I had back surgery. now I'm stuck for post-op pain!!!!

I have posted here before, but not for awhile.  I had a discectomy/laminotomy/foraminotomy this past Wednesday.  My disk (L5/S1) was so dehydrated that it was pretty much rock solid.  My nerve was stuck between a rock (disk) and a hard place (bone) literally.  Makes me feel VERY validated in the amount of pain I have suffered the past 2 years.  It also makes me feel like this surgery (I chose open rather than micro) was the absolute 100% right thing to do.  ALL my PRE-op pain is gone!!!!  No more hip to knee to foot burning, gnawing, sharp pain, and my numbness along the right side of my thigh is gone, too.  Excellent outcome so far.  

Now, POST-op pain. OMG this is hell.  They kept me on morphine and oxycocodone in the hospital so I felt really good, walked a lot, was cheerful, etc.  They took me off morphine on Thursday night, I woke up in level 9 pain crying.  My surgeon said they were discharging me and gave me a scrip for one 5/325 percocet every 6 hours. Uh, I take 15mg oxycodone every 6 hours PRE-op.  Taking me down to 1/3 of my pre-op meds???? WTF!  He also put me on Etodolac, a heavy anti-inflammatory.  I held it together but lost it with my nurse.  She said that b/c I have a pain doc and no pain contract w/ my surgeon that I needed to call my pain doc asap and that they would have to handle it.  Now, when I called to tell my pain doc that I was having surgery and to ask if I needed to change meds or do anything differently he said no that they surgeon would handle my post op pain.  I called my pain docs' office the second I got home yesterday but being a Friday I knew I would not hear from them until Monday.  Thank the stars above I still had ONE Fentynal patch from when this disk ruptured even more in July so I slapped that on as soon as I got off the phone leaving a message for my pain doc.  It IS helping to keep me at about a 5, which is my goal.  Please, just let me be at a 5.  I can tolerate that. 8, 9, 10..hell no and I should not have to.  Now, what do I do if my pain doc refuses to up me for a couple of weeks?  I just need a couple weeks of heavier meds so I can a) heal and b) do my PT and walking because at a 8/9 pain level I can do neither.  I would like something heavier and the SECOND my pain starts to taper off with healing I want to start tapering off all my meds and get off EVERYTHING for FOREVER!!!!!  That is my ultimate goal.  NO MORE MEDS!!!!!  Before I herniated I rarely took a tylenol.  I want that life back, thankyouverymuch.  I never wanted to be on pills, and slowly I ended up on a lot of them.  Anyway, what do I do if my pain doc refuses more meds?  Do I go to maybe another doc in the clinic?  I could so that...Or do I go to the ER?  I refuse to be in massive pain.  I could barely breathe in the hospital yesterday it was so intense.  HELP me out guys.  I need recommendations!  

[mellie4]

Wow, not sure what to suggest.  I know how you feel about wanting to come off the pain meds.  That was my plan after each of my surgeries but unfortunately for me, it didn't work out that way.  All the surgeries have failed and I can't get my pain to a level I'd be okay with (five would be good.)

I went into pain management last year.  For my first six surgeries, my surgeon managed my pain meds.  Once I went to pain management, though, the NP at the pain clinic did.  She always would up or change my meds for post-op and then back to something else when we realized the surgery failed.  (I see the pain clinic for arthritis pain in my hand as well as RSD which came about because of all the surgeries.  I do have other pain issues, arthritis in other areas, as well as fibromyalgia and a herniated disk in my back but the pain from those are more stable than my hand.)

I would hope your pain doctor would take care of this for you.  How long have you been going to him and how is your relationship?  I'm fortunate with mine because we really have a good working relationship together.

You could go to the ER, and I'm sure they'd give you something for the moment, but I think it's unlikely that they'll give you anything long-term.  

It's a shame you didn't work it out with your pain clinic doctor before your surgery but I think it's disgraceful that your surgeon has left you like this.  You can't heal properly if your pain is out of control.

I hope someone else has some suggestions for you. Keep us posted on what's going on.

