Bulging discs

I have had lower back pain with pain down my right leg for about 5 years now and I just recently went to the doctor to finally figure out whats wrong because its getting worse, well my doctor took an xray and put me on tramadol for pain, well the xray showed nothing and I had to call her and change meds because tramadol did nothing for me, so she put me on Hydrocodone 5mg/500. Then I went back and told her I wanted an MRI done. The MRI showed I have two bulging discs in the lower back pushing against my nerves to my leg, so then I had to call her back again to change meds again, so she put me on hydro 7.5mg/750 and Ive been on that for a week now but thats still not working and now im not sleeping cause im in pain, and my mother is telling me to call the dr. again to change meds to stronger but I dont want the dr. to think I just want the meds or Im taking too much, but Im in pain and I cant see the neurologist till march 2nd. What should I do? Should I call the dr. and change meds again?

[femmy29]

Hi and welcome!

I am sorry to hear about your pain.  I suffer from something very similar to you.  I have a ruptured disc at L4/L5 that is spilling out and indenting my spinal cord.  I also have a bulging disc at L5/S1 that is pressing on the S1 nerve root.  I deal with debilitating lower back pain and pain that radiates down mostly my right leg, sometimes my left leg.  I also deal with myfascial pain syndrome and nerve damage in my thoracic spine.  These types of issues have been going on for over 12 years now.  I have been on opioid pain medication for almost 6 years and before that, I was on strong ibuprofen (800 mg of motrin 3x daily until it ate a hole in my stomach) and a muscle relaxer.  In the very early stages of my chronic pain, I tried tricyclic anti-depressants like amitriptyline which did nothing.  I have been through Tramadol, Vicodin (same as the hydrocodone you are on now), and Morphine in extended release form.  I am now on Opana ER with Percocet for breakthrough pain (also used Percocet when I was taking the Morphine).  My pain is very controlled now, I am feeling the best I've felt in over 12 years!

I am somewhat disappointed that your doctor switched you to hydrocodone 7.5/750 mg.  This is further limiting how much hydrocodone you can take at a time for pain.  Let me tell you how this works.  The first number is the mg of hydrocodone, which is the opioid (aka narcotic component of the medication).  The second number is the mg of Tylenol (aka acetaminophen).  The max dose of Tylenol you can take in one dose without inflicting damage to your liver is 1,000 mg.  The Hydrocodone 5/500 mg has a built in maximum dose of two pills, which provide up to 10 mg of hydrocodone.  The Hydrocodone 7.5/750 mg has a built in maximum dose of one pill, which provides 7.5 mg of hydrocodone as taking two would exceed 1,000 mg of Tylenol.  So with the so called "dose increase" your doctor gave, actually provides less of the opioid component which is the component that really helps with pain.  In other words, all your doctor did was give you an increase in Tylenol which isn't going help much with the type of pain that you have.  If you were only taking one 5/500 pill, then you are getting a 2.5 mg increase of hydrocodone but had you have stayed with the 5/500 pill, you could have taken two to get a 5 mg increase of hydrocodone.

If you are still in a lot of pain then I would encourage you to ask for an increase in pain medication.  I do find it odd that your doctor would make the change that he did by giving you more Tylenol.  Really the next step for you is to switch to Norcos, they come in 5/325 and 10/325 strengths.  There is less Tylenol so you could take three of the 5/325 pills to get 15 mg of hydrocodone or up to three of the 10/325 pills to get up to 30 mg of hydrocodone, safely.  The next tier up from hydrocodone would be percocet. And from there, you would most likely benefit most from an extended release opioid medication (long acting, lasts 12 hours or more).  If you are seeing a Primary Care Physician, at some point they may want to refer you to a pain managment doctor.  

I have also went through 5 rounds of lumbar epidural steroid injections.  Not sure if the doctor has brought this up as an option for you but you could try it to see if it helps.  The relief is temporary (usually 4 to 6 weeks at the most) and the injections are not a long term solution as long term use can cause bone loss.  Be sure to take a calcium supplement during injection therapy.  

Hope this helps.  

femmy

[msp87stang331]

Yes that did help very much, So I called the doctor back today and asked for stronger meds because the 7.5s weren't working for the pain at all and all she did was prescribe me 60 more of the 7.5s and told the pharmacy to tell me that these have to last 30 days. Now does that make any sense?

