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Back Pain Management....Could Really Use Some Help
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joefnh posted:
Hello my name is Joe

I do not have a lot of experience in posting to these forums but will give it a try

For starters here are the diagnosis I have

Lumbar Spinal Stenosis (3 levels) 3 bulging discs a L1/L2. L2/L3 & L3/L4 with spinal cord effacement Full loss of spinal curvature in the lumbar region Thickened ligament flavem Facet Joint Hypertrophy of all 6 of the facet joints in the lumbar region with fusion starting Suspected Anklyosing Spondylitis (Dx testing underway) Crohn's disease Microscopic Colitis (CC)

As far as meds

Note: can't take NSAIDS with the Crohns and Colitis per my Gastroenterologist

Imuran 100mg daily Allopurinol 100 MG daily (to help the Imuran) Atenolol 50 mg daily Oxycontin 15mg 2x daily / every 12 hours for pain Lidoderm patches for the lower back

I have been seeing a pain management doctor who is a anesthesiologist who is trained in pain management. He does not work full time in PM doc but like all of the doctors at this PM center gives a certain percentage of his time to the group.

About every 8 to 12 weeks I have been getting an epidural steroid injection with 80 to 120mg of Kenalog-40 usually at the upper portions of the lumbar region using the transformal approach

I usually get about 2 to maybe 3 weeks relief that is reasonable and a LOT of mood swings, sweating insomnia etc.. and of course each time I usually gain about 7 pounds. Since starting in October of last year I have had 6 of these injections done, each with about the same result.

The pain I experience is mostly in the lower back and pelvic region in the hip joints. Overall making any real activities not possible.. I can't drive for more than about 45 minutes without pain, stand for about 15 minutes without pain and both upper legs going numb from the knees up.

Laying down is the most comfortable, but can't lay on my back without my legs going numb from the knees up and can't lay on my sides without the hips hurting. Overall sleep is a problem.

My pain doctor does not want to increase the dosage and does not want give me anything for the breakthrough pain (due to the Crohns I cannot take NSAIDS) although he wants me in physical therapy which causes a lot of pain the night and day after. He also would like me to consider doing without pain meds altogether and rely on the steroid injections which have minimal long term effect.

My PM doc is willing to prescribe the 15mg oxycontin as long as I'm able to receive the epidural steroid injections.

The 15mg Oxycontin has minimal effect and is only really useful in reducing the pain while I am laying down, it does nothing if I try to become active.

What I am trying to do for myself and is helping a bit, is using swimming as a form of excercise and have a adopted a low carb diet with has worked wonders for weight loss. I also use meditation to help deal with the chronic pain.

Overall I am at my wits end...I have missed my daughters college graduation and my sons graduation from the Air Force Academy. I'm in bed most of the time while I'm not at work. Fortunately I work as a physicist at MIT which accommodates a very flexible schedule. Almost any other job I would have had to leave by now.

The question is what do I do?? Why is it so hard to manage pain from a well documented condition (MRI and CT)

Any suggestions?? I really could use some advice right now. It his has been going on for about 8 years now at a lower level and has been 'critical' for about a year now. It took almost 7 years just to get the MRI and CT.

Thank you in advance

Joe
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bj1208 responded:
Hi Joe and welcome to the support group -r

seeing the right kind of docs is vital - I see a PHYSIATRIST Pain Management Specialist (trained in medicine/anesthesiologist pain specialist).

http://www.spineuniverse.com/treatments/what-physiatrist

They go deeper into pain management control based on patients needs. they can also refer you to a good spine specialist as most work with one ore more.

seeing the right kind of spine specialist is also vital - either a Orthopedic Spine Specialist or Neurosurgeon Spine Specialist (my preference is Orthopedic)

this is really the first place to start - they can request new MRI/CT Scans especially if it's been more than a year since your last. They will examine, may order other tests, give you an accurate diagnosis and offer treatment options. Having Crohns etc makes it hard on you and what you can and can't take - but these specialists will be able to work with you on that.

Keep us posted what you find out~~
~~ Click on my name or picture and read my story ~~

Take care ~~ God Bless ~~

~~ Joy ~~


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