Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Failed back surgery and multidisciplinary pain management


I am a 34 year old reasonably healthy male well with the exception of my back. Anyway I had a work injury in December of last year (2014) I work for a moving company and was lifting a heavy table and ended up herniating my L4/L5, L5/S1 discs, and went through 3 months of therapy and rest and pain meds and had no success or relief. So at the end of April I had a double microdiscectomy and a laminectomy and a few other things done. I was excepting a fast recovery but wasn't the case, just over a month into recover I was still in the same pain I had before surgery (leg, groin, butt and back pains) So my doctor ordered a MRI and low and behold the discs had reherniated within a few weeks of surgery, and I have instability in the area too my spine shifts and pops. So I went back to PT and did that for 2 more months until my primary doctor withdrew his support. My neurosurgeon said the next best step would be a 2 level fusion PLIF and even though I don't like the idea of having a fusion we agreed mutually that it was our best option to get a good recovery.

So now my workers compensation wants be to go see two multidisciplinary pain management doctors for a 2-3 hour session which is in Portland (2 hours away from me) My question is this, will they be able to override what my primary doctor and neurosurgeon say (they both support a lumbar fusion) Being these pain management doctors are chosen by the workers compensation I am wary that they are going to say I am fine and go back to work, or as I feel my open claim is costing them too much money and they don't want to pay for a fusion and a hospital stay. And my job if/when I ever go back requires heavy lifting of 100-150 pounds every day 8+ hours a day. As my doctors have both said I won't be doing that ever again and if I do then I will be working on L3 herniation in no time.

And what can I expect from these pain management doctors? I have already done months and months of therapy, inversion, massage, tens units, going in the pool, cane for posture and a back belt and nothing. And not to mention 9 months of ibuprofen, aleve, oxycodone, flexural, endocet. No relief. I am worried they will demand me to have a spinal injection and I do not want that. Again both my doctors say that spinal injections have been show in studies to be very unreliable and can do more damage than good. If I decline a injection will I be seen as being uncooperative patient? Or can I state that I have a genuine fear that the treatment will cause more harm than good?

I have never been to a pain management clinic and just don't know what to expect especially since it's workers compensation and I know who they work for and DO NOT trust them. Sorry my post went long just a lot of unknowns.

Thank you.


  • Hi,

    Wow, you have been through the mill! I did a similar injury lifting a heavy table at home. I herniated my L5/S1 last July and then had a discectomy and laminextomy in December. I too re herniated and four months later had a second disectomy and laminectomy. I've been on PT ever since, been told my back is unstable and may need a fusion.

    I had a pain management clinic appointment which took 1 1/2 hours to 2 Hours. They discussed everything that had gone on in my life that may have been stressful and related that to nerve pain saying that nerves, even stress related, can effect nerve pain. They organised my pain meds and now I have another appointment in a couple of days, this time with a psychologist. Not sure what will happen then? I've had two spinal epidural steroids, one before each surgery and in my case they didn't help. I have been offered another but have refused. I didn't feel that the benefits of the injections outweighed the pain I went through getting them done, but I do no of people who have benefitted from them.

    Good luck and I hope you get sorted out, it must be stressful when you don't know if your compensation is going to cover your operation.
  • MrAnderson1981MMrAnderson1981 Posts: 17
    edited 09/06/2015 - 6:10 PM
    Hi Michelle, seems exactly what I have gone through. I don't have any faith in pain management, I am hoping my attorney will be able to stop it and go forth with the fusion and just get it done, I am tired of waiting month after month. Anyways I hope your psychological appointment goes well.
  • Hi again,

    I hope you get it sorted soon, it's dreadful waiting and not knowing, you just want to get on with life, tick the box and carry on. I know exactly how you feel. All the best. Let me know how you go on.
  • Prior to my first fusion surgery, my neurosurgeon told me that the surgery was necessary because of serious issues with stability. He told me that there was a high chance, however, that the surgery would not resolve my pain issues. He was right.

    The value of a Pain Management Specialist is that they can find ways to help make the pain more manageable. They can do a range of treatments such as corticosteroid injections to reduce inflammation, radiofrequency ablations to stop the nerves from sending pain signals to the brain, various medications to help with peripheral pain, other medications for base pain control and breakthrough pain management. They can also turn to aids like spinal cord stimulators and or pain pumps. There are so many ways that a pain management specialist can help.

