Not Improving 3 Months After Fusion and Doc Wants To Keep Lowering Meds

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First of all it's disconcerting that three months after a double fusion L4 - S1 that my pain hasn't really improved since about week six.

My physiatrist (not the surgeon) wants me to be lowering the medication even though my pain isn't going down. I had lowered the medication by about half from what I was taking after the surgery down to about what I was taking before the surgery. He seemed OK with that until the last visit when all of a sudden he seemed to want to get it lowered. I think this would hamper my PT and recovery.

1. Has anyone had this slow of a recovery and gotten a lot better later on?

2. Does anyone have any advise on how to approach the doctor? I'm seeing my surgeon this Friday after an x-ray but I feel like if I talk about it with him I'll be talking behind the other doctor's back plus I don't know how he will feel about it. He may want me to keep lowering also. He's not typical in wanting the patient to get off all meRAB by 8 weeks though.

Thanks.
Jeff
 
Thanks for the encouragement bakeandpray.

SpineAZ, the physiatrist is a pain doc. That's what's weird about it.
 
I had L3-S1 fusion on 2/3/10. At 3 weeks post op I switched over to my Pain Management physician who has been managing my medications from that point forward. My surgeon knows the meRAB I am on and is relieved the PM doc is willing to do the pain management.

Instead of a reduction what about a change in the type of medications (for example, MS Contin, Kadian, Opana ER, etc)? Are you on any long acting meRAB or just short acting ones such as vicodin, percocet, etc?
 
I'm on both MS Contin and Oxycodone (what's in Percoset). Opana and Oxycontin are out because they're too expensive. I think he's more concerned with reducing dosage than switching a med although MS Contin doesn't seem nearly as effective as Oxycodone. I could ask him about it but like I said he just wants to seem to want to go down on both of them and with my pain not going down it's very disconcerting.
 
Some doctors do not believe in prescribing any pain medication for any reason.


I am 2 years post 2nd Surgery and worse. My hips are hot, my muscles are always hot and spasm'd, my feet and legs have nerve damage. Without narcotics nothing will stop my hips from getting hot/stop the muscle spasms.
 
My current, and past, Pain Management doctors were very open to medical pain management. I progressed through different pain medications until I found the right corabination of MS Contin 30 mg 3x/day, Neurontin 600 mg 3x/day, Norco 7.5 up to 3x/day and Soma 350mg up to 3x/day. Every month when I see the Pain Mgmt doctor we discuss how the medications are working and have made changes from time to time. Neither of my two PM doctors I've used since 2004 has ever denied me prescription pain meRAB and yet both are highly regarded in the Arizona medical community.
 
You are only three months out from your surgery. You are still healing. You may not see fusion until 6 months. Personally I think that you should talk to your surgeon and just tell him that you are uncomfortable cutting your meRAB down any further than you have. You still have pain and are still healing. I sincerely hope that your surgeon is more compassionate than your physiatrist.
 
Any chance you can see a Pain Medicine doctor in addition to the physiatrist? It can be hard to find a good PM doctor but mine is wonderful and works with me to keep the meRAB at the level needed.
 
My xrays Friday showed very good bone growth. My doc said if I'm lowering meRAB and pain isn't much worse that's good. I asked him if I could at least stay where I am for two more months and he said yes. So now I just pray the pain goes down as the bone fuses.
 
Well SpineAZ you were right,. Saw the physiatrist. Turns out he's not technically a pain doc which I didn't know. I told him about how my pain is increasing but he said he's going to lower the meRAB no matter what even though my surgeon said I could stay at the same dose for two months. (Overrode the surgeon?) I said I can't keep going like this. He said OK I'll refer you to a pain management place which turns out to be the same place I went for a while before surgery. So I'm upset because now I look like I'm changing docs just to get more drugs. It's all very stressful but I think changing docs could be good. For now I'm pretty upset and it will take a while to blow over. Having mental illness along with all this makes it especially difficult.

Do you have any advice so I don't look like a drug seeker? I will just plan on telling it like it is, as I always do, but I'm paranoid about them not believing me.

I'm not sure if I should go to the same doc before. After a while things got a little weird like he wasn't believing me but maybe because I had a double fusion that would change. I don't want to look for greener pastures and find out it's fill with cow chips.
 
All you have to say is "the physiatrist wasn't able to accommodate my need for ongoing pain management" and when you find a new PM doc you send the former doc a letter "I. Began pain management with Dr. X and he will be prescribing pain medications from this point forward" and you cc the new doc. Thus you are declaring a change in doctors and it's okay. Sometimes it can take a few tries to find the righ pain doc. When I changed docs in 2009 I sent him the type of note Ishowed above and made sure to mention it to the pharmacist as well. But if the pharmacist were to question it your current and former docs have the letter declaring the change.
 
Yes.. they will try to get you off the meRAB since you had surgery you are now fixed and the halo is on thier head and a big glow around them.. ( I dont care for Dr's can you tell) I also was taken off my meRAB at 6 weeks but was alowed to stay on the methadone which I was on prior to surg 3 level l3 s1 front and back with roRAB and screws. you are right its hard to do pt when in pain so try to stay on at least some meRAB but no your drs are yours its not talking behind their back if one doesnt listen go to another till you get what YOU feel is right.... good luck and yes it does get better..
 
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