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Pregnancy after lumbar fusion and SI joint problems
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Pregnancy after lumbar fusion and SI joint problems

Hi.  I really hope that you have some suggestions for me.  In june 2006 I had a lumbar fusion of L4-5 with bone graft.  I also have DDD of at least 3 other discs in my lumbar spine.  I also have unresolved sacroiliac joint problems.  Right up until I found out I was pregnant (which was a surprise) I was seeing a specialist for my SI joint, had more scheduled prolotherapy pumice solution injections and had been started on the fentanyl patch for chronic pain.  I have had 4 epidural injections in my lumbar spine before the fusion with no relief.  We were focusing on my SI joints up until recently because they are my worst pain.  My lower back has been bothering me more and more for the past  6 months but I was trying to deal with one thing at a time.  Oh yeah I almost forgot about my tail bone.  I have also had a few injections for the extreme pain that I have in my tail bone which is bothering me REALLY bad right now as is my left hip.  As soon as I found out that I was pregnant, I stopped all pain meds until I could get into a OB doctor to see what my options were.  I decided to see a midwife whom I really feel comfortable with.  She sent me to her supervising doctor to discuss delivery options and pain medications because I have been completely miserable.  This doctor said that she doesn't know why the midwife sent me to her because she knows nothing about me and she suggested that I go and see my neurosurgeon that did my back surgery and the specialist for my SI joints.  Neither one of the doctors feels comfortable suggesting or prescribing anything for my pain.  So I am in limbo.  No one knows what to do with me and mean while I am in agonizing pain.  I was just wondering if you have any suggestions on what my next move would be.  I am willing to try anything at this point.  Thank you so much for your time and reading this long drawn out question.  
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Hello,

Pain medication in pregnancy is a risk/benefit affair.  Non-narcotic meds such as tylenol and fioricet are used commonly in my practice.  These will not address your pain needs.  Narcotics can be used in pregnancy if needed.  You should talk to your neurosurgeon and have a consultation with a high risk obstetrician regarding formulating a regimen that will be most appropriate to manage your pain and minimize the risk to your fetus (that risk being neonatal withdrawal upon delivery).  This also means you should deliver at an institution that has experience managing infants faced with major withdrawal symptoms.  

I hope this is helpful.

Best regards,

Dr. Downing  
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