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How to treat pain

Most everyone who comes to spine health and stays with us long term has chronic pain.  Of course we do have transients who come for a while, maybe have surgery or injections and actually get better and have little or no pain.  I wish to put those individuals aside and focus on the patients who have had surgery and remain in pain.  Also those who did not have surgery or were told surgery was not an option.  I want to include those  of us who have DDD or arthritis.  Basically anyone who suffers long term pain.

There are many treatment plans available to us all.  We have surgery, injections, PT, medications, ablations, mindfulness, meditation, acupuncture, ice, heat and I am sure there are a few I am missing.  After doing all of the above there are still a percentage of us who will remain in pain.  I can think of no better treatment plan than pain medications for those of us who have tried everything and are still in pain.  I am excluding those patients who by sheer willpower are able to withstand the pain.  I must say I envy those who can do this.  I can not.  I have spent countless nights awake because the pain was too great to sleep.  I am not a person who can deal with their pain without help.  If anyone can teach me how to eliminate my pain by mindfulness I am open to it.  When you are at a 7or 8 on the pain scale, reducing it by one pt is not doing a lot. 

I am not a rebel or someone looking for a cause to exploit.  I am listening to all sides of the chronic pain story as told by patient, doctor, politicians, media personal, advocates for elimination of pain medications totally from the medical community.  (I was once approached by a person who was hired by drs to lobby for the total elimination of pain meds.  I was dumbfounded when I listened to his speech.  Another story for another time.) 

I would like to ask the SH community if anyone here is able to eliminate or reduce their pain levels by a significant degree by any of the above listed treatment plans?  I am not speaking about using meds with the treatment plans---meds plus mindfulness--or meds and ice or heat.  Has anyone found they are able to eliminate or reduce their pain to the degree pain meds are no longer necessary.  When I am in pain I cant focus on anything other than pain.  I am not saying my pain is worse than anyone else's.  I am talking continual chronic pain that will not let up. 

Now we are being told by drs that opioid treatment for chronic pain does not work.  Wait....backup....I have been in pain many years.  I know what works and what doesn't.  I am not saying that condition A, B and C can only be treated with X, Y and Z.  What I am saying is opioid pain medications are a great way to treat pain.  How do I know this?  I have been living in pain and trying many different treatments for years.  No one is going to tell me, throw away the meds and if you meditate hard enough, the pain will go away. 

I have spoken to countless others here on SH and other venues.  All treatment options have their place in the quest to control chronic pain.  The biggest gun we have at our disposal is the opioid medication.  Without it the rest just crumbles.  I still applaud the individuals who can live without any type of pain med but advil or Tylenol.  I am not one of them.  I read story after story of my brothers and sisters in pain who can no longer obtain the meds they need to function at some level to live their lives.  It breaks my heart. 

The War on Opioids is now upon us in full force.  It is said the first casualty of War is TRUTH!!!   I have never stood so deep in lies.  I hope this does not offend anyone as this is not my intent. 

God bless

dmo

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1

Comments

  • grtgrandma1aneeda70ggrtgrandma1aneeda70 Posts: 1,129
    edited 06/08/2018 - 6:15 AM

    Hi DMO,

    I have read your post a few times now, and decided to comment.  Like you, I want to make clear these are simply my personal opinions.  

    I have recently started on a schedule of opiads to relieve some pain.  I bet this surprises you, it certainly surprises and disappoints me that I finally made this choice, or had the choice forced upon me by continued rising intractable pain levels.   (I think I fall into your group "I am excluding those patients who by sheer will power are able to withstand the pain. I must say I envy those who can do this.")

    I have never withstood the pain.  I simply developed other methods of dealing with pain due to childhood abuse.  Please do not envy this high pain threshold, you would not envy the price I paid, as a child, to get it.  I have tried to explain this to people and seem unable to get most to understand.  Although, I understand more, each day, why people chose to use opiads.  It's all a learning process.  I would love to have a third surgery.  Again my neurologist refused.  I have decided to seek another surgeon.

    I find it humorous that ER doctors, who do know me, have seen fit to lecture me that after three weeks I need to stop taking pills, stop getting the meds from various doctors (in ER visits at the same ER) as I will be "in trouble" for this, and others silly suggestions.  I have some suggestions for them.

    The last ER doctor refused me a pain shot, refused to give me pills, and refused to refill a prescription.  It is what it is.  I didn't blame him, rules are rules.  I am not at war, I am in pain.

    He said he was calling my PMD and "telling him all".  What am I, five years old?  After that conversation with my PMD, he came back into the room, said he didn't mean to "torture" me by withholding medication, and handed me two pain pills.  (I hit a wrong button this posted before I was finished, lol.)

