Hi Kathy,
The reduced effectiveness of your medications can be due to 1 or 2 things. The first thing could be that your pain has worsened over the past year. The second thing is as you said, a tolerance to your current medications have been reached.
I think it is a good idea to tell your doctor about how much you are struggling with your Activities of Daily Living (ADLs) and let him know that your medications aren't working as well as they used to. Be specific. If the vicodin worked for 4 hours but now only works for 2 hours, be sure to tell your doctor that. Explain what activities you used to be able to do given pain relief from the vicodin and your other medications, that you can no longer do. Tell him what your goals are for living and ask that he helps you in achieving and maintaining those goals.
You may want to ask about a medication called Gabapentin (brand name is Neurontin). It can be a very effective medication for the type of back pain you are experiencing. Additionally, you may want to consider also looking into a long acting medication that lasts 12 hours that is taken on schedule everyday. These types of medications are very helpful for chronic pain. Then, short-acting medications like vicodin would be used only if/when you have breakthrough pain or pain that occurs above the level that the long acting medication is covering. Some examples of long acting pain medications are MS Contin (Extended Release Morphine), Oxycontin (Extended Release oxycodone), BuTrans Patch (7 day pain patch) and there are others.
Your doctor may decide to switch you to Percocet which is a little stronger than the vicodin to cover the additional pain you are experiencing but I would inquire about an extended release medication as that would give you round-the-clock coverage of your pain and you wouldn't have the up and downs of short-acting medications, where you get an hour or two of relief and then the pain slowly begins returning but you have to wait 2-3 hours until it is time for your next dose.
I have been on Flexeril for 7 years. I think it is a good medication. I don't get much pain relief from it but it keeps pain from springing up due to muscle spasms and muscle tightness. Mobic is an anti-inflammatory and I think that it is an important medication to take for your pain as a lot of inflammation is usually present with the types of injuries that you have and that inflammation causes pain.
General rule of thumb: You want to typically add medications not replace or take away medications as the medications together are working in a synergistic manner to provide you pain relief due to the additive effects.
Hope this helps. If you have any other questions please let me know! :)
femmy
I do have another question regarding my medications. My pain management doctor prescribes me Flexeral once a day, Mobic twice a day and Vicodin 10/325 4 times a day for the pain. This was working for a while, but now it seems it does not help as much as it did before. Is it possible that my body has become tolerant to these medications? I am wondering if my doctor should try something else for the pain. I have been on this regimen for over a year now.
Thank you!
Kathy
Thank you so much for responding and helping me understand. I have my next doctor appointment next week with my Pain management doctor. I will discuss this fully with him. I beleive most of my pain must be the DJD as you mentioned. Again thank you so much!
Have a fabulous day!
Kathy
Hi Kathy,
From reading the results of your MRI, it sounds like most of your pain is being caused by osteoartritis as you have Facet Degenerative Joint Disease (DJD) through many levels of your lumbar spine. The synovial cyst can also cause some pain if it impinges on nearby nerve roots, which could be the cause of the leg pain you are experiencing. Synovial cysts typically resolve on their over time. It does not appear that you have significant spinal canal stenosis nor impingement on nerve roots. However, several disc bulges are noted throughout the lumbar spine and the lower thoracic spine.
Facet DJD causes more pain in the lower back, while spinal stenosis with or without bone spurs along with nerve impingement from the spinal stenosis (spinal canal narrowing) or a bulging or ruptured disc, produces more significant leg pain than back pain typically. I have both scenarios, which result in a mixture of lower back pain and sciatica (leg pain).
You might benefit from facet joint injections and/or radio frequency ablation along with anti-inflammatory medicines and other opioid and non-opioid therapies.
Please consider discussing this with your pain management physician to hopefully agree upon an effective treatment plan that works for you. It is likely that your condition will worsen with time as it is a degenerative disease that you have. The disc bulges may rupture and cause nerve impingement in the future. However, it is not guarantee that this will happen. For a small percentage of the population disc bulges retract back within the vertebrae. The best thing you can do is be gentle with your back. Bend with your knees when lifting and push up with legs as you make your way back up.
Wishing you the best.
femmy