1. Therapy. Nothing will help as much as a good therapist. In this case, I recommend a psychiatrist because they know much more about pharmacology and can write an Rx, if needed.
2. Mind-Body pain management techniques. Biofeedback, systematic relaxation, hypnosis, meditation, Yoga. I can reduce my pain by as much as 20% with biofeedback alone. You can learn to stop your anxiety before it becomes a problem. These services are often found in comprehensive pain management programs.
3. Medications. A combination of long and short-acting opioids, plus a mild sedative could help a great deal. Over time, the side effects dissipate and the patient only feels less pain and less anxiety. This should be an important part of your treatment regime.
I know how you feel. My dad and several members of his maternal extended family had DDD early in life. He had two disc herniations and two surgeries (laminectomy, followed by another laminectomy lumbar fusion).
My DDD began days after my 17th birthday. I have had three disc herniations and four failed spine surgeries, including multilevel (L3-4 to S1) fusion. I now have another disc herniation around c5 or c6. It turns out that we were born with a condition called central canal stenosis. My dad, a neurologist & psychiatrist, was able to work until his heart gave out in his 70s.
But I was forced into retirement by severe chronic pain at age 51, almost ten years ago. Today, I can tolerate five minutes of standing and 15 minutes of sitting. Otherwise, I must be horizontal. Even then, I'm in constant pain.
The success rate for all forms of spine surgery is a little over 60%. It's obviously lower than that for fusion and lower yet for multilevel fusion. Compared to all types of surgery, this success rate is deplorable. I wish that I had never had surgery.
What's missing from your post is the pain management options you have attempted. A comprehensive pain management program will offer dozens of non-invasive and minimally-invasive treatments. Some of these options could work for you. The better your pain is controlled with medications and with other forms of pain management (especially mind-body techniques), the less you will fear pain and the lower the chance of having an anxiety attack over it.
Here is the latest, greatest most comprehensive and well-appreciated research for all forms of contemporary spinal interventions: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . This report is today's Holy Grail for spine conditions and the milieu of treatments and therapies that can be brought to bear for pain management.
Not an enviable situation. I'm sorry for your pain.
As I'm sure you realize, addiction disorder is a psychological condition, not physical. It's hard to imagine a situation in which you could use an opioid and not crave it for reasons beyond chronic pain. But you already know this.
Neurontin is not a pain drug. It was designed to treat convulsions. the same applies to Cymbalta, which is an anti-depressant. Yes it is an SSDI inhibitor. But it's still not designed for treating chronic pain.
You could consider Suboxone or naloxone. They were designed to treat addiction disorder and some ( a few) physicians are using it to treat chronic pain, especially with addiction-disorder patients. I would get my hopes up. From what I understand, these drugs are not nearly as effective as today's powerful opioids (Fentanyl Transdermal, Oxycodone, Kadian, etc.).
Finally, you might see if you are a candidate for the spinal cord stimulator, which involves no medication at all. It might have a positive effect upon your sciatica. However, not all of us with degenerative disc disease are a SCS candidate.
Another option is the Intrathecal infusion pump (IT Pump). In this case, your medication (possibly Prialt or a combination of opioids at very low dosages) is distributed via a pump surgically implanted into your abdomen, through a catheter that ejects the fluid upon your effected spinal nerve roots.
Many of us here understand exactly what you have in terms of chronic pain. But most of us are able to use powerful and effective opioids because we do not have a history of addiction disorder. That puts you into a very, very small and frightful group of people caught between a rock and a hard place.
I'm sympathetic to your condition and your inability to use the drugs that help the rest of us. It's a difficult place to be. Best of luck.View Thread
I don't know much about vascular issues. My condition is much different. One recommendation that I can offer is to work with your family doctor or a pain management physician to discover which combinations of medications produce the best pain control for your unique pain and body chemistry. What works well for one person may do nothing at all for someone else. It took literally years for my physician and I to try various combinations. And I stress the word "combination." For moderate to severe chronic pain, this is typically one long-acting medication (Kadian, Oxycontin, Fentanyl Transdermal, etc.) and one short-acting medication (Oxycodone, Hydrocodone, etc.) for breakthrough pain. Then there are many off-label drugs to try, including anti-depressants (to inhibit the reuptake of Serotonin), anti-convulsants (for neuropathic pain, etc. I mention using your family doctor because that person might know you well and trust you enough to prescribe a wide variety of opioids. Otherwise, pain management physicians are there for this condition, although they often make patients fly though many time-wasting hoops. Best of luck.View Thread
If you have constant moderate to severe pain, you'll do better with a long-acting opioid (Kadian, Oxycontin, Fentanyl Transdermal, etc.). You could then keep the Oxycodone (Percocet) or Hydrocodone for breakthrough pain. That way, you'll eliminate the ups and downs associated with short-acting meds. Of course, if your pain is more of an inconvenience than a disruption in your life, then OTC should work.
