Need advice on how to manage my pain...

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Mologony

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Thank you all so much for your help. You've been far more helpful and have much more information than my general physician.

SpineAZ- My doctor has risen the possibility of a CT/MRI in the future if the pain does not get better, and i'd like to get one but unfortunately cannot afford it. I'm a completely self supporting student and the health insurance i get (first administrators) from my daRAB work (a non unionized construction company) is a complete joke. I go to school full time and also work 25 hours a week. My job is in retail and there is no such thing as sick leave or short term disability. Last thursday i went to the PT for the 2nd time and as we were going through the stretches and excercises, i noticed that i was having extreme pinching pain on my right side sciatic nerve (its almost as if the horrible pinching pain from my lower back moved down to the joint in my butt). I figured this was just a result of the things i've been doing with the PT, apparently i need to strengthen that joint and re-align my pelvis. I believe the exercises help, but 6 hrs after i leave the office im moping around complaining of pain. Also something odd about the PT session last thursday...When they did the ultrasound on my back, they went lower and put it over my sciatic nerve area since thats where i was hurting most on that day. Suddenly it felt like my skin was bursting into flames, like my nerves were going haywire. She turned down the power on the ultrasound and all was well. They continued to observe a very obvious difference in where my two legs hit the ground (left leg aprox 1/2inch shorter).

On friday i ran out of the 15 vicodin that was given to me. I was at work, i was in pain, and i needed to make money. So i put aside my anxieties about calling and asking for a refill for narcotics from my condescending physician and called the office. The secretary said she would have him call in a refill that day, and that was that.

Friday, saturday and sunday were the first real shifts i had worked in about 2 weeks because of this. Each shift was 7 hours long and would not have been possible without 1 vicodin at the start and 1 at the end

Yesterday i had my follow up with my physician. From the get-go he snickered at the physical therapists diagnosis claiming 'ive never heard of anything like that' (even though when i was walking to the clinic i did a quick google search on my phone about sciatic nerve problems and quickly found that it's a very very common problem). It seemed like he had no idea what to do next, and finally decides i should go get 3 xrays. Of what? Well, he wasn't quite sure! So he clueless says something like 'how about two of the lower back and one of the right hip' Literally just shooting around in the dark, each xray costing me a thousand dollars. This aggravates me.

My doctor called me back yesterday afternoon to say he didn't find anything out of the normal in the x-rays. He said that i need to just keep with the PT, ice and heat, and take ibuprofen. He said if the pinching pain near my sciatic nerve or nurabness/tingling in my right leg gets worse or if it is still continuing in 3/4 weeks to call him, and he will refer me to an orthopedic. I said ok, and before getting off the phone I started to ask about what to do in half a week when the pain pills are gone and the pain is still too unbearable to work a job with. I couldn't even get out that full sentence before he interrupted saying 'I'm not giving any more narcotics...I've already given you a months worth'

...Him not giving me another refill when my current one is done was no surprise to me, but 15 vicodin given on last Monday prescribed to take once every six hours and you do the math, I was taking it twice a day until this past weekend, then it turned to one when i wake up, one when that wears off (5-6 hrs later depending on what I'm doing, but i never dose early) and then another about an hour before i plan to go to sleep. Even with that regiment, if i take my nightly dose at midnight while I'm exhausted, and go to sleep...i will usually wake up in the early morning hours from pretty nasty pain (around 8 hrs after falling asleep).

Recently, the lower back pain is not horribly noticeable when i first wake in the morning, but as the day goes on it gradually hurts more. And if i'm at my job moving around large boxes of shirts and bending over folding tables constantly i cant make it longer than about 4 hrs in my shift without becoming so physically (and emotionally) exhausted that i need a break...And then the pain returns as bad as ever about 30 min after i take a break and do all my exercises. So right now i'm basically just sticking with the physical therapy and trying to be good to my body. I suppose i should switch my primary physician anyways (lack of script refill issues aside) since this was my childhood family doctor. Ever since i got arrested for posession of marijuana with intent to deliver, he has been consistently sort of...condescending. (it wasn't a violent crime or anything, and he knows i do no other drugs and dont even really like to drink) I often feel put down or uncomfortable in the ways he interacts. On top of that I'm starting to feel like i have more insight into whats going on with my back then he does.

Sorry for the wall of text. Where should i go from here, wait as long as i can once the vicodin runs out and if it gets unbearable in a week or two seek an orthopedic?
 
There are some non-narcotic medications for nerve pain. The 2 most common are Neurontin and Lyrica. Nerontin is available as a generic while Lyrica is not yet available in generic.