[MamaAng]

Thank-you so much for your reply!  I am, thus far, convinced that this has been successful, it is the incision/nerve/site pain that is killing me.  It's a LOT of pain, which makes sense b/c he took out quite a bit of disk, bone, and tissue.  I DID ask the pain clinic/doc before surgery and they said that the surgeon would take care of my post-op back pain and I took that as truth.  Turns out they gave me some meds but nothing even CLOSE to being able to take me to a 5!  I have been with my pain doc for 2 years and he knows I never intended to be on narcotics, now I am and so much more.  I want off all of that and I will make it clear that when this pain calms down we are going to work out a tapering program.

If I may ask, how long after surgery did you realize it had failed?  Things look so good so far.  I am very hopeful.  

[MamaAng]

at the urging of a dear friend I just called my surgeon's emergency number and talked to him, he said there is nothing he can do since it is the weekend and to take up to 3 of the percocet and that puts me up to the 15mg of oxycodone.  Uh I need MORE than that.  Dammit.  He also said to ice it, which I have been doing religiously since last night.  There has got to be some program in place for chronic pain pts.  This is ridiculous.  I realize there is going to be pain, Demanding it be under a 7/8 is NOT uncalled for.  I am so frustrated.  I don't know what to do.  When the patch wears off....it is going to be ugly.

[mellie4]

Initially my surgery looked okay.  But the problem was the implant.   It failed across the board, not just with me.  If I had gone with a different surgery, things may have gone differently but the implant looked really promising and due to my age, he thought it was the way to go.  (And I had a second opinion before I had it.)  I had the surgery in June '06 and in October I started having trouble.  He thought it might be the hardware and took that out in December.  Unfortunately, I ended up with no relief so he went back in in April '07 to take the implant out totally and try using tendons from my arm to recreate the joint.  But that didn't work either and I ended up somehow with the bones rubbing against each other plus nerve pain.  Went back in a bunch more times but so far no luck.

I would LOVE to get off these pain meds.  It's one thing to take a Percocet once in a while for a toothache or after a surgery but being a slave to pain medication is no fun.  I'm on the Duragesic patch, 75 mg., plus 45 mg. oxycodone every 4 hours and Cymbalta and Clonidine for nerve pain.  I also have to prescription creams and a lidoderm patch.

Initially I thought I could get my pain to a 1 or 2.  Then I thought I'd be happy at a 3.  Most  days now with all the medications I'm on I'm at a 5 or 6, but there is usually some point in the day when it shoots up.  Basically using it causes a flare.  But with 4 kids and the ex no help, I don't get to rest it much.  Before I had the RSD I would have it casted for a few weeks and that would sometimes quiet it down.  These days there isn't much touching the pain.

I think you'd know though if your pain was more than post-op pain.  There's a big difference in it.  If I didn't get a response from either the pain clinic or the surgeon, I think I'd go and sit in one of their offices until they gave me the relief I needed.  After you being on such a high dose, it was somewhat negligent of your surgeon to think you could get by on what you're on now, especially since they had it well-controlled in the hospital.  

And are you having withdrawals?  (Probably not with the patch on but I'd imagine you would if they don't get you something.  You can't just cut your dose so drastically.  You need to taper down.)

Hope you keep posting and let us know what happens.  Very discouraging to hear doctors that don't do the right thing.

[paingotago]

