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Pain management 5 weeks post Transforaminal Lumbar Interbody Fusion (Illiac Crest graft was used)

BrittBBritt Posts: 1
edited 03/08/2018 - 6:03 AM in Recovering from Surgery

Of those of you who have been through this surgery, or a similar surgery, what was/were your prescription med(s) for managing your pain during recovery? Also, did any of you notice a stubborn pain just in your sacrum area that just will not respond to ice, meds, rest? It's the most painful when I'm lying down, no matter the position; side, back, knees up. I also use my wedge pillows. And then, even log rolling myself to a sitting position is aggravating that area. Once I'm sitting or standing, it's minimized considerably but then, of course, I tire easily and do need to rest so I can't exactly be on my feet constantly just to avoid that pain. Plus, it's making sleeping not an easy task. Even in my deep sleep, I'm still hurting. I dream about it. (How sad. Haha)

I know this is a rough surgery and I'm sure the pain I'm describing is just stubborn inflammation but reassurance is always helpful. 

The medications I'm on: Oxycodone Acetaminophen 7.5-325, every four hours as needed and Tizanidine 4mg, usually just taken at night because it really knocks me out. I am curious as to what others have been prescribed. On one hand I feel that I feel like my pain is not managed enough just to allow me to do gentle- restricted activities. On the other hand, I'm afraid of making myself look like a drug seeker. Honestly, I want to get away from this stuff as soon as possible but the reality is, I must have my pain controlled so that I am active and allowing myself to recover. I'm struggling with stubborn pain and with having no gauge as to what is "normal" to ask for anymore. (Especially since my insurance will not pay for more than 7 days at a time for a narcotic. And they only allow THOSE 7 covered days to occur twice in a 45 day period. Prior authorizations were denied, and appeals, and peer to peer. They will not budge. But...that's another issue. I we have to pay a bit more, we will just have to pay a bit more.)

I appreciate any thoughts on the matter, everyone. Not new to chronic pain but very new to this recovery. Thanks!

P.S. I am walking quite a bit, daily. 

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Comments

  • Hi Britt

    Welcome to Spine-health

    I had a TLIF L4-S1 but without graft in June 2017.  They used a mixture of bone remove from the site and said they would add to that if needed.

    I am not in America so my medication list is different.  I was given 20mg Morphine doses, slow release, 2 x a day, which stopped after 3 weeks.  My body would not tolerate the other Morphine medication I was given in hospital, so this was an alternative.  I am also on 50mg Tramadol. 1 or 2, 4 x times a day.  I also take 100mg pregabalin (Lyrica) 2 x a day, which is ongoing.  My medical team also encouraged Ibuprofen, for the ladder affect,  but I kept that to a minimum to protect the fusing process.

    I had had 2 other spinal surgeries and have ongoing issues elsewhere in my spine, so everybody is different and given different medication to suit their conditions and pain levels.

    If you are suffering pain that you think is not right or extended, you must contact your surgical team and ask for advice and guidance with that.  They need updates from you if there is a problem, so they can assess that and confirm if normal and expected for you.

    I have always tried to keep medication to a minimum, rather than a maximum and have found that walking regularly really does stop me seizing up.

    I have always ask the doctors advice on medication, just explaining my pain levels and how it is affecting my life or recovery and let them make a decision on the symptoms.  I have never asked for increases, just accepted what is prescribed and then worked forward with that.

    After my 6 week check up, I was given access to a physiotherapist, who I am still seeing now.  It is a challenging surgery and slow recovery I have found, but I was quite aware of that beforehand, so just have to work at the long term patience, while my two levels fuse :-)

    Good luck with your ongoing recovery.

    I have added two links below to help new members with information and these also contain the forum rules.  There is lots of material to research that will give you the power of knowledge.

    Welcome to Spine Health


    AJ 

    AJ


    AJGormit
    Spine-Health Moderator
    ---------------------------------------------------------------

    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
    L4-S1 TLIF with decompression June 2017
  • Britt:

    I had  a L1-S1 fusion and TLIF 4 months ago.

    It was a tough recovery the first month, but I'm doing much better now. Will have my 2nd X-rays next week to see how the fusion process is going.

    Regarding medication:  I tapered off pretty quickly from the slow release Oxy within the first week. Was then on Percocet for 2 weeks.