[femmy29]

No that doesn't make sense.  I would make it very clear that the opioid component of the medication is not sufficient at reducing your pain and explain that you can't take more than one hydrocodone as you will overdose on the tylenol.  Let me know what your doctor says.  If she is still giving you the runaround, ask to be referred to pain management.  

femmy

[Smiley2000]

Hi there,

You are still very young and in pain, so you obviously actually need surgery to replace the disks and I think that is what Neuro-Surgeon is going to advice you to do, when you see him in a few days.

All these pain medications are just short-term solutions and should be taken with care and remember not on an empty stomach.  You can also apply some heat (heatpacks or towels) to the area on your back and rest as much as you can.

[femmy29]

Not everyone is a candidate for surgery.  I have been told I am not a candidate and I have bone spurs, arthritis, spinal stenosis, mild scoliosis, a ruptured disc at L4-L5 pushing the L5 nerve root and a bulging disc at L5-S1 pushing the S1 nerve root.  Along with ligament thickening.

I would consider back surgery VERY CAREFULLY.  Back surgery is still only 60% successful and many have come out from back surgery with worse pain than they had before surgery, often requiring implantation of a spinal cord stimulator or morphine pump.

Opioid pain medications are VERY SAFE when taken as prescribed by a physician.  Only 1-3% of chronic pain patients become addicted to their medications.  I am 31 years old and I have been on opioid pain medications for over 6 years and they have truly given me my life back.  

Additionally, I would like debunk the statement that was made that said pain medicines should never be taken on an empty stomach.  THIS IS NOT TRUE!  Opana ER MUST be taken on a empty stomach either 1 hour before eating or 2 hours after eating...not doing so will increase the potency of the medication by 50%!  And Opana ER (i.e., oxymorphone) is the strongest opioid medication in pill form based on pharmacology so a 50% increase in strength is not trivial.  

There is A LOT of opiophobia out there these days and there are many that claim it is only a short term solution.  IT IS DEFINITELY NOT.  Especially in the case of chronic pain.  With chronic pain, the pain is most often NOT treatable and many require opioid therapy for the rest of their lives just like many require insulin for diabetes for the rest of the lives or blood pressure medications for the rest of their lives or anti-depressants for the rest of their lives.  Opioid medications are no different from other medicines used to treat diabetes, high blood pressure, and depression.  Opioid medications; however, have a terrible stigma because of those that have abused the medications to get high, chronic pain patients on opioid therapy are looked down upon for no good reason.  Don't let this discourage you from getting proper treatment!  No one has to know what medications you take for pain and you shouldn't suffer when there is treatment.  No one but you need to know your medications!  The only difference others will notice is that you have increased functionality and are a happier individual overall.  

Lastly, opioid medications DO NOT cause any damage to organs or tissues.  It has been used to treat pain for over 3,000 years and to date...there is NO SUBSTITUTE!  Most have to deal with constipation over the long term but there are very effective over the counter medications that treat that.

I encourage everyone to conduct their own research and not go by what they heard from someone else.  Knowledge is power!

femmy

[Smiley2000]

Hi there,

You have a very complicated case.

The post from msp87stang331 said "The MRI showed I have two bulging discs in the lower back".

For this patient surgery to replace the discs should be an option as it is a straight-forward problem.  I know of patients in my ward (when I had my neck-Fucion in 2011) that were in there 60's and had the back surgery done and were out of hospital 5 days later and good recovery and feedback.

[femmy29]

That is a good point that you mention.  Bulging discs do not necessarily cause pain.  Degenerative disc disease does not necessarily cause pain and in most people it doesn't.  And in some cases a ruptured disc can bring relief from pain to some individuals.  The original poster did not state that the discs were hitting nerves.  If the discs are hitting nerves and even worse, causing bowel and urinary problems, surgery is a medical emergency to address these issues.  Additionally, the nerve can be impinged so badly that a person risks paralyzation (sp?) if surgical intervention is not taken.  Most neurosurgeons will not do surgery just because a person has bulging discs.  The discs have to be ruled the cause of the person's pain.