Hi there, when I read your post I want you to know I am so sorry you are in this situation. First I want to say I have so much compassion for all of us in the Pain Management community. Due to a horrible automobile accident 16 years ago  the motor of my truck pushed the steering wheel through my pelvis. Since then I have had a total of 6 major pelvic related surgeries, and 2 ankle surgeries, and then recently 7-monthsof chemo so far so good?                                                                                                                                                                                                                                                           I was a Master Electrician of a large Medical center for many years, and due to numerous surgeries, and being pasted up in my hips time after time Its danagerous for me to do any work because I have such a risk of catastropic pelvic failure. So 5 years ago my orthopedic told me I was "done" ,and had to go on disability. Please bear with me.                                                                                                                                                                                                                                                                          You see when I worked at the Medical Center I gained trust,and respect from alot of Suegeons ,and General Physicians because one of my many duties was being charge of all the electrical maintanance in the O.R. ,and the ER .  I kept trying to go back to work after the first 3 sugeries.I guess thats why I have been somewhat fortunate when it comes to being treated.                                                                                                                                  Thats why I get so sad when I see or hear peoples story similar to mine, and all the hell they  go through trying to get out of pain so they can live life, and have a balance of quality in their life so they can be good mothers, and fathers. I honesty don't like having to take all these meds, but without them I can't funtion to even get my morning shower, and like many of us I'm stuck trying to do the best I can to get some quality of balance in my life.                                                                                                                                       Pain Management first came around in my area in 1995. At that time the Dr.s didn't feel the total effect of the abuse. They used to tell me it was only 1% so if you had sever pain they would be more willing to help. Over the years  things have gotton backwards. Its hard to explain, so stay with me (ok)?  Some Dr.s in other states got real liberal in the early 2000-2005 years. does anyone remember the Dr.s down south getting in trouble? I believe it was top headlines at the time.  Anyway its  got real strict now because of the abusers doing all the negative things I'd rather not say , but you know what I mean., and unfortunately the system has been abused so much that Dr.s are being forced to change their methods of protocol.                                                                                                                                    I heard that when patiants sign the Pm contract in some states,  it is taking 6months to 1 even 2 years to form a trusting realationship, and if a PM patiant has an  Emergency Surgery they sometimes are left out in the cold. So unless a patiant has a plan with Post OP medication already worked out some of us in PM suffer, and this bothers me, because I think EVERYONE  that has a PM Dr. should have the same benifits as others in Pain Management.                                                                                                                                                                                                                                                           My son is in his 4th year of medical school, and he is just finishing up his 200 hours of the shadowing program to get ready for the proffessional part of his Med School. He came home last weekened, and we talked. He said Dad I feel like our hands are tied at the hospital. He had a lagitamate patiant come in with a badly swollen sprained ankle from a job related accident , and because he was in Pain Management, and working miles away from home the protocol is to see if the paitiant had a written Pm contract, and when the Dr. my Son was shadowing found out he did. the only narcotic they were allowed to give him was Darvacet. My son felt so bad for the man!, but its hospital protocol, and they have to follow it.                                                                                                                                 I guess what I'm getting at is we as patiants have to now have to cross every T, and dot every I with our PM Dr.s .We have to make all the preparations with them, and never ever make a mistake.  In my opinion its getting so political that the future has me concerned. Why are we getting pentalized as CHRONIC PAIN PATIANTS here in America when in other countries made class #3, and #4 medications are over the counter??, and they don't have nearly the abuse rate we have. I did some research , and other countries believe in pre edjucation at an early age,and they don't have nearly the problem we do, and if they have pain they just go to the local drug store, and go about there business. why can't it work here? Can anyone answer this question for me please? I'm not complaining because I am blessed to have a decent Dr., but its not fair for everyone, and thats what has me abit upset. I just want the powers at be to let the authentic chronic pain patiants all be treated equal, and right now its going the other way. The abusers are destroying everything for us. Well I'll stop on my soap box now,  PLEASE remember I wish every body here in this community the best of health always, and I wish us all a possitive ,and Healthy future. Sincerely,  Paingotago

[happyhbmom]

I have heard of this situation before.  Why can't the surgeon do anything over the weekend?  Pharmacies are open 24/7 these days.

But I'm thankful others who have gone before me have warned me so I can work this out before my surgery!  I think it's bordering on malpractice to release a post-op patient with inadequate pain relief.  It isn't the patient's job to do that, it's the surgeon's!  Ugh.

So sorry you're going through this.

[flower12345]

It's really wrong that your PM doctor did not work this out with you before surgery. You should be able to be focused on healing, and instead you are focused on the pain and how bad it will get without medications.

Please keep us updated. I hope that your PM changes your medications, because you don't deserve to suffer like this.

[MamaAng]

the surgeon said he would not be able to get me a scrip over the weekend because it must be handwritten and signed, which is law and I understand.
Yes, this has all been totally mismanaged and I am still battling it.  The Fentynal is worn off, patch got tossed early this morning.  Now the pain is coming back and I am stuck.  I called the surgeon's office at 8:45am, got a call back at 10am from his MA saying she'd get right back to me, it is now almost 1:30 and I have not heard a word.  Now IF he writes a scrip I have to find someone to go downtown and get it, I don't even know if someone can do that for me.  This is utter and complete B.S.  I have followed every rule for 2 years now, I've dotted my i's crossed my t's and this is how I'm treated???  After MAJOR surgery!!!!  My pre-op pain is gone, which is beautiful and wonderful and crazy-cool.  The pain from the operation is pure and utter hell.  I seriously feel like I am on the cusp of the abyss of hell right now.  The pain is insane.  Insane.  So, if they fail to call me back I am going to head on down to the ER tonight and file a complaint.  

