Young and in Pain Management - need advice

[s_88]

I am currently a patient in my late 20's and in pain management. This may sound harsh, but I did not think it would happen to me. I thought this stuff happened when you were at least 45 or older. Someone hit me from behind in a car accident. I am stuck with bad back and neck pain. I have had several MRI's, and a CT. 2 Lumber disc are bulging, and several in my neck are as well. I did a lot of PT, tried basic meds such as muscle relaxants and Tylenol. Now I am in PM for about a year. I am really frustrated with being forced to choose which part of the day to function better in. I am taking pain meds as prescribed (short-acting). I am currently trying a new one but it is just not working well. This is the fourth one I am trying. Since I am so "young", I get that attitude that the pain can't be that bad, and have flat out been told that before. I am on a pain management agreement. I follow it strictly. I don't go to the ER no matter how bad it hurts, nor do I go anywhere else. I follow the instructions, don't ask for early refills, don't take more than prescribed, etc. I don't mind giving the UDS whenever they ask. I did miss one appointment this year, but called as soon as I realized it (not for meds). I have tried alternative therapies and frankly am going to result to steroid injections more because I am almost out of other options even though the thought is pretty uncomfortable. They are pretty expensive and would require work off both time and school.

Basically I am told it is the DEA and all their over-regulation., which has made it such a harsh environment for  patients that truly need meds and that it will only get worse.

Should I be looking for a new doctor? Do you have any other suggestions? I am burning the candle at both ends per se by trying to go to school and work as well. I live in the south.

[s_88]

Does anyone know of any resources that help pay for medical bills (ongoing or even temporary) for patients with Chronic pain?

[s_88]

Hi caregiver222,

Thanks for your post. I do use a lidocaine topical gel which has a temporary effect. A med was recently changed that provides better relief, for about 6 hours a day. I already did a lot of PT which included some traction, lots of core strengthening, similar exercises that you recommended, manual therapy, home exercises, TENS/stimulation, and some traction. I am about to do more PT, I will ask the doctor about that. I am very aware of the vicious cycle of pain > avoiding activities > reduced  mobility > more pain. You have to break the cycle at several points, and of course yes, you must keep moving and doing everything you can so your muscles don't stiffen up and result in more pain.

I will look into those books.

Thanks.

[caregiver222]

My two cents is that muscle relaxation drugs are contraindicated, as well as steroidal injections. A transdermal lidocain patch may help, but wear it for no more than 12 hours.

What I recommend is axial traction. Pyrchase the unit, discard the water bag and suspend yourself gently (not fully) for for to five minutes six to eight times a day. You don't wan't to hang yourself. Just stretch those veretbra so they pull apart slightly.

The second drill involves strengthing muscle tone, which is done through isometric exercises. Place the palm of your hand against your forehead and push gently foward. Repeat this around your entire head at thirty degree spacing. Perform several times a day. Sit-ups are also helpful.

A cervical collar is contraindicated. You lose muscle tone.

What often happens is that you feel pain and self-splint, by limiting range of motion,.After a few weeks more you begin to self-splint more. Finally you can't move your head without pain.

In the normal human being such severe pain tells you "don't move" because you will damage yourself. This is common sense, but not necessarily true. The drill is (assuming there is no inherent instability of the cervical veretbra) is to force movement through the limits of pain.

I suggest you go to the website of Dr. Jerome Groopman and read his excelle nt article that he published in the New Yorker regarding this kind of pain, and read his two books "How Doctor's Think" and "A second opinion".

Dr Groopman had level ten pain from spinal injuries and suggests protocols to resolve the agony.

[philnoir]

It is a harsh reality, but one can live a functional, happy life in spite of the pain.

A good medical support team is crucial. Compassionate staff up and down the hierarchy is also very important.

Having a good psycho-social support group is equally as important. In my experience, the pain psychologist is at the center of my treatment.

And access to non-surgical treatment options is essential for people living with spine disease.

You're right about the pendulum, but as a friend says, it's only halftime.. The outcome of this game has not yet been decided. Many in the field are on the side of compassionate care for people living in pain.

