1. The SCS is for those of us with neuropathic pain (pain that radiates down an arm, hip or leg). If your most disabling pain is from structural damage and it's primarily nociceptive pain, then you are not a candidate for the SCS. In that case, consider the intrathecal infusion pump. Diagnosis always precedes treatment.
2. Mind-body treatments, such as biofeedback, are worth the try. Meditation and Yoga (within physical limitations) can help. I can drop my pain about 15-20% with biofeedback.
3. Know that the vast majority of us will never be pain free again. Accept it. I was a vocational rehabilitation counselor for 7 years. Each day, there are millions of people who will never be able to sit, stand, walk, feed themselves, bathe or care for their bodily needs. There are millions of others in chronic pain who by virtue of being homeless, unemployed or just down on their luck who are in just as much pain, but cannot access pain medications. Compared to them, we are the lucky ones. Exercise perspective.
4. Try EVERYTHING, especially with medications. Just one pain medication added 9 terrific years to my university career. I was ready to toss in the towel when this new drug came along. I'm far from the only one. Millions of people use it daily. Don't cheat yourself out of many happy years of activity and relationships by disrespecting the efficacy of powerful opioid medications, especially as it does not enhance the possibility of addiction (comprehensive research shows that the rate of addiction in the general population is significantly higher that in the population of chronic pain patients using opioids).View Thread
Why don't you like the idea of "being on the opiate pain medications?"
You've tried maybe 15% of all combinations of pain medications. Have you tried most of the options at a comprehensive pain management program, such as TENS, biofeedback, acupuncture, PT Kinesiotherapy, meditation, systematic relaxation, Yoga, intrathecal infusion pump, etc.?
Millions of pain patients who have had unsuccessful experiences with other comprehensive pain management programs have had no problems worse than constipation over a number of decades using the most powerful opioids available. Yes, decades.
Overwhelming new research reveals that the addiction risk among chronic pain patients using such medication is actually slightly lower than the general population. Yes, lower.
Most chronic pain patients using opioids either experience mild side effects that dissipate over time or none at all. Very few are allergic, on the order of 1%. Very few experience side effects that last more than a few weeks.
Opioids are natural substances that bind with opiate receptors in the brain to reduce the sensation of pain. They damage no organs used as directed.
So... what's not to like? No one's forcing to do this. I'm just curious about the reasoning behind this. I'm sure there a good explanation.View Thread
Fifteen years ago, ust one long-acting pain medication (Fentanyl Transdermal) wiped out 80% of my chronic severe back and leg pain. It added 9 years to my university career. Just one long-acting medication added 9 years! So, what do you fear?
Since then, I've learned which common opioids and off-label drugs work best for my unique body chemistry. Yes, it took literally years to discover which combination of long and short-acting opioids, plus off-label drugs, work best for me. But I'm glad that we took that time.
The SCS and IT pump are for those unable to benefit from combinations of opioid pain drugs. Surgery is required to implant and remove those devices, which have an overall success rate of about 50-60%.
As one continues to use an opioid medication over time, the side effects, such as feeling "drugged" or sedation, dissipates. Eventually, all that you will notice is less pain. This is the experience that almost all of us have. You need to persist through the first few months until you reach the point that you no longer notice the side-effects.View Thread
I have the very same condition that you have. I've had four lumbar operations, including micro discectomies, laminectomies and multilevel (L3 to S1) bilateral autologous donation fusion. So, we have experienced essentially the same problem.
May I ask why you're not using powerful opioid pain medications? Or, have you discovered that they create severe side effects? Just one potent pain medication added 9 amazing years to my career. It instantly wiped out 80% of my severe lumbar pain. Those 9 years were among the very best of my life. Just one medication.
Have you participated in comprehensive pain management programs? I can reduce my pain by about 20% with biofeedback alone. Some people benefit from TENS, PT, kinesiotherapy, acupuncture or hypnosis. Others do well with various types of mind-body pain management techniques, such as Yoga, systematic relaxation, meditation and variations of biofeedback.
