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where to go from here...

manaleriemmanalerie Posts: 549
edited 06/11/2012 - 8:19 AM in Lower Back Pain
So most of you by now should know my issues with my back, though I am fairly new to this site. I have posted my MRI results under the introduction section "hi, new to all of this"


I have been on Kadian for apprx 4 weeks. Started on 30mg 2x a day, was increased to 60mg 2x a day after 2 weeks.

The 60mg Kadian seemed to work wonders... still had breakthrough pain, but had felt better than I had in months. Tuesday afternoon, my back became aggravated, and by 9pm the pain was back in full force. I could hardly stand, let alone walk without excruciating pain, and could not find a single comfortable position, sitting/standing/walking/laying down.

I called my neuro wednesday am, and he was able to squeeze me in that afternoon. I sat (If I could even call it that) In the waiting room in tears the entire time, and was unable to do any bends or movements the neuro asked of me. He tried to gently move me himself, with his hands on my shoulder, and I yelled out in pain.

He prescribed me 5/500 hydrocodone for acute pain, to be taken every 4-6 hours, along with the soma I already had at home, and told me to call him on Friday (Today) to update him on my pain.

Today I am still in pretty bad pain. I can sit and lay comfortably, but standing up or bending over is a nightmare.

Now, my concern is... have I somehow unknowingly, injured my back even more? Or is it possible that the Kadian has stopped working all together? because it certainly feels that way. I am on a pretty decent amount of pain meds, without relief.

Should I request a new MRI... or wait it out? If I should wait it out, how long should I wait? Is this normal, to just have days or even weeks when the pain meds do nothing at all?

Thanks for your thoughts


  • Amanda:

    Wow! There is nothing more un-nerving than to find a treatment plan that works very well, then something happening to screw it all up. I'm sorry that has happened to you. If you can't or don't remember any traumatic incident that happened, maybe you just bent/twisted wrong.

    I don't know how old your MRI is; maybe if you are not feeling better 7 - 10 days after your initial bout of pain, you should speak with your NS again to see what he recommends.

    What did he tell you at your appointment - other than "take these and call me in a week"?

    I like the "Therma Care" heat wraps. I get the ones that are designed for your shoulders/wrists and place them on the small of my back for a while. Really helps loosen up those muscles. Of course, everyone is different. Too bad what works for one doesn't work for all, eh? ;)

    I sincerely hope you find you some pain-free moments. Keep us posted on your progress, ok?

  • My MRI was only about a month ago. At the time I had it done, I wasn't in any pain. By the time it was done, I couldn't get off the table without help. I was afraid that when I went in for the MRI, not being in pain at the time, It wouldn't show anything, but it did.

    The neurologist told me to take it easy for a few days... which I have been doing. The most I have done around the house is load the dishwasher, and pick up toys (which I pick up while sitting on the floor, so that I am not bending)

    I only have enough Vicondin to last 2 more days, and I guess no one will be in the office on Monday, so I am crossing my fingers that he will write me a refill today... I really don't want to be stuck on Sunday and Monday.

    I actually put an IcyHot patch on last night... which helped with the spasms, and plan on getting some heat wraps today, since my hubby just got paid. (those things aren't cheap lol)

    *sigh* waiting for neurologist to call me back...
  • Best of luck to you hon!
    (By the way - I just LOVE your pandabear!)
  • :? So now I must just be flipping crazy. :?

    As the neuro was writing my script, he said to me:

    ~I am writing a couple days worth of vocodin
    Take one, in a couple hours if you are still in pain take another, in a couple more hours, still in pain... another... till you feel better, call me on Friday, and let me know how you are doing~

    Those were his words. I know better than to take vicodin every "couple of hours" so I have only been taking them as written on the bottle, every 4-6 hours, basically 4 a day.

    When I called this morning, I told the nurse I was taking 4 of the vicodin a day for pain.

    I just called the neuro and spoke to the nurse agian. She told me that she spoke to the doctor, and that I am not supposed to be taking "4 a day" I am supposed to take them as needed. He told her that 20 tabs should last me a month, and that he doesn't prescribe for more than a month at a time. I told her that I am taking them as needed... I am still hurting, and I need to take them every four hours, to get any sort of relief. She said... but you are feeling better right? Well yes, better in that I CAN MOVE but I am still in pain, and I am feeling "better" because I am taking the vicodin 4 times a day... "as needed"

    I've decided that I must just be crazy. Think I'll start looking for mental hospitals instead of a PM... :?
  • Thank you Jeaux... your support is much appreciated... as for that panda... I love it too!!! Thats my "manda panda" :D
  • Unfortunately I've heard too many stories just like this. The doctor writes a Rx, and tells the patient to take "as needed". The bottle says take X number every X hours. And if you actually take the maximum amount, every day, there aren't enough pills to last a month (the usual amount of time to get the next Rx). Even then, sometimes the maximum on the label isn't enough to give pain relief.

    This drives me crazy. It seems a lot of people are in more pain than their meds can handle. And people have to choose whether they want to be in pain, though less, for the entire time by taking the least number of pills per day to get through the month. Or to take the maximum and get the most pain relief they can, and suffer the remaining days without.

