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Usual opiates don't work - what are the options?

flensrfflensr Posts: 6
edited 02/07/2015 - 7:37 AM in Pain Medications

I'm going in for L5-S1 fusion (anterior + posterior due to previous discectomy) in a couple of weeks, and I'm wondering what kind of pain meds I should expect. After my discectomy I discovered that the standard opiates like vicodin and Percocet are completely ineffective for me. They don't provide any relief at "normal" doses, and maxing out the allowable dosage (due to the Tylenol) makes me itch, again with no pain relief.

After my discectomy, the only med that helped was soma because most of my pain was caused by nerve impingement causing muscle spasming. But the soma made it very hard for me to remember things so I was sort of an idiot while on that stuff which made it hard to do my job at work.

Since the discectomy I've been using a lot of ibuprofen which delays the onset of the muscle spasms during daily life, but even that hasn't been very effective the last couple of years and its getting worse, which is why I'm doing the fusion. I don't seem to have permanent nerve damage with pretty much stable sciatica-like symptoms long-term over the last 7 years, so we're hoping any instability-induced pain will go away with the fusion and crossing fingers we won't induce any bad nerve effects that don't already exist.

So, any ideas what kind of meds I should expect, since Percocet and vicodin are less than useless? Thanks in advance.


  • LizLiz Posts: 8,835
    Welcome to Spine-Health

    Use that above hyperlink to help you get started with Spine-Health and navigate through the system.

    If there are any questions, you can always post them here, send Liz or myself a private message or contact Ron rdilauro@veritashealth.com

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Hi There
    Sorry to hear you are in so much pain, lets pray the surgery relieves things
    so you can feel better.
    I might have read it wrong but did you say the pain meds you are currently taking provide no relief right?
    I am curious why you continue to take them especially when you are facing surgery
    it would be so much better for you to be as drug free as possible that way they
    will be able to control your pain easier after surgery. It is just a suggestion but I would stop if
    they are not helping you but first talk to your Doctor don't do it on your
    The thing is surgery, pain levels, what meds will be given is up to your Doctor and you.
    As you know everyone feels and reacts differently.
    Because everyone is so different and we don't have the knowledge that a Doctor does
    we cannot give advise to you on that subject. So please have a heart to heart talk with your Doctor
    about your concerns, so that you feel comfortable having your surgery.
    I wish you the very best and please let us know how it goes.
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  • I'm not taking anything right now except a little Tylenol. I tried the usual pain meds after my last surgery 10ish years ago and they didn't help at all, and since then I've been taking ibuprofen which has helped, but symptoms have gradually gotten worse over the last several years.

    So I've been taking motrin up until last week, and now I'm taking nothing but a little Tylenol because motrin is no good before surgery. I'm asking about options after this surgery, since I know in advance that opiates like Percocet and vicodin won't work.
  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    Before attending a pain clinic I thought pain meds were opiates and that was it. Boy have I learned a lot (and I used to work in pharmacy too!)
    I'm currently on Lyrica which helps nerve pain from nerve impingement. I'm on MS Contin which is a slow release dose of morphine daily..... I never realized morphine was available in a daily pill. I take oxy-codone (Percocet) for break thru pain. (I'm allergic to aspirin and NSAIDS so I was afraid I wasn't going to have options either!) I also tried Lidocaine patches which didn't help.
    And, as I read through these forums I'm learning more about more pain patches and different narcotics. (And the surprising slime from a fish!)
    I was really going to the Pain Clinic expecting to not have any med options and be taught how to best apply heat and ice. In some cases I've come home and researched medications before agreeing to them or refusing them.

    Pain medication has come a very long way since my first surgery in '98 and my second in '08.

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
  • dilaurodilauro ConnecticutPosts: 11,348
    about your comment:
    flensr said:

    I'm asking about options after this surgery, since I know in advance that opiates like Percocet and vicodin won't work.
    Is this something you have been on before without any success? There are so many different dosages of each. Which have you tried or not tried before?
    I am also very curious about your statement:
    flensr said:

    After my discectomy, the only med that helped was soma because most of my pain was caused by nerve impingement causing muscle spasming.
    No question about soma helping with the muscle spasm, it is a very good, but potential dangerous muscle medication. I say dangerous because many doctors dont like to prescribe it because it can be so very addictive. But you indicated that most of your pain was do to nerve impingement. Did your doctors talk about nerve medications (ie Lyrica < Pregabalin > or Neurontin < Gsbapentin> ) Those are the medications that are best at dealing with nerve pain.

    I would talk with your doctor prior to surgery to discuss various options regarding pain management after surgery.. There are so many pain medications available. You just want to have that discussion before surgery and not waiting until after surgery.
    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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  • Hi there... I recommend prescription strength Aleve (Naproxen), 800mg tabs. These are amazing, and I recommend them highly for post-op pain / swelling. In my opinion they are far better for pain than Tylenol, or Ibuprofen. Hope you feel better and it goes well.
    Left foramina stenosis of L3/L4 (retrolisthesis)
    L2-ilaic revision fusion ( loose screws) with a laminectomy at L3 (cage at L3-L4)
    (PLIF) -@ L4/ L/5 - S1 (cage at L4/L5)
  • In looking at your post, I see you were under the impression the Tylenol was making you itch, and the higher dose of meds was the issue. This most likely is not the case. Itching is a common, non-serious side affect from opiates, and will decrease over time. If you were only taking Percocet / Vicodin after the first surgery that is not much at all. Usually people take a long acting narcotic, and one for breakthrough pain. I was on much higher doses of pain meds after my surgeries than you, and that was scratching the surface. I'd give them another try, but again the dose you were on was not enough to put a dent in post-surgical pain, trust me on that.
    Left foramina stenosis of L3/L4 (retrolisthesis)
    L2-ilaic revision fusion ( loose screws) with a laminectomy at L3 (cage at L3-L4)
    (PLIF) -@ L4/ L/5 - S1 (cage at L4/L5)
  • I ran through all the traditional opitate meds before my ACDF and the only one that worked for me without negative side effects (severe depression) is a drug called Nucynta. It also has a lower risk of dependency according to my doctor and the literature I've read.
  • After my discectomy in 09, they were giving me Dilaudid, which is an amazing drug. I had absolutely no pain.

    Then after my fusion in 2012, with less insurance, they tried just the morphine drip, which did NOTHING. So I switched to Percocet, which at least got me through. Plus gabapentin (2700 mgs/day).
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