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Drastic sudden pain increase. Need thoughts/ideas

asignor908aasignor908 Posts: 339
edited 02/23/2014 - 1:48 PM in Chronic Pain
Monday I had a sudden and very dramatic increase in my pain to the point I couldn't walk because every movement was so excruciating. I . I had an MRI about 5 months ago and two neurosurgeons say that they did see a clear way that a surgical option would help and there was a 50/50 chance it could make it even worse. The sudden onset of this increased pain and the severity has me wondering fearfully if something gave way in my spine taking me to a new level of pain. I have been trying to rest and not aggravate it again but pain severity is still very escalated even with my higher medication dosage.
I don't understand why they seem reluctant to do the fusion on my lower spine. Well they really just say there's nothing they Totally Wicked Electronic Cigarette e-liquid
do as far as surgery to help. Pain doc pushes injections which have been little to no relief and have actually caused more pain for a few days. Suddenly Monday after doing very minor choirs like emptying the dishwasher , clean letterbox and a few other light things my pain went through the roof. We were having an ice storm that day and we my wife couldn't take me to the ER. I went to the bathroom and when I was walking out it hit harder still to the point it was so excruciating that I couldn't take another step. My wife got me more medication virtually doubling my dosage from 15 to 30 mgs. Finally I managed to get to my bed, crawled I but when I tried to turn I couldn't it was just that bad. I am barely mobile without higher doses than prescribed. I finally called my pain doctor this afternoon because even with sitting still, hot pack, cold packs etc pain is still escalated in my lower back, inner thigh/groin. Any turning or slight ending makes it shoot up. I am waiting to hear back from the pain doctor petrified that he won't raise my dosage and since I acted on my on increasing my dosage because of this pain escalation I am going to be in trouble. I am also worried that a disc slipped, herniated or something to cause this. I wasn't very mobile prior to this, I mean I can walk but after 5 or 10 minutes pain is increasing and of course now it's even worse.in 7 years of being on pain meds I have never abused them or taken more than prescribed like this, ever!! I am always fearful of even asking for an increase because there are so many rules, contracts etc.
I have been with this doc for over three years and never had an issue except pushing the injections I spite of their lack of effectiveness and the spine stimulator test which I van't get approval for because of depression plus my research shows they are very ineffective and some get a placebo effect that lasts only two months. I am very concerned about what is going on with my spine now to cause this.
My ACDF on my cervical spine worked great but the laminectomy on my lower back made things much worse. I hope I didn't screw myself with my meds but it really wasn't much of a choice. Don't know if any of you have any thoughts on what could have happened.


  • PEDMMPPEDMM Posts: 39
    edited 02/18/2014 - 8:27 PM
    Well I feel exactly how you are with pain escalating and not being able to determine what is causing it. But increasing the dose on our own even though I am guilty of doing it from time to time but never to the point where I admit to doing it. Just biting my lip when I short myself. You should ask for a new appointment and try to see if you can schedule a new mri to see what has happened. I have been having groin pain as well as hip and thigh pain recently and I don't know what has caused this since I have done nothing that would cause my condition to worsen. Let the doc know what has happened try not to ask for more meds or at least try to ask to be seen first then see if they will work on temp working up your dose at least until this episode subsides. I wish you luck and keep us posted as to what has aggravated your condition =
  • increasing one's dose and going to the ER are not good things to do. your pain doctor could drop you on the spot and you would be n trouble. going to ER for pain meds is a bad idea especially for back pain. the ER doctors are out to look for things like this and all they would give you is naisd;s and then call your pain doctor to let him know. never increase your dose. if it is not helping, go to your doctor and ask. if he does not increase your meds then he is the one calling the shots. you always have the option of getting another doctor.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • dilaurodilauro ConnecticutPosts: 9,842
    edited 02/19/2014 - 8:56 AM
    on your own should never be done.
    It may give you that temporary relief from pain, but you might suffer longer consequences. Many doctors react very negatively to any patient that does that. In fact, some doctors would refuse to see that patient any more

