you are wanting to continue taking a medication that you don't even know that you need .......you don't know if the disc issue has resolved, and that is why you are pain free, or if the need for surgery is still there, yet you want to continue taking a medication that may not be necessary so that you can continue to work to lift 75 pounds? That is where the concern lies for me. Most of us would give anything to not be in pain, and would give up the meds in a heartbeat if we ever got to that point, yet you want to continue to do something that might in fact endanger your back ( lifting huge amounts of weights) and continue to take meds for what reason? So you can medicate it in case your pain comes back?
    That's not how it is supposed to work, and I think that you know that.......No one is telling that you returning to pain medications if needed, is not possible but rather are telling you that going off the meds now, while you don't appear to need them is not necessarily a bad idea. You can return to the surgeon, get a new MRI , find out where things stand now, and then, make a decision based on what the new findings are.....that's all.
  • catfishmanccatfishman Posts: 185
    edited 10/03/2013 - 1:19 PM
    yes i understand all that, i said i still have some numbing in my leg, and a burning sensation, once in a while. to me 75lbs is not a huge amount of weight, and i am only 5'9' 167 lbs. what i guess i should have mentioned, was yes i get some numbing in my leg, only pain once in a while. and yes they are basically saying no more meds, no more gabapentin, nucynta er, because there is a sloution to my problem, the dreaded microdiscectomy. and yes i am still reading new post on here about there failures. i am not totally pain free, i believe it is a combination of everything i do, the stretching, drinking plenty of water, not being overwieght, and taking meds. so if i seem to feel so good, should i stop stretching, drinking water, not sitting for long periods, start gaining weight, i think not.
  • sandisandi Posts: 6,343
    edited 10/03/2013 - 1:36 PM
    If you are still having nerve pain, then opiates are not the best choice for treating that, lyrica or gabapentin is. I am not sure why they would not continue the gabapentin if that helps but since the labeling has changed for the use of some opiates, doctors are going to be stopping medications for patients who are not in what is classified in severe pain as I explained to you in one of my first posts to this thread. They are going to send patients back to their surgeons rather than continue to write narcotics for patients who could be fixed by a simple surgical procedure. You do have the choice not to undergo surgery but the doctors retain the right not to continue to provide medications for a patient as well. By law and regulation, things are changing. I do understand your fears about undergoing the micro d , which is why I suggested to you earlier that you talk to your surgeon about other options when you see him......and if you discuss your concerns with him, maybe he can allay them so that you aren't so afraid.
    75 pounds is a huge amount of weight for someone with back issues......no matter what your size is....improper lifting techniques come into play and can do more damage....
    Ultimately what you choose to do is only going to impact you, and I'm sorry that you seem to feel so angry at my responses but I am trying to help you, and get you to see that there are simple options available to you, and you don't seem to want to listen.
  • no need to apologize, i am a bit stubborn, and no i do not know everything about back issues, i do not have all of your knowledge, but i welcome it. as far as a simple surgical procedure, from what i understand, any back operation, even if minimally invasive is still a major deal. also i have read on here more than once, dont know if you posted it, but someone stated back surgery is not to relieve or cure pain, but to stabilize it. and if i am going to have to continue to lift 75lbs, i dont see the point of getting surgery, then its no blt, at least probably up to 75lbs. heck my son weighs more than that
  • sandisandi Posts: 6,343
    edited 10/04/2013 - 3:42 AM
    but in the grand scheme of things in back surgery, a micro discectomy is the least invasive, and has the easiest recovery as far as these types of surgeries go.
    I am not saying that you shouldn't be concerned about the idea of undergoing surgery, or that it is even the right decision, what I am saying is that your PM doctor isn't giving you any choice in what he wants you to do, and because of that, you need to decide that it is what it is, and what you are going to do from here.
    Going back to the surgeon, getting an updated MRI is not a bad thing. It will tell you where you stand now- if things have improved or worsened or are stable. If things have improved or are stable, the surgeon may very well tell you that surgery is off the table and that you should get injections or return you to pain management. If you are sent back to pain management, they may at that time decide to continue the gabapentin but not the nucynta. Or they may come up with some other strategy to help you but at this point, the PM doc is saying that you need to see the surgeon.
    You can call the PM doctors office and ask them if they will continue to prescribe the gabapentin, it is possible that you misunderstood something in regards to what meds they were planning on discontinuing, and that should help the nerve pain when you have it....and since you don't seem to have significant pain , try some of the over the counter meds and see if that manages it when it does flare.
    I hope that it all works out for you, no matter what decisions you make Catfishman...we do understand and really do want to see you do well no matter what you decide.
  • thanks, actually 20 minutes after, i left the appointment, the nurse left a message on my cell phone, saying after i left she had spoken to the doctor some more, her message said to call her back, or she would get back with me at the end of the day. well i have left a few messages, they will not put me directly on the phone or let me hold. i find it totally ridiculous that she cannot just call me back like she said, another nurse called me, but she had no idea what was going on at all. this was on tuesday, that she left me the message at 8:30 am . i am off work wednesday, i might just go to the office, it is only 5 minutes away.
  • I hope that she either calls you tomorrow or if you do go to the office that she is there to tell you what she was going to say during the message when she called you
  • me too sandi, and thanks.
  • catfishmanccatfishman Posts: 185
    edited 10/07/2013 - 12:05 PM
    well i got my phone call today from the nurse, she said she told the doctor, she thought i was a good person, always on time to appointments, always passed the drug test, so they would leave it the same, and continue to treat me, she just said they like the primary to treat their own patients. i dont really know what it was all about, but could not be happier. i believe she sees it the same as me, they are one key to help manage my pain, along with everything else that i do, whether i do physical work, or sit on my behind, it is helping.
  • AnonymousUserAAnonymousUser Posts: 49,671
    edited 10/07/2013 - 1:28 PM
    I am glad they will continue to treat you. It is funny they said they like the primary to 'treat you'. I am thinking you are saying they like the primary to manage meds?? If so that is exactly the OPPOSITE of what my (new)primary said to me, he said he wanted Pain Management to manage my meds. Funny how everyone has different experiences with different MDs. Today I had another new Dr visit with a new RX.-All under the military umbrella- I tried to give up Dr visit as my new year resolution, lol. Interested in how this will work out.
  • I also understand about anticipating pain. When I have my ESI I do have a benefit of less pain for a couple weeks to months. I know they are temporary but when I start to feel them wear off, my anxiety goes thru the roof. I have to increase my meds and try to keep on top of the pain. Sometimes I don't do so well, physically or emotionally.
  • yes that is what they must have meant manage my meds, but my primary is the one who originally sent me to see them. also thanks, necksoup.
  • I am sorry for the issues you are having with your PM doctor. I dont believe all are like tha and my oldest brother of 61 has been in pain management for 11 yrs after deciding that he did not like the odds of a 50-50 chance of paralysis with surgery. He has such deteriorated. Vertebrae in lumbar that his surgeon said chances were good he would be paralyzed to some extent even without surgery. He has a pain pump and does have to use wheelchair when going outside the home. His doctor gave him a choice of either surgery or the pain pump. He brought up a very good point after my last spine surgery. He said I still have chronic pain after each surgery and am on pain meds so why should he have thecsurgery but because myvstenosis was severe I had to have the surgery even though pain is still there.

    I wish I had an answer for you and could help. I cant imagine the frustration in deciding on surgery. There is never an easy answer. We never know which surgery could make us pain free or paralyze us. I will keep you in my thoughts and prayers.

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