    We are all different with our pain levels and tolerance. I found that while taking the  narcotics it was hard to gauge how I was doing (and thus tended to overdue walking, etc.)  I also had a severe impaction- this was when I went off of those meds and switched to Tylenol.

    I was fortunate that my pain level wasn't too bad...I totally understand those that need these drugs to manage!


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  • Britt - I had this surgery in 2012 and was oxycodone  5/325 for 9 months prior to the surgery and when they released me it was increased to 10mg oxycodone and a long acting buttons patch that each patch lasted 7 days. I was very aggressive and was back to work in a week after being home, however everyone is different and as both AJ & Steffie has said, speak with your doctors, they are able to prescribe you a 30 day supply... ithere is a numeric code that can be written on the script, that code is for chronic pain patients and will allow medication for more than 7 days at a time.  Best of luck to you and listen to your body, it will tell you when your ready.  

    Michael 

  • AJGormit:
    It's interesting that you were encouraged to take ibuprofen within reason. It's an absolute 'no' from my doctor for the first three months of recovery. I understand how it can reduce the effectiveness of the fusion. As long as I am getting my pain controlled otherwise, I was okay from withholding NSAIDS for the first part of the recovery. I am getting near the 3 month point (5/1) so hopefully I can take it soon as I feel that this lingering pain is inflammation. 

    steffie:
    I completely agree with you on losing that true pain gauge while taking narcotics. I expected it to blur those lines for me but it has ended up being even harder than I expected, unfortunately. I'm so glad your pain was decently controlled with Tylenol. Although I fully understand that we are all different with our pain thresholds and tolerances, getting off narcotics so soon after a surgery like this is fantastic! Maybe I need to look to that in my current situation that I will explain below. Do you still have lingering inflammation?

    bldbeaner99:
    Glad to know you went right back to work and successfully. Even with the medications, that is impressive. Just the 7.5 Oxycodone alone makes me far to sleepy and unfocused to resume normal work, (yet they still manage to keep me from sleeping well at the same time). My sensitivity to meds is one reason I'm looking forward to being done with them, honestly, but I want to be realistic with what my body needs and not rush it. That layered with being afraid of looking as though I am "milking" the opportunity to keep on the narcotics and also that fear of losing sight of my real pain made me unsure as to how to go forward. As far as what you described for the 30 day supply, I would not fall under the category of chronic pain, in regards to the surgery. I believe the difference is that since you were taking a narcotic before your surgery, you are not a first timer to the med whereas I am. I've had other surgeries and have used narcotics in recovery for very short periods of time but not for my chronic pain. I had managed (though it was getting close) to avoid opioids to deal with my chronic back pain for about 15 years. I struggled as a pre-teen well into my mid-20s because I was a "don't complain- suck it up" kid. I thought I had to. I had a routine CT scan and another doctor let me know I had an old bilateral pars fracture and spondylolisthesis. PT, exercise, and eventually facet injections and a couple of radio-frequencies kept surgery away until last year. Eventually that foraminal stenosis was overwhelming. I think that if I had asked, I could have started a low dose opioid treatment on strict terms and I likely would have fallen under the category you described, but I never did. And because of that I would be considered "new" to opioids, especially considering the post op status. It also might be more specific to state laws that are evolving. Also, it's still ultimately up to the doctor. He has been prescribing 50 pill prescriptions for me and he was rather stern on keeping it that way.

    To all:
    I had been working in pain management and orthopedics for several years, up until two years ago. In this practice, the surgeons prescribe pain medications through the post op period as he/she sees appropriate and begin the weaning process with the goal of removing the drug entirely by the time the period is over, (in my case 3 months). If the patient is still in need of pain management, this would be considered a job for the pain management doctor and the patient is referred over for chronic pain treatment. Sure enough, my surgeon let me know at my appointment two weeks ago, that it was time to wean. Honestly, this is fine with me. My only concern is that I don't want to suffer because I'm afraid of looking like a seeker. Unfortunately, I think that's going to have to be the case while I get a true feeling as to what my pain is like. Often times our bodies respond very poorly to quitting narcotics, even when weaning down. I always have a sensitivity to meds and expected to struggle but this is frustrating. Going from 7.5 to 5mg, I felt the hot/cold flashes, intestinal issues, anxiousness, and hyper-increased pain for a couple of days. Now I'm having to do the same going from my 5mg to 2.5 (after having to split them myself) and it's just miserable. I do not want more but there's no good way to wean down more gently for metabolizers like me. The pills split messily as it is. There is no way I could try to split them into quarters. I've been alternating between doses to ease down too. 

