Unpleasant itching and the desire to scratch is sometimes referred to as pruritus. Pruritus can have many different causes including medical conditions like kidney disease and medication reactions. One of the mechanisms that can create this unpleasant itching is the release of histamine from cells inside the body. Certain medications, including opioids, can increase the release of histamine in the body, and therefore serve as one potential cause of itching. Again, there could be other causes as well, so scheduling a follow up with your doctor to discuss this as well as other potential causes makes sense as a next step.View Thread
One thing I often tell my patients is that we don't know everything in medicine, and we certainly don't have all of the answers when it comes to complicated pain problems. In fact, it is estimated that for 90% of patients with low back, the causes are not really understood. Just because doctors don't know all of the answers is no reason for others to make you feel that your pain is any less "real" or problematic than anyone else's. Trust me when I say you are not alone, and there are many many others out there trying to better manage their pain, too.
While it may be frustrating when you can't get better answers or solutions from others, that doesn't mean you can't work with different practitioners to develop your own self-management program to help you feel better and function better. For example, some physical therapists may be better than others at working on more chronic back pain problems. Some patients find alternative treatments to be a big help, like tai chi, yoga, Pilates, acupuncture, or even mindfulness-based meditation. A simple daily walking program is often beneficial, as well.
Remember to first go over anything new with your doctors before starting new treatments. Good luck!View Thread
I have a colleague who does a lot of work with IV ketamine, and she was kind enough to forward me these considerations if you are considering this type of treatment:
Recs for a patient to gain access to ketamine infusions in general. I would say the following: 1. Email our coordinator at Ketamine@FreedomPainHospital.com . We need the volume and will get appropriate patients in ASAP ok, seriously, here would be my tips"026 1. Make sure they are being treated by a provider who is familiar with complex regional pain syndrome (if they are being treated for CRPS) 2. Get a referral from their primary treating physician to be treated with Ketamine. 3. Make sure they do not have any contraindications to Ketamine treatment. All of our patients require a psychiatric clearance and a cardiology clearance. In addition, the following are exclusion criteria: hyperthyroidism, increased intracranial pressure, sub-aortic stenosis, pregnancy, neurogenic bladder, liver dysfunction with elevated LFTs, and some others. These are off the top of my head ( I am traveling to LA this morning and am on the move right now), but I can certainly access my protocol tonight and get you the complete list of contraindications. 4. Obtain Ketamine infusions at a location that has a relatively high volume and / or a good familiarity with Ketamine infusions. There are many dosing protocols out there, and choosing a provider with experience and familiarity with potential adverse effects will lead to a better experience for the patient. 5. Common adverse effects for the patient: nausea, headache, vivid dreams, insomnia 6. We recommend being on a total daily morphine equivalent of 120mg or less. There is some thought that opiates interfere with the ability of Ketamine to reduce central sensitization. We do not require that patients get completely off of opiates prior to infusion. Some patients choose to do so on their own because they believe it puts them at a higher chance of pain remission. Of course, I support decreasing opiates whenever possible. 7. Some centers will offer daily outpatient infusions, and some will offer inpatient infusions. Each has own set of pros and cons. Inpatient: 3-5 days. Shorter, continuously infused. NPO status maintained, and bed rest with bathroom privileges usually the only activity. Outpatient: 10 days (M - F x 2 weeks). 4 hours each day. Able to go home at night. Able to eat lunch and dinner. Able to ambulate. If traveling from out of town, the increased length may be seen as a negative.) 8. Active online community with CRPS support groups. May be a good idea to connect with others who have been through Ketamine infusions.
Annette also brought up the mirror box. We have found this to be a very helpful tool for our CRPS patients.View Thread
The active ingredient in the Butrans Patch is buprenorphine, which does have some partial activity on the opiate receptor. These are the same receptors that traditional narcotic-based pain killers would act on, like the hydrocodone, for example. As a result, there can be withdrawal symptoms when discontinuing buprenorphine from your system. Withdrawal symptoms can be extremely uncomfortable in some cases, but they usually subside over a period of days. There are certain medications that can help dampen the withdrawal symptoms until they eventually disappear, including clonidine and ondansetron.
