Medical Spinal cortisone and painkiller injections

[bobze]

Thanks. my fear of gaining a tolerance to pain pills (I'm not the addictive type) limits my intake of pain killers to less than a half pill per day. A bottle of forty 10/650 percoset has been known to last me 11 months. I'm taking at least a half pill a day now since my doctor told me that the stress from the pain was more damaging than taking the pills and to TAKE THEM AND STOP SUFFERING SO MUCH.

On a more positive note, "real" pain mitigates tolerance in opioids. The problem is when people keep taking them after the pain has subsided. That's when you get into that tolerance, dependence and withdrawal stuff.

 

[Evo]

They shouldn't be giving you opioids for chronic pain, bad doctors--BAD! (or nerve pain, like back pain, potentially mediated by A-fibers)

Have you talked to your docs about TCAs? They can help sometimes in chronic back pain, you should broach the subject at your next visit if you never have before (like a well informed internet patient ).

Back pain sucks though (understatement of the year, perhaps). I threw mine out years ago and its never been the same. I hope it gets better for you Evo, stay positive about it (as hard as that can be)--psychodynamics and health and all that.

Like Cymbalta? My doctor gave me that last year and I tried to keep taking them for a week to see if I could build up a tolerance, but they were so horrible that I had to quit, I was too sick to get out of bed unassisted. I tried them again a few months later and the same thing. But SSRI's make me violently ill too. Projectile vomiting.

Right now a nice demerol drip would be nice. I had that for my colonoscopy and I was happy all day. Just give me one of those beer can hats filled with demerol.

Thing is, my back doesn't hurt, I have referred pain, I guess that's what they call it, the pain is in my tailbone area (in the muscles) and down my legs and into my feet. My spine feels fine.

 

[rhody]

Thanks. my fear of gaining a tolerance to pain pills (I'm not the addictive type) limits my intake of pain killers to less than a half pill per day. A bottle of forty 10/650 percoset has been known to last me 11 months. I'm taking at least a half pill a day now since my doctor told me that the stress from the pain was more damaging than taking the pills and to TAKE THEM AND STOP SUFFERING SO MUCH.

Yep, been there. After gall bladder removal a few months ago, those six little holes and the bloating pain were enough to keep me from sleeping so I took what they gave me on day two after surgery, they barely took the edge off, so I just toughed it out. To be honest in about a week, the pain was manageable. I hate pills too, and only use them when I lose sleep for extended periods or am in serious agony from kidney stones. There is no choice in the matter when that happens unfortunately.

Rhody...

 

[Evo]

Yep, been there. After gall bladder removal a few months ago, those six little holes and the bloating pain were enough to keep me from sleeping so I took what they gave me on day two after surgery, they barely took the edge off, so I just toughed it out. To be honest in about a week, the pain was manageable. I hate pills too, and only use them when I lose sleep for extended periods or am in serious agony from kidney stones. There is no choice in the matter when that happens unfortunately.

Rhody...

Yeah, the percoset either just takes the edge off the pain or has no effect that I can tell. I mostly take it for my stomach pain, it seems to help that more than anything. And I am so sick of pills! My doctor told me one woman had just come to him that had been treated by a pain doctor and was taking 9 percoset a day! More than half of one makes me itch like crazy and vomit. How can people get addicted to this stuff?

 

[bobze]

Like Cymbalta? My doctor gave me that last year and I tried to keep taking them for a week to see if I could build up a tolerance, but they were so horrible that I had to quit, I was too sick to get out of bed unassisted. I tried them again a few months later and the same thing. But SSRI's make me violently ill too. Projectile vomiting.

Cymbalta is a SNRI. TCAs (tricyclic ADs) have been used for some types of back pain/referred pain/opioid resistant pain. Though they generally don't have great side effects, so if you've had trouble with SSRIs/SNRIs then they might not be for you. Still something you should possibly broach with your doctor if you are having trouble managing the pain.

Right now a nice demerol drip would be nice. I had that for my colonoscopy and I was happy all day. Just give me one of those beer can hats filled with demerol.

For some reason, I don't picture a beer-can-hat of demerol going over well with the FDA/DEA and scheduling departments

Thing is, my back doesn't hurt, I have referred pain, I guess that's what they call it, the pain is in my tailbone area (in the muscles) and down my legs and into my feet. My spine feels fine.

What did they find on the imaging, do you have stenosis of the intervertebral foramina or sciatica? If that's too personal, I understand :) Lots of nerve pain is opioid resistant. The only effect that opioids have on that kind of pain is sedation, which doesn't really alleviate the pain--It just knocks you out. That is why opioids are /supposed/ to be used with such caution in the case of chronic pain, bone pain, nerve pain, etc. Though how things are supposed to work and how some doc's proscribe are two entirely different stories :(

Yeah, the percoset either just takes the edge off the pain or has no effect that I can tell. I mostly take it for my stomach pain, it seems to help that more than anything. And I am so sick of pills! My doctor told me one woman had just come to him that had been treated by a pain doctor and was taking 9 percoset a day! More than half of one makes me itch like crazy and vomit. How can people get addicted to this stuff?