    My experience is that my neurosurgeon and my pain management specialist work together to improve my life. My surgeon focuses on function and his job is to keep me on my feet. My pain doc focuses on managing the pain. I would be lost without the both of them.

    Give the pain specialists a go - you may be surprised.
  • Thanks for that Cheryl, I'm giving it a go tomorrow, so, fingers crossed. I've reached the point where I will try anything.
  • Thanks for the info Cheryl, so does that mean that I will be denied a fusion and just have to go through pain management and that alone? I am unwilling to try injections or a stimulator. And I have been on medications for 9 months now and not wanting to do any more medications. I will be open to trying some things, but as I said I will refuse any injections or stimulator implants since my neurosurgeon and primary doctor both say there is little evidence to support any benefit from them. And a implant is not what I want at all. I guess I am just ready to be done with the whole thing and I think going to pain management is just delaying the inevitable with my 2 herniated discs / degenerative discs and the instability caused by them.

  • Hi again,

    I hear what you are saying and I'm in the same situation, possible fusion, pain management just about to start and over the whole thing. I'll let you know how I go on. Had another MRI last week and waiting for results so I may know soon whether the fusion is happening.
  • SavageSavage United StatesPosts: 5,427
    Pain management is very useful, not only in helping to manage pain both pre and post op, but also in its diagnostic contributions.
    Many tests contribute to better awareness of spinal issue. In some tests for lessening the pain, are also diagnostic, as doctor can also see the spine through fluoroscope (sp?)

    In my experience, my doctors , even without working from same office....they work as a team.
    They all cooperate with each other, all know what the other is doing..prescribing...and work for my best interest.
    And they each give me information so I can be as knowledgeable as possible...for my benefit.

    Im pretty sure it is under FAQs, or you could use..search on this site to fine...Preparing for pain management doctor visit.

    As you read, you may be led to more questions....and you may want small list of questions for doctor to alleviate your fears.
    He will assess, guide and or reassure you.
    Good luck with your future appointment! Please keep us posted!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • CherylCCCherylC Posts: 185
    edited 09/08/2015 - 3:48 AM
    No it doesn't mean you will be denied a fusion it just means that you may be able to get some additional help.

    Please believe me when I say that a fusion may not solve your pain issues. I tried radiofrequency ablations and injections before finally having my first fusion in 2011. Complications in that first surgery left me with permanent nerve damage on my left side. I had to have a revision surgery and a second level fusion less than 12 months later. Pain has been a constant battle and I finally had a spinal cord stimulator inserted via laminectomy in 2013. Even with all these surgeries, I still suffer with intractable pain an am on some pretty nasty drugs.

    Don't be too quick to dismiss the good that a pain management doctor can do for you and be prepared in case the surgery doesn't take away your pain.
  • MrAnderson1981MMrAnderson1981 Posts: 17
    edited 09/08/2015 - 6:13 AM
    I'm not saying that a fusion will fix everything, my neurosurgeon and therapist both said that no matter what I will most likely never be 100% pain free. I am just hesitant to go through the pain programs because it will most likely delay the inevitable, the one I am going to is a 3 week program and then 3 months of home exercise then follow up visits, and the whole time my nerves will still be compressed by my herniated discs. I don't want to wait months and months and months to get this fixed. That's my fear that this will never end and I'll end up an unproductive member of society.
  • Promise. You will have to wait most likely..I sure hope you don't! None of us like it, trust me...but it is the protocol of spinal problems. I believe the outline of the process is in the new member area of this site. For instance:

    Have had two microdiscectomies and two fusions over 14 years. All good outcomes=I walk and return to society, a little more limited each time, but I have had excellent health and happiness. You wouldn't know I ever had spinal issues unless I had flare ups. You learn to manage those and you learn when a flare up is a kindle, and when it is out of control and you have to go back to the specialist.

