Preface: This post is based solely on my experiences and opinions. I am not a physician, nor do I hold any professional medical position. I am merely wishing to provide a description of the different approach to which I and my doctors have taken at treating the constant radicular pain I developed some 3 months post-op from a L5-S1 microdiscectomy. I am posting this up mostly for informational purposes as I know I ran into many dead ends when doing typical searches for treatment options when dealing with epidural fibrosis/fibrous adhesions/failed back [surgery] syndrome (FBS/FBSS)

That said - bit of background on my situation and treatment up until this point. I am a 24 year old male who has been diagnosed with degenerative disc disease and epidural fibrosis. In the fall of 2009 I developed a debilitating unilateral radicular pain in my left leg, accompanied with pain on straight leg raise, some numbness and a very slight change in motor function. I had a series of epidural steroid injections (ESI's and TFESI's)between Jan. 2010 and Sept 2010. At that point I elected to have a microdiscectomy in an attempt to correct what we discovered was a ruptured L5-S1 disk with a para-central bulge effacing the ventral thecal sac. Surgery in October of 2010 was a success; however, by the end of January '11 I had started to slowly, but surely, notice a familiar pain returning to my left leg and left lumbar region of my back... A follow up MRI showed a small fibrous lesions several nerves at the level/side on which I had the microdiscectomy; this branched off from a 1cm-1.5cm lesion that not occupied the space where the hemilaminectomy was performed during surgery.

My neurosurgeon refereed me to their in house pain management physician in April '11 who then tried more ESI's/TFESI's, accomplishing nothing more than solidifying the fact that a L5-S1 medial branch block eliminated any hint of pain. At that point it was recommended that I go ahead with a SCS trial. Long story short I saught another opinion and avoided the SCS for as long as I could, but by the summer my pain was worse than ever (even before the microdiscectomy!) and I was caught in the cycle of increasing narcotic med doses every few months because nothing was really working. I have nothing against narcotic pain management, worked great in post-op situations for me but I personally just didn't like the side effects I dealt with when on opiates and wanted something different.

Another long story short - I got the SCS trial, went ahead with the SCS implant - it has been a so-so investment in my health quite honestly. It works well for my leg at times, but never touches my back pain which became more debilitating as time went on.

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I kept my head up and decided to start using some resources that had recently been made available to me through research ties at the university I attended in addition to familial ties to individuals who practice medicine (not gonna get more detailed than that).

Not gonna get into the heady-details of the pharmicodynamics, or any of that science stuff for that matter, to make it more simple...but through diligent research and endless communication with my physicians, and never without their approval(!) I started on my current pain management medication regimen with the aim of reducing the cause of my pain (epidural fibrosis/adhesions) rather than treating JUST the symptom of pain with narcotics.

Here is what I'm taking:

600mg Palmitoylethanolamide (Normast), 2x daily since 11/2011(OTC dietary supplement, sourced from Europe as it is not commercially available in the US yet - it has shown significant promise in my case own case by decreasing the intensity and duration of the worst episodes of pain)

400mg Pentoxifylline (Trental ER), 2x daily since 2/2012 (This medication has been used for the past 20 years or so, in conjunction with other supportive medical therapies, for reducing scaring from various causes; most notably fibrosis induced by radiation therapy undergone by cancer patients. It has been preliminarily investigated for use on epidural fibrosis but it is currently an OFF-LABEL USE)

1000IU dl-Alpha-Tocopheryl, 1x daily since 11/2011 (Vitamin E - antioxidant - used in combination with pentoxifylline in the treatment of post-radiation treatment fibrosis as well as other fibrotic-scaring conditions)

500mg Naproxen, 1x daily since 10/2009 (Helps with muscle aches caused by spasms, doesn't help the nerve-based pain directly though)

20mg Baclofen, 3x daily since 5/2011 (An anti spasmodic, I am very sensitive to migraine headaches and this has been the only "muscle relaxer" type medication that I've been able to tolerate. Works decent on reducing spasms, but doesn't hasn't had a measurable effect on my pain levels otherwise)

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I just started the pentoxifylline today, based on the literature it takes between 1-3mo to notice any measurable (physical or pain score) differences, and up to 6mo to take full effect. But I am excited to be approaching the treatment of my pain from a new angle, rather than throwing opiates at it until blue in the face! Prior to starting Normast I was up to 3x 30mg Oxycontin per-day, and was still in 7/10+ pain every day. The side effects which were once minor at lower doses were blown out of proportion when my dose ticked over the 70mg/day or so dose. Believe it or not I was unfortunate enough to have some really rare reactions like joint swelling and osteoarthritis type symptoms in addition to the plethora of other SE's one may expect with oxycodone. I slowly but surely transitioned off of narcotics by the beginning of Dec. 2011, of course along with the close supervision of my doctors.

There are still many avenues unexplored in managing and treating failed back-type syndromes accompanied by fibrous lesions- I have been put on the path of just one but so far I am glad I have gone the direction I have!

In addition to the medicines which I'm on my pain management physician has also mentioned trying a catheter based ESI/adhesiolysis using a caudal approach (Racz catheter method I believe, or something close to it, I see them again tomorrow and will hopefully have a bit more clarity then) after we have given the Trental/Vitamin-E some time to work on their own. This in conjunction with the medicines I'm taking, some that has proven to prevent and even reduce existing scar tissue in other types of cases where fibrous scaring is present may prove to be an effective way to treat certain cases, like mine...I sure hope it works!

Any discussion on this topic, personal experiences, thoughts, or questions, would be awesome!