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Forced to eliminate Opioids

As the subject indicates eliminating my opioid pain meds is not my choice. I am not an addict or someone who has abused their meds. I follow my doctor's instructions and that where I'm having a problem.

I have chronic neck and back pain, which started to become persistent starting in 2006. I have degenerative disc disease and arthritis. I was sent to pain management where I was started on opioid pain meds. I started out taking Vicodin 7.5mg and when I left the practice due to losing my health insurance at the end of 2011, I was taking Kadian 50mg twice daily and Oxycodone 30mg 4 times a day. I was also taking Lyrica and muscle relaxers. The dosage increase was probably due to tolerance and slow worsening of my spine.

Being a Veteran, I was allowed to enroll in the VA heath care system for my medical care. Immediately, my 75 year old PCP said my opioid dosage was excessive in a very demeaning way. Another time he arrogantly asked how long I had been an addict. An MD had prescribed all my pain meds, not me. Each doctor that I saw spoke badly of opioids for pain. There was so much negativity.

In January of 2012, I had my first pain management appointment. I asked if my meds were excessive. She said yes and no, but decided that the nasty opioids should be eliminated from my daily regimen. She told me that too many Veterans have been dying in their sleep from their opioids. She quoted that I had a 6% chance of dying in my sleep. I'm pretty passive and non-confrontational and was glad that she would prescribe me anything. She prescribed Morphine SR 75mg 3 times a day and Oxycodone 5mg 4 times a day. I was given a place to reduce my dosage of Morphine by 15mg each mo.

I'm only able to be seen every 6 to 8 weeks, because of the doctor patient ratio. At my next visit, I discovered I had a new regular doctor, who was also going to follow the taper plan. I actually did OK until I started drifting below 45mg of Morphine SR. Then the pain slowly started to increase. At 30mg of Morphine SR, that seemed like the lowest I would say I could live with. Every time I explained how I was doing to my PM doctor, I was met with resistance. Especially since he discovered I'm depressed, even though I've had that since I was a teenager. He said we would control my pain with non-opioid pain meds, specifically Meloxicam, Tylenol and Capsaicin cream.

A month ago, he read my sleep study report. One bad or good thing about the VA is that all my doctors have access to my records. He wasn't the one that requested the sleep study. The Nurse Practitioner that I see at the Mental Health Clinic suggested it after I told her I didn't sleep well. I figure on account of my pain, because it's really bad when I wake up. It reported that I have severe sleep apnea and mild central sleep apnea and suggested weaning off my narcotics and other CNS depressants. Well, that just reinforced his idea that I eliminate my opioids I was instructed to eliminate taper off all opioids in 2 weeks. That's 30mg of Morphine SR and 5mg of Oxycodone 3 times a day.

I tried my best to follow his plan, not in 2 weeks, more like a month and I'm down to 15mg of Morphine once a day. I try not to take any Oxycodone, but the pain will get so bad, I give in and take 2.5mg. It's only been 2 days that I've been take one Morphine SR a day and today the pain began increasing all day to the point where it was more than I could stand and broke down and took a second Morphine SR and 2.5mg of Oxycodone.

I only want to use the opioids because the of the pain. The other stuff he has prescribed doesn't help at all. I'm also on 1,200 mg Gabapentin 3 times a day for a year and Methocarbamol. The problem is that I don't understand what's happening. I had a lot of pain back in 2006. I don't know if the severe nerve pain I'm experiencing is simply from opioid withdrawal or I have a lot of pain that's been helped by the opioids.

I should also mention that the VA will send me to an outside facility for ESI's. The last cervical ESI I had late summer helped modestly for a week. I was supposed to have 3 in a row, but was unable to get a ride for the last 2. I plan on asking him to request a new authorization as I think I can get a ride.

Any suggestions will b appreciated. I can provide more information if requested.

