Just diagnosed with multiple severe back problems, general and medical advice wanted.

[SaosinEngaged]

I had my first lower lumbar MRI last week after about a year or so of moderate to excruciating at times back pain. Well, the results came in today and I made a visit to my doctor. Turns out I have 4 herniated disks, two discs that are "desiccating," and one severe nerve pinch that is causing me horrible pain down my legs. I left with a script for Tramadol 50mg and Percocet 5/325. I also have to make a follow up with a neurologist because of the severity of the problems. I'm only 23 years old and my doctor told me he's never seen someone my age with a back so completely fucked. Figures. I may actually need surgery I was told.

Here's where it gets tricky. As of 3 weeks ago, I recently ended a 2 year+ Oxy addiction. Of course I'm never planning on divulging that info to anyone as it would be counter-intuitive to my clinical need for adequate pain relief. I'm in such severe pain as of the past three days it's completely bed-ridden me. No work, no school, no work on the home I'm closing on with my fiance in a month, etc.

Before I quit, I topped out at about 60mg Oxy (2x 30mg Roxi)/day. Never a huge habit, but I was certainly more tolerant to Oxy than being capable of feeling a 5mg perc. My source for the 30mg Roxi's has also permanently dried up, which is one of the reasons I eventually quit. Emotionally/psychologically, I've been much better about the addiction aspect of it. It was hard, but I'm more or less only concerned now with pain relief instead of absolute recreation. With my lowly script for 5mg/325 Percs, I really don't know what to do. The Tramadol is great for chipping some points off my pain, and I can at least feel 3 Percocets if I take them at once (which would be the limit for APAP), but how am I going to go about getting adequate pain relief having the tolerance I've built up already?

I have to see a neurologist soon and eventually a pain management specialist. I was wondering what you guys think I should say or how I should approach this scenario so I'm adequately taken care of. I'm really in tremendous pain right now daily, and if I were to take 3 Percs 3x daily as I would need to control it, I'll be through my initial script in a few days which I'm sure would be very suspicious to my doctor.

I also know several of you bluelighters are chronic pain patients with what I'm assuming would be back problems. How do you guys cope? What are things to do and things to avoid?

Thank you for any and all advice.

(Mods: Really don't know where this goes, also unsure if you think this question is allowable, please understand I'm in a lot of pain and dealin with a ton of stress relating to this diagnosis and really am in need of adequate pain relief. This isn't about scoring drugs. Please do as you see fit

 

[SaosinEngaged]

It's bad to admit, but my 2 year oxy habit hid from me the severe pain I was experiencing in my back and delayed me seeking appropriate medical treatment. Now I'm kind of screwed.

 

[amapola]

I'm going to send this to Other Drugs (OD) as it is the best place for it. One of their mods might merge it into the "pain management mega thread" as well.

homeless >>> OD

 

[sekio]

I am going to lock this if it diverges into "What do I tell my doctor to get strong narcotics?"

You should be contacting your pain management specialists - not random people on the internet. This is dangerously close to "How can I get my doctor to prescribe more narcotics?" - and it's not a question I am comfortable answerring. "How can I get the most out of my meagre narcotic supply" has also been covered; look up opioid potentiation.

If the question is really 'How can i manage my chronic pain effectively?" - you need to come clean with your PM doc that your meds don't cut it (it's probably neccesary to point out your previous abuse because it does play a factor) and find a treatment (either higher dose opioids or alternatives) that works for you. Whether that is a combination of physio and drugs, NSAIDS, or even massage therapy/chiropractic, depends on your particular case.

 

[mrflowers00]

if they can do surgery to fix it you might want to consider that but most of the time back surgery is very risky and can even make the pain worse so you may just want to find a combination of medication that will work for you

 

[SaosinEngaged]

That's fine Sekio, I completely understand where you're coming from if you have to lock the thread. I'm just reaching out because I'm sure others have been where I'm at now and that someone has good advice.

My other thread was focused on the interaction of Tramadol and Oxy, this is more advice for my current situation.

 

[TheLostBoys]

I take Norcos & Tramadol together & they work great together. I never used Tramadol with Percs but im assuming they will work great together. Instead of taking 2 or 3 Norcos at a time, I take 1 Norco & 1 Tramadol & get relief for up to 4 hours.