    I don't think a lot of doctors understand chronic pain. They think that the pain will go away at times, and maybe that is true in some cases. But to make the assumption that a patient doesn't need some kind of med at all times, is really unfortunate. I know this isn't exactly your situation, but it just brought to mind many other posts I've read here (well, on the old forum), and it made me mad.

    I'm so sorry you have this pain, and I hope that you get back to the kind of relief you had before this incident.
  • Thank you Cathy...

    What is really bugging me, is how he worded it to me...

    ~I'm writing a couple days worth, take one, in a couple hours still in pain, take another, in a couple hours, still in pain take another, and so on.~

    That is (probably not word for word) but as close as I can remember to exactly what he said. cCouple hours take more, couple hours, take more... hey in a couple hours, why not take more... that was his attitude about it. That was Wednesday, and he told me to call him on Friday to let him know how I was doing

    I haven't been taking them "every couple of hours" as he said, since I know better than to do that, but I have been taking 4 a day (and I am still struggling only taking that)

    When I called today, he pulled a complete 180 on me, and said "NO" I was not to be taking them 4 times a day, and that the 20 pills he gave me should last a month.

    This is why I have decided that I must be crazy. I guess its possible that in two days, he doesn't remember what he told me... and I haven't been too great with my memory lately, but I'm pretty damned certain his words were to take them "every couple of hours" while the pain is still severe.

    I just don't understand how he can say one thing one day... and the complete opposite two days later.
  • dilaurodilauro ConnecticutPosts: 9,859

    You know one of the more difficult aspects in dealing with spinal pain is WHEN you get it. And by that I mean a what age.
    So many people just assume back and spinal problems are reserved for the older folks. Well, we all know that aint true. But it is many times harder when you are younger. You were full of vigor and bouncing with activities and then the spinal problem slows you down a bit. Its harder to take, I know, it hit me when I was around 23.
    But, back to you... Many times after taking a certain pain medication for a while, you body adjusts to it and it no longer seems to be as effective as before. So you can feel more pain while on the same dosage of medication. One of my earlier PM doctors liked to change prescriptions about every 60 days. He didnt always think that just increasing the dosage would help, but changing the type would. Or, for example, if you stopped taking a med for a while, in your case, the Kadian.. And then started taking it a week later, that first dose would probably provide you with the same initial pain relief you had the first time you took it.
    Sounds easy, but unfortunately its not. While you are in pain, there are two basic types of pain medications that you can take:

    The Iimmediate Relief type. These are designed to provide you with quick pain relief but will last maybe only 2-4 hours.
    Examples are: Oxycodone IR 5mg, Vicodin 5/500 and other doses

    The Extended Relief type. These are designed to provide you with an even level of pain relief over a period of time. It should last 8-10 hours.
    Examples are: Oxycontin ER 10,20,40mg

    The most efficient pain control that I have had was a combination of the ER medication (Oxycontin) and breakthrough medication, IR (Oxycodone)

    Your doctor should be providing you with detail instructions on how to take the medications. That should be clearly identified on the pill container itself. It is somewhat unreasonable of a doctor to expect their patients to remember exactly what was told to them, especially if they give you somewhat different tunes.

    You are not crazy, you are just part of this world of Spineys! I mean that in a way that says that you have a problem and you know what has to be done to fix it and that you have a large vast resource of folks out here in Spine-Health that can try to give you a hand.

    Until the medication situation is straightened out, try some warm baths/showers followed by some warm/moist heat Also you may get some relief from those medical pain relief rubs/gels. Many contain parts of menthol (keeping you cool to reduce the pain) and capsicum (the ingredient in hot peppers to warm the araa).

    Hang in there Amanda, if we can be of any help from a virtual world, please just post and ask.

    Hoping that you get a good ight sleep and that tomorrow will be a brighter and a day without as much pain and discomfort
    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

  • Amanda,

    My doctor did that to me the first rx, "just take them every 6 hrs, but if the pain escalates take them every 3/4 hrs till it stops".

    When I got my first refill, he could not believe that I went through all of them in 1 month exactly.I said per our intractable pain contract I am alloted 4x daily, more only when its absolutely necessary with the stipulation no extras will be given to make up the offset.He told me I misunderstood, I said we went over the amount exactly before I signed on.I swear he just wants me to fail and he's my PCP that knows me very well too.The 3rd fill is coming up in a few weeks so will see.
  • All of you are a blessing to me, you seem to be living my life and it sure helps that someone else is out there like me. A Physician once told me that most medical schools teach "pain" for about 1 day or maybe 4-6 hours during the training of a new doctor. You and I have had that much experience with pain in an afternoon. I am not trying to justify how doctors sometimes confusion pain medications, but imagine how little they really know or understand about what we are experiencing.

    I think Doctors don't "get it" that we are in pain all the time. They think "acute pain" and can't get their heads around full time, long term pain. I honestly believe that for some, not all, they believe that we become addicted to the medication. I did a 5 or 6 week program at a Pain Management Clinic and they told our group that people with Chronic Pain normally do not become addicted to pain medications. I say "normally", they reported that many studies had proven this. Yet, how many times wil Doctors argue with their own patients, whom they have known for some time, with proven, documented, long term pain and refuse to either provide any or sufficient medication.

    I am one of the lucky ones my Doctor and I have an pretty good relationship and the meds I take keep me able to bare life as long as I don't try to do anything.
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