Resources like:

http://www.nationalpainreport.com
http://www.uspainfoundation.org
http://stopthedrugwar.org/topics/drug_war_issues/medicine/under_treatment_of_pain?page=5

help one stay in touch with current pain issues and can identify key treatment options of which your doctor may not yet be aware.

I have found that the pain patient who has a working knowledge of his/her disease state, is aware of the available treatment options, and works with a pain team that is compassionate and receptive to your goals, receives the best pain care.

On a personal level, I've lived with chronic pain for over 30 years, and pursued a profession, enjoyed family life, helped raise three children, pursued business opportunities when available, was active in community issues, and exhibited other behaviors that are used to measure a functional life, but unfortunately may be inconsistent with a victim of chronic disease.

It is possible to set goals and reach them, maybe not always in our time or to our satisfaction, but with perseverance (and a lot of help) a certain quality of life can be achieved.

[s_88]

I don't want to be on large doses of pain meds. I wish I didn't even have to take them. You may have misunderstood my post. I don't want to be drugged up. I get zero pleasure from the medications, only pain relief. IMHO I did find the post a bit harsh.
I have spent a lot of money on Heat wraps for back and neck. I use them regularly (not cheap), and I also use a heading pad, in addition to a topical gel.
I do not want to gain a rapid tolerance, I understand your point, and I had already thought about that long ago. It is good and bad. I don't want to be in an amount of pain that significantly impedes my functioning (but expecting to be in 0 out of 10 is ridiculous) and I also don't want to gain a rapid tolerance.

It is about a balance.

Having zero pain relief (whatever form that it may come in that is legal), is what is scary. I don't care what type it is, shots, meds, injections, etc. The thought of living with a high level of pain for the rest of your life is a harsh reality.

[s_88]

remar,

Thanks for your reply. I am going to discuss this with my doctor. I am finally keeping a pain journal. The current med I am on (I was advised not to tell people which ones I take) is short acting and causes that bad interdose wearing off problem, and causes headaches when it wears off (Has anyone had this with a particular med?). Sometimes I feel as he just doesn' t listen. Part of it is likely my fault in failing to clearly and effectively communicate. It is not the easiest thing to advocate for yourself in that type of environment. LA meds may work best. His and my original concern were that they don't actually last 12 hours (takes an hour or 2 to work, and in total provides maybe 9.5 hours of relief). Apparently, I rapidly metabolize things. I am compliant with the regimen, and although it hurts like hell many times, I don't take an extra dose. It is just not worth it and it would put strain on the trust between me and my doctor. Thanks for the advice.

The regulations are too strict in general. I do see some basis for them, because things got out of hand with a subset of people and the media blew it out of proportion. It seems that when people can't agree on something they try to legislate it which is a terrible idea. It only further complicates things. We are in a period now where "The pendulum has swung." I will not go off on that topic. Hopefully, things will turn around to a healthy balance soon.

If anyone else or you guys has any further suggestions, I am all ears. I would like to get in front of this pain and at least get moving better again.

Sorry for the long post. Thank you guys. I appreciate your time and advice.

[s_88]

philnoir,

Thank you for the recommendation of seeing a spine consultant. I will absolutely check it out. It may also be useful to get a second opinion from a board certified pain management specialist and ask him to type up his findings, as well as some more diagnostic tests.

I do see a pain doctor that believes in the multidisciplinary approach (as do I).  It is not a simple whiplash situation. That would be much easier. It is not also just DDD. Taking meds is not a cure all - although they do make a significant difference in your ability to function and quality of life. I am about to do more PT in hopes of gaining better mobility which would allow at least some form of activity to maintain during the day -hopefully leading to a better QOL and some pain and stiffness relief.  I do use biofeedback and distraction as well, and all patients are required to see a pain psychologist regularly. I have taken educational courses, and trying Trigger point injections (these provided a few hours of relief)  I do not expect 100% improvement (although that would be great!). Opioids I was told generally provide a benefit of no more than 40% relief in pain. (As a side note, I don't see why people enjoy taking these- I get zero happy feelings and am not bothered by that at all. All I care about is even partial relief of the pain. That is what makes it easier to be productive and live a more normal life)