As far as you coming off a 60mg habit of Oxy & now dealing with much lower doses, its gonna be tough but look at it this way, maybe this is a good thing. I just dont see any doctor giving a new patient 60mgs of oxy for every day use. My doctor 1st gave me Tylenol 3's but I was using hydrocodone by myself for my back pain for over a year before that & when he prescribed me Tylenol 3's, they didnt do shit for me.

Next month I went in & told him the Tylenol 3's didnt do much, he was surprised & said, lets try Vicodin. There are some doctors out there that will give you pretty much anything to take away your pain but they are usually in private offices. Stay away from medical corporations like Well Span if you are looking for doctors willing to treat you right.

 

[Kledsky]

Why does it always have to be "he's looking for drugs, shut the thread down"? Maybe he's looking for the best course of treatment for someone in SEVERE chronic pain that had a prior addiction? I know severe chronic low back pain, it's excruciating and takes over your life. What I would recommend to the OP is that you get on maintenance drugs like MSContin or Methadone, something that doesn't have such an up and down opiate high. I would also suggest that you give your meds, at least for sure your breakthrough meds, to someone you trust that can dispense them for you. This has proven to be a godsend for me in terms of moderating my usage. When talking with doctors you are going to want to make sure that you don't get labeled a drug seeker. Look into "drug seeking behavior" and do the complete opposite of that, even if it means going through a few months with more pain. Once you get labeled a drug seeker and also are in chronic pain you will be fighting a depressing uphill battle. Dr.'s also always want to see that you are trying every alternative out there to take care of your back. In your area I'm sure there is some free "health insurance" or maybe you got a good insurance from your work - work this as much as possible. Try physical therapy, try biofeedback, try a TENS unit, try epidurals, try any and everything that is around the circle of opiate usage. Dr.'s don't like to feel like they are just your drug dealer and I don't blame them.

OP, if you want to talk about this more just PM me, I had lower back surgery when i was 15 and have a tumor now found in my back from my recent MRI, I know back pain and I know what you are going through. I'm 26 now so I've been around the medical bs and the MRI's and the ER visits and all that a lot and now consider myself pretty well versed in getting through the maze it creates. Know above all that you will always have pain to some degree and that you can never completely get rid of your pain, no matter how many meds they put you on. This is a very important thing to accept. That's all with my rant plz PM me if you want to talk more. I feel for you I really do. Peace, and hang in there...

 

[muvolution]

Hey man, I am a chronic pain patient. You can look through the CP/ Pain Management megathreads both here and in TDS and see many of my posts - I went from poorly controlled pain and abusing my Opana prescription to using no narcotics and exclusively alternative therapies, and now have settled on the alternative therapy end of that spectrum, with a tiny bit of help from Dilaudid when I am doing really bad.

I will give a short list, and these are things that your Pain Management specialist will want to try also.

Orthopedics, Accupuncture, Sympathetic Nerve Block (intra-spinal injection), Lidocaine Patches, Ketoprofen/ Neurontin/ Ketamine topical gel, plain ol DMSO topical gel, Medical Marijuana (smoked, eaten, in topical creams), Spinal Stimulator System, Exercise, Diet

I could go on and on, but until you try most of those out, you shouldn't be drastically increasing opiate doses.

Also, evaluate your Pain Doctor. If you don't feel comfortable, you might just tell him thanks for your time, but this isn't the clinic for me, no I don't want prescriptions, thank you, goodbye, and then try another doctor. This way it is clear you aren't looking for drugs. Also, if you do and can find the right doctor, don't by shy about telling him you are an ex-addict. Honestly, I need the control that comes with that to keep me straight, and additionally, I t helps explain why you are needing these huge doses of opiates. This is very personal, though, so even if you do find a great doctor, you might wait a couple months to tell him/ her.

Feel free to PM with specific questions.
I would recommend Acupuncture, Diet, and Exercise above all else.

 

[TheLostBoys]

Hey man, I am a chronic pain patient. You can look through the CP/ Pain Management megathreads both here and in TDS and see many of my posts - I went from poorly controlled pain and abusing my Opana prescription to using no narcotics and exclusively alternative therapies, and now have settled on the alternative therapy end of that spectrum, with a tiny bit of help from Dilaudid when I am doing really bad.

I will give a short list, and these are things that your Pain Management specialist will want to try also.