    It's almost over, though, I only have a few 1/2s left. I'm hoping that my "real" pain will be evident quickly after these are out of my system. I also hope that my "real" pain is bearable with Tylenol alone and that I'm given the "ok" to take ibuprofen again soon. Overall, I feel optimistic about the success of the surgery. My nerve pain is completely gone. All that's left is that inflammatory type pain. I just need to get through this part first.

    I appreciate your responses very much! Thank you for your input and thank you for letting me vent about this recovery. Feel free to add anything else as I welcome continued advice. 




  • Britt-

    I had an L5 S1 fusion 4 months ago.  My initial hospital recovery was complicated with a nicked spinal cord and issues with getting my pain under control.  Ultimately, my surgeon was able to take care of my needs.  Every person is different.   My recovery has been slow and I am still in pain and trying to wean off from my corset brace and return to work.  I am still having troubles sleeping comfortably and getting out of bed in the morning.  I often come home from work and just have to lay down because of the soreness. 

    I had a challenging time stepping away from the Norco's as my pain was so intense with activity.   I either had remain in bed often or be dependent on the pills.  As it turns out, my fusion is healing slowly.  I think that you should speak to your doctor regarding your pain level and maybe you may need additional testing etc.  I am a firm believer that no one should suffer for fear of looking bad.  This surgery is major and the recovery is painful.  I often wonder if anyone (even a surgeon) understands the recovery process if they haven't actually been through it.  I know they understand the procedure etc but as we all know- it's very different to go through and actually live it.  Just my input.   I wish you luck in your recovery.  Keep us posted!

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  • Britt

    I was fully aware of everything said about Ibuprofen and linked with fusion and discussed this fully with the medical team at the time and as I said, my usage was extremely low if I did have to take it. When you have multiple issues, the whole picture has to be taken into consideration.  I had issues with very high spiking blood pressure before my first surgery and that was linked to pain.  Doctors have assessed with this in mind and the implications of my blood pressure raising uncontrollably if my pain isn't managed.  The ladder effect is to reduce the risks of high doses of narcotics being taken long term and then not working.  Unfortunately I will be a long term visitor to my medical team.

    My fusion is fusing well with bone growth showing clearly on my last X-Ray so progress is looking good.

    Good luck with your continued healing.

    AJ

    AJGormit
    Spine-Health Moderator
    ---------------------------------------------------------------

    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
    L4-S1 TLIF with decompression June 2017
  • johneskijjohneski Posts: 3
    edited 05/13/2018 - 4:30 PM

    Good morning happy Mother’s Day to all of the Moms out there. I am 12 weeks post op on L4/5/S1 fusion. 

    I have 15 year history of LBP that was managed with combo of Therapy and OTC/ NSAID/opioids/ muscle relaxers/ benzo through the years. Had a previous failed laminectomy 

    My medication regime post op was 10mg ER oxy and 2mg Dilaudid, 3000mg Tylenol and gabapenton. for the first month  

    The dilaudid was changed to 5mg Oxy quick release at  month two and stayed with 10mg ER and other non opioids 

    At month 2.5 they discontinued the ER oxy and moved me back to dilaudid.....this is where my pain management issues began  

    I gave the change two weeks and found the deterioration of my activities of daily life unacceptable as a result of the severe and persistent pain. 

    I contacted my surgeon who sat down and reworked my recovery plan and added new modalities and a different medication plan  

    I share this to encourage those who feel lost in their recovery. The new pain management environment has predictably created unintended consequences, one I have observed is apprehension in communicating issues in a recovery plan. to your providers.  

    My experience has been as I spent time understanding others perspectives I was more confident in my ability to develop a joint recovery goal and adhere to the plan.  Give the plan time to work but willing to advocate without fear of reprisal for your health if your plan becomes ineffective in achieving your reasonable goals.

    We live in a world that saying no is easier than arriving at a sensible yes. Be knowledgeable be honest and be a true advocate for yourselves Less is more, however, more is sometimes required to get to less.


    JS

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