tapering down on the duragesic patch

I am a 50 yr old male who in 2001 was involved in a terrible work related accident.I underwent a lower back surgury involving A cage,screws,rods It was a fusion of L2-3-4-5.I also underwent a cervical fusion consisting of C -2-3-4.With the same technique cages, rods,screws etc.I am still in pain 24/7 365days a year with pain in my left lower back radiating down my buttocks down into my left leg.I use a cane because I never know when my leg will  just collape.My pain specialist has me taking Duragesic 75 mcq for pain and temezapam for what little sleep I sometimes get.I have been on this same drug regiman since2002.I dont seem to grt near the releif I achived in 02.I am still on worker comp,but have been fired from my job of 30yrs due to the restrictions the doctor placed on me.Now I have been informed that the medicare setaside fund is suggesting I be dropped from the Duragesic and placed on Ultram for pain and meletonin for sleep.I think this is a unrealistic idea. What do you think .Also I am on Federal partial disability.Any suggestions? Thanks Lightning1958

[Nassim Abi Chahine, MD]

You are not alone in such situation, what are you telling me in a total failure of what we call pain management specialty;
1- Durogesic for months: you are already addicted, and with failure to remove the pain.
2- what about Baclofen ? if good effects, so you can insert a baclofen pump.
3- what about Gabapentine ?
4- what about Pergabalin ?
5- Did your pain specialist proposed you a surgery ? like DREZotomy, or he prefered to treat you via his methods
6- about sleeping disorder, you can try Melatonine, why not. But you can also associate it with phototherapy (wake up in the morning and go outdoor), dont look to you TV after 22:00... you can try Clonazepam 2 mg (half tab or a complete tab), and if all these measures do not help: smile to life and look for a work at night. and dont forget to assess if no depression is present.. i have a feel that physicians in your country did have not used all their possible measures
best of luck (from which country you are ?)

[Lightning1958]

Thanks I will research your ideas and forward them to my M.D. Lightning U.S.A.

[Nassim Abi Chahine, MD]

Yes man