    The thing to do is talk to your doctor about what is happening and that your current dosage is not helping. They may provide other alternatives to help with your pain. They may even suggest changing the time frame between taking the medication or writing a script for something new. But that has to come from them
    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
  • I echo what the others said about increasing your medications, so I am not going to beat that drum, however, your symptoms are concerning to me, since you mentioned increased pain, inner thighs and groin pain that are greatly exacerbated. I think that you need to contact your PM doctor and discuss these symptoms . Are you having any difficulty moving or maintaining your bladder and bowels? Any increased numbness in new or worsening areas?
    If you are having the above mentioned difficulties, it might be wise to be evaluated sooner , rather than later.
    Do you have a herniation in the lumbar area? I can not recall specifically if you do or not, but there is a danger of sudden onset of Cauda Equina Syndrome and that has me concerned.
  • On the comments I found to be helpful. I have seen my PM and in fact he did injections again on Monday unfortunately I don't find them all that helpful. As far as medication increase Ohio supposedly passed some kind of guideline either through the medical board or the legal system saying that the maximum that should be prescribed can not exceed the morphine equivalent of 115 Mgs per day. My oxycodone Percocet cocktail is at 85 milligrams a day so the conversation has me at about the max. Thank you big brother/ nanny state for coming between me and my doctor. I don't know how anyone else feels about this but I think it is so wrong but seems to be par for the course in the US as more and more laws are passed in all areas chiseling away our freedom. So it is what it is.
    Ron I would not take my medication not as prescribed on my own.
    My wife said if or when it get's that bad again she is taking me to the ER. We probably would have went this last time but there was severe winter weather and ice storm on top of snow. My driveway is on a hill so I can't risk a fall and my wife is fearful to try to drive in those conditions.
    Well that's where I am out until we see a couple of neurosurgeons next month.
    Thanks again!!
    AL S
  • 85mg a day? each oxy is 5 mg and the maximum dose is 2 x's 4 a day which would be 8 pills times 5 mg would be 40 mg a day and if you take the 10mg pill that still would be double the dose. then you want to go to the ER? this does not add up in my book. imho, this is not about personal freedom, it is about you taking twice the dose allowable. where do you get all of these meds and no doctor would prescribe this amount. if you go to the ER and tell them this dose, there will be major issues.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I must tell you that I think you are misinformed. My oxycodone are 15 mgs each and my Percocet are 10/325 and between the two I take 6 doses a day. This is not at all unusual for people with moderate to severe chronic pain issues as for me after several surgeries. Having been to the ER numerous times they don't bat an eye. I am really not sure what you are talking about. Oxycodone also comes in doses as high as 30 Mgs.
    AL S
  • you said oxycodone not oxycontin, there is a big difference. oxycontin comes in 30 mg every 6 -8 hours a day which is 90 mg a day it is an extended release med, make sure you get your meds correct. oxycodone only comes in 5 or 10 mg. have never and i mean never been to the ER for back pain and i have had 4 f;usions and have been a chronic pain guy for 13 years. i think you need to get your facts straight about your dose and going to the ER. my friend who is a nurse would call you a frequent flyer if you kept going to the ER. this is a major red flag with pain doctors and ER doctors
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 101
    I take two 10mg Oxycontin every 12 hours (SR). It has never given me "a buzz" only makes me lethargic and frequently it feels like it does nothing at all. I tried not taking it one night only and boy do I know why my surgeon prescribes it that way. I did not take extra for not taking it the night before either but it was a really uncomfortable day. I'm also on #2 5mg oxycodone 4-6 hours a day and valium 5mg twice daily as needed but I usually take them twice daily to help me sleep through the night and feel limber during the day. I must admit I do change my dosage occsnlly if my pain level is an 8 but usually a 6. What I mean is I still take the amount of pills per day but I might take 3 oxy's instead of two and at my next dosage time I only take one. So I guess I'm not taking more in all just taking more mg's when I'm at my worse.
    My doc ideally like to start decreasing my oxycodone to one pill 4-6x/day and that scares me to pieces. One thing we all seem to have in common here is being scared of what hasn't happened and wanting the security of knowing we can continue taking what we need (as long as it is within recommnd dosing) without persecution, justification or discrimination. I don't know why but everytime I call in for my refills I get nervous something will change. My husband thinks I'm being paranoid. Am I?
    Just a clarification about narcs:
    Hydrocodone Bitartrate is the generic form of Vicodin. Except that Vicodin contains acetaminephine as well. Each one comes with the exact dosing guidelines. Oxycodone is the generic form of Percocet which also contains acetaminaphine. The reason doctors prefer to prescribe just hydrocodone or oxycodone is acetaminophen is highly toxic to the liver if over 1000 mg is taken within a 24 hour period. And because most of us are on either one or the other, it is always best to add acetaminophen separately or adding a NSAIDS like ibuprofen. Both Oxycodone and hydrocodone by themselves have very short pain relieving properties. So when people who have pain suddenly and won't require months worth of narcotics either Percocet or Vicodin is prescribed because of the inclusive nsaids or acetaminophen.

