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The role of the GP with pain managment
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MattyB13 posted:
Hey Everyone,

I had an operation in 2004 where I had an arthroplasty done at my L5/S1 level. I was the poster-boy for the study I was in. My surgeon even signed me off as 100% to join the Army!

Now though, I've got some issues. Over the summer (7 months ago), I stepped off into a shallow pool and jarred my back. No worries I thought, I just went to the acupuncturist and he fixed me up. Then, a month later, I was carrying a leaky truck battery into Costco and immediately hurt myself. Since then, I've had an MRI, an injection through my tailbone and started PT, in preparation for a possible second operation for L4/L5 ALIF. I'm getting a second opinion on the surgery from a neurosurgeon.

I'm on 1-2 Norco every 4-6 hours and it isn't helping. I've got radiculopathy in both legs, pain and numbness, and numbness to the point where my feet fall completely asleep. My surgeon has been helping me with the pain meds, but I think I need to ramp it up a bit and I'm ready to go on short term disability. I haven't had to deal with this for quite some time, and what I'm learning is that the GP will not do pain management with pain meds. Does anyone have any experience with their GP helping them out while they wait for surgery? Also, will they typically do the necessary disability forms?

Thanks everyone!

Regards,
Matt
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tuloud54 responded:
Sorry for your loss! It is a loss when pain visits and never leaves. Like a third cousin. Please click on my name to read my messages to save me repetition. My Dr of 12 years knew me pretty well and signed me out on temp disability. 3 Months later made it full disability. He knew me well so I'm hoping you have a Dr of some time that knows you. Regardless,you are going to have to fight like crazy to make this happen. Make it your fulltime job because ssdi will most likely deny you/sop. Took me 2 years to get in front of a judge but my story was pretty simple. I would work if I could. Been on ssdi since may 2007 and though I'm grateful,I would not choose this. Had a pain pump in Nov 27,2012 and slowly feeling better.Not pain free but not rolling on the floor writhing in agony.Knew it wouldn't kill me but wished it would. Please stand up and fight for you.You are worth it.Painfully better today. Peace!
 
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caspertab replied to tuloud54's response:
Hi tuloud54,
I have had my pump since 2008 and have found it to be the answer for me. You can click on my name with my story. It hasn't been always a smooth road, but oral medications were not the answer for me. I am clearer thinking now as well. I also have a spinal cord stimulator so I am definitely a bionic woman!
Those of us with chronic pain have to fight for our lives and stand our ground with the doctors. We know our own bodies and should not accept their saying it is all in our heads!
 
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MattyB13 responded:
Thank Everyone,

I had an amazing visit this morning. Very nice Christian doctor (very important to me). I had to sign a pain contract. He prescribed me the same meds I was on, which is good. I also was able to get off work while doing PT for 6 weeks so that I don't have to drive which is a God sent. The most important thing that I came away with is that I have an advocate and can do what I need to do to steer my case. I also had a C Xray and he referred me to a local neurosurgeon. All of the lights were green on the way there this morning! I feel blessed today and for the first time in months I have a glimpse of hope I'm finding that you have to look for the small victories in the battle.

Thanks again!

Matt B
 
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ctbeth responded:
Hi Matt,

I am wondering if your surgeon is willing to refer you to a pain management specialist.

My neuro-surgeon referred me to pain management as he believed that I needed more pain med than he felt comfortable prescribing.

This was years ago.

You can also click on my name or little pic to read a very brief narrative of my history.

Pain management prescribed a long-acting opiate to be taken twice a day PLUS a short acting for breakthrough pain. That is to be taken only now-and-then when I really need it.

I also have an implanted spinal cord stimulator. For me, it has been a miracle in pain management.

What does ALIF mean? When you say, "injections through my tailbone", are you referring to epidural steroid injections? Did these help at all?

Is the surgery that's being considered an L5-S1 fusion?

So, in brief, I would ask and hope that the surgeon, with whom it sounds as if you have a good relationship, to refer you to pain management.

