Advice Please

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Gettuit

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I have had PLIF L-4 L-5. The L-3 ,L-4 disc is now protruding and causing right buttock pain down the right leg to toe. I have been out of work since 2/24. The neurosurgeon said that he was 50% sure that the L-3 L-4 disc is the cause of my new pain. I have had nerve blocks at L-3,L-4 but it did not help. I am on 10 mg of codeine every 4 hours. Now I am being sent to a pain management doctor. What can I expect from this doctor . I do not want to be on MeRAB to control my pain ,I want the problem fixed. The Neurosurgeon said that he would not perform surgery until he was 80% sure. Has anybody had this problem? Help please
 
Well I did have an L4-S1 fusion in 1993 and then the L3 vertebrae went out of line in April 2009. My surgeon made me go through physical therapy, MRI, CT myelogram and then finally a discogram to determine if the pain was coming from L3.

A pain med doctor can certainly get you on some pain meRAB (which don't necessarily have to be permanent) and may also be able to assist with Epidural Steroid Injections and Discograms. Be sure you are seeing a practice with an Interventional Pain Management doctor. This is the type that does minor procedures to diagnose and treat pain.

Most PM practices will require that you sign a contract saying you will only get pain meRAB from them and you will only seek them from one pharmacy. My PM doctor's practice requires I inform them of which pharmacy I use and they also use random urinalysis to test to make sure I am using the medications. There are those that use PM to get meRAB to try to sell and/or to use multiple sources to get pain meRAB as an addict. Thus many PM practices hold you to some strict rules.

But don't let that scare you. For me the rules have been easy. Early on in Pain Management I tore ligaments in my ankle when out of town and went to an urgent care who prescribed stronger meRAB, which I filled locally. All I did was call my PM office and leave a message about an out of town emergency, what I filled, where I did it, and with the name and nuraber of the Urgent Care I had gone to. No problem. Then when I had surgery this past February I informed my PM that my surgeon would prescribe post-op meRAB for the first 2-3 weeks post and then would return to PM for further meRAB.


Have you had an MRI with this new pain? One test, that's not pleasant, but often helps is the CT myelogram. I do agree with you that if there's a problem at a new level there has to be an action plan to attack that sooner rather than later, but you'll have to have a strong discussion with your surgeon on this.
 
I have had Mylegram and CT but still the surgeon says until 80% sure that it is the L-3 L-4 he want perform surgery. I go to the Pain Mangement Doctor tomorrow. Can this doctor do any tests to assure the surgeon that it is the L-3 ,L-4 disc. I do get relief with the narcotics but I work in a security position at a Nuclear Facility and cannot report to work with narcotics in my system. That is why I have been unable to work and am out on short term disability. I want to be able to get off the narcotics and get back to work. I am 59 and close to retirement. PLIF L-4, L-5 The Fusion is great and has not failed. RoRAB and screws are still perfect. I have reduced my weight from 234 to 180 reduced my waist from 46 to 36. I have done everything possible to prevent additional Surgery but if Surgery is the only thing that will get me back to pain free and working ,then so be it . Thanks for the reply !:wave:
 
One test that is often done is a discogram. There's some disagreement in the spine care industry as to how well the discogram works. But it is very commonly used to try to figure out which level pain is coming from if the pain is disc oriented (for example, a discogram will have no way of measuring pain from vertebrae, bone spurs on nerves, etc. It only tries to evoke disc related pain).

Many PM docs do Discograms, but it's only done by PM docs who are Interventional Pain Med docs or who have one in their practice. The PM practice I go to I see one doctor for medications and another doctor in the practice did my pre-surgical discogram and also did an RFA (Radio Frequency Ablation) at L5 and my right SI joint.

For me my surgeon said he wanted the discogram before doing surgery. He does not do them so I had to see if my PM practice did, and they do. If not they would have found another place for me to get it done. But, my doctor went back and forth trying to figure out if it would really help. He knew that he was going to have to go in and do surgery likely regardless of discogram results.

I understand the medication frustration. I was on STD and am now on LTD. I have other spine problems (neck) that lead me to be continually on pain meRAB. Thus it would be difficult to get a job with those meRAB in my system. There are some jobs where it's okay as long as it's therapeutic but other employers or jobs require that you not have any in your system. My old job required travel (air and car) and I could not do that on the medications. I was laid off after my FMLA expired (but I figured a lay off may be coming anyway as our office was sinking financially. They were only able to replace me last month and I was laid off 7/2009). So if I were to look for a job I'd have to take the pain meRAB into consideration. Thus at age 43 it looks like I may be on LTD (and SS as LTD will require I apply) for a long time (or possibly until retirement age when LTD enRAB).
 
Update, I went to the Pain Management Doctor. He wanted to try 3 weeks of 10 mg percoset every 6 hours and started me on Lyrica to try to calm the leg nerves down. Have you heard of this Lyrica for calming nerves? I am trying this but still can't sleep even with the 10 mg of percoset. I am getting really depressed that I am only masking the pain and not fixing thee problem. Thanks for responding to me .I am now alone because my wife passed away last July and I have no one to talk to or vent my frustrations. Have a great day!
 
There are two meRAB out there commonly used for nerve pain. One is Neurontin (available in generic as Gabapentin) and Lyrica. I use gabapentin and have had moderate success.

Like you, meRAB such as Vicodin and Percocet used to keep me awake or seem to disrupt my sleep. Somehow I seemed to have adjusted somehow, after extended use, and this is no longer an issue. When I had that problem I used generic low dose arabien on occasion. I also had muscle relaxants that helped.

After this brief trial consider discussing the use of long acting meRAB. One that I used was Opana ER which didn't have sedating effects BUT reduced my use of vicodin. LA meRAB release slowly in your system. I am back on MS Contin now, instead of Opana ER, since I have reduced finances and Opana was too much. I'm not working so the sedating effects of MS Contin isn't a huge issue.
 
Thanks for the info on the pain meRAB. I will continue to take them and see if I can begain to sleep better. I appreciate you corresponding with me. I hope that you are doing OK and feel better.
 
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