    Fracture and collapsed L5 from cage insertion after two level A/PLIf November 13, 2013. Constant pain at coccyx from fracture and muscle weakness along with surgical discomfort of lumbar region. Highlight though is there are no signs of sciatica bilaterally although beginning to feel some numbness/thingling on left foot which radiates upwards when top of left foot is touched. Three prior laminectomies and revisional decompression at L5/S1 & L4/5
    Staying Positive
  • My doctor jokes that when it comes to pain most of his patients are 'doctors' - Diagnosis : PAIN! Treatment : MORE narcotics!! He laughs 'Why did I spend so long in school?'
    If you suddenly experience a huge spike in pain or different pain tell your doctor. If you trust your doctor, TRUST your doctor to diagnose & treat you! Not all pain is managed well with narcotics, particularly nerve pain. I know my doctor hates it when his patients tell him what prescriptions to write. Give your doctor a chance to raise the subject of narcotics before you do. It just doesn't reflect well on you if you seem to be demanding.

    Asignor908 - Have you found out what caused this spike? Has it settled down now? I always experience a huge increase in pain when really cold weather hits. The last ice storm was brutal for me. Hopefully you'll get some answers next month. What does the ER usually do for you when you go in this sort of situation?

    I've had Oxycodone HCL 30mg tablets.
    When Hydrocodone says 10-325 the 325 is how much Tylenol/acetaminophen each tablet contains. My doctor says that they can't/won't write for more than 4 a day for this reason. Acetaminophen does help you absorb the narcotic. I've been told to take Oxycodone with a strong cup of coffee in the past. It's supposed to help if you don't want the acetaminophen liver issues. I don't know how much difference it makes...
    Osteoarthritis & DDD.
  • anelsen15anelsen15 Posts: 119
    edited 02/21/2014 - 8:23 AM
    Englishgirl, I could ask that same question to a few of my old doctors who misdiagnosed me lol

    And while I understand doctors not liking advice about meds, i think sometimes you have to say XXX worked well in past for nerve/pain. Because like me I usually discontinue the med such as lyrica when i have gotten better in past, yet the PM doctor I was now seeing was not neccessarily the same dr that prescribed it.

    Lets be very clear about something, I went to school for 5 years to be mechanical engineer and i have people without degrees. laborers who work with this engineered product everyday, know it in and out and how it works so much different than what a book says, that often find things i missed or am flat thinking wrong about. Working as a laborer prior to degee we called them " dumb engineers" because they said things should work a certain way because a book said so, go in the field and see if thats the way it does.
    So us in our bodies are the people without degrees but we work with our bodies everyday , know them in and out and the doctor is like me ,college educated ( much smarter and well trained though) and he is the expert in medicine ( Im def not an expert but you know what i mean) but has outside view of our body. So dont go to far with all dr went to med school so they must be geniuses. Education does not make you fool proof.
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • I feel that what I have said is misconstrued . I take oxycodone which some call roxycodone, not OxyContin .
    Also I take it in 15 Mg doses and it does not contain Tylenol for if it did it would then be Percocet. I take 3 15 Mg oxycodones a day and 3 10/325 Percocet a day. Again not OxyContin which is the long acting version. I have been taking pain meds in some form for eight years. I was a cop an never wanted to be dependent on a drug like this which I have seen abused. As pain got worse over time and a MRI showed my cervical spine was unprotected and in danger of paralyzing me with any minor trauma they rapidly moved to surgery in 2010. First a ACDF and the a Laminectomy 6 months later. The upper spine surgery was successful and lower spine got worse, much worse.
    As far as my recent acute extremely painful agonizing attack the ER gave me IV pain killers and IV steroids which did offer some relief. I then came home for almost complete bed rest as they thought as I do some very light housework aggravated the nerve from movement of vertebrae in the lower spine. I have to sit like Cleopatra
    , lol , because sitting in my recliner or laying on my back puts to much pressure on the lower spine causing more pain. As I said I am scheduled to see neurosurgeons next month to see if there are any better options. I have PTSD, anxiety, and depression from my military service which is aggravated greatly if my pain is not well controlled.
    My point in some of my previous comments about government interference with anyone's treatment is a very bad thing. I am not talking about protecting pill mills or doctor shoppers but the chilling affect that these laws and government intimidation on good doctors is having. Many doctors have stopped writing for pain meds because it's not worth the hassle or just fear. I was in the military to defend a free country not a over regulated nanny state. Taking pain pills long term is not something I want or wish for. As I said at the beginning I had to come to terms that being dependent on a drug dies not equal being addicted. I see therapist and psychiatrist at the VA who helped me understand that and do not want me to quit taking my meds and keeping control of my pain because things get much worse in my PTSD and depression when it is not controlled. I know I have a right to be treated by my doctor who is a true pain management physician and that he should feel free and unencumbered to manage my pain without having to always consider how big brother will perceive it.
    Finally we have done so well about getting pain meds under control that many people who were abusing them have now gone to heroin increasing overdoses and death. Unintended consequences that is spreading like wildfire. Sorry about seemingly confusing some of you and I do appreciated all my spiney friends imput.
    Take care all
    AL S
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 101
    edited 02/21/2014 - 2:00 PM
    I couldn't agree with you more. Especially if you happen to have a dr who does not like to be challenged/questioned. They are looking at us from the outside in...We are looking at it from the inside out; in other words: what their perception of us is by assessing how we are acting/talking. While we are trying to tell them what we are experiencing and how one day can be so different then the next. It is a generalization on the Drs' part but unfortunately our bodies don't take commands just by someone telling us we should be this or that....(if you get my understanding).
  • Ha ha ha ...you used the words 'genius' and 'doctor' in the same sentence! That immediately made me think of my last PM..I requested a new MRI (I hadn't had one in 2 years & felt like something was very wrong) he told me he was getting a machine in the clinic but I would have to wait a year. I said I felt this was urgent. He got angry & said "if there were something physically wrong with you maybe I could help more but...". The total shock on my face silenced him. He had been treating me for nearly a year. I have a long list of diagnostic results including MRI's etc. I've had many procedures. The base of my spine is bone on bone & it only gets slightly better as you go up. To cut a long story short...I have no idea what he was treating me for or why he continued to prescribe many medications including ER & breakthrough narcotics when apparently I have "nothing physically wrong with me"!! (sometimes you've got to laugh or you'd be crying 24/7)

