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.
My degenerative disc disease manifested just after my 17th birthday with an exploded lumbar disc (L5-S1). This was followed by more disc herniations and collapsed vertebra, leading to spinal nerve root damage and necrosis. Like you, the pain was moderate in my 20's, but became much worse in my 30's. After four failed spine surgeries and two comprehensive pain management programs, I've tried just about everything. I had to retire from a terrific university career at age 51.
With regard to medication, the operative word is medications, not medication. My doctor and I devoted two decades to trying various combinations of medications, because no single drug helped much. Eventually, we settled upon a combination of long and short-acting opioids, plus an anti-depressant (because they inhibit the reuptake of one of the body's natural pain fighting chemicals, serotonin, in the bloodstream), plus an anti-inflammatory, plus an anti-convulsant (for neuropathic pain). Remove any of these drugs and my pain is much worse. My point here is that we're all different; what works well for one of us does nothing for someone else. Together with your doctor, you can try various combinations safely.
The "drugged" feeling that many people experience when they start an opioid medication almost always dissipates after several weeks to at most, several months. After that, one will typically only feel less pain. I encourage you to push through it the next time you try a new pain medication. Almost all of us eventually lose that feeling of being drugged.
Virtually all research in the topic of chronic pain reaches the same conclusion. We are much better off using a long-acting pain medication (Kadian, Oxycontin, Fentanyl Transdermal, etc.), than a short-acting drug. Hydrocodone (Vicoden) is a short-acting pain medication. With all short-acting drugs, you'll have to deal with periods when your last dose is running out and your pain is skyrocketing. You take another dose and same thing repeats endlessly. But with a long-acting medication, you avoid the ups and downs in pain relief. One (Fentanyl Transdermal) lasts two to three days! Ask your doctor about trying one of the long-acting opioids.
You should also know that Hydrocodone (Vicoden) is one of the milder opioid pain medications. It is indicated for the patient with chronic mild to moderate pain. If you use it and still have considerable pain, perhaps it will never be efficacious for you, used alone. Or, it might be far more effective backing up a long-acting drug, for breakthrough pain.
Just one powerful pain medication wiped out 80% of my pain. It added 9 truly wonderful years to my career. Many others have had a similar experience. Again, those who experience a drugged feeling typically lose that after several weeks. If it added so many years to my career, it might do the same for you. It's at least worth a try.
Finally, ask for a referral to a comprehensive pain management clinic. Comprehensive means that they offer a wide range of treatments, not just injections. I admit that most of what you try there won't help. But some do. I can still reduce my pain by about 20% with biofeedback alone. Other mind-body options include Yoga, meditation and systematic relaxation. Some people even vow that hypnosis is efficacious for chronic pain.
Best of luck to you. Most of us with serious degenerative disc disease will spend the rest of our lives in pain. But we can learn how to effectively manage chronic severe pain and keep our career intact, at least for a few years. Hang in there.View Thread
It's a tough and depressing task today to manage intractable severe pain. But I think you might misunderstand how the system operates.
It is not up to the ER physician to know anything at all about you, your medical history or your past and present Rx medication for pain. How could the ER physician even know that you are being treated for chronic pain by someone else? They are not mind-readers.
On the other hand, you violated the contract that you signed by obtaining Rx pain drugs from a source other than the singular group you go to for pain management. Mostly likely, somewhere along the line, someone told you (or handed it out to you in writing) what would occur if you obtain opioids elsewhere.
I know that this sounds harsh to you. We don't know you. I'm guessing (hoping) that this is all an innocent mistake on your part. If you admit what happened and vow to never do it again, perhaps you'll be welcomed back.
Your family physician/internist might be the best person to prescribe all of you medication. That doesn't mean you can't or shouldn't use a comprehensive pain management program. But you have the right to ask that your own family doctor issue the Rx. Your family doctor likely knows and trusts you far more than a PM physician who you've never known until just recently.
I believe that there is a specific combination of long and short-acting pain medications, plus specific off label drugs, used in combination, that will allow each of us to better manage our chronic pain. Experimenting with various combinations of Rx pain medications and off label drugs (with your doctor) will help you understand which combination works best for your specific body chemistry. Most PM physicians don't trust you enough to issue the necessary opioids. But your kindly, old, family doctor might let it happen.View Thread
There are highly specialized and trained physicians called "spine surgeons." These doctors are surgeons who complete a fellowship in spine surgery at one of the handful of such training centers in North America. No one on the planet knows more about diagnosis and treatment of spinal trauma and disease than a fellowship-trained spine surgeon.
I would see two spine surgeons. They can be located at or near teaching hospitals, often in large cities or attached to major universities. They might order an MRI, CAT-scan, EMG or myelogram. This will assure you of a good diagnosis. But treatment is another story.
I know exactly how you feel when people dismiss your pain, suggest that it's not real, that you don't exercise enough or that it's all in your head. It is not. It's real. I was only 17 when I started herniating discs. People didn't believe me either.
Maybe the best question to ask right now is... why is your sciatic nerve pinched? Is it from bone, disc, osteophyte... what's causing it? Is it bone displaced by your fracture?
Diagnosis precedes treatment. Maybe you can obtain a referral to a spine surgeon. Good luck.View Thread
"50% of doctors completing medical school finished in the bottom half of their class."
LOL...LOL...LOL Very funny.
My dad was a physician. I grew up with an among physicians. I have since had many spine surgeries and met many doctors of all kinds. I can tell you with assurance that some of the doctors who barely graduated from medical school became well-known fellowship-trained specialists in their fields. And the doctor who finished the top of my dad's medical school class at Michigan never practiced a day of medicine. He ended up doing research. But some of those near the bottom of my dad's medical school class turned out to be spectacular physicians.
Where a physician graduated compared to others in her or his class is completely and utterly meaningless. What makes more sense in terms of research is to discover where the physician attended medical school, where she or he did a residency and fellowship, how many successful operations a specialist has performed, how many failed and how many times the physician was litigated against.
Talent as a physician 10, 20 or 30 years after graduating from medical school has virtually nothing to do with where they attended medical school or where they graduated in their class. Give this the logic test.View Thread
Lyrica is FDA approved, has been out in the market for many years and has been proven safe and effective for neuropathic pain. I've used it for at least 8 years with no trouble at all.
People should never fall for others who tell you not to take something because they had a bad reaction to it. Don't let such comments frighten you. That sounds like someone warning you not to use an opioid because you'll get addicted. But the real addiction rate among pain patients who have no history of addiction disorder is less than 1%.
Does anyone here really believe that an FDA-approved drug like Lyrica that has passed tens of thousands of human trials, prescribed by hundreds of thousands of doctors globally would cause people to become suicidal in large numbers? And if that happened often, why haven't we heard about it? Such side effects for Lyrica are exceedingly rare and often initiated by a predisposed condition with the patient.
Frightening people here with stories about what happened to one person serves only to keep people in pain unnecessarily. Millions of people around the world use Lyrica safely and effectively. Listen to your physician.View Thread