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Having surgery, was wondering about meds

Hac711HHac711 Posts: 6
edited 06/21/2015 - 9:01 AM in Chronic Pain
Hello, so finally figured out the problem with my back/leg/foot. I have 2 herniated disks, arthritis throughout my back and a pinched nerve. After 4 steroid injections, physical therapy, chiropractic work, exercise and pain management meds (I am on lyrica, oxycodone, OxyContin, etodolac) and having nothing alleviate the pain, in scheduled for surgery this Monday to shave the disk off the nerve and hopefully be out of pain. I am currently taking 10mg oxycodone 5x/day, Lyrica 75mg 3x/day with a double dose in the evening, etodolac 400mg 2x/day and OxyContin 15mg at bedtime. In wondering if the surgeon is going to give me additional pain meds after the surgery. My issue is even with all the pain medication I take, nothing is working anymore. I've been taking this dosage for over a year and my pm doctor has never raised my dosage to compensate for tolerance. I'm scared that the surgeon won't give me any medication because I'm already on so many meds. Anyone have experience in this? Will my surgeon give me additional meds in a higher milligram to take care of my pain? Some days, when the pain is intolerable, I double up on my meds (which according to my pm contract I'm not suppose to do, but I'm desperate ). Are surgeons required to issue pain meds after and for surgery? Since my surgery is coming up, I had to stop taking my etodolac due to thinning of the blood and my meds without it don't do crap unless I take a higher dose, which I've been doing so in going to run out of my meds before my next scheduled appointment. I'm already near the end of my bottle of OxyContin (3 pills left) and only have about 30 oxycodone left. This won't get me through surgery, at all, and I'm so scared I'll be in tremendous pain. Anyone can tell me what surgeons do after surgery if you're on pain management? Thanks!

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  • Given meds for pain in the hospital, the surgeon will probably refer you back to your pm doctor for post op pain management. You should have confirmed this with both doctors prior to your scheduled surgery.Who is responsible for acute post op pain management and for how long?
    You could very easily be in violation of your contract by not making sure how to proceed with the pain management if you get prescriptions from the surgeon without clearing it with your pm doctor ahead of time.
    The other issues I see, are the self medicating you are doing. The biggest reason that your extended release meds aren't working is your taking 5 -10mg tablets of immediate release oxycodone or more on top of the extended release Oxycontin. Breakthrough meds are not meant to be taken on a regular dosing schedule, as you are taking them. They are meant to be used for severe, sudden increased pain that can not be managed through other means. You are taking more than twice your extended release dose in immediate release meds, every day. All that does is raise the total amount of opiates in your system, that your body will quickly come to expect, leaving nothing for managing true episodes of severe pain. Tolerance isn't so much the issue, but misuse of the medications is.
    Extended release meds should cover most of your all day, every day pain levels. Breakthrough meds should be used ONLY when there are severe spikes in pain, and only for as short a time period as possible to bring the pain spike back under control.
    You also should never take more of any prescribed medication without the approval of your PM doctor BEFORE taking any extra.
    The other issue is that you may have a difficult time in the hospital post op with pain control by you just taking extra meds when you feel like it .

  • Hi. I'd phone both your surgeon & your PM doc tomorrow & clarify who's going to prescribe for you. Explain that you've got concerns about tolerance & that you've been regularly taking your breakthrough for increased pain....the cause for surgery I assume, & still experience extreme pain. Be honest about how scared you are!
    A good attitude is important for pain management & particularly going into surgery which increases your risks for depression (or so I've read. Being laid-up makes me miserable anyway!). Take lessons learned, move on. You're going into surgery & getting your pain managed straight after & as the days/weeks progress is a big deal. It's important to move & follow post surgery instructions. I've known people on huge doses of narcotics who have had great post op pain control by ensuring ALL the people involved (hospital anethatists included) know truly what they're dealing with. Now is the time to be asking the questions & getting the answers clarified. Best of luck ;-)
    Osteoarthritis & DDD.
  • Hi everyone!
    Had surgery on Monday and my fears were only that, fears! I actually feel pretty good! You were right about contacting my pm doctor and expressing my fears and concerns to the surgeon. He gave me a higher dose of extended release OxyContin and I haven't had to use the oxycodone for spiked pain levels yet. My surgeon was a neurosurgeon who did the operation, and other than the pain from the incision, the extended release is doing it's job. I spoke to my pm doctor and told him what the doctor prescribed and he actually thanked me for letting him know, but my surgeon already called him and spoke to him about appropriate after surgery care. The pain in my leg has subsided (due to there being no more vertebrae bone pinching the sciatic nerve). The biggest issue I'm facing is that the MRI didn't show the extent of the damage. They left about 40% of the bone, mainly because I will need a fusion of my L4 to my L5 and they wanted to make sure I had enough bone material to fuse. Though I'm not looking forward to that, I have to say at this point, I'm so glad I went through with the surgery and the appropriate measures about my meds. I was in a crucial amount of pain before the surgery (which is why i was doubling up my instant relief pills. I haven't needed to take any of those yet and I'm hopeful to be off all meds by September.
  • Hac711HHac711 Posts: 6
    edited 06/24/2015 - 9:28 AM
    I'm sorry if you misconstrued what I was saying. I wasn't popping pills anytime I felt like it. Pre-op I was in severe, excruciating pain to the point I was in tears and couldn't move or walk. I have a 9month old baby to care for and I wasn't just sitting in my room eating pills like skittles. My pain level was at a 10. When I had my surgery they told me if the vertebrae was a half centimeter more to the left I would have been temporarily paralyzed on my left side until I had it removed. It was the reason why my leg kept giving out on me; the bone would temporarily shift causing me to lose function.
  • Hello all,
    For anyone who has had back surgery, What is the ideal level of movement I should be doing? I'm in pain but not like before. I have been walking every day, even the day of my surgery I walked around the block . I know I'm not to lift or move items due to the possibility I of re-injurying myself. But what about me moving? My family wants me to stay in bed and rest, but I think moving and being mobile is correct. The doctor said not to so the stairs more than 2x a day so I already went downstairs for breakfast and back upstairs to rest. What did everyone else do post surgery,
  • sandi123ssandi123 Posts: 456
    edited 06/24/2015 - 10:21 AM
    No one said you were just sitting around eating pain meds like skittles. Taking more of prescribed pain meds, no matter what your reasons are, without clearing with your doctor FIRST , creates problems for you, and for your doctor, and more often than not, results in the patient being dismissed. Taking more of a medication than you are supposed to is misuse/abuse in the doctors eyes.
    That being said, I am glad you are feeling better, and are far more comfortable. As far as recommendations regarding recovery, you should always follow your surgeons directions. Walking, several times a day, limiting sitting usually to meals, resting as much as possible, standing no more than 15 minutes ,and the usual no bending,lifting or twisting.