    Anyway, saw my PMD the next day, got a prescription refill to last until he gets back in three weeks, and hopefully I will have seen an ortho surgeon by then and have a better plan in place.

    In the meanwhile, I wish you the very best, I always have.

  • Hi Miss Aneeda,

    I am sorry you are suffering and in pain.  It seems that is all I ever say anymore.  What you have posted is part of what I am trying to say.  I do not know your age but Great Grandma kind of gives it away.  We are at an age where pain becomes a daily part of our life.  We have imaging evidence of our condition.  We have a long history of dr recorded visits and definite medical conditions.  Given all that why are drs taking the hard stance and denying us any medication to possibly make our lives a little more tolerable.  What would they rather do, withhold treatments and let us suffer?  For what?  For  the sake of saying they did their part in curbing the abuse of meds by a geriatric generation?  

    I am not surprised in the least you have chosen to treat your chronic pain with opioids.  I have done the same thing myself.  I choose not to live in pain if at all possible.  Pain medication should be given out on a case by case basis.  No one should be denied appropriate medical treatment based on a policy to restrict pain medications across the board regardless of the consequences to the patient.  

    The war on opioids is a reckless policy forced on the chronic pain patient with no regard to pain and suffering.  Let me say I am all for curbing pain medications for those acute cases where long term treatment is not necessary. 

    I have no idea of your past history.  I am sorry for your childhood abuse.  Such a thing is unconscionable.  This world we live in can be cruel and heartless.  I pray you get the help you need.  I also pray the drs and politicians realize the problems and hardships they are imposing on the chronic pain patient. 

    God bless

    dmo

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  • Great post DMO,

    In my case, after a failed ADR C5-7 I desperately needed Vicodin (and did receive it) to limp through the period until I could have a revision ACDF.  The failed surgery also seems to have caused some chronic muscular issues but I hope they will resolve in time.  I am younger still so opioids are probably not the right choice for me at this stage... but I hate the idea that I may ultimately not even have control over the decision whether or not to take them, in consultation with my doctor.  There is a place for a lively debate about when these drugs should be used, but I think all those of us who have needed them can say without a doubt that the idea they are not effective for chronic pain is silly.  

    Kevin

  • Kevin,

    I know how you feel about choice.

    My mental  status was badly declining due to the continued levels of pain that I was at.  I had stopped eating.  Forgot to take medications, or took them twice, etc.  Thus no choice.

    I still spend too much time at level 10.  But am mostly at a low nine and time spendt at level 8 increasing.  Hopefully, the nerve block will work better soon.

    I hope you never HAVE to make this choice.  I know now what I didn't know before, sometimes the choice really isn't ours.

  • Hi Kevin,

    Sorry to hear about your failed surgery.  I had a fusion at the same levels you had ADR replacements.  I have a question as to weather my fusion is complete or not.  I can see lines below where my doner bone is at both levels. 

    Not being sure of your age, you said you may not be a candidate for opioid therapy.  If your revision surgery does not go well what then?  Do we have a hard and fast rule of anyone under the age of 60 not being allowed to have pain meds?  What should we do with the 40 and 50 year olds who are in chronic pain?  We need to get away from the age related Idea of when a person needs pain meds.  The only criteria should be their medical condition.  Should we allow the 50 year old to suffer another 20 or 30 years because we need to curb the abuse problem?  Has common sense gone completely out the window? 

    As always this is my personal opinion.  Pain and suffering knows no age. 

    The question is can we save lives by stopping pain meds from dr to patients.  I would say yes but with an asterisk symbol attached.  By reducing the number of legal prescription drugs we can reduce the number of opioid deaths.  We can reduce the number of people who use opioids as a stepping stone to illegal drugs.  However the larger percentage of drug related deaths by illegal drugs will not be reduced or affected at all.  Chronic pain patients will have to look elsewhere to find the pain relief they need.  I have recently read that the average person who OD's has a minimum of three different illegal drugs in their system.  Again I am no expert of facts and statistics.  Please excuse my ignorance. 

    What we need is a system to bypass this new crackdown on pain medications.   A system where we are registered with a pain management dr with documented evidence of the need for chronic pain meds.  I am sure there is a way to protect the rights of the chronic pain patient.  All we need is a advocate to help us.

    God have mercy on us all

    dmo

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  • DMO,

    Did not mean to imply that I should be excluded from having opioids because I’m 40... just that it makes sense to weigh the risk of long term use against the current level of pain.  I’m at a moderate to manageable level so I’ve determined I want to hold off - but if it affects my activities or ability to work then I’d absolutely be willing to start on them, assuming the choice is still available to us!  