    When you go back, each and every single time..the process begins again. As you have read, these people are correct. First it's imaging, drugs, pt. then a little plan is made, usually for mid level remedies to fusion. The goal is care without going to the extreme. This is when I like this metaphor of baseball: u r the batter. The pitcher is the neurosurgeon or orthopedist. The catcher is the pain management dr. The dugout is filled with your family and coworkers.some like u and understand and some want you off the team. The bases are what you have to complete to get the run (solution). Each base will feel like a month of pt and epidurals or other therapy. The goal is to get the score, the score of relief. If the bases are not beneficial, you still have to visit each one. Ie..sometimes the injections work, sometimes they don't. But each one tells the catcher and pitcher what the exact problem is. Sometime you have side effects from the bases..you had to slide on one, twist an ankle at another(spinal headache or you used all your spoons on one day that you had for a week) (Google spoon theory).

    There are no home runs in spineball. No one skips a base. The bases are there to slow you through the process, because sometimes you don't need to go all the way around. Sometimes the pain does go away. That is awesome! Think of it as a wonderful rain out. Go on with life and try not to flare up

    Flare ups happen, sometimes because of you, sometimes because the sun came up.

    With a good relationship with pitcher and catcher they let you be a designated runner and start up from the base you were last on. If so much time has passed (which is a good thing), you have to start out in batter box again..which is no fun. I know. But it is what it is.

    That's spine ball. None, no one, wants to play. But the key to winning is a good team. The support is the fans, that is us. And a good therapist doesn't hurt, trust me Mr Anderson. If I could, if any of us could get the hit and sweep thru, we would. One day I believe this will all change. I really do. When our spine ball can be treated in the same caring and compassionate way a cancer diagnosis is made..that will be when things change this process. In the meantime, we are not Americas favorite sport. Even though our condition is the number one world wide pain cause and reason for missed work (world wide! Google it) we are in a horrible slow moving process. Like I mentioned, there is some reason for that. But for those of us caught in a horrible barnstormer of a flare up that won't go out..we endure.

    Your fan, m

    Sorry for the epic post, I never edit well.
  • No, it's a good post, but it just seems a bit contradictory that workers compensation wants to get me back to work sooner than later and save money. So I don't see being out for years and years with this claim and not working. I would think the money I've cost them with my claim, 9 months of therapy, 1 surgery so far, meds and paying me weekly wages that they would soon start pressuring the doctors to find a way to deny me a fusion sugary and settle with me and get me out of their hair. Just a thought, since I am costing them a lot of money and they are in the business of saving/earning money not spending it. And I'm sure this pain management course won't be cheap either. I just feel when it all said and done my herniated discs will not have magically reabsorbed into their body. As my lawyer said when he read the surgical report from my microdiscectomy surgery that it was something of a train wreck there. And now that I've reherniated again after surgery and the discs are degenerating (at a rate you wouldn't expect with a 34 year old) that I feel that a fusion is going to have to be done at some point. I'm not crazy about it I just feel from talking to my doctor that it is the best option. But who knows there could be some miracle with this pain management program and I'll be doing back flips and going back to my heavy lifting job full time but to be honest my outlook on that is not exactly hopeful. So I guess in this game there are no winners.
  • Sheri76Sheri76 Michigan Posts: 486
    Sarcasm? I do both at times.

    I hear you with the insurance and work disability. When I go back to work, with my work disability policy, if I am unable to continue work within six months of returning because of complications related to why I was last off work, I wouldn't have to go through any waiting peroiod for approval of disability, it would continue from past claim. While that may take some pressure off financially, I would rather not learn that by having to take on more body damage, trying to cope with more pain. The not knowing is frustrating, can only make choices on what we know. Hopefully, when the time comes, I will make the right one.
  • 2dgs4cmpany22dgs4cmpany Posts: 200
    edited 09/08/2015 - 3:36 PM
    I really hear you and I am sorry for the situation and mostly for your pain. If you have to attend pain management, it will either help, or it will prove out fusion..per my own experience only.

    34 is young! I had my first fusion at 32, and I was like a new woman. Again, from my experience only, and with ten years and lessons learned..I did run marathons after that first fusion. I roller bladed. I toted my boys on my shoulders, daily. I should never have done that. Granted, it's what I did. Of course I wouldn't change a thing..I lived my life to the fullest and don't regret the experiences. My back does suffer the regrets now.

