Pain Management Community

You might try your primary care doctor. He could help you.

If you feel like "doing something stupid" please call your local ER or hot line for mental health emergencies.

Take care, Annette

Here is a link to the most comprehensive spinal intervention research that I've seen in the past 40 years: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . It provides an in-depth examination of all major interventions, along with morbidity data, short and long-term efficacy.

Almost all contemporary double blind, algorithmic, control group research pegs the success rate for spine surgery at around 60% (lower for fusion and for patients with prior spine surgery), because of the proliferation of fibrosis and osteophytes. No, surgeons don't tell you this.

I'm assuming that you have tried all major pain management techniques, including biofeedback, TENS, brace, corset, traction, acupuncture, systematic relaxation, meditation, PT, kinesiotherapy, etc. The only two other choices are the spinal cord stimulator and the intrathecal infusion pump. They also have low success rates (40% - 60%), particularly if you've had prior surgery. None of these are likely to remove most of your pain. But I would examine mind-body techniques. I can reduce my pain by about 20% with biofeedback. They are all worth a try.

One other aspect of your story merits discussion. It's rarely useful to fire one doctor who has been prescribing opioids before you have replacement. While opioids rarely take away our chronic pain, in most cases they do help at least a little. Since one never knows how long it might take to find a new physician, there is a real risk of running out of medication and experiencing not just higher pain levels, but also withdrawal symptoms, which can be exceedingly uncomfortable and can last for a few days. Even when we are tolerant to a medication, it is likely to be still helping.

Disc replacement for the cervical spine has been in use globally for about two decades. The success rate is pretty good. The reduction in pain is good and you have better range of motion than if you had the spine fused. However, disc replacement is still considered rather experimental for lumbar surgery. Think about how much more weight the artificial disc must bear at the base of your spine, compared to the top (in your neck). I was a Guiney Pig for a microdiscectomy in 1984 and again in 1985. My surgeon recorded the operation as a teaching tool. Needless to say, both surgeries were failed and I ended up with even more pain because of the fibrosis (scar tissue). We all grow it at our own rate. In my case, I grow it like it's going out of style. My last myelogram resembled a road map of New Jersey, with scar tissue everywhere. Fibrosis can impinge a spinal nerve root just as extruded disc material, a tumor or an osteophyte. Therefore, spine surgery is a poor risk and it should be avoided unless absolutely necessary.

We call the treatments for our pain, "pain management" for a reason. Those of us with damaged spines, degenerative disc disease and failed back surgery syndrome will never become pain free. At best, we'll eventually discover which treatments and which combinations of medication are useful for our unique history and body chemistry. But we'll deal with our pain for the rest of our lives. Therefore, attitude can make a great deal of difference. For example, I worked for seven years as a vocational rehabilitation counselor. On a daily basis, I worked with paraplegics, quadriplegics and people with terminal illnesses. On our worst day, we can still sit, stand, walk and care for our bodily needs. Yet, there are millions of people who will never be able to do those simple things. Compared to them, we are the fortunate people.