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end of rope?

rottyrrotty Posts: 6
edited 06/11/2012 - 8:42 AM in Lower Back Pain
I have had low back pain for appx. 4 years. MRI's show DDD L3-S1. March 2009 I had a laminectomy of L3-4 performed by a Neurosurgeon and assisted by a Orthopedic Sergeon. This gave no pain relief. The surgeon thought it was the facet joints and wanted me to have injections and possible ablations performed by a Pain Management doctor. The injections helped in the area above my belt but no help below belt. I have had at least 10 injections targeting the facets L3-5, nerve roots L3-SI. The PM doctor has had me on 5mg oxycodone (4 per day) and Robaxin (3 per day)for the last 8 months while doing the various injections. Still I spend about half my life in pain, grumpy and just dont feel like getting out and about. With each dose of the oxycodone i get about 2-3 hours of relief. Most of the time my pain level ranges from 3-6 and it drive me crazy.
My last 2 visits to the PM doctor I have asked him to increase the medications but he says "No". I don't understand why my pain management doctor will not manage my pain.
I just don't know what to do but this aint much of a life.


  • Hello and Welcome. You have had 10 inections? Of Cortisone? I think that if I was not feeling like things were progressing after all of that, I would go back to the surgeon and have a talk. Or get another opinion. Seems like they are missing something, as the injections should help.
    When was your last MRI? I just think your pain Dr is not listening to you, and that you need to have a talk with your Nuero or ortho and see what else they have available other than injections. Take Care, Robin
  • Last MRI was December 2008. Believe it or not my PM doctor asked if I wanted to try more injections. I told him no not at this time. Guess that is why he won't increase my meds.Another funny thing is.... They put me to sleep for the injections and that is done by the PM doctors wife. My surgeon and PM doctor are in the same group/office. So I feel like I am taking a risk to rock the boat. If I make the PM guy mad then he cuts off the meds and I would be in deep poo.
    If I could just make it 2 more years to retirement!
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  • rotty said:
    Last MRI was December 2008. Believe it or not my PM doctor asked if I wanted to try more injections. I told him no not at this time. Guess that is why he won't increase my meds.Another funny thing is.... They put me to sleep for the injections and that is done by the PM doctors wife. My surgeon and PM doctor are in the same group/office. So I feel like I am taking a risk to rock the boat. If I make the PM guy mad then he cuts off the meds and I would be in deep poo.
    If I could just make it 2 more years to retirement!

    Have you asked your PM to put you on something longer lasting? Like Extended released drugs like MS oe OXY contin? Its worth a ask, because if your taking the 5 MG stuff eventually your going to get a tolerance to it, and you will be in pain anyway. You could always get a different doctor too. ;)
  • Do you live in a small town so these are the only people in the game? I wonder why they have not investigated the possibility that your pain is coming from a lower lumbar disc?

    Where is your pain located? Is it more in your lower back or leg? Did you have any discograms prior to surgery?

    Some pain management doctors rely much more on one technique than another. Not to be rude, but it sounds like yours has found he makes more money giving shots than handing out prescriptions. If at all possible, I would suggest you get another opinion from a fellowship-trained spinal specialist and look into a different PM or physiatrist to manage your pain.
  • I am so sorry to hear what you are going through. It seems to me that you have suffered long enough and that somebody should take you seriously and offer some relief. There are long acting meds available that may give you long lasting relief. I went through a similar situation as you and have found that methadone has helped me tremendously.

    If I were in your shoes I would continue to look for a doc that is willing to help me control my pain in order to have some quality of life.

    Good luck to you and please keep us posted.
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  • My doctor is in Augusta Ga. and this is my second group of doctors. The first group only wanted to treat with vicodin and missed the 50% compression at C5-7. So I changed to this group. This new group did find bad problems at C5-7 and did fusion there and it is fine. My main pain is at L5-SI.
    I feel I am in a sticky situation. If I call the surgeon and complain the PM guy may cut me loose as they are in the same group.
    Maybe I should call the PM doctor and request he review my case with the surgeon because I need relief.
  • If I were in your situation, I would go back to the surgeon and ask him to take another look at your L5-S1 problem. As we all know, MRI is just one piece of the puzzle. There must be something that is causing your pain, and it doesn't sound as though the pain generator has been located.

    Where is your pain located? Do you have more located in your lower spine or leg?

    I just wanted to mention that just because doctors are a part of the same clinic, they are not necessarily "working together." They could be partners where each of their incomes depends on the other, but they also could all just work for the same umbrella group, as in a multi-specialty clinic. My point is that maybe your surgeon isn't all that committed to the PM guy.

    Also, it has been my experience that a surgeon will tell the patient that if you have had two injections that provided no relief, there is no point in having a third.

    If you cannot find a way to work with these guys, I would suggest you go into Atlanta and find someone there who can help you.
  • I'm sorry you have been suffering for so long. It sounds quite similar to my own experience, which I'll briefly explain to see if any of it helps you.

    I've had lower back pain for 4 and a half years now. I had two discectomies (within one month of each other because the first didn't work) and numerous conservative treatments (7 facet joint injections, 2 epidurals, radio ablation, attending 6 week pain management programme, chiropractice, physiotherapy, electric heating pad, heat patches, TENs machine, frozen peas! the lot). Also, I am now on morphine patches (changed weekly which is brilliant) with extra supplements through the day as/when I need them. However, this medication has side effects and my doc now wants me to reduce the dosage - but that's another story.