Thanks,
Scott

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13456

Comments

  • hi have a read in the intractable pain guide to survival [sorry i don't know how to do the like but if you google it } that many doctors try the don't take narcotic or if you stop you pain will be better rubbish at some time in a patient's treatment ,its total BS .narcotics are there for a reason without them many of us would have NO quality of life what so ever ..it was my consultant that told me to have a look at the on line intractable pain guide ..its very easy to read and free to down load {handy if you have to explain your narcotic taking to anyone .}.yes there can be problems with narcotic and many of us will become dependant on them but its the best of a bad situation in many cases ..in the uk the pain killers are a last resort but as long as you are genuinely ill you will get them...i am sorry about your pain .and i wish you a better day take care
    tony{UK}
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • dilaurodilauro ConnecticutPosts: 11,348
    edited 01/18/2013 - 3:19 AM
    For starters, everything I read indicated that you have not had surgery and that your diagnosis to date has been Degenerative Disc Disease and Arthritis. Both not uncommon, almost everyone by the time they reach 25 will show some signs of each. For the most part, both are managed through approved exercise programs and OTC NSAIDs.

    So, based on this, I would say that your narcotic dosage is high,almost very high considering you condition identification.

    There is a huge problem when people feel that narcotics is the only way to manage pain, even moderate to severe pain.
    Its good that you have a mix of medications, which include nerve medication (Lyrica) and some muscle relaxer which you didnt identify. There are so many other components for pain management. Physical and Aqua Therapy, TENS units,
    Traction, Massage, Acupuncture to name a few.

    I was a bit surprised about an ESI. Unless you have not posted more about your condition, Spinal injections would not seem warranted.

    The Sleep study is very important. This way they can identify if you have Sleep Apnea. The statement you made about dying in your sleep, many people with Sleep Apnea are at a risk with that. Using a CPAP machine a night is just one way in working with Sleep Apnea.

    Your statement .......
    Scottm said:

    I only want to use the opioids because the of the pain. The other stuff he has prescribed doesn't help at all.
    would be very alarming to any doctor. I would look at the total picture and see what all of the options you need
    to manage your pain. I have not read anything regarding surgery in your future, so minimizing narcotics would be
    a goal.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
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  • Forgive me if there are any typos in the following information as I had to transcribe it from the original documents.

    ACDF C5-C6 in 1998

    Cervical MRI – 03-02-2011

    C2-C3: There is central disc bulge at this level, which indents the central ventral portion of the subarachnoid space but does not abut the underlying cervical cord. No foraminal stenosis.
    C3-C4: Annular disc bulge, which completely effaces the ventral portion of the subarachnoid space and abuts the underlying cervical cord.
    C4-C5: Broadbased disc bulge which completely effaces the central portion of the subarachnoid space, but doesn’t abut or indent the underlying cervical cord.
    C5-C6: There is broadbased disc bulge extradural defect that appears to represent bony changes secondary to fusion at this level. This effaces the ventral portion of the subarachnoid space and minimally indents its ventral component narrowing the AP dimension of the cervical cord approximately 15%. No foraminal stenosis.
    C6-C7: There is broadbased disc protrusion across midline effacing the ventral portion of the subarachnoid space completely.There is quite prominent bilateral foraminal stenosis marked on the right and there is narrowing of the AP dimension of the cervical cord at this level.

    Lumbar MRI – 09-23-2011

    At the T12-L1 level mild disc desiccation is noted.

    At the L1-2 level mild circumferential disc bulge is noted without disc protrusion or stenosis.

    At the L2-3 level more prominent disc space narrowing with grade-1 retrolisthesis is noted with moderate circumferential disc bulge noted. Small posteromedial annular tear with small disc protrusion is noted. Ventral thecal sac indentation is identified with mild to moderate central canal stenosis. Circumferential disc bulge component produces some mild bilateral neural foraminal narrowing.

    At the L3-4 level disc desiccation and mild circumferential disc bulge are noted slightly asymmetric to the left. Mild grade-1 retrolisthesis is noted without disc protrusion or central canal stenosis. There is moderate left and mild right neural foraminal narrowing noted.

    At the L4-5 level disc space narrowing with grade-1 retrolisthesis is noted with moderate circumferential spondylitic bulge. Mild bilateral poaterior facet arthropathy is noted. Some mild central canal stenosis is identified. There is moderate right and mild left foraminal narrowing.