You can enroll in a comprehensive pain management program and try the dozens of non-invasive and minimally-invasive options. I can reduce my pain substantially with biofeedback alone. Some people rave about acupuncture, kinesiotherapy, meditation or even hypnosis. It doesn't hurt to try. When you ask for a referral, just make sure it's a comprehensive pain management program, not just an injection mill. Research on injection shows that if they don't work initially, future iterations are unlikely to help. It's a huge money-maker for physicians, but can be a time-waster for pain patients.
Finally, how do you know that you are not a candidate for spine surgery for your herniated disc? How many spine surgeons have you consulted? When I say spine surgeon, I do not mean an orthopedic or neurosurgeon. I mean one with a fellowship in spine surgery. That's 3-4 years of highly specialized training at key facilities and universities AFTER a residency. Just ask if the doctor has completed a fellowship in spine surgery. These highly specialized surgeons are light years beyond any orthopedic surgeon or neurosurgeon in experience, training and technique. I would not (and did not) make any treatment decision until after consulting with at least TWO spine surgeons. They can be found typically at or near teaching hospitals and in urban areas. Take your latest MRI or have it done there. It's definitely worth traveling to consult with a fellowship-trained spine surgeon. Don't learn this the hard way, as so many spine patients learn. Nothing is more important than your health. Why trust it to anyone less than the very best-educated and most talented surgeon? Maybe you'll be told that you're not a surgery candidate. But at least you'll have heard it from two of the best trained spine surgeons in the world. You deserve it.
It could be a sacralized L5 vertebra, which is part of my diagnosis. Some of us have malformed or partially-formed vertebra. These can collapse over time with the level below. I'm hoping that this is really not your diagnosis, because there are no magic bullet cures. Your symptoms sound like mine. I ended up with four failed spine surgeries, including multilevel fusion.
X-ray of your spine, which only shows hard material (bone) is not very useful. That's because soft tissue like extruded disc material and tumors do not visualize on X-ray. Nor do ligaments or other connective tissue. You really need a myelogram, MRI and/or Cat-scan.
OK, so you "don't need surgery and you don't need narcotics.." Well, then, what DO you need? And if they won't provide opioids (no physician today uses the term :narcotics" any more), then how are you supposed to function?
I usge you to find a spine surgeron. That's an orthopedic surgeon or a neurosurgeon who has completed a fellowship in spine surgery. After all of the mistakes I've made, I would never again allow anyone without a fellowship in spine surgery to treat or touch me.
Please do not accept what you've been told until you hear it from at least two spine surgeons.View Thread
Sorry to hear about your pain. Actually, the long-term (12 months) success rate for a rhyzotomy (a.k.a. radio frequency ablation) is around 60% (lower if you've had spine surgery). I know... no one tells you these things. You have to do your own research. So, here it is: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . This is most comprehensive research on all types of spinal interventions that I've seen. Sadly, having your Facet nerve roots destroyed has a poor outcome. BTW, I had one about 14 years ago and I will attenst that they are EXCRUCIATINGLY PAINFUL. I tend to tolerate pain pretty well. But my wife could hear me screaming through four closed doors in a waiting room at least fifty yards away. You see, in order to be certain that they are frying the correct nerve root, very little anesthesia is used. The doctor must ask at various times, "What do you feel now?"
The morbidity here is quite low. Sometimes the physician will nick or impinge the nerve, leaving it part alive and part dead. Occasionally they will destroy the wrong nerve.
Frankly, I'll take the pills and patches rather than try this again. Good luck.View Thread
Very sorry to hear about your accident and pain. It must be very difficult for you.