Keep us updated, ok?

CTB
 
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Onehurtguy replied to ctbeth's response:
Sorry in advance for my ignorance, but what's a GP?

Not knowing what we're speaking about exactly, but I'm assuming that your point is that you're not getting enough medication for pain prior to your surgery?

If that's the case, why not speak with your regular MD to up your dose?

I'd be very carefull about that though, as you're already getting tolerant of the opiates, going up before surgery, then the massive doses you'll receive during and after surgery, plus recovery are going to leave you dependent on HUGE amounts of medication that you certainly will have to deal with eventually, and that's almost as bad as the pain itself...

I would do anything you can to decrease your meds before the surgery, so that pain management in the hospital will be far easier on you, and you won't end up taking 300 MG's of opiates when this is all done. These medications are as bad as the are good in the end.

Try heat/cold compresses, massage, TENS units, inverted therapy, stretching, lt exercise, spa, swimming, ANYTHING that may help besides more medication.

There is nothing wrong with taking medication as needed, or becoming tolerant and needing higher doses over the years, but know that there is a limit to how much you can take OR how much your PM will feel comfortable prescribing, after that, you'll have to pay the piper, and that price is steep!

Good luck my brother, stay strong!

R
 
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annette030 replied to Onehurtguy's response:
GP usually stands for General Practitioner, I assumed this was what the poster meant. That is usually your primary care doctor, or family doctor.

Some folks use initials or abbreviations that I don't understand at all.

Take care, Annette
 
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MattyB13 replied to annette030's response:
I'm in telecom, you should see what we have to deal with Annette Sometimes it is hard to not carry over!
 
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MattyB13 replied to ctbeth's response:
Hey CTBeth,

Sorry for the late response. Today was not good and PT aggravated everything pretty bad yesterday

I had an arthroplasty in 2004 at L5/S1 (This is a joint replacement, or total disk replacement). I was pain free for about 7-years, but now I've got an issue with what seems to be L4/L5. I've got heavy disc pain and left leg numbness and reflex issues. I also have numbness in my saddle and groin. I'm also dealing with electric-like pain in my forearms and burning upper back pain with loss of about 80% of my grip ability in both hands. Waiting for second opinion/ and evaluation for my issues from a second surgeon here in my town before having to go back to San Francisco.

The ALIF stands for Anterior Lumbar Interbody Fusion. Basically, surgery is performed through about a 2.5-3" incision in your lower abdomen. This is where they approached in my first operation. The scar looks a lot like a C-Section. My wife and I have matching scars!

I've had several epidural/steroid injections in the past. My first one was horrible. It was done under fluoroscopy, but I was in so much pain afterwards that I had to go to the ER and get a shot of pain meds. Later, I began have incontinence, not fun! Later, after my surgery, I needed a myelogram done, again, needle in dural sac = pain goes through the roof. My surgeon in SF began going through the hole in tail bone to administer the medicine through a catheter. That keeps the scar tissue and other "junk" from being disturbed. It was way better in my opinion!

Thanks again and love the community!

Regards,
Matt B
 
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MattyB13 replied to Onehurtguy's response:
Amen! My first go around 10 years ago was pretty bad. I was on fetanyl and lost over 70-80lbs. I have been living pain and med free for about 7-years. I have been managing with acupuncture and massage and exercise. I'm on two 20mg every four hours of hydrocodine. I'm hoping to get this done before it becomes chronic.

I really don't want to live there again. I'm in my mid-30s and have a lot to do still. Two little monkeys running around. Beautiful wife and a great church family. I have found that pain is a deep dark hole that is incomprehensible to most. But, the best thing to do is be honest with those close to you. And, thank God that we have such good medicine and doctors to help.

Thanks again for your kind words.

Regards,
Matty
 
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ctbeth replied to MattyB13's response:
Hi Matt B,

I haven't been on the site for a few days.

Duh, my lumbar fusion is also anterior approach and I am an RN. I should have known that.

More later. I'm just reading the new posts now.

CTB


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