Honestly, without the specifics of the MRI, I don't know what the real root cause of this person's pain is.  All I know is the person has pain coming from somewhere and it is causing them to not be a fully functional individual.  I don't know what the other person has tried in terms of non-opioid therapies to help with the pain.  Usually, opioid therapy is a last resort option to control the pain so I did "assume" that all other non-opioid therapies have been exhausted.  But I don't know if that is truly the case.  

The issue with spinal fusions are that they tend to put a lot of pressure on the remaining discs to perform.  Depending on how many levels are fused, it could be too much for the remaining discs to handle and they begin to bulge and rupture causing another cycle of chronic pain.  I have heard from my doctor that one level fusions are usually sucessful, but any more than that, the patient risks a breakdown of the remaining discs.  For me, they would have to fuse two levels and I just received the news that I also have bone spurs, arthritis, spinal stenosis, and ligament thickening so I don't know what my spine orthepedic specialist will say in regard to the new findings.  However, with the knowledge of just the ruptured and bulging discs, the neurosurgeon told me that I wasn't a candidate for surgery and proceed to refer me for injections.  I honestly don't know what the final rule will be with this new information as I just had a repeat MRI this past Tuesday and I haven't met with the doctor to discuss the results yet.  

I do have a friend that had a microdisectomy and she still has these horrific flare-ups and goes on these oral steroid regimens two weeks at a time.  But before surgery she could get out of bed at all so I think her surgery was a medical necessity.  I honestly don't know what the outcome would be for me.  All I know is that the success rate isn't incredibly high.  I had gall bladder surgery in December and the sucess rate for this procedure is almost 100%.  Prior to scheduling the surgery, I researched that it was a very safe procedure and that complications were rare.  Not the case with back surgeries.  I have had no complications from getting my gall bladder removed and it was causing tremendous pain so it is not that I am against surgeries, it is just that I am leary of back surgeries and proceed with caution in that area and encourage others to do so.  I do think the sucess rate goes up if you get a very experienced surgeon that has performed hundreds of successful surgeries.  So my only other advice is to not take the cheap road when it comes to back surgery.  Make sure you have done your research on the surgeon before you let them cut you open.

There is a possibility that the bulging discs are not the cause of this person's pain.  It could be SI joint dysfunction...especially if the discs are not hitting the nerve roots.  And unfortunately, SI joint dysfunction is another form of chronic pain where there is no known fix to the problem.  My spine orthopedic specialist sent me back to physical therapy as he believed I also had SI joint dysfunction...if I do, then I am guaranteed to still be pain after I have a two level fusion but will it be more or less pain?...I honestly don't know.

femmy

[msp87stang331]

So I went to the neurosurgeon at $300 an appointment since I have no Insurance, this guy as soon as I shook his hand I could tell he was not going to care about anything I say and just be a ****, well he was, anyway all he did was look at my MRI disc and watch me walk and tell me that he is going to refer me to some other doctor, for now Im done with this **** until I at least get insurance. I am tired of the runaround and doctors charging me INSANE amount of money just to refer me to some other retard.

[femmy29]

Neurosurgeons are really the worst!!!  I was referred to a neurosurgeon once and went to the appointment.  Back then I was in tremendous pain and hopeful that he would at least refer me for spinal injections.  At that time, all they had were MRIs of my cervical and thoracic spines not the lumbar spine.  There was a small disc protrusion in my thoracic spine along with something that they called a "bony bulge".  The first 5 years of chronic pain was localized in my mid back that spreadout to the shoulder blades to the sides of my back and up into the neck area.  The neurosurgeon basically did the same exact thing that he did to you and proceeded to tell me that I have bad posture and coached me on how to walk with my chest stuck out and my chin tucked in and then said that I should look into breast reduction surgery!  At the time I was only a C cup!!! What a moron!!  

I had to have another round of MRIs completed and this included the lumbar spine and then I had to be refered back to neurosurgery again only to meet his PA and she said that based on the findings in my lumbar spine that she would refer me for injections but that the herniated discs were not something that they would do surgery for.  When I went in for injections, I asked about other options like an injection in my thoracic spine as well as lumbar along with injections with pain medicines instead of steroids...I was told that I needed another referral for each of those things...I said to myself, "Screw that!!" as I knew if I went back to neurosurgery and requested a different treatment plan they would say no and I might have not even gotten that far as my PCP needed to submit another referral to neurosurgery just so that I could make an appointment to ask the question!!  Ridiculous!