If you had cervical fusion at C5-6, why did they not also fuse your collapsed C3-4 and 4-5 vertebra? Why would they leave you with an unstable spine?
Did you have disc replacement at C5-6? Today, you can have a permanent (artificial) replacement disc for cervical herniaitons. That provides as much stability as autologous fusion (using bone from your hip or a cadaver), with much greater range of motion. Or, did your surgeon simply remove the disc and insert metal hardware?
I don't know what to say about your instability. No one should have to live like that. Once the spine is accessed surgically, many levels can be fused (at the same time) to prevent instability in the future.
On the positive side, damaged nerves can take a very long time to heal. So, you may still experience some decent improvement.
For now, ask your doctor for a referral to a comprehensive pain management program. There, you will find dozens of treatments for your spinal intervention, including: TENS, 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. Just be certain that the pain management program offers more than just injections. Good luck!View Thread
There are still some options. Here is a link for the most comprehensive research I've seen covering all major forms of spinal interventions http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . The SCS and IT pump are really last-resort options for chronic pain patients who cannot benefit from medications or non-invasive treatments.
Have you tried biofeedback, systematic relaxation, meditation or Yoga? Mind-body treatments are unlikely to remove most of your pain. But they can help a great deal temporarily. I can drop my pain by up to 20% with biofeedback alone. When people say, "pain is in the mind," they are mostly correct. It is possible to train the mind to temporarily push some pain aside. The same applies to distraction therapy. When I'm wrapped up in a good book, or when I'm focused on my writing, research or editing, my mind is pushing aside some of the pain as it focuses on something else. The cost to use this (after learning how) is nothing. There are no side effects. Just less pain.
I have also tried acupuncture, TENS, corset, brace, PT, exercises, swimming, injections and a host of other options. What I've learned is that the road to success lies in multiple options used together. That means a long-acting pain medication plus a short acting medication (for breakthrough pain). It means using an off-label drug (anti-convulsant) plus an anti-depressant (to inhibit the reuptake of Seratonin). It means using biofeedback plus systematic relaxation. All of these treatments, used together, make my life more tolerable. I still can't sit or stand for long periods of time. But without the combination of treatments, daily life would be intolerable.
I'm very sorry to hear about your terrifying experiences with chronic pain. Mine has been going on for almost 40 years.
Most spine surgery carries a long-term (12 months) success rate of about 60%. That's one of the lowest success rates for all types of surgery.
You mentioned trying the IT pump and the spinal cord stimulator (SCS). Yet those are the last two treatments that should be attempted at a comprehensive pain management program. The others to try first include: spinal decompression, corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, injection of steroids and anesthetics, non-steroidal anti-inflammatories, cortisone, rhyzotomy (radio frequency denervation), off-label medications (anti-depressants, anti-convulsants), combination of long-acting pain medication with breakthrough meds, counseling, hypnosis and meditation. If all of those fail, then you can try the IT pump or the SCS. The reason to delay them is because surgery is required to implant and to remove these mechanical devices and all surgery entails some morbidity risk. Some chronic pain patients have succumbed to MRSA infections related to implantation. In fact, some of the less risky treatments are very helpful. For example, I can reduce my pain by about 20% at any time with biofeedback alone. Some people find acupuncture useful. Even hypnosis can help.
Knowledge is power. The most important thing in your life is your health. I was too eager to have spine surgery and it failed four times, including multilevel fusion. Now, the surgical fibrosis (scar tissue) creates even more pain.
1. What happened? Why do you have chronic pain? Where is the pain? What other pain management treatments have you tried? What is your dosage for Vicoden (Hydrocodone)? Why are you using the anti-convulsant Klonopin? Do you have neuropathic pain? If so, why? We can't help unless you describe why you have chronic pain and how it has been treated so far.
2. Virtually none of us with chronic pain will have it "go away." That will never occur. What we desire is to MANAGE our pain. We want our pain to be reduced just barely enough to function as an employee and as a family member. That's it, my friend. Chronic pain almost never will "go away." That is an unrealistic expectation.
3. You said that you, "had surgery." What kind? Where? By whom? When? With what specific results? What prompted you to have surgery? Was it congenital? Or, were you injured? If you can't provide more detail, you leave us with insufficient data to respond. Sorry, but you need to be much more informative. View Thread
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