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I think this might be a time to take a step back and re-evaluate how you want to go forward in managing your chronic back pain problem. Think about developing a long-term plan on how you will live the life you want and deserve for the upcoming years and decades.For example, where will the Lortab fit into that plan and how long did you plan on using Lortab as a primary means of managing your pain?
Approach your back pain as if it is a chronic medical problem, like diabetes or hypertension, that needs to be managed well. Chronic pain is more complex in that it effects so many different things including physical activity, sleep, mood, relationships, and work performance. As a result, you want to develop a program for yourself that will help you with all of these different but related areas of need. Try to learn some tools and activities that you can use daily or weekly to better take care of your back and how you feel.
Certainly, you can make the decision of whether or not you would like to find a physician who can re-start the Lortab for you, but at the same time recognize that there can be a lot more to successfully managing chronic pain than just using medications. This might be a good time to see what other healthy alternatives are out there that might benefit you.View Thread

Even though you are treating the symptoms well, the problem with your trapezius may not be getting better because some of the underlying causes haven't changed. For example, ergonomic changes to your work station may help, as well as potentially other modifications to your body mechanics. Learning some simple techniques to manage stress during the day may also help. Try taking a step to see if there any root sources for this problem that you can modify.View Thread

I think you and your medical team should work together to help you not just "learn to live with it," but to get you on a path where you can "learn to live well with it" so you can have the type of fulfilling life that you want. Chronic nerve pain problems can be frustrating, but a comprehensive approach that can help you learn tools to better manage this is still within reach. Perhaps there is a physician with expertise in treating nerve pain problems that you could consult with who can help guide you?View Thread

Certainly, studies carry more credence and more statistical value when they are done with large sample sizes. I don't think drastic changes in practice habits should come from one study alone, either, but it is important to follow trends in data over time. The old adage about medicine being an art based on science still exists, but we have to be careful how we interpret both the scientific information and our own biases and perceptions of the art. In my own personal practice, anything that gets published will get evaluated against my personal experiences of working with thousands of patients over 16 years. It is natural to have a practice style or philosophy and try to build off of that when new research or treatments become available.
I am glad this original topic generated such a great discussion!View Thread

I think one of the cool things about this forum is that it is a great way to bring together what is going on in the scientific world with the needs of the real world. Doctors usually don't have time to talk about new academic research projects going on with their patients. Here is the link to Dr. Apkarian's article as well other related articles that you might find interesting: http://www.jneurosci.org/content/24/46/10410.abstract .
There are a couple of concepts to help understand this exciting area of neurology and pain research. One is the notion of brain plasticity. This means the brain is a malleable and ever changing organ. It doesn't stay static, and we can influence how it changes.
The other concept is that of neurogenesis which means our brains have the capacity to grow new nerve cells, even when we are older. This gives us the ability to learn and adapt, and I believe help us better manage pain. I have a chapter devoted to this subject in my book "Take Charge of Your Chronic Pain."View Thread

There are a number of medication choices to consider to help manage neuropathy pain in addition to the the ones you have tried. For other options, as well as other ideas for other treatments for nerve pain, consider going over this link from the American Pain Society: http://www.neuropainhk.org/Portals/0/mpnp-newsletter-issue-20-international-neuropathic-pain-guidelines-dec-2010.pdf . View Thread

Here are a few ideas to get started:
- Try to find some movement experts that you can work with and learn from. That could mean a physical therapist, pilates instructor, or yoga teacher, as examples. Look for folks who really understand how the body heals and start to develop your own daily movement program.
- Learn some basic breathing exercises to calm your body and mind that you can use when you feel flared-up. Research shows that meditation is effective in relieving pain and lowering stress.
- Consider consulting with a psychologist who specializes in working with patients with chronic pain to learn more tools and work through things like depression, anxiety and insomnia that often accompany pain.
- Work on maintaining your ideal body weight and choose foods that have anti-inflammatory properties.
Once you find certain activities, exercises, or stretches that are helpful you will gain confidence that you can succeed with this. Incorporate these things into a daily program for yourself that fits into your regular day. Try to spend time focused on managing your health and well-being, and while this may not magically cure your pain problem, it will keep it in control so you can thrive.View Thread

Some good news on neck pain came out in a recent study published in the Annals of Medicine that showed exercise and chiropractic treatment to be more successful than medications in treating neck pain. Here is a link to a review of this study on ABC News: http://abcnews.go.com/blogs/health/2012/01/04/neck-pain-chiropractors-exercise-better-than-medication-study-says/View Thread

The hard part is trying to not get caught in the trap of thinking about your pain throughout the whole day. Directing your thoughts and actions toward other aspects of your life, whether that be your family, friends, career, or developing other interests is also important, and this will serve to limit the impact that pain has in your life.
I know this is challenging to do when the pain is always present, but it might help to think of the pain getting put into a box where you know it is there but you don't let it distract you from everything else. This could be considered a mindfulness approach to better controlling your pain, and this is a promising subject that has gained a lot of research funding lately. To learn more check out this link from NPR: http://www.npr.org/templates/story/story.php?storyId=7654964 .View Thread

The amount of adjustments that may be needed in the post-operative pain medications can depend on different factors including the amount of medication you are on before the surgery, the type of surgery performed, your age, and even your own personal genetics. Psychological factors, like anxiety levels, also can have an impact. Talking to your doctors and asking them to have a thought out plan ahead of time (which is what you are doing) is very reasonable and should make this easier for you and your surgeon. Certainly, it makes sense to go through this before the surgery as opposed to after.View Thread
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