This post is very very long, so I apologize in advance. But I would really like some feedback if you can make it through.
I am quickly coming to the point where I need to “confront” (that word is a little strong) my physiatrist about my pain management, and I’d like some feedback from the community. But I think I need to give my history first to help you all understand where I am coming from.
21 years ago I was found to have a bilateral pars defect with very minor spondy. I was a wrestler and VERY fit. After a lot of PT the pain went away and I was able to wrestle for 2 more years before the pain started again. Once I stopped wrestling, I was ok with only minor, sporadic pain for the next 16 years.
Three years ago, I started having pain in my back and butt. Shortly thereafter I found a lump near my rectum. After 8 months of being told no one could find anything, a colo-rectal surgeon found a rectal fistula and related abscess (that was the lump). In Jan of 07, I had a rectal fistulotomy- a minor surgery that was extremely painful. At that time I took Percocets for 2 months of recovery. But by March of 07, I was hurting again. I went back to the colo-rectal surgeon many times to no avail, but my butt hurt SO badly. Finally I was told nothing was wrong and to not come back in Jan of 09. I was crushed and since they said the pain was in my mind, I started seeing a psychologist. All this time I never thought it was my spine… it never crossed my mind… I thought the pain was from the rectal surgery.
In March of this year, the pain changed. It intensified and began radiating down my right leg to my foot, my left leg to the knee and up to my beltline. My psychologist referred me to a PM doc. The PM doc would not take a referral from a psychologist and wouldn’t see me. Crushed again, but his nurse had called my pain sciatica. Sciatica? OMG… this is from my old spine problems I realized. My GP ordered an MRI and sure enough. The breaks in the bone (L5 pars) never healed. I was referred to a neurosurgeon. But after xrays (flexion and extension) showed my spine to be stable, the NS wouldn’t see me and sent me to a physiatrist in his practice.
The physiatrist tried me on various NSAIDs, prescribed a brace that was useless and a course of PT. The PT helped a bit, but that was it. He finally gave me Tramadol and I am one of those lucky people who get decent relief from Tramadol… but if I take it past 3pm, I cannot sleep that night. I had no pain control at night and as a result I was missing about a week’s worth of work every month. When I asked the physiatrist for night time meds and to sign a form for intermittent UNPAID FMLA job protection he fired me. Crushed again. And to add insult to injury, he referred me to the PM who had refused to see me 3 months earlier. I didn’t know what to do!
I decided I’d had enough with these specialists and went to my GP. He saved me. He signed my FMLA form, continued my Tramadol and gave me 30 vicodin. I started walking 2-5 miles a night and eating better and lost 40 lbs! I was determined to beat this pain myself if I could.
I couldn’t beat the pain myself and went to another physiatrist for ESIs last month. We tried 2 ESIs and they failed. He also started me on Amitriptyline for my nights since I still wasn’t sleeping well regularly.
Finally we are to the present. This week I went back to my current physiatrist. I broke down and cried in his office as I told him how this pain is tearing my life apart. He started me on Gabapentin and told me he couldn’t do anything else and I needed to go back to a surgeon about a fusion. He ordered a new MRI to be done tonight and we are meeting next Wednesday to go over the MRI.
This brings me to my current issue. I don’t want stronger meds, but I also don’t want surgery. But if I have to choose between meds and surgery, it seems to me that meds should be tried first. I mean, I have never had anything stronger than Vicodin and Tramadol for this pain. I feel like these docs are cheating me out of options because of their fear of narcotics. Well, I am afraid of them too, but I am more afraid of surgery. Surgery is irreversible. You can’t go back. Why would we go the surgical route before trying narcotics if I don’t NEED surgery to keep more damage from occurring? This is what I am considering “confronting” my doctor about.
So if you have made it this far into my story (Thank you!!!), here is what I want. I want to tell him that I need a plan, not a hodge-podge patchwork of pills. Since I don’t feel he is interested in coming up with a plan, I have one to propose. Here it is.
90 Tramadol (3 per day) - I'm taking 4 most days now and cheating myself on weekends.
30 Gabapentin (1 per night)
30 Amitriptyline (1 per night)
30 Vicodin 5/500 (1 per night) - 2 on a lot of work nights and cheating myself on weekends.
120 Tramadol (4 per day)
60 Gabapentin (1 at night, 1 at lunch)
No Amitriptyline- makes me too groggy in the mornings
45 Percocets 5/325 (1 per night, 15 others available for breakthrough pain for the month)
Is this reasonable? Oh, and I am more than willing to take pee tests, sign a contract and come in for pill counts. I drive by his office everyday on my way to work. I am just scared that this doc will fire me if I push. I mean he hasn’t even taken over the Tramadol and Vicodin scrips from my GP… and really me GP shouldn’t have to do this forever.
Please give me feedback. What should I do at this point? I don’t want surgery and I feel I am getting pushed that way because docs are scared of any narcotics stronger than Vicodin. Shouldn’t all options be tried before surgery? Aren’t I asking for pretty small amounts of meds? What would you do? And thanks for reading the whole story… I am sorry it was soooo long, but I needed to tell it. Thanks.