[MamaAng]

okay well the final update is that the surgeon prescribed 15mg of oxycodone.  The exact same thing I have been on for months.  So, there you have it.  I haven't filled it yet, I'm not sure what the pharm. will say....I DO NOT want to look like a med shopper since this is a diff. doc same med.  UGH.  

[JadedSweetheart]

I'm so sorry this happened to you!  I think it's all of our worst nightmare to get left in the lurch by our doctors.  It happens far too often and it's not right.
I don't think you'll look like a doc shopper for having the same script, different doc.  It should make sense to the pharmacist that the surgeon would write a script for post op pain.  I hope the meds will help with the pain from post op so you can heal and feel a lot better as you are supposed to.

[Ashelen]

just fill your script...I just had to fill a post-surgical script that was the same med that my neurologist usually writes me (but at a far far different schedule) and they had absolutely no problem with it. if they bring it up say "I just had surgery, please call my doctor to confirm"...because pharmacists CAN refuse meds, but it's unlikely that they will.

[Ashelen]

sorry i hit enter too soon lol...I hope you feel better soon I'm so sorry they handled it this way :(

[MamaAng]

the pharm refused, BUT it will be filled the fifteenth and I have plenty until then.  I am having to mess with my dose and make what I have work.  It's been frustrating but I am done dealing with the surgeon and having him prescribe the wrong med over and over!

[Totie]

I have to disagree with you. The same pain prescription from two different doctors would make any pharmacy question, because that is what drug seekers do....its called dr. shopping....Those are the type of things going on that make it hard for the legitimate patient.....

[JadedSweetheart]

My point was that a pharmacist should use common sense when dealing with a prescription from a PMP for months on end and then a recent prescription from a surgeon or even an ER doctor.  It's not the same as bringing in multiple scripts for the same thing from different PMPs or PCPs.  The pharmacist could easily call the PM to confirm that they told her the surgeon would take care of PM.  They could also call the surgeon and ask if he knows she was previously on the same med and when she had it filled.  
The problem with PM in this country is the lack of common sense used by health professionals when treating legitimate patients.  Doctor shoppers are a huge problem for us as legitimate patients, but so is misinformation about the proper use of pain medication.

[paingotago]

I read your post, and I can relate to Surgeries I have had 6 major pelvic Sugeries,a 2 ankle surgeries. Altough I can't relate directly to your surgery, and can say I know what pain is ,and I'm sorry for yours, also I respect your feelings to all of this. With that said., and this is just my opinion, but its been 1 week post surgery, I want to give you some info that might possibly help you or at least save you from problems in the future. In my state the attending Surgeon is only allowed to write (one) script to send a patiant home POST-OP -SURGERY only ONE, and that SCRIPT has to come frome the HOSPITAL ONLY. Then  pain management  has to take over. For instints; all 6 surgeries my orthapedic hospital nurse called my pain management to make me a early oppointment because of the operation. Or I had this worked out two to three weeks in advance so I would have plenty of MEDS. (NOW) because of all the abuse MY PM DOCTOR is the ONLY Dr. allowed to write my medicatins. He told me I am "allowed" to get any meds while I'M IN THE HOSPITAL, but when I leave their property HE told me HE wants all his PATIANTS to alreay have their own medications from HIM PRE-FILLED out so their is NO problems. He also told me when I go home from surgery to call him if there is a problem with pain ,and he will make adjustments.HE told me this way there is no reason for any of his patiants to be without there medications. "I personally love this plan".  Its just my opinion only, but I think if I were you I would not fill any more perscriptions untill I went to see my pain management Dr. I hope the best for you, I really do, but it is our personall responsibility to make sure we have all our medications from month to month ,and if we have Surgery then thats when we should be talking to our PM that much more. I want to make it clear. This is just how it is for me in my state. Your state, and Dr. might be different. Either way I hope you get the help you need without any problebs with your PM doc. Best of health to you. Sincerely Paingotago

[MamaAng]

