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Post-Op Pain Meds Questions

So, 8 weeks ago I had an ALIF (L4-L5-S1) fusion.  The hospital stay was short and great. I left the hospital on a regiment of percocet (5/325, 2 every 4 hours), roxi's for like 2 weeks ( forget the dosage, but it it did the trick) Valium (5mg 1-2 every 8 hours for 10 days), and gabapentin, 300mg every 8 hours. Unfortunately, a medication plan or refill plan was never communicated to me.   About a week later, the abdominal pain could only be compared to a scene from ALIENS.  It ended up be nothing (that they could find), but in the interim they upped my percocet to 10/325 (2 every fours hours).  Apparently, this is a lot. I saw the Ortho PA at my 2 week post-op and gave me oxycontin 10mg (1 every 8 hours for a week, then 1 every 12 hours for a week) to work me down off the high level of percocet.  Although, again, I was given no target for how much I should be taking.  In a phone call a few dos later after calling about a fall down the stairs, the PA said I should just be shooting for less meds...I assumed the original prescription.  Every time I called for refills of percocets they gave 6 days worth of 3/325s to to take 2 every 4 hours.  I never asked to refill the valium for muscle relaxers because the original script said for 10 days...and again, back to no communication.  So, I went back to taking the Robaxin 500mg, 2 every 6 hours that the primary care physician had been prescribing me for months prior to even being indicated for surgery even though it work well at all.   Fast forward to my 6-week post-op, the first time I see the surgeon since the surgery, and he tells me that my back is in spasm which impeded recovery and that I should be refilling my valium and continue my percocet for pain.  No, we're back to today.  My pain levels haven't improved since 4 weeks pos-op, I feel like my recovery has plateaued, in fact, since starting PT this week, my pain has increased.  And my spasms have not improved one bit in the last 6 years except when recently taking the valium.  I called this morning for another refill since they only give me 6 days worth at a time.  When the nurse called back and left a voicemail, she stated that the surgeon was out, but the dosages would likely reduce since it had been six weeks and that a Nurse Pract would call me back later.  Well, the next voicemail I get is from the nurse pract stating that my prescription for Robaxin, 750mg 1 every 8 hours is ready to pick up.  So,less than my PCM gave me that doesn't work and nothing for pain.

I'm not drug seeking, but I am still hurting.  The pre-op pain was at waist level and down both legs to my feet, predominately on my left and usually around an 8 of 10.  My current post-op pain is lower, tailbone level, down both legs and predominately on the right and probably an 8 out 10 shooting to 10 out of 10 with any movement.  

So, does anyone have similar pain management / mediation story and if so, what did you do and/or your surgeon do about it?  I know it's Friday night but I emailed my Surgeon's office asking for an appointment to discuss medication management...I don't know what else to do.  I go back to work Monday and so far my conditioning and endurance levels allow me last about 3-5 hours without needing a nap and being in severe pain....

Sorry for the rant....thanks for "listening."

I apologize for any run-on sentences, spelling errors, and/or grammar issues as it 1.00AM here in AK, I'm in pain and trying to ration my meds.

Feeling lost and depressed...

AKpatient0
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Comments

  • SavageSavage United StatesPosts: 7,385
    Hello...
    Sounds like surgeon not as clear, or somehow misunderstanding, re Valium and tapering off Percocet.
    Does your surgeon know you getting Robaxin from your primary? Just to double check that all MDs are on same page.

    I have heard much success with surgeon referring their patients to pain management doctor post op.
    Surgeons schedules and their focus on actual surgery being okay maybe can contribute to some of these misunderstandings..such as your Valium. I dunno...

    Pain management doesn't have to be forever...and PM also monitors spine and would refer you back to surgeon if necessary.
    I think there is much benefit from getting scripts like these from one source and someone you could call who has specialty to care for that continued pain.

    It is crushing to live maintained at 8 ...as at 9 I'm ready to phone a friend for ER.....and at 10 ....it may be 911 as my body makes decision for me.
    Sue
    Honorary Spine-Health Moderator
    -------------------------------------------------------------------------------------------------------------------------
    Please read my medical history at: Medical History