    I completely agree that we know our bodies & our history better than anyone (particularly my last PM doc! lol). I read often 'I need more/some narcotics. I told/asked my doc'. I know that I couldn't function without them. I've tried..not pretty! I don't know how many people go on suffering with out that kind of relief in their PM routine. We don't like taking these things but often there's just not an alternative. I just know that the doctors I've experienced view you as a 'better patient' if you tell them what's going on with you & let them make suggestions for treatment & never ask for narcotics. It's the crazy world we live in now. We give advise on 'How to manage your pain management doctor' if it wasn't so bloody depressing it would be funny!

    Sorry for rambling...don't know where that came from ;-)

    Thank you for answering the ER question. I've only ever heard 'never go to ER!' it's nice to know that someone gets emergency help when really needed. I completely get why it can be a bad idea but from someone who's blood pressure, pulse etc goes through the roof when my pain spikes it's reassuring to know its possible to get treatment over a long weekend...
    Osteoarthritis & DDD.
  • Thank you both for responding. I thought I was going crazy because no one seemed to understand what I was talking about and kept going into the weeds about medication doses , did I know really what meds I was on, oxycodone was generic Percocet etc. My real point and frustration is my doctor and many others trying to treat their patients and deal with the laws, big brother, drug seekers, contracts, urine screens etc.
    We suffer for the bad guys.
    AL S
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 02/21/2014 - 5:00 PM
    Coming from England I find it so hard to wrap my head around the medical system over here. It's all so foreign ;-)

    My father has very similar back issues to me (genetic short-straw) so we frequently find ourselves walking similar paths. It's getting increasingly harder to explain what I go through to him. He's a very proud man. When I mention peeing in a cup his response is 'I wouldn't do that! Tell them to get stuffed!'. I say they'd refuse to give me my prescriptions if I did that...he says 'they can't do that. They take an oath to do no harm!'. I tell him about prescription drug abuse & he says 'that's what the police are for'. I'm lucky that my family are so understanding & supportive of my pain but that creates many frustrations when I comes to the 'system'.
    People are people all over the world. England has plenty of drug addicts & every country must have unethical doctors so prescription drug abuse must be an issue there. You know what I mean? I've never known anyone who has been made to 'jump through the hoops' that we have to just to receive medical care. Before my spine problems my only real experiences with the medical industry were having my 2 kids (both born USA) & were polar opposite of pain management. My first was a real 'problem' pregnancy. I was even hospitalized 26-28 weeks in & no one could explain the cause so there was a lot of pain & frustration. Every specialist I came into contact with was kind, compassionate, understanding & proffesional. My regular appointments were the same. I know that they're very different circumstances but I've gone to pain specialists feeling frustration & pain, being scared & depressed only to leave feeling even worse. I've known PM docs frustrated & defeated by insurance companies, legislation, drug seekers. They just seem so cynical & distant to me.