    Kevin

  • Nothing was implied Kevin, my statements were for general use.  Age should have no influence on weather a person uses pain meds.  A person who is 40 can be in just as much or more pain than someone 70.  Age is irrelevant in the equation.  Absolutely weighing pros and cons is the way to go.  It has already been established pain meds administered under dr supervision has a very low chance of causing addiction.  I often wonder if there is a hidden agenda on the war on opioids.  Alcohol related deaths far exceed opioid deaths, yet there is no outcry to ban alcohol.  The same is true of tobacco related deaths. 

    As you are young I hope you can get your pain under control.  You have many years ahead of you.  I hope and pray they are pain free.  It is sad to say if you do need pain mediations your chances of obtaining them in our current climate is very unlikely.

    God bless

    dmo 

  • DMO

    I dont know what to say, because you are saying exactly what I feel, think and believe!  This current treatment plan the government has set out for opioids doesn't include people with documented, image showing, black and white, based on factual information chronic pain other than from cancer suffers.  Who was their voice?  Who protected them under this newer regulations?  My back surgeon knows the pain I am in, I can see it in his face when he tells me... you know I have to send you to pain mgt for that.  Knowing I am NOT getting the dose I need, yet he can't risk his lively hood for me.  Heck even my old pain mgt nurse practitioner that I had seen for years, knew her reducing my level of medication due to "management rules" was wrong. 

    So, both my back surgeon, and my pain mgt provider both know is wrong, but yet nothing is being done.  It is getting worse, especially in a state like mine.  Then in small country areas like where I live, there is an monopoly on the pain management practices.  Yea may look like a lot of offices, but dig down, they are all owned by the same doctors group.  No choice, no say, no voice, just pain. 

    Its wrong, right? Or am I just crazy?

    Tabel69
    Laminectomy and Fusion Spine Lumbar
    FLI, L3-5 Lateral Fusion
    L5-S1 TLIF, L3-S1 Per.Screws
    July 2014
  • Dmo

    I agree with you that opiates are a good way to help a person live with and in pain.

    I have seen too many articles saying PT will help..no in some cases a person is beyond PT or simply cannot do PT.

    that narrative is not sane.

    William Garza
    Spine-Health Mod
    erator

    Welcome to Spine-Health

  • nutcase007nnutcase007 United StatesPosts: 795

    Great discussions in this thread!  Thanks to all who made comments.

    Opioids likely saved my life.  Since my second ACDF in 2014, I was in severe chronic pain.  Most days were at a pain level of 10.  My neurosurgeon saw that I was in severe pain, but he could not prove it with diagnostics tests.  The one test that would have shown my need for another surgery was denied by the insurance company (cervical discogram).  I was left to rot in pain without any options.

    I was taking a mid-level dosage of oxycodone.  Many opioids were tried, but oxycodone was the best that was still available.  The old original Oxycontin ER worked the best, but once it was reformulated, Oxycontin ER was totally worthless for me.  I had many second opinions where I was told that I had to get off of opioids.  I've been on opioids most of the time for 21 years, except for a few months after my first ACDF. 

    With my days at pain levels of 10, I started having strange symptoms develop.  I ended up in the ICU for four days with heart attack symptoms.  Yes, blood tests showed elevated troponin levels which are generally accepted early markers of a likely heart attack.  Once I was stabilized, a heart catheterization was performed and a heart attack was ruled out.

    A few months later, I developed stroke like symptoms, was paralyzed on the right side of my face.  After a CAT Scan to rule out bleeding in/on the brain and three MRIs later, a stroke was ruled out.  The only explanation that the neurologist and vascular doctors in consultation with my neurosurgeon could come up with was the pain/spasms were so great in my neck that it was triggering the heart attack and stroke like symptoms.

    My neurosurgeon gave me a lecture that I needed to increase my oxycodone to the max allowed (60 mg a day) limited by the new rules and hopefully it would bridge me until he could get surgery approved by insurance.  This past December, I finally got surgery approval for an ACIF (almost like an ACDF, but with a device implant).  The surgery was performed in January.  I have been able to get down to 20 mg of oxycodone a day with the dream that some day I can get totally off of it.  Will that ever happen?  My neurosurgeon thinks I can/will.  Time will tell.  I'm only six months into a likely 18 month recovery period, whatever recovery I can obtain. 

    As a side note, the state I live in only recently allowed medical marijuana            

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