Pain Management

[ceejay]

I have been in pain management for the last three years due to an MVA
taking Lyrica and lortabs Have also tried epidurals triggerpoint injections with
limited success Now it appears I have hit the point at which the meds do not
work The flareups are constant and daily The major herniations ar at c3-c6

Is my only choice to go onto to stronger meds any other choices

My pain management guy will see me on a good day will not suggest surgery
The surgeon insists that the pain doc agrees that nothing else wil work

[tooyoungforthis]

Hey Cee,

I am sorry to hear about your daily struggle. What pain medications are you currently taking? What tests have been done in the past, with what results?

Sorry for the questions, just curious what your journey has been.

[2cool4U]

The key to successful medical management of pain is staying with a specific medication as long as it is working, and then switching to a different pain med as you develop tolerance to your current medication. What you switch to is a personal decision between you and your experienced pain management doctor. Different meds work for different people and different conditions. Sometimes dosage increases are needed and sometimes completely different classes of drugs are needed.

The key is to rotate into and out of medications as needed to keep getting effective relief. Sometimes switching to new med for a few months and then back to the old med works well. Sometimes moving between 3 or 4 different drugs works. Sometimes combinations of more than one drug are needed.

They call this process medication rotation, and it takes some experimentation. Don't be afraid to let your doctor know when something isn't working or was working well but is becoming less effective. A good pain specialist will expect this to eventually occur and will be able to move to an appropriate new medication as needed.

I've learned that to get adequate and reliable long-term pain relief, you must become a strong self-advocate. Let your doctors know politely but firmly when something isn't working. It's the only way they have of knowing when you need a change, and it happens to every pain patient at some point. A good pain specialist should expect it and be prepared to readily deal with it.

Hope this helps.

[ceejay]

Ok, here is my story

I was in an MVA 4/06 and the major injuries a broad based bulge at c3/c4 and a major herniation at c5/c6 The PA sent me for for pt and told me to come back when the pain was bad enough. The PA told me we only do surgery here Only saw the specialist after my attorney contacted him With the Buffalo winters things have gradually gotten worse.
Epidural did not help much.

Switched to Dr Cappuccino after the first guy wouod not consider an Adr, Three years after my accident things have not gotten much...better Cappuccino will not do surgery until my pain guy signs off. He thinks you can manage chronic pain without pain meds. He gives me Voltaren Gel which does not help much.

I am luckyI did not drop my other pain management guy who gives me lortabs and lyrica.

My question is that he did do a procedure in which he put some meds in my nose that relaxes the neck muscles It did help for around a month... It was a long name I did not catch. Ever heard of that?

[Jack]

If your drug changes, make sure your doctor gives you the equivalent dose. They usually try one that the equivalence is lower. The doc is just in CYA mode in case you body is sensitive to it in some way. But withdrawals and pain are not fun. You need to be an advocate for yourself. Make another appointment for one week out for a medication adjustment. Make sure you have plenty of your break through meds too.

[Harrison]

Good points all around. Forgive the obvious question, but what classes of NSAIDs have you tried? Tim (the moonlighting realtor: location, location, location ...) and Jack have a good point. It's a weird game patients have to learn, but keep trying and advocating for yourself.

NSAIDs are never a solution, but some can be really helpful, depending on the nature (cause!) of the inflammatory pain. And here's my beef: some docs won't even try them on a patient FIRST and go right to the "hard stuff."

OK, I am off my soapbox. Back to you...

[annapurna]

One thing to remember about NSAIDs vs. the harder drugs is that heavier hitters have fewer side effects if you're talking about long-term use. Addiction is not fun and nothing to laugh at but long-term use of NSAIDs can destroy cartilage, take out a liver, etc.

[Jack]

Another thing that I didn't know when my Lumbar spine issues developed was that not all pain management doctors go at pain control the same way. Physiatrists are MDs who treat musculo-skeletal pain with NSAIDs, PT, and various nerve blocks and injections. True pain management doctors are anesthesiologist who has completed special training in conditions that cannot be treated surgically. They generally consider treatment with narcotics long term as just another tool. Surgeons treat pain by surgical methods. There is quite a bit of overlap, meaning they all can use some of the same techniques such as steroid injections. Naturally only surgeons do surgery. For the most part, only the anesthesiologists feel comfortable using narcotics, especially the schedule II narcotics.

My experience has been surgeons & physiatrists view the use of narcotics long term with a degree of contempt. Some of the younger practitioners are a little more open minded to the use of narcotics. Those who are a little longer of tooth were indoctrinated to the dark side of narcotics. For years I was one of those. Intractable, dehabilitating pain via first hand experience tends to change a persons point of view. The use of narcotics is never desirable but given no other alternative, should not make anyone feel weak or in any way less of a human being.

[Harrison]

Excellent points, Jack and Laura!

[Sean]

I have been thru years of pain management and the meds will play a important part for sure. Recently I changed my diet to a very strict low fat veggie diet. By lowering your acid intake which most fatty processed food are high in acid content will help your body tolerate pain much better even without meds. I know this sounds crazy but it truly works. The average American diet puts your body in a nearly constant arthritic state compounding any problems you already have. Believe me I am all for meds when needed, but you would be amazed how much better your body will heal itself and improve your chance of healing with the right diet. I have found the green diet a high alkaline diet help reduce back pain along with a better energy level. The worst case you will lose weight which is a constant pressure on a weak link your back.

Aloha Sean