Yeah these pain clinics are becoming a big problem in the US, especially the eastern parts of the midwest (cause we don't have good heroin) and the south. Its unfortunate and I'm not really sure what the solution needs to be.

The itching and GI symptoms are common side effects of opioid analgesics. Its mediated through Mu-opioid receptors. If the percocet work for you pain though, let your doc know they are working, but you are having trouble with the side effects. Generally with opioids if there are side effects but good pain control your doc can add an agonist/antagonist (different opioid receptor action) that can alleviate side effects. Nalbuphine is used for this.

If you have poor pain control though and side effects or side effects with pain control, but sedation--they should really switch the opioid (there is a lot to choose from). Sometimes lowering the dose of an opioid can still get you analgesia w/o side effects, but the rule of thumb is to just switch opioids as there are many and the body's response to them varies greatly between individuals.

On top of that the problem with some of the opioids like vicodin (Hydrocodone) is that the parent drug itself isn't analgesic and requires metabolism by the liver to a biologically active opioid to produce analgesia (hydromorphone in the case of hydrocodone). The problem is that a significant portion of people lack the enzymes to produce, or sufficiently produce, the active analgesics.

Percocet (oxycodone) is a bit of an enigma. Supposedly oxycodone itself is analgesically active--Though it is metabolized to oxymorphone, which is active. Despite what some people will claim to you, no one is really sure whether it is the oxycodone or oxymorphone that provides the majority of the analgesic effect (both are Mu receptor agonists). It stands to reason though that since percocet or oxycodone literally doesn't work for some individuals that metabolites of the drug have a significant role to play in alleviating pain. So again, if it isn't working make sure to let your doc know and they can try one of the many, many other opioids available.

How can people get addicted to this stuff?

Like one of our anasthesiologist lectures on pain meds (opioids and non-opioids) was fond of saying: "It takes work to get addicted to a opioid". The side effects, like you've pointed out, are generally pretty horrible. The receptors and wiring are there in our brains (VTA, nucleus accumbens, VP wiring and all that jazz), but it actually takes an effort for incentive learning and maintenance to really "code" those addictions into our brains.

 

[turbo]

Q

Yeah, the percoset either just takes the edge off the pain or has no effect that I can tell. I mostly take it for my stomach pain, it seems to help that more than anything. And I am so sick of pills! My doctor told me one woman had just come to him that had been treated by a pain doctor and was taking 9 percoset a day! More than half of one makes me itch like crazy and vomit. How can people get addicted to this stuff?

When I was a kid, our family doctor prescribed cough medicine with codeine when I had a bad case of bronchitis. I woke up screaming because of all the snakes and bugs that I "saw" crawling all over me. I had to turn on the lights and the TV and stay up all night until that stuff wore off. (Pretty pathetic, because after the last late-night show went off the air, all I had was "the Indian" logo and tone signal, but that helped anchor my brain.)

When I had my first knee operation (a bit more invasive than the second one) the doctor sent me home with a prescription for an opiate (can't remember which drug off the top of my head) but his instructions were to take two pills at a time as needed for pain. I couldn't function, and puked my guts out (not good when you can't walk well), so cut that back to one pill at a time, with similar results. Cutting back to 1/2 pill at a time was tolerable (no puking) but didn't really cut the pain. Those pills went down the toilet. I'm not a fan of opiates. Just tough out the pain.

When my wife's favorite (fun) aunt was in terminal stages of her cancer, she was medicated with a morphine pump. It took all of the spark out of her. I would have hated to see her end her life in intolerable pain, but she was a lot more fun to visit and play cards with and talk to when she was in pain. She was a Rosie-the-Riveter type and had worked building ships in Quincy during WWII. Welding fumes, asbestos exposure, and other solvents, chemicals in such close quarters probably led to her early and painful demise.

 

[Evo]

What did they find on the imaging, do you have stenosis of the intervertebral foramina or sciatica?

Ok, here's what I got on my copy of the MRI findings.

L1-L2 demonstrates mild disc bulge. This effaces the interior thecal sac.

L2-L3 demonstrates mild disc bulging and mild hypertrophy of the facet joints. The disc bulging effaces the interior thecal sac and causes left-sided neural foraminal narrowing.

L3-L4 demonstrates a diffuse disc bulge. There is advanced hypertrophic degenerative facet disease and ligamentum flavum thickening. There is mild grade 1 anterolisthesis. There is mild unilatertal and symmetric neural foraminal narrowing.