    I've been under different orthopaedic consultants and consultant anaesthetists (who have come and gone over the years) and, after all this, the pain is still there. I do not get the pain down my right leg 100 per cent of the time like I used to (since having the discectomies), but at certain times of the month, or if I do anything physical, then it comes back - and I have to get up quickly and walk around for a few minutes (wherever I happen to be, which can be a little difficult and embarrassing sometimes).

    My last consultant has said that after 7 fji's, he feels the steroid dose is too high and that continued use may bring it's own problems later on in life. My dilemma has always been that I have tried anything/everything in order to continue to be able to work full time (which is essential in the current economic state alot of us seem to be in the UK at the moment). I've only been at my current job for 2 months now, but there's alot of bending, hence why my back pain is worse (and at the end of the day you can usually find me on the floor or laying down on the sofa to relieve the pressure).

    My point is - and this may indeed be the same for you - is that nobody had actually told me definitively where the pain was coming from. I've had numerous x-rays and MRI's and all the treatments I've had to date have either been for the facet joints or the discs (but none have helped - like your experience).

    I decided to get a second opinion after reading an article in our national paper last year and had my first appointment with the new consultant in November 09. After more x-rays/MRI I was actually shown the precise area of concern and scheduled for a discogram (which confirms either way if the pain is disc related). Anyway, turns out my result was 'positive' and the pain I felt during the procedure certainly confirmed this (though I must say that afterwards you don't really remember any conversation because you are heavily sedated, so it's all good). This new consultant says that the pain is NOT from the facet joint at all (which has been pumped full of steroids when I've had the facet joint injections). I should know if there is anything that can be done to alleviate my (worsening) pain next week when I attend the review appointment. If they cannot help, then at least I've tried, and feel 100 per cent confident in this new consultant and his team to give me their valued opinions, advice and any suggestions.

    I was wondering if your docs have actually CONFIRMED where exactly the pain is coming from in your case? Could it be coming from your L5-S1 disc? And if so, it won't help you too much if any treatment you receive is centred around your facet joints.

    If they are certain where the pain is generating from, what tests have they done to prove it? I'm not sure if MRI is enough on it's own and x-rays won't show it unless it is bone related I suppose (though I'm not a doctor of course so I'm only guessing!). Can they offer you a discogram to rule out disc pain? If the ablation you talk of is the same procedure I had, then it'll concentrate on burning the nerves - again not much help if your pain is solely coming from your disc eh?

    Ultimately, although it may be difficult for you to broach the subject, because you are not benefiting from the treatments they have given you so far, and are still in pain, you may be best to ask for a second opinion (if it's possible). It'll give you more peace of mind and may even diagnose the exact problem so that more effective treatment can be given to you.

    Keep posting to let us all know how things are going and I really hope you feel alot better soon!!!

    I've found this forum to be extremely supportive and friendly and, because we all seem to be in the same boat as far as back pain is concerned (albeit at different levels), they can offer good constructive advice as well.

    Take care

    2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!
  • I am wondering if you are effectively communicating to your doc the amount of pain that you are in? It may be helpful to keep a daily journal of your pain levels and what seems to make it better or worse (laying down helps, bending elevates pain). If he is not willing to increase your meds maybe you should ask him if he could change your meds possibly to one of the long acting meds. Make sure you tell him that you have little to no quality of life because of your pain levels and that you need some relief.
  • I will try to clarify a bit and answer some of the questions asked of me.
    Some time in 2006 I went to a Ortho Surgeon (Dr.C) and had an MRI that indicated problems at L3-5. He treated with oral steroids and Hydrocodone. He also had me go to a PM doctor (Dr.D) for ESI’s. ESI’s didn’t help and the meds were marginal. After about a year the PM doctor wanted to refer me to another PM doctor (Dr.Y). The new PM guy started me on Oxycodone 5mgs and gave me many ESI’s targeting specific spots. The ESI’s didn’t help
    So I decided to find another back specialist. I asked around and chose the one that is suppose to be the best in my area. I will call him Dr. O.
    December 2008 got MRI and Dr. O recommended a laminectomy.
    March 2009 Dr. O performed a Laminectomy of L3 & 4, Disc clean up L5/SI and nerve root passages checked / opened as needed. This was done by a Neurosurgeon assisted
    by a Ortho Surgeon. My complaints were muscle pain just above belt and in center of back, sharp pain just below belt just left and right of center line and pain down left leg.
    After this surgery the pain and weakness in my legs pretty much went away. The pains just above and below belt remained.
    Approximately June 2009 Dr. O wanted me to see a PM doctor (Dr.TC) for ESI’s of the facet joints and possible RFA. To date I have had a number of ESI’s of the facets, nerve roots and SI. The facet injections helped the pain above the belt area which felt like muscle pain mostly. The Oxycodone 5mgs and Robaxin 750mgs work pretty good with the following exceptions, it takes about an hour and a half to start relieving pain and the relief last about 3 hours. My current prescription is 1 every 6 hours not to exceed 4 per day. Do the math, 1.5 hrs of pain, 3 hrs of relief then 1.5 hrs of pain till next dose and another 1.5 hrs before any pain relief. At my last 2 appointments with Dr. TC I have requested him to increase my medications but he refused. I faxed Dr. TC a letter on 3/1/10 requesting him to discuss my status / history with Dr. O so we can discuss my options at my appointment on 3/8/10. It is my guess he has no previously discussed my case with Dr. O and never will but I will find out Monday.
    I have already seen 2 back specialist and 3 PM’s and there aren’t that many around.
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