I just switched insurance carriers this year and now I don't need referrals for anything, just prior authorization from the insurance company for some procedures.  My spine orthopedic specialist can do whatever types of injections he wants to do.  Based on the latest lumbar MRI, I have been recommended for either a spinal, joint, and/or trigger point injection as well as radio frequency ablation.  I have never had joint or trigger point injections nor radio frequency ablation so I don't know if they will be helpful or not.  With radio frequency ablation they burn the nerves near your spinal cord dead and it takes 6-24 months for them to grow back.  Sometimes when they grow back, the pain returns and in small cases the pain doesn't return.  I hope they are no more painful than the epidural injections I have received.  I go in on the 14th for both of those procedures.

I would be beyond livid if I had to shell out $300 to hear the crap that neurosurgeon threw at me.  But, starting with a spine orthopedic specialist who is also a psysiatrist has been very helpful to me thus far.  He and his team reside in a teaching hospital.  A spine orthopedic specialist or psysiatrist might be a better starting point.  

Based on what happened at neurosurgery, it sounds like you aren't a candidate for surgery just like myself.  If you prefer to wait to see a psysiatrist when you have insurance, you could find a good pain management clinic in your area.  They often have psysiatrists onsite and provide injections as well as pain medication.  Given that you don't have insurance, you should be able to self refer yourself to pain management.  They typically do require monthly appointments for opioid therapy but I think many have payment plans and will negotiate pricing and your treatment plan to fit your budget.  In pain management, I believe you will be given more effective pain medication to manage the chronic pain you have.  

I am sorry neurosurgery didn't go well, just know you are not alone...they treated me like trash too.

femmy

[femmy29]

I would also like to recommend that you try Gabapentin in addition to the hydrocodone you are taking as sciatica (pain down your legs) is often nerve pain related and Gabapentin works well for this type of pain.  You could ask your PCP about Gabapentin or if you go to pain management, you could ask about it there and they might also recommend it to you as an option.  I take 1200 mg/day for nerve pain and ever since I started taking Gabapentin several years ago the pain in my thoracic spine disappeared.  Dosing for Gabapentin goes up to 3600 mg/day.  The pain in my lumbar spine persists but it does help reduce the pain in my lumbar spine.  

Other medications that I take that are also helpful are valium, flexeril, and remeron along with a long-acting opioid that is taken on a schedule with a short-acting opioid for breakthrough pain.  Valium is a benzodiazepine or anti-anxiety medicine but it is also a very potent muscle relaxer and sleep aid.  Flexeril is a muscle relaxer and helps with the muscle spasms and tightness.  Remeron is an anti-depressant which increases serotonin in the brain and has been shown to reduce pain by changing the way the brain perceives pain.

The non-opioid medications are called adjuvant therapies that when used with opioid therapy can reduce the amount of opioid therapy required to control the pain.  Keep in mind that each adjuvant medicine may provide a 5-10% decrease in pain and as additional adjuvant medicines are introduced the total pain reduction is additive, for example: a muscle relaxer and gabapentin together may provide 10-20% reduction in pain; whereas: adding in an anti-depressant can provide 15-30% reduction in pain.

femmy

[msp87stang331]

My uncle is recommending that I go to an acupuncturist because he had back problems too and when he went and got acupuncture done, it solved his pain within 6 sessions, but I don't understand how an acupuncture is going to solve bulging discs or herniated discs. Do you have any experience  dealing with acupuncture and would it help at all? I'm trying to get as many opinions as I can.

[femmy29]

I have had accupunture sessions before but the relief was always very temporary.  Within an hour after each session the pain was back.  The same thing happened with massage therapy...pain relief was very short lived.

Accupuncture unfortunately won't do anything to heal the discs but it can reduce the pain that the herniated discs are causing.  I think accupunture helped more for the severe myofascial pain syndrome that I have as the needles they insert into the skin help relax knots of muscle called triggerpoints and this helps reduce pain from myofascial pain syndrome.

I wouldn't not try it because I didn't get any long lasting relief.  Before I started strong opioid and non-opioid medications for pain I tried every contemporary medicine related procedure out there...accupuncture, massage, chiropractic, massage with cupping; but the relief from all of those procedures were very short lived.  However, there are many that have found significant relief from these therapies so I think trying them to see if they will help you is a good idea.  

femmy