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Pain specialist or neurosurgeon ?

I've been diagnosed with cervical DDD. Pain can be too much to take at times, seems no medication my reg dr has given works complete. He says next step is Neurosurgeon. I'm on Celebrex, flexeril, hydrocodone 7.5 when needed and Nodolor for the headaches. I have neck pain and headaches 3-4 days a week. I also experience extreme fatigue at times, probably a few days a month. I need to know next step - pain specialist or neurosurgeon? I hurt most of the time even with the meds I take right now, I just want to feel as close to normal as possible. I have a desk job that is very stressful which seems to aggravate my condition. I'm worried if I go to a neurosurgeon he will say my only option is surgery because that is what he/she does. Is that accurate? Should I go to a pain specialist first and neurosurgeon as last resort? Or the n surgeon next?
Lisa Chappell


  • Hi There!!

    So sorry to hear you're in so much pain! I received my referral for the pain specialist from an orthopedic surgeon as part of my treatment plan. After seeing the pain specialist I went back to the orthopedic and then was referred for surgery. At that time I saw a neurosurgeon as I felt more comfortable with him doing the fusion. I would recommend seeing the neurosurgeon first- just because they're surgeons doesn't always mean they will think that surgery is the best option. The neurosurgeon may think that pain management is a great treatment, but you never know until you go.

    Good luck & keep us updated.
    Olivia Douglass
    MIS TLIF L5/S1 on 5/1/13
  • LizLiz Posts: 7,832
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    Spinal stenosis since 1995
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  • senior41ssenior41 Posts: 7
    edited 01/02/2014 - 4:55 AM
    I assume you have had imaging tests done. I suggest you see a spine specialist first. Typically they will suggest injections and perhaps physical therapy before undergoing surgery. Good Luck
    Grayslake, IL USA
  • dilaurodilauro ConnecticutPosts: 9,856
    a spinal and/or pain specialist would be your next path.

    Degenerative Disc Disease has been the most misunderstood of spinal conditions. Just the words make it sound much worse. DDD is basically the aging of our spines. So almost everyone by the time they reach 25+ they will show some signs. Most people can manage DDD through approved exercise programs and OTC NSAIDS. Only the worst cases will require surgery.

    The medication you are currently on,m so seem like more than appropriate for DDD. But without more details and without knowing results of any of your diagnostic tests, its impossible for us to make a fair assesstment

    For more details, please read: All about Degenerative Disc Disease

    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 01/04/2014 - 6:41 PM
    is considering changing your desk monitor for your computer arrangement around so that you are not constantly looking downward and putting it at eye level, as well as arranging for more ergomic aligment.
    Someone with a neck issue is going to have to rearrange his work environment to ease some of the muscle tension and strain on your neck.
  • I have a lot of the same symptoms you do, thankfully my insurance doesn't require referrals so I can go to any doctor I want. WhenI first had my neck/shoulder/arm start hurting I went to a sports medicine doctor simply because I didn't have a regular doctor, I am not a doctor kind of person. That doctor didn't try much, he did the usual round of steroids and anti-inflammatory drugs and physical therapy. I did the therapy for 2 sessions before they told me that I needed to get the problem fixed before they could do anything for me becase nothing helped more than a few hours. I found a spine specialist but he was non-surgical. He diagnosed me and sent me for an mri, it came back with multiple issues. He wanted to do esi's but he was to far away so I am now seeing a pain management doctor, and that doctor has done so much to help me out, my inital visit was much more indepth than both of the other doctors and physical therapy combined.
    If I was you I would try some pain management first and if you don't get help from that doctor they can refer you to a surgeon. My symptoms are constant every single day, the tingling never stops, the fatigue is constant but I can't sleep, I get headaches almost every single day, I am on hydorcodone 10/325 6x day, flexeril 5mg 1x day, trazodone 50mg 1xday and I am asking for something for my headaches today. The meds don't take the pain all away but it makes it so I can function, before the meds I couldn't function. I also have ddd and multiple level disc herniations.
    Keep us informed on your decision and your progress
  • Did your MRI show signs of nerve compression? What did the surgeon recommend as far as treatment went? The concern with a patient who shows numbness or tingling is that there is a nerve compromised somewhere, and the longer it is left untreated ( the compression removed) the more risk there is of permanent injury.
    The usual course or standard of care, is to try interventional therapies, injections, etc, but if the nerve is compressed, usually the only course of treatment to relieve the compression is surgery.
  • jbnms99jjbnms99 Posts: 182
    edited 01/10/2014 - 6:21 AM
    My mri showed lots of problems that I have never had any symptoms of before, I think they just started progressing and maybe I did something to aggrivate the nerve and thats what started this whole game. First off I am 36 years old and only had stiff necks once in a while, nothing that I thought was serious, never any numbness or shooting pain or anything. I have DDD on every disc in my neck except 1, they all showed up black except for that one, I have foraminal narrowing in all of my cervical discs, It also mentioned stenosis in all of my discs, I have 5 bulging discs in my cervical spine and 1 in my thoracic spine (thats as far as my mri went down). 2 of the 5 are pressing in my spinal column, but they say they are not on my cord, I disagree with that. I can't afford to be off of work for a significant amount of time (I have a family to feed and I am the only income in the household), I have insurance that will pay for most of the surgery and dr. appts and I get paid 60% of my pay while im off but 60% doesn't cover it. My doctor suggested I get a fusion at my worst disc herniation c5/6 but I know that with ddd in the discs above and below that sooner or later I will have to have those fused too, then the ones above and below those are bad too and it keeps going and going. My doctor told me if I wanted we could start with the epi and see if that gave me any relief but if that didn't work then my options were going to get thin.

    When my MRI was done they had me in a position where I was fairly comfortable, I am not able to look up at all because it will send massive shocks down my arm, my fingers go completely numb and then I get cramps in my entire left arm for long periods of time. I think if they would have positioned me a little different on that table it would have showed some completly different results. . I take muscle relaxers to help with the cramping, they help out tremendously, I know of many nights I have to get up and pace the floor because my left leg and my left arm are in a ball with cramps and I can't do anything to get rid of them.
    I have been seeing a pain management doctor because that is my only option at this time. She gave me 2 epi's in my neck that gave me relief both times for about a day to a day and a half. I had a facet block done on 12/11 from c1 to t2, that gave me relief for about a week, I go back on 1/14 to get a 2nd round of facet blocks, maybe that will help with the pain.

    With LChapp, I understand the feeling they have not wanting to go to a surgeon because a lot of them only want to do surgery and just bypass all the other things. They didn't say if there were any imaging tests done or not. Pain doctors can order an MRI then evaluate your symptoms, give you better pain meds and possibly give you an injection before you even get into your mri appt just to try and help out your symptoms. It may not be that way with all doctors but of all the ones I have seen I trust my pain doctor the most.
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