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Pain Management

Hello all. I am a 24 year old with a herniated L5 disc that has given me trouble on and off in the way of a flair up at the rate of every few months for the past few years. I have received only one injection for the pain to date in 2012 and while it helped I hope to avoid them in the future as the cost, even with my insurance, is astronomical and I have concerns about the shot itself.

My doctor began giving me tramadol when I had a flair up and it helps to relieve the pain that makes the slightest moves, walking, and even laying down agonizing. Recently though on my last trip to my doctor he reduced the amount of tramadol he dispensed to me by half with no refills. This was distressing to me as that is my key to functioning normally while in the midst of a flair up....without the tramadol I wouldn't be able to go to work or drive a car...I'd be stuck in a chair until the pain lessened.

I understand that in the state I live (Missouri) the drug has recently within the past year become classified as a controlled substance but if it have a condition that warrants pain medication does that not justify the normal script? My question here is....how can I broach the topic of asking for a sufficient amount of pills to help me get through the worst of the pain until I'm at normal again? I never finished the full dose he gave me in the past and just save them for future flair ups. I do not abuse my medication and take only as needed. If he denies me a refill again I would prefer to switch doctors but that comes with trouble of its own.

In 2012 I had x-rays and an mri done. That is how my disc situation was diagnosed. As of this date, I still owe the mri tech for the balance on the bill....i retained a ridiculous amount of medical debt for the tests and the injection...and I was insured when I received the care. My fear is that going to a new doctor who may be understanding about my need for pain medication as a fix until the day I can actually afford the surgery (it that even ever comes) will necessitate completely new x-rays and mris. Is it possible to obtain my medical file from my current doctor and present it to my new doctor and explain my situation? If my pain is so bad that my torso is leaning (which it does when the pain peaks) I'm positive that there hasn't been improvement and if there has...it's exceptionally slight. I just want to have the ability to get enough pain medication go see me through the flair up and allow me to function so my work doesn't suffer and I think my doctor is more afraid of the idea of writing a script for a controlled substance than aiding me in my pain. Any advice for how to proceed? All suggestions are appreciated.


  • EMS GuyEEMS Guy Posts: 916
    edited 01/27/2015 - 9:48 AM
    Do you have a government health insurance plan or employer sponsored? It sounds like you have a high deductible plan either way. My suggestion to you is ask the doctor on your next visit what his/her plan of treatment is going to be for your pain. Once you know that, it wont be a matter of guessing what's going to happen. They may have other medication alternatives that can help (creams, NSAIDS, TENS, Etc.) Tramadol is not a very strong medication, so there may be a suitable non-controlled medication that can help. You are very young to be considering surgery. I get it that pain hurts no matter how old you are, but surgery is a last option for chronic back pain. It may help or it could make things so much more worse! I'd suggest you read these message boards to get an idea of what can happen both good and bad with back surgery.

    Best of luck!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I'm young as well, also have L5 problems (spondylolisthesis), my first steroid shot was very expensive too (insurance doesn't care about huge facility fees) and tramadol was the second drug I was prescribed in pain management! Right after gabapentin...

    This is all to say that I personally connect with your post, but I'll say exactly what EMS Guy said - don't rush into surgery. A successful surgery Does Not necessarily mean lower pain levels.

    I think you need to be forward and honest with your doc next time you see him/her, and say that you have suffered for having a smaller prescription. If you have been on the same dose for a long time, I would go so far as to ask why this bottle was smaller than previous ones. Maybe it was only a mistake! Just take a deep breath and spit it out without accusing him/her.

    My pain doctor can be inconsistent too... but I'm surprised the two of you didn't have a conversation about a smaller prescription before you left his office. Build a relationship with your doc, even though it may be tough when painkillers are the topic :)

    edit: or just call the office up now and say 'help me I've run dry! I can't function properly during a sudden and unexplained tramadol reduction!'
    Grade I Spondylolisthesis L5-S1, bilateral pars issues
    Mild Scoliois double curve
    Arthritic activity in SI area and L5 through L3
    Chronic headache
    Nerve pain
  • I only know how to spell spondylolithesis because I suffered from it. And as for Tramadol, it may as well be baby aspirin when it comes to relieving that kind of pain. I had a lumbar fusion (L4-S1) that did take care of that situation, although L5/S1 was so collapsed that it could not be rebuilt. I empathize with anyone going through any of those conditions, esp. if insurance isn't much help. I'm fortunate to be on SSDi now and have Medicare, BCBS, and Medicaid. I believe it's a federal regulation that now classifies drugs like Vicodin, etc the same as morphine. While fusion surgery is a big deal, if a good surgeon does it, it can be life changing. As good as my orthopedic spine surgeon is, he was not able to help with the condition I now suffer from. The PM group he referred me to did not help me. They went about it all wrong. I've since learned it's not uncommon to develop facet joint issues after a lumbar fusion. Mine are all the way up near my cervical spine. It's a difficult process and, at least in my case, a lengthy ordeal. My advice is, esp. if you have spondylolisthesis, is to find a top-notch surgeon and get it fixed. Until that area is locked down you will continue to have episodes of the vertebrae shifting, which I don't need to tell anyone who's had that happen, is beyond painful. If I can be of help to anyone, by all means leave me a message. I also had a world-class neuro spine surgeon do my cervical fusion.
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