  • Hey there!  Very sorry to hear your recovery has stalled somewhat.
    Have you been given any imaging tests aside from x-rays since your surgery?  I only ask because I have been experiencing excruciating pain/spasms in the tailbone area, down both legs and into the feet (along with a few other symptoms)--an MRI was ordered which revealed a mass in my lumbar spine that was likely causing my symptoms.  I didn't think I would be on medications this long (3mos post-op), but it's not a complaint, as I would hate to think how I'd be feeling without them since I'm in a considerable amount of pain even WITH them! 
    Getting a medication plan together with your doctor is a smart move on your part!  I'm surprised one wasn't in place before you left the hospital.  Better late than never, though.  Perhaps if you haven't had any MRI/CT scans done, it might be time to ask your doctor about it if your pain level and spasms continue to impede your recovery.  Remember that how you communicate with your doctor is important, too.  Framing your concerns as "What do you think of ___?" usually gets a better reception than "This is what I think I need". 
    Good luck, and I really hope you get some relief/answers soon!   
    Kimmy72, Spine-health Moderator
    Firm believer in PMA!
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  • PS:  Yor poynt wuz wel mayd--hoo cairs abot sppelling and gramer? :D
    Kimmy72, Spine-health Moderator
    Firm believer in PMA!
  • dilaurodilauro ConnecticutPosts: 13,515
    THere were a number of items I wanted to discuss about post op pain management, however, when I read that your pain levels are at 8 and when you move 10 out of 10, my only comment is for you to head over to the ER.

    When pain levels start to reach 8, we should always start to think about the ER.   Cause at that level slowly we begin to loss the proper physical and emotional ability to manage ourselves.   When pain level is 9 and above, no one is able to properly take care of themselves.   They can not drive, nor make any rational and correct decisions.

    I think right now in addition to thinking about an ER trip is to really consider if returning to work at this point is the best thing to do.  I assume your doctor has given you the ok to return to work.   But that approval, does not mean its something you can do.  You have to use your best judgement here.  But again, I worry about those pain levels.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • Thanks for all your comments.  I'm hoping to hear back from the surgeon's office tomorrow to discuss my pain management and pain meds plan.  As for going back to work, being Active Duty in the Air Force I don't have a choice.  

    Yes, they knew about the Robaxin from the PCM, I suspended taking it while taking the valium, but now they want me back on it, just at less than 1/2 the dose I was taking that didn't work. 

    So, Monday at work all day w/o pay meds or effective muscle relaxers should be grand!
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  • Update as of today...19 April 2016

    So, I had my first appointment today with the Medical Pain Management doc.  He seemed ok/good.  He work's in the same practice as my surgeon.

    As far as my current pain meds go as prescribed by my surgeon:

    Percocet: 5/325 (1-2 pills every 4-6 hours) 
     -- I've only been taking 2 pills 4x/day
    Valium: 5mg (1-2 pills every 8 hours)
     -- I've been following this prescription
     ---- He also gave me a weaning plan for the valium but it's written on a yellow sticky on the fridge...too lazy to go get it
    Gabapentin 300mg (1 pill every 8 hours)
     -- I've been following this prescription

    My pain doc was concerned first about the amount tylenol I've been taking.  Next, of course, about becoming addicted.  I don't think I am addicted or I am becoming addicted, but I understand their concern.  Heck, most of the time, I take the percocet only when I'm in pain and thats outside of the 4-hour window, but what do I know.  Anyhow, the wants to work toward getting me off the narcs as soon as possible.

    He prescribed:

    Percocet: 10/325 (1 pill every 6 hours for 2 weeks then 1 every 8 hours for 2 weeks)
     -- Then he said we would aggressively work to eliminate percocet/narcotic pain killers 
    Zanaflex: 4mg (1-2 pills at bed time)
     -- I'm just worried that it won't provide muscle spasm relief throughout the day, but we'll see
    Gabapentin 300mg (1 pill every 6 hours...so 4/day vs 3/day)
     -- I guess this is the ideal dose according to the doc

    I'm all for getting off the narcs, in fact I've been asking surgeon's office for a plan for weeks and they keep prescribing the same amount.

    I'm hopeful this plan will work, but the pain won't be gone when I'm done with the narcs so then what?  He said, we'll have plenty of options.   I surely hope so.  The last few days I have been in more pain than I was pre-op and have even begun questioning if it was the right thing to do it the first place....but I guess that too late now.

    I also start Physical Therapy on Friday.  I had started a couple weeks ago, but that guy was too passive and didn't offer the aqua therapy my surgeon ordered.  I know there's always PT homework, but I know from years of experience that I'm a more compliant patient when my therapist is actively involved in the sessions when I'm there vs. just showing me a couple exercises and sending me on my way.  Maybe that works for some people, but not me, I need and I think I deserve active therapy at my appointments...it's not like they're free.

    So, that went longer than expected, but that's where I'm at as of now...2-1/2 months post op... 

    Still trying to stay positive!

    Thanks!
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