    At the L5-S1 disc space narrowing and moderate circumferential spondylitic bulge are noted. Small posterocentral disc protrusion is identified. Partial effacement of extradural fat is noted with mild central canal stenosis. Some mild bilateral inferior neural foraminal narrowing is noted.

    The conus medullaris appears normal at the T12-L1 level.

    Cervical MRI – 12-12-2011

    There is normal cervical lordosis. Vertebral body heights are maintained. There is bony fusion of C5-C6. No acute fracture is seen.
    No significant abnormality is seen in the prevertebral or paraspinous soft tissues. Limited visualization of the posterior fossa appears within normal limits. Artifact limits evaluation of the spinal cord, however, no definite signal abnormalities identified. There is decreased signal intensity involving the C1-C2 articulation corresponding to sclerosis, which is likely degenerative in etiology.

    C2/3: No significant disc abnormality, central canal stenosis or neural foraminal stenosis.

    C3/4: No significant disc abnormality or central canal stenosis. There is uncovertebral hypertrophy on the left which results in mild neural foraminal narrowing.

    C4/5: There is minimal diffuse disc bulge without significant central canal stenosis or neural foraminal stenosis.

    C5/6: There is a bony fusion at this level. There is a left paracentral osteophyte only seen on the axial images that touches the ventral thecal sac without compression. Facet hypertrophy results in mild bilateral neural foraminal narrowing.

    C6/7: There is a diffuse disc bulge with irregular central and right paracentral protrusion which indents the ventral thecal sac resulting in mild to moderate central canal narrowing. Facet hypertrophy results in severe right-sided neural foraminal narrowing and moderate left-sided neural foraminal narrowing.

    My muscle relaxer is Methocarbamol.

    This is probably controversial to most people, but due to my personal reasons, I have not chosen to have surgery at this time.
  • Hi Scott,
    As Dilaurio said , given that the conditions you stated are considered normal findings ona MRI
    You were taking a lot of opiates. When were you last given an updated MRI or CT scan?
    It seems to me that getting a new scan done to get a more current idea of what's going on
    Is appropriate if your last one is over a year old.
    Tapering opiates can cause temporary increases in pain until your body starts producing
    It's own endorphins again.
  • ScottMSScottM Posts: 54
    edited 01/18/2013 - 9:05 AM
    My last cervical MRI was 12-12-2011, Lumbar 09-23-2011.

    Just of curiosity, "Facet hypertrophy results in SEVERE right-sided neural foraminal narrowing and moderate left-sided neural foraminal narrowing." is considered normal?

    I have to say that I am really confused and concerned.

    Over the years, I've had numerous ESIs. I have a cervical traction device, TENS unit, been to physical therapy and last summer pool therapy. I was amazed that after 3 visits to pool therapy, my pain went from acceptable to severe.

    On the sleep apnea situation, besides eliminating opioids, there is no follow up planed, which I was concerned about. At the time of the sleep study I was taking 30mg of morphine SR x 3 and 5mg Oxycodone x 3.
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  • ScottMSScottM Posts: 54
    edited 01/18/2013 - 9:55 AM
    backache99 said:
    hi have a read in the intractable pain guide to survival [sorry i don't know how to do the like but if you google it } that many doctors try the don't take narcotic or if you stop you pain will be better rubbish at some time in a patient's treatment ,its total BS .narcotics are there for a reason without them many of us would have NO quality of life what so ever ..it was my consultant that told me to have a look at the on line intractable pain guide ..its very easy to read and free to down load {handy if you have to explain your narcotic taking to anyone .}.yes there can be problems with narcotic and many of us will become dependant on them but its the best of a bad situation in many cases ..in the uk the pain killers are a last resort but as long as you are genuinely ill you will get them...i am sorry about your pain .and i wish you a better day take care
    tony{UK}
    This guide was very interesting. I can relate to it. Especially the sleep topic. My blood pressure has sky rocketed in the past year. The VA has given me two prescription for my BP. I just checked it at home and it's 163/99. My pulse rate was only 74. I was content with my situation during the summer when my Morphine was 30mg to 45mg. But since then it has been all down hill.

