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Thread: Pain is on the increase, but I'm reluctant, need advise.

  1. #1

    Cool Pain is on the increase, but I'm reluctant, need advise.

    Hi Folks,

    This forum is a God send if for no other reason we have a place and experienced people who care to offer their point of view of a particullar situation. It also gives us a chance to rant a little and if it is just a rant, someone will smack the sense back into the ranter. I truly try to offer experienced advise from time to time on particular posts that I have had to deal with myself in the past.

    I find myself woobling on a problem I currently have. At times I don't know if it's the old continual pain playing with my brain or another rachet up of a worsening condition. I've come to the conclusion that I will most likely deal with this nightmare for the rest of my days. In itself a very crappy realization. After just having facet blocks in December, I found no relief from the injections, 28. I did however, as mentioned in another post, find relief immediately after the procedure in the recovery room. The relief turned out to be caused by the lidocaine used for the procedure and lasted just an hour or so. So now, I feel the rhizotomy RF is worth a shot even though my research has indicated that if the blocks don't work, chances are the rhizotomy doesn't have a great chance. At any rate the situation is expected to worsen because of the procedure, for 30 days afterward. The meds will continue and the RF will help me be able to do those thing that I'm unable to do now, if successful.

    Ok ... so here's the deal. At the PM's 10 days ago or so. I decided to keep the same dosage of meds that I've been on, last adjustment 2 years ago. I did this for a couple of reasons, one being the gamble you take with this PM doc when adjusting meds can cause a complete change into guinea pig world which in the past has made things worse. Usually, prescribing something the turns me into Rip VanWinkle. Over time, I have found that oxycodone gives that "felling of well being" that gives me the boost to get going into the world. The current menu has worked to that end for a couple years now. (current menu) 4 1/2, 15 mg. oxycodone, 1/2 to 1 every 3 hours, not to exceed 4 1/2 a day, and 30 mg. Avenza, (morph. sulph. ER) take 2, 4 hours a part in the evening. Also, I take 1mg. Klonopin at bedtime.

    Now, meaning lately, the menu only allows me to exist, without constantly napping. If I do something, anything, there's a price to pay in additional pain. This I don't mind if I have the available meds to help me through the rough times. I will save the 1/2 dose of oxy a day for just such occassions. This way I can plan a 2 hour ride to visit family or work in the yard or just take a walk on the beach. Each activity has a bill of pain that will come due. I equate what that will be, hours or days, and plan for it or opt out of participation. That option doesn't now exist because I need all meds just to get through the day.

    Sorry for the ramble, but this is what's going on in my head and it's good to vent out a bit. BTW, the PM doc gives a patient about 10 minutes to talk. Not sure it can be called a conversation. He is one of the best practitioners here but he has his drawbacks. So, this makes the presentation of your thoughts a bit pressured. Then you have to deal with the age old problem of, "are your sure it's not the drugs talking?". This is after 10 years of a clean, no abuse, record and procedures totaling over $250K to alieviate the problem all together. Not to mention, a cold turkey withdrawl, my own choice, from 140 mg. of oxycotin. That lasted a year before I realized the pain was affecting not just me but my whole family. So, back on the program, a little at a time.

    Ok to rap this up. Should I call the PM doc to try and up my oxy by 15 pills a month, 1/2 more a day, to give me the arsenal I need to have a life. Or, do I not chance a complete med revamp and just exist until my rhizotomy and hope for the best. Or perhaps someone can just stop putting the pins in my voodo doll. If I've finally gone off the deep end, don't hold back. Thanks for your time and patience!!
    Last edited by snorp; 04-20-2009 at 08:56 AM. Reason: correction
    No matter how cynical I try to be, I just can't seem to keep up with how bad things really are!

