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
I've been using Lyrica for at least 8 years with NO side effects. I know many others using Lyrica with no trouble at all.
Please do not assume that others will have the same experience with a medication that you have had. Have you thought about all of the pain that people are now enduring unnecessarily because they were frightened by your post?
Lyrica is safe and effective. If it was not, the FDA would not have approved it.View Thread
By the time I was 38, I had four failed spine surgeries, including multilevel fusion. I had to retire at 51 and now I must be horizontal nearly all of the time.
Most surgeons will tell you that their success rate is "80%" or "90%." That is pure BS. They are lying and here's the proof: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . The real success rate ranges from 60% to 70%, lower if you have fusion and implanted hardware. Read about all spinal interventions there.
What to do about it? First, obtain a referral to a comprehensive pain management program. "Comprehensive" means many treatment options, not an injection mill. All recent comprehensive research reveals that injections simply do not work long term (beyond the placebo rate), if at all. What should you try first? Go for mind-body interventions, such as biofeedback, Yoga, systematic relaxation, meditation, hypnosis, etc.. I can lower my pain by about 20% with biofeedback alone. You may also wish to try acupuncture, physical therapy or kinesiotherapy. Considering the quite low success rate for injections, plus the horrible result when tainted vials were used, it's simply not worth the risk.
If all of the above treatments fail, you can ask if you might be a candidate for the spinal cord stimulator or the intrathecal infusion pump. They entail some risk of morbidity as they are surgically implanted. Plus, the long term success rates are bad. The leads of the stimulator can move away from your spinal nerve root or the infusion pump's catheter can be poorly placed, move away from the nerve root, become blocked or crimped. Sometimes the implanted machines fail. They should be a last case resort, if you are even a candidate and you might not be. They are designed for patients who are unable to benefit from opioid medications.
Finally, instead of dreading to remain on opioid pain medications for the rest of your life, be happy that they exist and that you can obtain an Rx. Just one powerful medication wiped out 80% of my pain - just one! Over the years, we all become tolerant to opioids. But that's not as bad as you might think. To deal with toleration, you switch to a chemically different pain medication for at least several weeks. Then, you can return to the original drug with much greater efficacy. Many of us use a long-acting pain medication (ex. Oxycontin, Kadian or Fentanyl Transdermal PLUS a short-acting medication (ex. Oxycodone or Hydrocodone) for breakthrough pain. This gives the pain patient 24/7 coverage, with peak plasma level obtained nearly all of the time. Sometimes off-lable drugs like Neurontin, Lyrica or an anti-depressant can help further reduce the pain. THC, the active ingredient in marijuana binds with opiate receptors in the brain to block or mdiate pain signals. This can be obtained leaglly with Marinol (Elan Pharmaceuticals.
So, you can use powerful opioid pain medications literally for a lifetime and it will pose very little or no risk of addiction or extreme side effects. Remember, tolerance and withdrawal are physical conditions that are easily dealt with. Addiction is a psychological condition that afflicts less than 1% of all of us who never had an addiction disorder in the past. There is no reason to fear using these drugs over decades, if necessary.View Thread