Orthopedics, Accupuncture, Sympathetic Nerve Block (intra-spinal injection), Lidocaine Patches, Ketoprofen/ Neurontin/ Ketamine topical gel, plain ol DMSO topical gel, Medical Marijuana (smoked, eaten, in topical creams), Spinal Stimulator System, Exercise, Diet

I could go on and on, but until you try most of those out, you shouldn't be drastically increasing opiate doses.

Also, evaluate your Pain Doctor. If you don't feel comfortable, you might just tell him thanks for your time, but this isn't the clinic for me, no I don't want prescriptions, thank you, goodbye, and then try another doctor. This way it is clear you aren't looking for drugs. Also, if you do and can find the right doctor, don't by shy about telling him you are an ex-addict. Honestly, I need the control that comes with that to keep me straight, and additionally, I t helps explain why you are needing these huge doses of opiates. This is very personal, though, so even if you do find a great doctor, you might wait a couple months to tell him/ her.

Feel free to PM with specific questions.
I would recommend Acupuncture, Diet, and Exercise above all else.

I am going to see a Spine Specialist in a month & they focus more on massage therapy, aquatic therapy & holistic healing with some pains meds when needed. Ive tried physical therapy for 8 sessions with no avail, it was very painful after the 2nd session & my ortho told me to stop when I told her how bad the pain was. Massage therapy helps very little for me as well.

There are some people out there that no matter what you try, only thing that will help are pain meds. I do agree that light exercise & stretching helps & im hoping the aquatic therapy helps as well, we shall see.

I look at it this way.......would I want to be in pain & suffering or would I rather be some what pain free with pain meds the rest of my life.......its no competition, I will take the meds & live a some what constructive life no matter how bad some doctors thing meds are. I have avery understanding primary & he says, a pain level of 7 for you might be a 4 for someone else, & that is one perspective some doctors wouldnt look at.

 

[muvolution]

I'm not trying to discount anyone's pain or need for medication, but I was at a point where my pain could not get any worse and no amount of opana would help. not dicksizing, just saying that taking opiates with an 8 or 9 on the pain scale (a ten being a compound fracture or GSW) is only going to get you to a 7 or maybe 6. But if you can get down to a 6 without opiates, with them you can hit 2 or 3. I don't think it is reasonable for doctors or patients to expect to live with a 4,5, or 6 out of 10 on the pain scale, whatever that is for them personally.
You have to try as hard as you possibly can to get your pain down without opies, because as I said, they typically only reduce pain by 20-30%. Exercise, Diet, PT, swimming - all are free, you pay no price with your body or mind (as you do with opiates) and they pay divends (your meds never will) and even if it doesn't help your pain directly, it helps everything else in your life (which your meds certainly don't)

The way I see it, you can put good into your body in the form of acupuncture, diet, exercise, physical therapy, etc, and when you use opiates for any reason, it takes that out of you even faster than just living normally, or living with pain does, so the more pain you are in, the more opiates you take, the more important it is to be proactive in these other areas.
You went to 8 physical therapy sessions? Are you even fucking trying? How many times have you done the exercises or stretches since then? be honest.

 

[redsweater]

ummm if you don't mind me asking how did you fuck your back so badly, why did you wait so long, and how did you manage to live through the pain for a year without opiates?

 

[SaosinEngaged]

ummm if you don't mind me asking how did you fuck your back so badly, why did you wait so long, and how did you manage to live through the pain for a year without opiates?

A combination of things. I originally thought I did something to my back 4 years ago when I was big into the gym and weightlifting. Something felt off for a while and I slowly stopped lifting. I'm not the type of person to run to a doctor at the first sign of a cough (I guess foolishly), so I just ignored it.

About two years ago, I was lifting something and tripped and totally threw out my back. It was so severe I couldn't stand and ended up at the ER where they loaded me (nicely) up with painkillers and muscle relaxers and dismissed it as a severe muscular injury that would heal in time. They did XRays and other tests but found nothing, which lead me to believe I didn't have any severe issues (oh boy was I wrong).

And lastly, this year I was involved in a car accident (that wasn't my fault) and it completely wrenched my back.

Also, before my MRI appointment was actually the first time I had been off opiates in two years. Two years ago was my ER visit, and it was right after that when I began to take Oxy daily. Me taking a potent pain reliever daily and often split up throughout the day completely masked any pain I would be feeling without. It wasn't until I got clean a few weeks ago that the pain became unbearable. And I'm not talking w/d. I w/d without pain because of the godsend that is Kratom, and woke up one morning almost unable to get out of bed. I figured it was finally time to see a doctor and here I am today with a laundry list of back issues.