While experiencing withdrawals can be very difficult to deal with, it isn't typically considered to be otherwise medically dangerous. Nevertheless, it is very important to work out your specific plan with your doctor before making any medication changes.View Thread
It sounds like you are continuing to have nerve pain from the original injury. Nerve pain, also known as neuropathic pain, is usually triggered by some type of injury to the nervous system, and it sounds like you had significant peripheral nerve damage at the time of the injury. Common descriptions of nerve pain include burning, stinging, shooting, or electrical pain symptoms.
The coldness is not unusual in this type of situation, and it suggests some dysfunction in the autonomous nervous system which regulates blood flow to the skin. Sensitivity to touch is also not uncommon, and it reflects nerve conduction channeling linking pain to light touch receptors, which can happen with certain nerve pain problems.
Surgery is often not the answer, but some simple things that you can try at home include contrast baths with warm and cold water and moving your foot around in a bowl of uncooked rice to desensitize the skin. There are other treatments like this that a physical therapist could help you with. There are also medications that can be considered for nerve pain that you could talk to your doctors about.View Thread
Deciding on a spinal fusion surgery is a big decision to make. While you and your doctors need to decide what is right for you, I would like to give you some food for thought to help with your decision making.
When the purpose of the surgery is to alleviate back pain, as opposed to correcting an instability problem, it is worth pointing out that evidence-based research has generally found extensive rehabilitation treatment as well as interdisciplinary pain programs to be just as effective. Another issue that is often not discussed in the decision making process has to do with the long-term ramifications of spinal surgery. At your age, there is a strong possibility that you may need more back surgery in the future if you have one now. Things just seem to degenerate quicker after surgery has been done and sometimes the levels above or below the fusion wear down.
Try to avoid choosing any medical treatment out of feeling desperate. If you do decide to have the surgery, be clear about your reasons and talk to your doctor about your expectations to make sure everyone is on the same page.
With skin sensitivity from nerve pain, there may be other ways of treating this beyond medications. As mentioned above by cweinbl, this is sometimes called allodynia, which means something is painful from a non-painful stimulus. We see a lot of this at my center, and we often employ what are called desensitization techniques to try to diminish the sensitivity. Some examples of this would include contrast baths, using parafin wax, clay, or making contact with textures like uncooked rice or lentils. Desensitization techniques can be found from a physical therapist or occupational therapist who can help guide you. You can ask your physician for a referral if it applies to your particular situation.View Thread
Spinal cord stimulation is a treatment sometimes considered for patients who are still struggling with pain after undergoing back surgery, like the fusion that you mentioned. It is generally considered to be more effective in reducing pain that radiates down the legs than the pain in the back itself. If the stimulation that you are feeling during your trial is uncomfortable, then it is possible that the trial leads, or wires, are not in the proper place and this should be evaluated promptly. If indeed they are in proper alignment, then it is possible that your condition is not receptive to this type of therapy.
If the leads were placed percutaneously, meaning through the skin without an incision, then they can usually be removed quite easily by your doctor in his/her office. If they were placed with a surgical exposure, then you likely need to have the incision re-opened in a surgical setting to remove them.View Thread
We have an acupuncturist at my center as part of my clinical team, and acupuncture is something that I often consider for some of my patients. As you probably know, acupuncture has been around for centuries and is based on Chinese medicine practices. In theory, it helps by promoting energy flow to areas of injury or illness that may be out of balance.
Acupuncture can be tried safely for a whole variety of pain problems including back pain, sciatica, arthritis, and neuropathy. I avoid recommending acupuncture to patients who have skin sensitivity to light touch or pressure as it may be irritating. I would suggest you check with your physician first before starting treatment, and if you decide to try it, ask around to see who others recommend.View Thread