    We are all different, and this was my experience learned: moderation in all things. Not to be your mom, but I do read that you would be returning to heavy lifting? I worry that may not be realistic. Just thinking about you right now.

    I am so very sorry this happened to you and wish this process over for you, and healing.
  • Well I know I won't be going back to my old job which is for a moving company. Dr said never again or I'll be right back where I started. Lifting 100-150 pounds repetitively 8 hours a day 5 days a week is out of the question. So I'm planning on going back to college to learn something less physical and not hurt my back again. I don't ever want to go though surgery again, one is enough but I know I'm going to have to have at least one more (2 level fusion) and that will most likely come with some permanent restrictions. And of course I know how to bend with my knees but even with that I wasn't able to avoid a bad injury.
  • Could it be possible that they want to send you to a PM since he may be able to help with pain that maybe the surgery can not fix? When I was recommended for L5/S1 fusion even then the surgery only had 80 percent and of course reherniation was always possible. Sometimes surgery can always make a situation worse that's why I think they are sending you there in my opinion. I think the younger you are the more surgeries will be needed.
  • I am as well, never too late to learn a new trick.

    Gramma is right, younger you start..the studies with fusion lead that way that more will be needed.

    Personally, I disagree a bit on that one. Again, my own experience. Yes, going on third fusion, started at 32.. But genetics play a huge role in my situation. Ddd is chronic three generations back on both sides! Grrr. But, had I taken a softer approach to life physically after the first one, I do not know that I would not have needed the second level done as soon. And I was told to get the third level taken care of by my second opinion doc before my second operation.

    My point is that nothing in this life is predetermined. You have choice. Some you regret, some you don't. I don't regret my life choices. I will never forget the freedom running gave me after my first fusion. I had never run before. I wanted to seize life because I felt I had, absolutely had to live life to its fullest. While the running didn't help my back..it made me a better mom and wife.

    I'm so glad I did. I just recommend others to maybe go a little bit easier. Besides..things are different now. There are so many activity choices for every level.

    I'm so glad you are making the choice to return to school. And to get your body into the best care and comfort. It will be worth it. This wave will pass. Wishing you comfort and joy, mr Anderson.
  • I know it's not a given that a fusion will fix everything and I see the pain management as a bandaid, I really do. I mean my discs have herniated twice, once before surgery and again after and I don't know how long if ever before the discs will reabsorb into the spinal column and if and when they will re herniated again. I am also worried about long term pressure on the nerves from the disc leading to irreversible nerve damage. I'm told when everything comes to the end workers compensation does not take into effect pain and suffering which I think it should. Anyways I am not a fan of the idea of a fusion but I trust me neuro and his opinion. He says this is also a "game" we have to play with workers comp and he is annoyed by it.

    I guess we will have to see.
  • MeydeyMMeydey Posts: 209
    edited 09/09/2015 - 12:12 PM
    I also feel you should go ahead and have pain management evaluate you. If necessary they will refer you to a spine surgeon. This was my experience..I was referred to a pain clinic after a microdiscectomy on L4-S1 when I reherniated 1 month postop. I was started on Fentanyl patches and Norco. After reviewing my last MRI, they referred me to a neurosurgeon because of instability (retrolisthesis), disc herniation, and the nerve being compressed. I had a 2 level TLIF, my second back surgery within a year. My NS collaborated with my pain doctor during that process, but despite the fusion my pain worsened and I had permanent nerve damage. Few months later I had a pain pump implantation surgery as a last resort, since additional surgery was deemed too risky. Since my back problems started I tried many conservative treatments like ESI's, PT, etc.
    My experience wasn't a WC case but my ex was given a choice from them: meds & injections or surgery. This was weeks after he injured himself and was told would be a quicker recovery opting for an operation. WC denied the case and no surgery took place..his back is in better shape than mine though. Whatever you choose to do, I hope things work out and that you attain better relief.
    Ol' Spiney...Microdiscectomy L4-L5, TLIF L4-S1 -post op central disc herniation L4-S1, sciatic nerve damage, retrolisthesis, epidural fibrosis, facet arthropathy, severe DDD & OA.FBSS- Medtronic SynchroMed II pump.
Sign In or Register to comment.