One of my goals are keeping my current job, which is getting incredibly difficult, as I have to stand on my feet all day, constantly reaching pulling, lifting, etc. I have spent more money on heat wraps than I care to mention.I am also trying to stay in school.  If surgery would provide 60-70% relief, I would already be on the surgeon's waiting list. I have also tried trigger point injections. What truly ***** is that Aleve and Celebrex have caused anaphylaxis, so anti-inflammatories are not an option. I wish I could change this, but it is what it is. I have tried SNRI's, and a gamut of things. It is not just "pain *****, that's life, deal with it." I am trying to come to grips that this may last a lot longer and you have to learn to adapt to it. There is no magic cure. Its a harsh reality, but it could be worse. At least it isn't cancer. I also try to surround myself with positive people, who have a great sense of humor. If nothing else, they can get a good laugh out of you and make you smile. People like this are a true blessing.

To clarify: I do not want nor need anyone's sympathy, that is not why I am here. I have some difficulty communicating due to an underlying disorder, so if anything comes off as that, it is not. I just tend to be direct. I try to avoid putting too much diagnostic information out on the free internet.

[philnoir]

I forgot to mention that young people with chronic illness have an especially difficult row to hoe.

You'll find support from people your age at Reddit in the chronic pain section:

www.reddit/r/chronicpain

See you there.

[philnoir]

Unfortunately, opioid pain medication is not ver effective in treating myofacial disorders, like the muscle ache of whiplash.

And as one becomes tolerant to opioids over time, they become less effective so that even at the highest doses, they remove 20% of your pain at most.

This is why chronic pain is best treated with multiple modes of therapy.

Bulging discs are painful, and you're correct, many doctors are afraid to treat with adequate opioid medications.

One thing you can do is get a second opinion from an objective spine doctor. I suggest seeing a specialist trained in pain management and the spine.

These doctors are a board certified pain medicine specialists, credentialed with the initials MD, DABPM after their name. This means they have a diploma from the American Board of Pain Management.

These are doctors who are trained in advanced anesthesiology and treat chronic pain as a disease – not a symptom. They have a thorough understanding of the nervous system, the spine, the use of advanced pain medication, and are trained in techniques that can deliver pain relief with injections and other non-invasive procedures to specific areas of the body.

They are also experts at diagnosis of rare pain syndromes, like central pain, CRPS, and RDS, and they treat spine pain all the time.

Unfortunately, pain is something you're going to have to learn to live with. Getting the proper doctor is important. So is getting multiple modes of treatment. A qualified pain center is most helpful in cases like ours.

Finally, a skilled and compassionate pain psychologist can help you find other pain reducing behaviors and assist you in your pain journey.

Best wishes

[remar]

I'm so sorry you're going through this. Yes, it can happen to someone as young as you, unfortunately.
Have you talked to you PM Dr about long acting pain medications? Many pain patients do well on them. Usually a Dr will also give you a short acting breakthrough pain medication too. This combination might be the answer for you.
Are you finding that your current pain meds are wearing off before it's time to take another one? If so, this is where the long acting pain meds can really help. It's best to stay on top of the pain because once it gets out of control it can be very hard to get it back under control. The reason for the long acting pain medications because they work around the clock. And, if you have any breakthrough pain then you have that medication too.
My sister has severe RA and her Dr has her on this combination. Before, she was only taking short acting meds and spending most of the day in such awful pain. When her Dr out her on this combo it really made a world of difference.
No, I don't think it's time to look for a new Dr just yet. You have to tell your current Dr what you need and what does and does not work for you. If you say nothing about the meds you're on right now not working he will think everything is just fine.
I've learned a lot about the new laws and in my opinion, I think they're ridiculous. That's only my opinion. It's made it so much harder for our Drs to treat us and these laws are keeping many of us in pain.
Can you make an appointment to see your PM Dr very soon and talk about what I've told you? I really hope so. If he will not budge then do research on how well people can do on a combo of pain medications.and take it to him. You can both go over it and discuss your options. I believe knowledge is power. I also believe it's in our best interest to be as informed as we can about our pain, the treatments and all of our options.