Thank you all so much for the advice I'm considering everything said to me. I also appreciate some of you being empathetic to my situation. This kind of support goes a long way, believe me. I'll repost in a bit and let you know how things are going. I can't get into the neurologist until October 10th and am deciding if in that time I'm going to go back to my GP and explain that I'm not getting adequate relief.

Although I will say on days where it's not as tremendously severe, 1 perc with 2-3 Tramadol gives me a pleasant but mild buzz and some very decent analgesia. Still, even going on 2 percs with 3 Tramadol isn't doing much on the days I'm in excruciating pain.

 

[SaosinEngaged]

Also; my back is totally and truly FUCKED and I guess I'm paying now for my dismissive attitude towards it over the years. The look on my doc's face when he looked over the MRI was priceless ~ he was in disbelief that a 23 year old could have a back resembling an 80 year old that had a cherry bomb go off on his spine, and he didn't sugar coat that fact to me.

It basically just steadily got worse as time went on, and me being on opiates masked the issue and made it a non-issue to me (which I suppose speaks to their efficacy).

I even remember multiple times where I woke up in pain and just said, "fuck it, I have Oxy. Ain't that what it's for?" I just kind thought, "hey, everyone has a bad back."

 

[SaosinEngaged]

I have one more question:

The topic of a pain management doctor hasn't been discussed by my primary. Do I need a referral for pain management, or can I take my MRI scans and diagnoses sheet to a local pain management clinic and get in off that?

And if you do need a referral, who generally handles that? Would the neurologist I'm seeing next Monday be the person or would I have to call my general doctor? If I have to call my general doctor, how would I go about bringing that up?

Thanks guys.

 

[muvolution]

usually your primary doctor will refer you when they no longer feel comfortable prescribing narcotics. I would stick with a regular doc or neurologist for as long as possible - trust me, the less PM, the better.

 

[aveoturbo]

When I went to begin seeing my pain doctor I said (truthfully) that I was seeking a second opinion from Dr. SoandSo and they set me right up and I saw the guy the next day. I dont think you need a referral, I think its like if you elect to see a psyche. Just call and make an appt (and if you have insurance, call them first and get a list of docs they cover).

I know about your pain and back problems. I was in the same boat and then got the surgery done, err, well for me, surgeries. You really should give that physical therapy another try and really work at it for a couple of months. You need to restrengthen parts of your body to help support whats crippled. Yeh, expect it to hurt. Thats why its called PHYSICAL therapy and not "sit on your ass and try to look pretty" therapy. I used to weight train too and thats how I futzed up my back and I thought that I was a tough old ox and that PT was just crap anyway. It hurt when I first started and I quit too. Looking back, that was a dumb decision. Maybe if I would have followed thru with PT, I wouldnt have some extra hardware in my back and have been on antibiotics since June of this year.
You will not get pity from me, just some encouragement. I hope everything works out for ya! I really do!

Seriously, go do PT for a while.

 

[SaosinEngaged]

So as an update, I finally saw a pain management doctor and he thinks the severity of my disc herniations are going to require surgery to correct. He has me on 60x 5mg/325mg Percocets and 45x 50mg Tramadol for the next couple weeks until we come up with a plan of action.

I'm going to be CWE the percocets I've been given as I still need more pills than I feel comfortable allowing APAP into my body for adequate analgesia. I'm building a solid relationship with my new doctor but I'm still unsure how to bring up, "I really need something stronger than 5mg Percocet." I feel like telling him I must have a rather high natural tolerance or something, as I'm sure some people do.

I'm going to be off from work and not driving for the forseeable future. I've become all but bed-ridden. The lowest disc in my back is like a mm away from my spinal cord and the leg pains I've been getting are making me see stars.

 

[sekio]

Honesty is the best policy.

 

[SaosinEngaged]

I had another appointment today and I asked him if I could take just two 5mg percocet together at a time for better pain relief, he responded "absolutely not, under no circumstances will I allow you to do that at this time." Even though I explained to him that the 5mg, one at a time, is ineffective and that I must have some "natural" tolerance.

Very aggravating. I guess everyone's doctor is different, mine is extremely strict. I have to compensate to make it through the day. I generally take 2 percs with 3-4 Tramadol, twice a day. It's allowed me to at least function. The Tramadol I have tons of with 3 refills, so at least going this route is better than suffering.

Sound like I need a different doctor?