L4-L5 demonstrates a diffuse disc bulge. There is advanced bilateral degenerative facet disease. The findings efface the anterior thecal sac. There is mild grade 1 anterolisthesis.

L5-S1 demonstrates mild disc bulging which is paracentric to the right. There is marked right-sided degenerative facet disease with intraspinal spurring.the findings cause moderate right-sided neural foraminal narrowing with effacementof the undersurface of the exiting L5 nerve root.

fatty atrophy of the erector spinae musculature

bone marrow signal intensity is mottled, but within acceptable limits

multilevel lumbar spondylosis

I was also previously advised that I had degeneration where my sacroiliac joined my pelvic bones?

 

[Astronuc]

Ok, here's what I got on my copy of the MRI findings.

L1-L2 demonstrates mild disc bulge. This effaces the interior thecal sac.

L2-L3 demonstrates mild disc bulging and mild hypertrophy of the facet joints. The disc bulging effaces the interior thecal sac and causes left-sided neural foraminal narrowing.

L3-L4 demonstrates a diffuse disc bulge. There is advanced hypertrophic degenerative facet disease and ligamentum flavum thickening. There is mild grade 1 anterolisthesis. There is mild unilatertal and symmetric neural foraminal narrowing.

L4-L5 demonstrates a diffuse disc bulge. There is advanced bilateral degenerative facet disease. The findings efface the anterior thecal sac. There is mild grade 1 anterolisthesis.

L5-S1 demonstrates mild disc bulging which is paracentric to the right. There is marked right-sided degenerative facet disease with intraspinal spurring.the findings cause moderate right-sided neural foraminal narrowing with effacement of the undersurface of the exiting L5 nerve root.

fatty atrophy of the erector spinae musculature

bone marrow signal intensity is mottled, but within acceptable limits

multilevel lumbar spondylosis

I was also previously advised that I had degeneration where my sacroiliac joined my pelvic bones?

 

[rhody]

Enough doom and gloom already. I saw this awhile ago. With all the poking and prodding you have gone through Evo, I hope you like this and gives you a few moments of relief. I encourage others to submit their's.

You know the ones, that bring tears or make you pee your pants. There is nothing, well almost nothing as a good laugh, but let's not go there. Are you ready Evo... and the PF collective, now submit your best.

Tim Conway - The Dentist



Rhody...

 

[bobze]

Ok, here's what I got on my copy of the MRI findings.

L1-L2 demonstrates mild disc bulge. This effaces the interior thecal sac.

L2-L3 demonstrates mild disc bulging and mild hypertrophy of the facet joints. The disc bulging effaces the interior thecal sac and causes left-sided neural foraminal narrowing.

L3-L4 demonstrates a diffuse disc bulge. There is advanced hypertrophic degenerative facet disease and ligamentum flavum thickening. There is mild grade 1 anterolisthesis. There is mild unilatertal and symmetric neural foraminal narrowing.

L4-L5 demonstrates a diffuse disc bulge. There is advanced bilateral degenerative facet disease. The findings efface the anterior thecal sac. There is mild grade 1 anterolisthesis.

L5-S1 demonstrates mild disc bulging which is paracentric to the right. There is marked right-sided degenerative facet disease with intraspinal spurring.the findings cause moderate right-sided neural foraminal narrowing with effacementof the undersurface of the exiting L5 nerve root.

fatty atrophy of the erector spinae musculature

bone marrow signal intensity is mottled, but within acceptable limits

multilevel lumbar spondylosis

I was also previously advised that I had degeneration where my sacroiliac joined my pelvic bones?

Wow Evo, you read like a gross anatomy tutorial on spinal imaging! I'm sorry to hear that

Anyway, just so you know there are other pain-killers besides opioids if they aren't working. Especially in nerve pains that aren't C-fiber mediated, like some poor little guys that are being squished by bulging disks or stenosed foramina :\. So if its not working, be sure to keep your doc updated and don't be afraid to get stern with them and give them the "this isn't working for me, I'd like to try another medication"--Heck, doctors love it when patients turn down opioids lol (well lots of them anyway :P)

 

[Evo]

Cymbalta is a SNRI. TCAs (tricyclic ADs) have been used for some types of back pain/referred pain/opioid resistant pain. Though they generally don't have great side effects, so if you've had trouble with SSRIs/SNRIs then they might not be for you. Still something you should possibly broach with your doctor if you are having trouble managing the pain.

I've been on Anafranil before, that caused my tongue to extend out of my mouth and wiggle on the right side of my face, this was preceded by facial ticks, then I started lactating. After my doctor got all emotional and told me that I must have a tumor on my pituitary gland, I asked him if it could be the Anafranil, he thought for a second and said "Oh yeah!" It was the Anafranil. I've been taking trazadone daily and there is no pain relief for a couple of years, I just take them at night to help me sleep now. I guess I'm out of luck.

The injections have definitely not worked.