    I know I've gone completely off point here. It's been a bad day.... I guess I just wanted to say 'yeh..I know what you mean'
    Osteoarthritis & DDD.
  • thoracic spine painthoracic spine pain Posts: 566
    edited 02/22/2014 - 11:29 AM
    Oxycontin is the brand name for oxycodone. Oxycontin comes in 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg and 80 mg tablets

    If you take 40 mg of oxycontin 4 x a day you are taking 160 mg of oxycodone a day.

    PERCOCET is also a brand name for oxycodone with acetaminophen which makes it work more quickly and increases the uptake of oxycodone. I think that is why it is usually used as a breakthrough medication.

    The usual adult dosage is 2 tablets every 6 hours as needed for pain. The total daily dose of acetaminophen should not exceed 4 grams

    Percocet comes in the following dosages PERCOCET 5 mg/325 mg; PERCOCET 7.5 mg/325 mg; PERCOCET 10 mg/325 mg

    The total daily dose of acetaminophen should not exceed 4 grams. As Englishgirl stated the 325mg is the amount of acetaminophen, the 5mg, 7.5 mg and 10mg is the amount of oxycodone.

    Therefore the highest dose tablet of oxycodone in Percocet is 10mg.
  • terror8396tterror8396 Posts: 1,832
    edited 02/22/2014 - 11:39 AM
    why go to the

    why go to the ER? you should have a doctor and should see them. not go to the ER. ER is extremely expensive up to $1000 and over where a a doctor visit willl be about $50 or more and if you have insurance, it is cheaper. even with insurance the ER is over a grand for a visit and one stays for up to 8 hours or more. ER is for genuine emergencies not for pain control . you should have pain meds and if you run out then you are really going against the rules. ERs are not for a doctor visit and pain is not an emergency unless you fall and break your leg but back pain is not an emergency. take your meds and if they do not work, see your pain doctor for a change

    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Urgent care works to
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • "oligoanelgia" this is defined as the under treatment of pain. There are articles/studies where trauma patients not chronic back patients failed to get adequate meds to treat their pain. Chronic pain patients are never going to receive proper pain treatment at ER if trauma patients don't sometimes. Go elsewhere
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • if a person wants to be labeled as a drug seeker then by all means go to the ER. ER doctors are on the lookout for back patients looking for narcotics. they will let their doctors know that this is going on. again, why spend tons of money to go to the ER to get drugs when one should go to their own doctors. I do not understand this at all.why sit in an ER room for up to 12 hours before getting treated and then at the end the chances are you will get some other med besides a narcotic.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • anelsen15anelsen15 Posts: 119
    edited 02/23/2014 - 1:48 PM
    Written by Panel of drs:
    Research has shown that ED physicians often fail to provide adequate analgesia to their patients. Pain management, particularly acute pain, is a subject not often taught within most medical school programs. Pain has been identified as the most common reason for patients seeking care in emergency rooms.

    ..... More reason not to go to ER for chronic pain if they struggle with acute
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • anelsen15anelsen15 Posts: 119
    edited 02/23/2014 - 6:24 AM

    Even more reason not to go to ER:

    Oligoanalgesia - lack of pain treatment

    The following are major causes of oligoanalgesia in the ED:
    Lack of basic knowledge and formal education on acute pain management.
    Prejudice toward and irrational fear of using opioids in the ED.
    Lack of adherence to acute pain management guidelines and clinical pathways.
    Underuse of analgesics titration protocols
    . Barriers preclude ED physicians from proper acute pain management that include ethnic, racial, and age bias as well as ED environment and culture.

    ( Sidenote: Very interesting that a medical publication says age is a factor in proper acute pain mgmt. I'm sticking w my belief it does throughout)
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
  • aaron
    my opinion on this matter is that family doctors do little prescribing of narcotics due to the fact that a lot of people with pain go to pain doctors and the family doctors let the pain doctors prescribe narcotics. they basically stay out of it. this happened with my first back surgeon. he said he would leave the narcotics to my pain doctor. he did the surgery and my pain doctor took care of the meds. my wife sees a family doctor for her chrones disease and she gives my wife minimal pain meds. the doctors at the clinic stay out of the pain meds for the most part. so now a lot of family doctors leave pain management up to he pain doctor especially for chronic pain
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Yea i agree family dr / ER dr not place to get meds or chronic pain treatment
    Herniated T6-7, multiple herniations in cervical, tears in T5-T8. Stenois at levels and smorls nodes from thoracic thru lumbar
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