  2. #2
    Hi Snorp -
    I hope the rhizotomy works and gives you some relief. One would think that the fact that lidocaine provided temporary relief that that is a good sign that the rhizotomy will work. Do they do that with ultrasound?
    I also wondered if you ever explored a surgical solution to spinal stenosis like decompression laminectomies? Not that anyone would want surgery but if it could afford you some relief it might be worth investigating.
    Another thought I had was to try to withdraw off the levels of narc you are at to 'reset' your tolerance to a lower dose. Easy for me to say, I know. If it were me, I would only alter one variable at a time and stay on your current regime until the procedure. Maybe your PM would give you some more oxy for breakthrough pain. You can tell him that you don't have a history of increasing doses or abuse.
    I like your description of life with chronic pain :
    "Now, meaning lately, the menu only allows me to exist, without constantly napping. If I do something, anything, there's a price to pay in additional pain. This I don't mind if I have the available meds to help me through the rough times. I will save the 1/2 dose of oxy a day for just such occassions. This way I can plan a 2 hour ride to visit family or work in the yard or just take a walk on the beach. Each activity has a bill of pain that will come due. I equate what that will be, hours or days, and plan for it or opt out of participation. That option doesn't now exist because I need all meds just to get through the day. "

    That was well put, there will be a price for the activity in increased pain. Thank goodness for narcs that they can give you some semblance of a "feeling of well being".
    Good luck....

  3. #3
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    Hey Snorp - chronic low back pain for 7 years plus here too - have had Rhizotomys. RF's epidurals etc with no "lasting" benefit too. Currently on 50 mg's Fentanyl patch and 40 mg x 2 times/day M-Eslon. I too find that either my tolerence to the pain meds is rising meaning I am not getting the pain relief I used to get. PM Dr. wants me to go on Gabapentin as a treatment for neuro pain but I am somehwat apprehensive/reluctant to start taking that med despite his assurances. He is on Gaba himself for a nerve problem he has in his lower back. I don't know what to do either as Gaba is such a big med to be taking in my opinion - anti convulsant that youi have to ramp up on to see if it benefits you and you can't just quit it either if it is not working. Wants me to start at 300 mg x 2 day and up to 6 a day - seems to be excessive. Maybe I am overacting? Any responses? I just find that I can handle taking a double dose of m-eslon and had great pain relief but major sleepy for the day then so adding Gaba with just make me more sleepy?
    Good luck and I do hope the Rhiz works for you!

  4. #4
    Arndog,

    Thank you very much for your considered response. There really is no one in my circle of family or friends that I can have a real conversation with concerning this nightmare. Following your other reponses throughout the forum, I know that you understand and are educated in your answers. I had a complete check at Mayo's this fall, and their finding was their is no surgery that they feel would be of any benifit to my condition. I assume that includes a decom lac. I will do more personal research on that though. As for the narc reset, beleive me it is a consideration I often think about. Timing and longevity of the reset are the major obsticles. And, admitedly, I hate change. Guess cause it has usually not paid off on the good side. When I went off cold turkey, I felt if I ever did it again, I would have to quit completely cause I couldn't go through that again. I now know my condition is physically worse and there are so many different things wrong that any other modality is really just an experiment. At 56, I feel young of mind and 20 years older in body. Confusion rules. But, your input I value, so if you have other thoughts, please let me know. I'm a fairly intellegent guy, but I just can't keep up on what's going on with the medical double speak. My daughter is a Dr. of physical therapy and she suggests that it is meant to keep the patient confused. Too much of the information they work with is soooo subjective that not even my PM doc will go with the analysis of the various radiologists. Well, thanks again and good luck with your own nightmare!
    No matter how cynical I try to be, I just can't seem to keep up with how bad things really are!

  5. #5
    Wheelz1,

    Thanks for your input. I really have no personal knowledge of the drugs you are currently on. Have read a bit about the Fentanyl patch, but know diddley. How does it compare to oxycodone or oxycotin. Time released I am not a fan of because of the loss of control when you feel you don't need an entire dose. I take Avenza at night, morph sulphate ER, and that seems to work for me in that the sleepies are used up during the night and the natural wake up chemistry of the body seems to eliminate that side effect during the day. It does give a good pain reduction base during the day though and the oxys are good for that kick in the pants if the pain level is somewhat managed. I have never heard of Gabapentin. It sounds like the same effect I get with straight up morphine IR. Just sleepy land or worse, druller city. There has got to be some inbetween cocktail where a person can have the pain managed to an acceptable degee without giving up your life to constant drowziness. I can drive confidently with my current menu, but there have been prescriptions in the past that took that option completey off the table. The thing i most fear about driving is if anything should happen, it seems your up the creek regardless of fault. And M-eslon is again a complete mystery to me. Hopefully you wil educate me on these drugs. My best advise is to try and find that medium that will let you do more than just exist. Hope Lady Luck will find you soon. Thanks again!!
    No matter how cynical I try to be, I just can't seem to keep up with how bad things really are!

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