I (while in between Anesthesiologists) have been treated for failed back surgery pain syndrome, spinal stenosis, (among other painful side effects of my body disjointing) for 22 years. An Anesthesiologist is quite effective at treating pain at the spinal cord level(something necessary to properly treat failed back surgery pain syndrome)
Technically, an anesthesiologist is the only properly trained medical professional, for treating our type of pain.(I had 5 total spinal surgeries between 1992-1999, [1999 surgery was from a second auto accident where someone rear-ended my friends car. I ended up with a hematoma under the skin at the iliac crest area above where they removed a large chunk of bone to make a new vertebrae. Leftover from my failed fusion of L2-L3-L4 fusion, I've had this reoccur several times over 22 years. it could happen from a bump into my lower back, or a fall] the pain started right after surgery and never went away. My neurosurgeon gave me a consult to the pain management center at the hospital I had my surgeries at)
There are many ways failed back surgery pain syndrome can be treated, by your anesthesiologist . They normally start with nerve blocks(and oral pain meds), which are effective in a certain percentage of patients. Depending on the results, they move forward with various other procedures such as: Discogram, Rhizotomy, Percutaineous Discectomy/IDET, Spinal cord stimulators, and of course, as I previously stated, Opioid pain relievers. Oral pain pills, ranging from Vicodin,Percocet, Oxycontin, up to morphine[aka MS-Contin] or internal morphine pump(I was always afraid of having a morphine pump in me. Not for me!) are quite effective at relieving severe pain, from failed back surgery syndrome
My pain was at a 10 when it first started, and I was prescribed methadone(synthetic morphene). I feel it's one of, if not the best medicine for treating failed back surgery pain syndrome because of its 24-48 hour half life(unfortunately a stigma which exists because of people who don't know enough about methadone, think it was created for heroin addicts. These people are severely unknowledgeable) It was created during WWII, when morphine was in a great shortage, and it was the best way to alleviate severe battlefield wounds. its use for heroin addiction wasn't discovered until the late 60's during the extreme abuse of heroin, in america became a plaque on society!
Most pain doc's prescribe it 2-3 times daily, based on the patients weight. Adjustments of medication will continue, while they try some of the procedures I listed in the paragraph above. My pain was brought down to a 3-4 most days, and was between 6-7 on rainy, or wet snowy days. Often breakthrough pain medicine will be added to your pain regiment for just those days![My breakthrough pain medicine was Roxycodone 30mg, which is quite effective at bringing my pain back down to a 3-4 level, which I can live with. That is, I have minor aches that let me know how not to move so I don't hurt myself worse. A little pain is a good thing, while hardcore pain is hellish, as I'm sure you are aware.]
I also have Epidural Steroid injections, and Cortical Steroid injections in places like where my ribs dislocate from my spine at thoracic 9-10. It does help to a degree, that prevents the pain surge when they pop out of their place aka dislocate.
They are highly successful in most cases. I do know one person who refused certain procedures, and wanted only oral medication, when the combination both is highly successful. He is miserable. that was 1 patient out of 3000 my pain doctor saw.
I see my new pain doc in early september but was given meds to last me.
Here's a study of electronic neuromodulation therapy used for FBS that had outcomes of 75.79% pain reduction and 62.52% pain reduction.
A similar study showed greater than 50% were improved with this therapy (spinal cord stimulator).
In my opinion, see an interventional specialist who is experienced in this work. Ask -- how many implants? Over 600 is the magic number.
Ask about success using various algorithms.
Read about neuromodulation therapy before your apporintment.
Hi philnoir for answering my post! Today is December 10, and I'm just seeing your post NOW! I thought I was signed up to get an email notice whenever my post was replied to. Guess not! lol
All the best to you. Norma
Hi! Thank you for answering my post! It was very helpful. The last option we have is an implantable device, which like you...... isn't gonna happen! But unlike you, methadone didn't work as also the anesthesiologist didn't. Hope is fading....Today is December 10, and I'm just seeing your post NOW! I thought I was signed up to get an email notice whenever my post was replied to. Guess not! lol
All the best to you. Norma
I too have failed back symdrome. I had a fusion L4/L5 after 2 years of low back pain. The steriod facet cortisone injections. Had stopped working. I have been in horrible pain ever since. I was doing okay on oxycodone but then was referred to a pain doctor who jus t wants me on the fentanyl patch. She just kept increasing the amount because she won't presrcibe break they pain meds. I developed central sleep apnea. Just diagnosed and started to sleep a bit better in the last month. I was able to reduce the fentanyl patch from 100mcg to 87mcg. I wish I could be off but th pain is just too intense. I an
Hoping that as my sleep gets better my body will be able to repair better and hopefully less pain so I can reduce more. My sleep dr says it's the patch giving me sleep apnea. I am wondering if you or anyone has had better pain relief from other medications. I have only been on Vicodin, oxycodone. And fentanyl. I want to be able to suggest other medications to try but also wondering just how you switch? I need a new pain dr I think. She seems stuck with only fentanyl
I am so sorry for your situation. I wish I could invent SOMETHING to help. But no, I don't know of anything at all. :(
I'm thinking you're right, a new pain doctor might be just the thing. Switching meds won't be super-easy, but it is definitely doable. You'll have to taper off the fentanyl, start slowly with the new med(s), but your doc can tell you more about that. So you'll probably need a long-acting medication, of which there are several: OxyContin, Opana, etc. I personally have had success with MSContin, also known as morphine, along with Hydrocodone 10/325 for breakthrough. I have different back issues to yours, as I do not have failed back surgery syndrome(I haven't tried surgery yet!), but figured I'd throw my two cents in. Hope this helps and good luck. Keep us updated!
Good thinking. Let me add a few more.
Exalgo (hydromorphone), Fentanyl patch, and methadone are all long-acting opioid medications.
I can't apologize enough that I just now, Feb 10, 2015 saw your kind reply to my post of August 2014! Thank you for sharing. The pain is still horrendous. ALL of the modalities you mentioned have failed. Don't know what else to do.
Best regards, and thanks again!
I can't apologize enough that I just now, Feb 10, 2015 saw your kind reply to my post of August 2014! Thank you for sharing. The pain is still horrendous. ALL of the modalities you mentioned have failed. The "test stim" was a failure. But I do see that you stipulate about a super experienced doc. Don't know what else to do.
Best regards, and thanks again!
I'd look for a PM doctor willing to try other treatments...trial and error is how to figure out what you need...and that's bad when you can't get breakthrough pain meds for the super bad days...
Keep searching. Help is out there, and what a relief it is when you find it.
No apologies necessary.