Someone messaged me questioning me on some things and I will just say that I made what I had (I filled my 15mg oxycocdone from the pain clinic on the 27th) work and my levels have been coming down.  My goal is to knock down to taking the 15mg oxycodone every 8 hrs, then every 10, then down to just the percocets that the surgeon gave me, and then I have 15 or so vicodin I will wean myself down and off.  That is my goal.  I am about to go walk 1/4 mile with my kids.  This surgery was WAY worth it.  I wish my surgeon had managed my pain better.  He did not know what he was doing with a chronic pain pt.  I had written my pre-op med schedule for the surgeon/hosp. many, many times and they flat out ignored it.  I should have been sent home on a med heavier than what I had been taking for months pre-surgery.  

[designgyrl0112]

I hope everything works out well for you ad that you have a wonderful time walking with your children.  I'm sorry your surgeon didn't take care of your pain properly but am glad you are starting to feel a little better.  Take care.

[mellie4]

I hope the rest of your recovery is uneventful.   I am so sorry your post-surgical pain was not handled properly.  Even though my surgeries pretty much failed, I am so fortunate that my pain was well-controlled.  My NP at the pain clinic and I had discussed at length how to handle my post-op pain.  And I had the medication before the surgery so I didn't have to worry about stopping after the surgery.  She also gave me her personal cell phone number in case I had any problems.  And I did.  She originally wrote me a high dose of Dilaudid but it didn't work for me at all.  I didn't use her cell number; I waited until morning and made do with a larger dose of my previous medication until I reached her.

Dealing with CP is difficult enough without having to worry about post-op pain not be covered.

Good luck with your recovery and keep us posted on how it's going.  I'm so happy for you that your surgery seems to be a success.

[paingotago]

Hi there, How are you doing today? are you doing any better?  I really wish you the best you sound like a really wonderful ladie. I just can't help myself from being concerned for us all. In our surgeries, in our different situations with our pain, and of the reason that is causing one's pain. I would like to say to you sometimes I can give opinions that sound a bit ecentric. Please I mean no disrespect in any way shape,or form.  Their is a method to my madness (lol).,, no seriously, I truely care about you, and all of us in the community, and I wish nothing , but the best of health care to us all.                                                                                                                                 The (only) reason I get sometimes overly concerned for the  people here in our community,   is  because of the Serious Abusers ("out their in the world" ), that have hidden agendas, and are really making it HARD  for us here in the community trying to go to  our Dr. appoitment, get our medications that we  need so we can funtion to a more possitive degree,  and  live our lives with  "some measure" of a better quality of life, and most importantly "Alot less pain".    I want you to know I care about knowing how you are doing?, and you are in my thoughts more than you know. I wish you a good day, and  Take Care                      

[MamaAng]

thanks for all the support. It truly means a lot.  The pain clinic finally called me yesterday, a week after I got home from the hospital and called them.  UGH.  When I told the MA house horribly my post-op pain was handled she was genuinely sorry which was really nice, because my surgeon didn't give a crap.  He didn't even take the time to look and see what my pre-op meds were and give me proper pain mgmt.  
My PM doc gave her a list of things to do to wean off my pain meds, and the choice to either start now or after my appt. on the 27th.  I am going to wait only because the s/e of going off are too much to handle right now and I still have incisional pain.  I am anxious to get off these meds but I also want some support for the symptoms of withdrawl (withdrawal) and after everything I've been through I think I deserve that.  Part of me would rather just quit cold turkey, knock myself out for 3 days w/ benzos or a sleeping aid, take zofran for the nausea, and get through it...but I realize that is probably not the best way.  
I did not end up walking with my kiddos.  My body said no for 2 days and then yesterday I felt enough energy and decided to walk the track across from my house, 1/4 mile soccer field track, and it was baaaad.  I was only 9 days post-op and NOT ready.  My back spasmed, I was nauseous, it did not go well.  My PT paperwork says not to attempt 1/4 miles until 2 weeks post-op and I tried 5 days too soon.  I will be waiting until sometime next week to try again.  I was so bummed.  However, this surgery takes 3-6 months to be 100% healed up from so I have a long way to go and I need to honor the process.  Thank-you so much for the support and the thoughts.  They really DO mean a lot and I am not offended!!!  I'll keep you all updated :)