    By the way, my pain management doctor told me that no one has died from pain, but they have from opioids.
  • dilauro said:
    For starters, everything I read indicated that you have not had surgery and that your diagnosis to date has been Degenerative Disc Disease and Arthritis. Both not uncommon, almost everyone by the time they reach 25 will show some signs of each. For the most part, both are managed through approved exercise programs and OTC NSAIDs.

    So, based on this, I would say that your narcotic dosage is high,almost very high considering you condition identification.


    There is a huge problem when people feel that narcotics is the only way to manage pain, even moderate to severe pain.
    Its good that you have a mix of medications, which include nerve medication (Lyrica) and some muscle relaxer which you didnt identify. There are so many other components for pain management. Physical and Aqua Therapy, TENS units,
    Traction, Massage, Acupuncture to name a few.

    I was a bit surprised about an ESI. Unless you have not posted more about your condition, Spinal injections would not seem warranted.

    The Sleep study is very important. This way they can identify if you have Sleep Apnea. The statement you made about dying in your sleep, many people with Sleep Apnea are at a risk with that. Using a CPAP machine a night is just one way in working with Sleep Apnea.

    Your statement .......
    Scottm said:

    I only want to use the opioids because the of the pain. The other stuff he has prescribed doesn't help at all.
    would be very alarming to any doctor. I would look at the total picture and see what all of the options you need
    to manage your pain. I have not read anything regarding surgery in your future, so minimizing narcotics would be
    a goal.
    When I wrote, "I only want to use the opioids because the of the pain. The other stuff he has prescribed doesn't help at all."

    What I meant is that I want to use the opioids, because of the pain. I don't want to take only opioids. When I wrote "I only" indicated that I didn't want to use them for recreational purposes, only pain control. The other meds that I've been prescribe are not working by themselves (minus opioids). Lyrica and then later Gabapentin was a big help with the tingling and numbness I had felt in my hands. To be honest, I'm not sure if the Methocarbamol is helping. The Meloxicam was prescribed to help with the stiffness and achyness when I woke up. But out of all my meds, the opioids provide the best pain relief.
  • It seems to me what your mri report said were reasons enough to explain your level of pain and the medication dosage. I feel for you because I recently had to change drs and I had a drastic change and I am feelin the difference. I dont like how tbey can read t our reports and just change it up on you and them with no end game plan to boot. What is that about? Is there any way not to go thru the VA system. Maybe get an updated mri and prove that its still as bad or maybe things have gone to worse. I hate this happened to you. I still cant understand. I wish you the best.
  • sandisandi Posts: 6,269
    edited 01/19/2013 - 6:36 AM
    I saw that you posted your recent MRI's after I posted previously......there are some issues with your cervical area, C5-6 has a bit of bony overgrowth on the left side, but that isn't in contact with the spinal cord but you do have some facet arthritis ( facet thickening) so that may be causing some pain and some mild compression of the nerves , and at C6-7 you have some severe nerve compression on the right side and a moderate amount on the left . There is also some mild-moderate compression of the spinal canal.
    When it comes to what meds are appropriate , given the issues with sleep apnea, etc , that is something that you are going to have to discuss with your doctors. I would strongly suggest though that you at least arrange for a surgical consult with both a board certified, fellowship trained spinal neurosurgeon and an orthopedic spine surgeon as well. They can tell you better than any of us here if your findings warrant surgery now or in the future and give you some suggestions for treatment. ESI's are only meant to be a temporary , at best form of treatment. That is assuming that they even are able to find the right spot, and you should have no more than 3 in the same area within a year, otherwise the steroids can cause problems of their own..........
    Even though you may not be wanting to go down the surgical road right now, if it was possible to eliminate the pain and fix the problem , as well as avoid any further deterioration in those areas, would you consider it?
  • I haven't had any opioids since yesterday and today the pain in my neck and back is indescribable. I can't write much.
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