Tough part is if you go to an orthopedic spine surgeon or neurosurgeon they'll need an MRI. Get a copy of the medical plan so you can be sure of the benefits. There's probably a family out of pocket max or individual max. Once that is reached you spend much less. I met my OOP max in March of last year so after that care and testing cost me very little.
 
I have a quick question. For the past 2 months i've had horrible lower back pain that has kept me from getting sleep and working. This past Monday I got checked out by the family doctor and after not being able to find the cause of the pain he told me to send a physical therapist and in the meantime gave me 15 7.5mg vicodins and 21 Skellaxin 800mg for the pain. Didn't put any refills on it and i've been taking two vicodin a day just to get by... ANYWAYS, long story short I know that come Monday ill run out and once again be in pain... but dread calling to ask for a refill simply because I'm a young male asking for narcotics. Also, the physical therapy has been helping most definitely, but I still have great amount of pain during a work shift. HOW CAN I ASK FOR A REFILL WITHOUT HAVING TO FEEL LIKE IM BEING TREATED AS AN ADDICT? thank you! P. S. -the physical therapist determined the root of the pain is from a pelvic bone mis alignment which is causing my left leg to appear slightly shorter than my right, and causing this horrible pinching pain.
 
I'd just like to mention a couple more things. First, it definitely sounRAB like you have some sort of nerve compression in your lurabar spine that is compressing one or more of the spinal nerves. Two, you will need to get a MRI or CT scan as X-ray will show issues with bone, but not soft tissue, discs and nerves. And some sort of doctor will have to order the test for you...but you have a choice as to where to get it. Take time to look around because there are some places that will do it for lots less than other places.

Many spine specialists (either orthopedic spine surgeons or neurosurgeons who devote the majority of their practice to issues of the back and neck) do NOT require a referral. Perhaps your insurance company requires it...that would be a different issue.

Not to disparage your doctor, but at least from what you said, it really doesn't sound like he knows much about the symptoms of spinal issues. If you have stenosis or a disc problem, many of your activities are aggravating the problem. Lifting anything that weighs more than about 10 pounRAB can really make the back hurt and ache, and can send a jolt of pain running down the leg. Doing anything that requires bending will make your back ache, too.

The issue of whether one leg is shorter than the other is an interesting one. This discrepency can also be caused by a rotated pelvis, which causes the patient to carry one hip higher than the other. This is often traced down to a problem with the feet. Posture is affected by the way we hold ourselves on our feet. If you have any pronation, it causes the ankles to lean in, which causes a similar rotation in the knees, which lead up to the hips, cause a rotation in the pelvis and in due time can cause the vertebrae to slant and can lead to all kinRAB of issues in the spine. Something as simple as a pair of custom-made orthotics or wearing a lift in one shoe, etc. (depending on problem) can resolve the whole issues, (sometimes).

On the other hand, they can measure the legs to see if one is physically longer...but always check the feet too to be sure there isn't a problem with your "foundation."

I know the first step with any back pain is sending someone to PT...but it can sometimes cause as many problems as it "cures," particularly when you don't have MRI imaging and a diagnosis so the PT knows what he/she is treating. With my sciatic problems, I could not stand to have any kind of electric current used on me...like a TENS unit. It greatly increased my pain and sent me into a worse flare. I don't think I ever had ultra-sound, but it might have had a similar effect.

You are right that sciatic pain is very common...and it often times will resolve on its own without further treatment. But this process can take awhile. But when you do activities that aggravate the nerves, it is difficult for it to calm down and eventually go away. I'm rarabling on here, but just wanted to give you a couple more things to think about.

You are right that there is lots of information on the internet. I would encourage you to do some research, read up on lower back pain and sciatic pain. If you don't get some relief soon, it may be necessary to consult with a spine specialist, if you can swing it.
 
Tell them the pain remains severe. Low back pain can be caused by kidney problems (or bladder problems) as well so ask for a possible CT and MRI to see what they find. Then if it is your back perhaps a referral to an orthopedic spine surgeon and/or neurosurgeon at the U of I hospitals for a consultation, and talk to the doctor about pain management until you and the docs can figure out what is causing the pain.

If you are working, you may find you need to take some time off if possible. If your employer offers extended sick leave or short term disability consider using this until the pain is under control. If you find skelaxin is not working there are other muscle relaxants such as flexeril and robaxin which are available in generic and often work well for people. I always ask for the generic option first to save money. Skelaxin did not work for me, it's the only muscle relaxer that actually made me nauseous 2-3 hours after I took it. It took me 2 weeks to figure out that was the cause and not the pain meRAB.

