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Getting to the end of my rope.
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An_254324 posted:
Hello everyone
I am a new member here and I would appreciate your insight and suggestions regarding my situation. I injured myself 10 years ago (for the 5th time) and this particular injury was a life-changing event. I fell down some oak stairs while carrying a heavy server and pulverized part of my vertebrae, They also found compression fractures, degenerative disk disease, stenosis, sciatica and nerve damage. I am now on total disability. About 8 years ago a doctor put me on Oxycontin and my life went to hell. I will spare you the gory details of my spiral into addiction but I managed to get off of the opiates, with the help of my Psychiatrist, Three years ago I was diagnosed with malignant melanoma and last year I was diagnosed with emphysema. I have been under Psychiatric care for 6 years due to depression and suicide attempts. I see a pain specialist and currently take Butrans patches, neurontin, cymbalta, and otc meds to try to control the pain. I puyt a brave face on to my wife and children but I am in agony every day, don't sleep, have lost interest in everything I used to love, lost my libido, my memory, and my quality of life. Several doctors have told me that I have to be realistic and go back on opiates. I have an addictive personality and that would probably lead to my demise. I have tried every remedy listed on this board and then some without success. I know there must be someone out there that has an answer or solution. I only hope that they happen to read this post. Thank you and I apologize for whining. There are many in this world worse off than me that are coping. Thank You
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cweinbl responded:
Not an enviable situation. I'm sorry for your pain.


As I'm sure you realize, addiction disorder is a psychological condition, not physical. It's hard to imagine a situation in which you could use an opioid and not crave it for reasons beyond chronic pain. But you already know this.


Neurontin is not a pain drug. It was designed to treat convulsions. the same applies to Cymbalta, which is an anti-depressant. Yes it is an SSDI inhibitor. But it's still not designed for treating chronic pain.


You could consider Suboxone or naloxone. They were designed to treat addiction disorder and some ( a few) physicians are using it to treat chronic pain, especially with addiction-disorder patients. I would get my hopes up. From what I understand, these drugs are not nearly as effective as today's powerful opioids (Fentanyl Transdermal, Oxycodone, Kadian, etc.).


Finally, you might see if you are a candidate for the spinal cord stimulator, which involves no medication at all. It might have a positive effect upon your sciatica. However, not all of us with degenerative disc disease are a SCS candidate.


Another option is the Intrathecal infusion pump (IT Pump). In this case, your medication (possibly Prialt or a combination of opioids at very low dosages) is distributed via a pump surgically implanted into your abdomen, through a catheter that ejects the fluid upon your effected spinal nerve roots.


To learn more about these and all other relevant interventions for degenerative disc disease and all other spinal maladies and trauma, see the latest and best research here: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf .


Many of us here understand exactly what you have in terms of chronic pain. But most of us are able to use powerful and effective opioids because we do not have a history of addiction disorder. That puts you into a very, very small and frightful group of people caught between a rock and a hard place.


I'm sympathetic to your condition and your inability to use the drugs that help the rest of us. It's a difficult place to be. Best of luck.
 
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turtle6 responded:
Hello, I'm very sorry to hear about all of your problems. I totally understand what you're going through. Although I may not have the exact same conditions as you, I have been in extreme pain with RSD, reflex sympathetic dystrophy, for over 10 yrs. I have it in both my lower legs and feet, caused by an auto accident. I have been on hard core opiates ever since it all started. I really have no choice in the matter because without the meds, I would have committed suicide long ago. I would love to get off of them, but just can't. I also have a neurostimulator implant in my spine which helps alot with the pain. I don't know if your Dr.'s have discussed this with you, but it could be an option. The device is like electrical impulses that send a message to your brain to send the electrical pulses to the area of pain, It kind of feels like a Tens unit. They place a remote control part under the skin near the buttocks area and then leads are placed in the spinal canal. The one I have now is old and needs replaced, so I'm about to get that done soon. My husband passed away last year from cancer so I didn't utilize the stimulator for a while and the battery went dead. Also lost my brother, mother, father and a sister all in a year and a half!! It was a very difficult and depressing time for me. I'm just now trying to get my head back in the game. if you haven't already, please ask your doctors about the neurostimulator implant by Medtronics. i hope that this info helps you. Any little bit can help. take care and good luck.
 
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cweinbl replied to turtle6's response:
Please keep in mind that the spinal cord stimulator (SCS) only helps with neuropathic pain. Many of us are primarily disabled by severe NOCICEPTIVE pain. If your pain is nociceptive, the SCS will fail and you'll require more surgery just to remove it.
All surgery entails morbidity risks. People have died from surgical implantation or removal after contracting MRSA infection. This decision is not to be taken lightly, or because someone in a chat room or on a message board raved about its results (from a situation likely to be different from yours).
For that, if all else fails, there is the intrathecal infusion pump.
But these devices, which have success rates ranging from 40% to about 60%, are last resort options. Before having surgery to implant (and remove) a mechanical device, please be certain that you have tried the dozens of viable treatments available through a comprehensive pain management program, including:
spinal decompression, corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, injection of steroids and anesthetics, non-steroidal anti-inflammatory drugs, cortisone, rhyzotomy (radio frequency denervation), off-label medications, anti-depressants, anti-convulsants, combination of long-acting pain medication with breakthrough meds, counseling, hypnosis, Yoga and meditation. If all of these and all medications fail to help, then you can consider the surgically implanted devices.
Here is the best recent research I've read about all major types of spinal interventions: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf .
Whatever you decide to do, please base it upon having tried every possible less invasive option first, lest you require additional surgery to remove a mechanical device that failed to help. Also, never allow anyone to surgically implant either device until you have first tried the exterior trial unit first.
Also, please know that every time you have surgery, you'll develop fibrosis (scar tissue). Fibrosis itself can impinge upon spinal nerve roots, creating as much or more pain as you had before the surgery. That counts for surgery to implant or remove a mechanical device.
Good luck!


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