Also, are you aware that the SCS is only effective for neuropathic pain? It disrupts signals from the hips, legs and feet. But if most of your disabling pain is in your back, from nociceptive pain, the SCS will probably not help beyond the placebo stage. That could be why you thought it was effective at first (placebo effect), but later it did not seem to help much. If your pain is primarily in your back and you cannot benefit from potent opioids, then the intrathecal infusion pump would have been a much better alternative to the SCS.
Physicians are so afraid of raising a red flag for the DEA that they talk their back pain patients into using a mechanical device unsuited to lumbar pain, even though they know it is only efficacious for referent (leg) pain. Other physicians talk their pain patients into many rounds of injections. But recent comprehensive, double-blind research has determined beyond any doubt that injections of steroid or steroid and anesthetic have no positive long-term efficacy. Who suffers when the pain comes crashing back? The patient. It's time for us to reclaim our lives, rather than do what is most safe for physicians.
My family doctor had the courage to provide the best and most appropriate pain medications and off-label drugs that help me to manage my chronic severe pain. I've been through two comprehensive pain management programs. Beyond biofeedback, nothing helped. Injections made the pain worse - permanently. But opioid medications allowed me to remain in my career, to be a husband and father and to continue to live a productive and rewarding life. Just a thought.View Thread
It should be noted that while injections seem to help some patients, they do not help all and they damage some. Comprehensive research published in the past year or two reveal that on the whole, injections of steroids or steroids and an anesthetic, do not show a statistically valid benefit. This is defined as pain relief that extends to 12 months. It seems that much of the benefit described as temporary might actually be from the placebo effect. I've experienced that myself. And the SCS only works sometimes for neuropathic pain. It's basically useless for nociceptive pain.View Thread
I have the same condition, which began when I was 17, in 1970. I've had four failed spine surgeries, including multilevel fusion, from L3 to S1.
The SCS is only effective for neuropathic pain. It can reduce sciatica, or the pain, numbness and tingling associated with nerve root entrapment. If most of your pain is in your back, rather than your leg, the SCS will be useless. Worse yet, there is a risk of infection in removing the surgically implanted device.
Here is a link to the most comprehensive recent research on all major spinal interventions: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . As you'll see, the SCS and the intrathecal infusion pump have a low success rate. Some patients have died as a result of MRSA infection. It should be a last resort option.
There are a multitude of other pain management options, including: spinal decompression, a corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, injection of steroids and anesthetics, non-steroidal anti-inflammatories, cortisone, rhyzotomy (radio frequency denervation), spinal cord stimulator, intrathecal infusion pump, off-label medications (anti-depressants, anti-convulsants), combination of long-acting pain medication with breakthrough meds, counseling, hypnosis and meditation.
With medications, the operative word is combination. By using short and long-acting opioid medications (short for breakthrough pain) and adding an anti-depressant (to inhibit the reuptake of serotonin) and an anti-inflammatory, plus an anti-convulsant (for neuropathic pain), you can benefit from a variety of sources. Almost everyone with chronic pain that I've corresponded with has said the same thing... it takes a combination of several different drugs at the same time that make a positive difference. Don't fear using three or four drugs simultaneously.
Therefore, your job is to work with your physician to determine which medications, in combination (and which dosages) work best with your unique body chemistry. This can take months or years of trial and error. But in the end, you'll be managing your pain to the best of your ability. View Thread
I was a vocational rehabilitation counselor for seven years, working to establish exactly what you describe - someone's ability to perform work of any type, level or extent. I could name a dozen tests designed to evaluate someone with your condition. They exist and they are valid.
You are on the precipice of a decision that will effect the rest of your life. This is no time to pretend that your are fine (for your children, an employer or for anyone else). If you are not as physically able as you pretend to be, you will be judged fit for work and then you will fail. It won't be long before someone assesses that you're not pulling your weight and that gives the company the right to boot you out on the street with no income and little hope for any future income.
Meanwhile, if you really can't perform as you should physically, you want the vocational counselor to witness it in testing. They might decide that you cannot sit, stand, walk or perform any job, which your labor attorney will use to obtain a disability judgment which will provide your family with a continual income. Believe me, living on SSDI payments is not a picnic. But it's much better than being unemployed and disabled, with no income.
Please, know that I've been through this myself as a professional vocational evaluator, in addition to in my career as someone with degenerative disc disease. This is not a time to pretend that you're what you were. This is a time to be honest.