PS Go Hawkeyes
 
Hi...and welcome to the forum. I'm sorry you are having so much pain. I do agree that you should have the tests that SpineAZ recommended and if they are negative, it is time to see a spine specialist.....either an Orthopedic Spine specialist or a neurosurgeon who limits his practice to the spine. They will know best what tests you may need to determine if you have a problem in your lurabar spine.

As for the pain meRAB, I would just call my family doctor and tell him that you continue to have severe pain and that you are finding it very difficult to go to work. Tell him you would like to have those tests done and that you will be asking him for a referral to a spine specialist. Hopefully, he will give you another prescription.

Please stay in touch and let us know how things are going, will you? Wishing you the best of luck,

Carol
 
Mologony,

Sorry to hear you're in such pain.

Be aware that a physical therapist isn't qualified to diagnose you. What your PT said may be true, but you may also have another problem or even more than one other problem. If you continue to be in pain, you should talk to or better yet meet face to face with your primary care doc to explain your situation.

It might be very helpful to jot down some notes to bring to any of your doctor appointments. Include things like what makes your pain worse, what makes it better, how often you wake up at night and where the pain is that wakes you up, information about how this pain has affected your ability to do your work, etc.

Doctors always start off very conservatively with back pain patients. They know the vast majority (something like 90%) will improve within 3 months through conservative methoRAB, and less than 5% will need surgery. My pcp once told me he sees at least 20 patients per week who complain of back pain. Regardless of your age, if you're not improving it's time to step things up and get more aggressive in diagnosing your problem and treating it. Ask your pcp for x-rays and an MRI, and for a referral to a neurosurgeon or orthopedic spine surgeon. It can sometimes take 1-3 months to get in to see these specialists, so it would be in your best interest to get the referral sooner vs. later, and it's a good idea to make appointments with 2-3 of them instead of just one.

You don't deserve to be in pain, and if you bring notes about your pain issues and explain that the narcotics help your pain and you have continued severe pain, you should be fine. For any narcotics, doctors don't give them with refills - you need to ask for them each time you refill them.
 
TwohanRAB,
What you wrote is not correct. Doctors do give refills for class 3 narcotics like Vicoden, Norco, Tylenol 3, etc., but cannot refill class 2 medications.

Mologony,

Even though your doctor can refill your medication by calling in the prescription, I would actually recommend calling to schedule an appointment. Speak with him about it face to face. I think that is much more effective, as things won't get lost in translation.

Please keep us updated. I hope that your pain goes down. Physical therapy helps me tremendously, but I often need more breakthrough medication on the days that I have PT.
I'm glad it's helping you!

Superspy
 
Mologony, there really isn't much more to add to what has been said. I agree that you need to see a spine specialist and have an MRI done. I also think it would be wise to stop PT for the time being as it could be aggravating your condition since there is no way to know just what is going on.

As for medication, it seems to me that your family doctor really isn't doing anything to be helpful. In fact, many family practitioners have no problem in prescribing pain medication until their patient can see a specialist. I find it unacceptable to be treated so callously and, if this happened to me, I would have to change doctors and find someone with more compassion and less attitude! But that is just my opinion and may not be something you want to do.

I hope you will stay in touch and let us know how you are doing and if you are able to see a specialist and to have an MRI.

Best of luck.

Carol
 
Might you be able to call around to your local hospitals? I know some in my area in NJ have sliding scale fees for MRI's, etc, depending on your income and/or may agree to let you pay it off over time. At least it's worth a shot asking about it. I have health insurance, but it's an 80/20 plan w/ deductible and coinsurance. I just had to have a bunch of x-rays and MRI's done as well as a bunch of spine injections for pain. Even though my insurance pays for most of it, I still owe around $2000.00 or maybe even more. Luckily for me, though, I told the hospital that I don't have all that money at once to pay my copay,etc, (which I really don't ) but that I know I am responsible for it, and they asked me if I wanted to pay a certain amt each month until its paid off. Let me tell you what a HUGE relief that was to hear!! I've been worried sick about it. At least I can afford monthly payments. Definitely call around to different places including hospitals and find out all your possible options. Someone might be able to work with you to try to help you.

I definitely agree that you might be making things worse with your work, the bending, lifting, twisting...that can no doubt make things worse. It's always possible that your issue could resolve itself over time, but what if it doesn't. I do know, though, what a bind it is to be b/c I've been there myself..not being able to pay and/or having no insurance at all.
 
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