  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    edited 06/24/2015 - 6:04 PM
    I'm glad you're feeling better and your surgery went well but reading about your medication use was troubling! Believe me, I understand pain and the desire for it to be gone yesterday BUT, not all pain relievers work the same way. You, at one point were talking about the severe sciatica. I've had that and had it severely before my first back surgery in 1998. NO doctor would give me meds to address this because sciatica is nerve pain. Opioids don't alleviate nerve pain. Lyrica does as well as neurontin, carbamazepine, and a few others. But I just wanted the docs to remove my leg because the sciatica was so bad- now I have learned that even if I found a nutty doctor to remove my leg the pain would have continued. The pain is nerve pain and exists between the insulted nerve and the brain.

    Another concern, and I writing this not just to you but because others read our posts too, tolerance is our bodies ability to utilize opiates without having them depress our breathing. Doctors start with a very low dose of an opiate to have the body learn to accommodate the side effects of the medication. The initial amounts of the medication probably will not fully address our pain. If it does, great but usually it's started at low doses to tolerate the side effects. There is a level in these drugs which our bodies simply cannot "tolerate" or build a tolerance to. This is where we hear about "overdoses." People want more of the drug to regain the euphoria but our sympathetic nervous system cannot accommodate this much of the drug and our respiratory systems become depressed to the point that we cannot inhale air or make gaseous exchanges.

    It's very helpful to learn about these terms so we can best advocate for ourselves with our treating physicians.

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
  • AJGormitAAJGormit Posts: 385
    edited 06/25/2015 - 3:30 AM
    Hi and well done for post op improvements you have shared :-). It is extremely difficult when in severe pain to see past that and think you will always have to deal with it. The relief after both of my surgeries were wonderful in different ways .. first time to get rid of the unbelieveable nerve pain and on second surgery to get rid of not only the nerve pain but also the nightly cramps in the right calf that had meant I could only sleep with my foot in a certain position, otherwise horrific cramp woke me . . a difficult thing to control so I became very very sleep deprived.

    You are doing the right thing to follow your doctors instructions re stairs and walking. Your family will be very concerned and may think bed rest is the best thing but be careful to follow your doctors instructions on this.

    My instructions post op were similar to yours but with exercises to do (which I did on my bed). In the first week or so, apart from the first 3 days I was generally on my own due to my partners work commitments. Due to this I spent the majority of time upstairs during his work hours with a flask, sandwiches and fruit and gallons of bottled water :-). I walked circuits around the top floor, watched tv standing up at times to make sure i wasn't laying down too much and did exercises as instructed. Post op tiredness can be extreme, so listen to your body and rest when needed as healing happens during sleep.

    Good luck and keep us posted on your recovery and enjoy the relief from pre op pain to help you through post op pain :-)

    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015

  • So tomorrow is a week post op! On still getting sporadic pains from before my surgery, but it's waning, thank god. Talked to pm doctor about everything and it's all good. We are going to start going down in doses at next appointment and I'm planning to be off pain meds completely by September. For the one who said they had sciatica and their doc didn't prescribe a pain pill, I guess each doc to their own. I was prescribed lyrica, oxycodone and an NSAID and I would have to take them all as scheduled to keep my pain from intolerable levels. Nerve pain or not, pain is pain and works on the CNS.
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