Facet Joint Hypertrophy

[rissa156]

i have 3 degenerate discs and a disc bulge at L5/S1 and facet joint hypertrophy. i also have pain on my hip that makes walking difficult as the pain travels down my leg and i use a crutch for support. I am on 125 micrograms an hour of transdermal morphine but my dose keeps having to be increased  is there any medication

[Tuckamore]

Hi Rissa,

Thanks so much for the update. Often ppl post, don't respond to our information or if they do we never hear from them again. We are left to wonder and often worry how our poster is doing. Obviously this does not apply to everyone.... some remain active and keep in touch. But it is so refreshing and welcome to read an update..... so again thank you.

Thank goodness you have finally be prescribed something that may help reduce and control your pain.... in other words provide you with adequate pain management.

I don't know what state or maybe even what country it is that you reside. In my state it is not the PMP that prescribes and follows Chronic Pain patients. It's our PCP that does so. However it is the PMP that makes recommendations for treatments and procedures and then often does them if it falls within their skill level. They will sometimes recommend medications also but again they generally do not prescribe them. This is contrary to how most of the states practice. I sincerely think it works better as the PCP best knows the patient as a whole and not just the pain producing issues. I truly believe that good pain management takes the whole person into consideration. Don't get me wrong, there are great PMPs that do see and treat their patients as a whole. I just don't think it's as common as it is with PCP. Obviously that's based on my personal experience.

I think you need to determine the laws and general practice of your state.  Once you do that you can be more assertive and insist that which ever one is responsible for these treatments perform them.

I never like to suggest that someone leave their long time PCP.... however if he/she is not listening to you or meeting your needs it may be your only good alternative. We often forget that physicians are truly Service Providers, very educated ones grated but still Service Providers. We hire them to provide a service, just as we do our plumbers or electricians. If we have a leaky faucet and hire a plumber to repair the leak and after $500.00 and three trips to our home we still have a leaky faucet what action do we take?? Among other things I hope your response would be FIRE the plumber.

So think about it and determine if your PCP is providing the service you require. However we have to be fair and let them know our expectations..... and obviously our expectations need to be realistic.  So don't be afraid to move on.  

You deserve good pain management, life is short. This isn't a trail run.  We only get one go-around. So make the most of it. And now I'll get off my soap box and remind you that you may rant her anytime. We all need an ear now and again. I know I do.

Once again I will look forward to your updates. You can post rather you "get anywhere" or not. You don't need "news" to post or update in our community. Be assertive and remember you are your own best health care advocate.

My Best to You,
~Tuck

[rissa156]

Thank you so much for your replies and my appologies for my late response. I wanted to wait until i had seen my doctor and spoken to her about this, and not so suprisingly she all but laughed in my face when i made these concrete suggestions to her, being her usual condesending self making me feel stupid for trying to find solutions to my problems because frankly ive had nothing from the doctors or specialists other than them continually saying to me "your pain is very real". Its no suprise also because i spent 6 months when the pain was intermittent trying to get an mri scan because i knew soething was going wrong and everyone refused- my then doctor, my physiotherapist and the A and E doctor that i saw when i went there. Ive been trying to tell my doctor that the buprenorphine patches were useless and that i was going through to much pain, ever since i was 52.5 micrograms an hour, and i said after having a callout doctor to my house, that i wanted to try fentanyl, she refused and now here i am on 125 micrograms an hour still in pain, the other day the pain in my hip going down my leg so much i couldnt even get in the shower, and she finally say "i dont think these patches are workin" so now shes suggested we try fentanyl. When i did my research it was said that steroid and analgesic injections to the facet joints would be most effective but when i suggested this to the pain management clinic who apparently are in charge of my care, they have said tat its my doctor who is in charge of my medicine and  when i have suggested things to my doctor she says the pain clinic is responsible- so i donot know who is looking after me i doubt they have a clue either. But thank you for your suggestions, sorry if im ranting but im just pure frustrated that in this whole year and a half that i have been going to the doctors and specialists the most constructive information and suggestions i have got is from a forum from people who havent even seen me. I will keep you posted if i actually get anywhere.

[Tuckamore]

Hi Rissa,

Welcome. I am sorry to hear that your chronic pain is increasing and not well controlled by medications. I agree that you should look into RFA. It has been a miracle treatment for some ppl.

What pain seems to be the most troublesome and difficult to treat? Is it your spine issues or your hip/leg pain? Have you been worked up for SIJD (Sacroiliac Joint Dysfunction)? I have facet joint disease, cysts on the nerve roots of my spine and SIJD. You would think it would be the facet joints and cysts that cause me the most pain, not so. It is the SIJD.  It's in my gluteal area, flank, hip, groin and runs down the back and lateral aspect of my leg. The pain can be consuming.

The reason I ask is knowing what is the major source or the primary pain producing site can often dictate the treatment. If my SIJD pain is controlled it decreases the other sites of pain and I can better handle it. I would assume that regardless of the pain sites if the primary pain producer is controlled it will help ease the other source of pain.

Frequently a "cocktail" of medications best treats CP, rather then any one medications. Are you on something for breakthrough pain and maybe a muscle relaxant? Good pain management often comes through a trial and error process.... it takes time and a concerned and caring physician that exhibits patience.

I hope this has been helpful.... and that you will keep in touch and let us know how you are doing. Please be active in our community. I'll look forward to your updates and input.

Peace,
~Tuck

[atonicat]

Have you tried radio frequency ablation? I have facet arthritis in the last four levels of my lumbar spine, DDD, as well as a herniated disk at L5/S1. I had RFA in February and I've seen a 90% reduction in my pain. If you haven't had RFA, it might be worth looking into.