Hi! Chronic back pain after a fall down stairs 19 months ago

[martikadragoon]

Hi! I'm Cindie and I fell down the stairs about 19 months ago at 4w post op from a csection. I hit my L5 area on the stairs HARD and have had chronic pain ever since.
Before my 2nd pregnancy I had been on Soma and norco for pain, then I got pregnant. my doctor stopped the meds and restarted the norco at 12w of pregnancy. I then got into Pain Mgmt who cooperated with my High Risk MFM and they put me on oxycodone. I was at 80mg/day at one point going each week to pain mgmt. They titered my doseage down and before I had my son I noticed changes in my body and lowered and stopped the pain medicine so that when he was born there hadn't been medicine in my body for over 24 hrs. he was fine, no W/d.

My doctor started me back on Norco and Soma following my delivery. I had initially tried flexeril with no help. I started developing a problem w/the soma (taking too many) and got off of them a month ago. The norco Ive done ok with but I did suspect rebound pain from the medicine.

I've been off the pain medicine 3 days except for 1 dose last night of darvocet (which dr. wrote for me to take in place of norco when I have less pain) .I have had xrays and a cat scan taken recently that showed no changes in my spine and no disk problems.
I've been diagnosed with muscle spasms, and neuralgia (during my 2nd csection they had to place my spinal 3x due to hitting nerves EXACTLY where my back pain originates)

I'm going to ask for an MRI since DDD (deg. Disk Desease) runs in my mothers side of the family (mom/grandma). my doc pulled me out of pain mgmt because they wanted to do spinal shots without new xrays and the prior ones were 16mo old at the time.

For those who want background the other non narcotic pain mgmt methods I've tried are: Tylenol, NSAIDS, Icyhot, heat/cold, Lidoderm patches, Neurontin, Excercise, Chiropractor, physical therapy.

here are my questions,

#1)  how severe can Rebound pain be?   I have had days before where i cant eat or sleep from the pain if I stop taking the pain medicine my pain doesn't immediately shoot up but goes from a tolerable 3-4 to a 9 within 24 hours
.
#2) is an MRI my best choice for diagnostics?

#3) does anyone have some treatment suggestions other than what I've tried?


keep in mind I have 2 baby boys to care for. my 19 month old TJ who has down syndrome, and my almost 4 month old Mason.

[martikadragoon]

No real diagnoses. Just problems that they made mention of.

Muscle spasms, and slight arthritis and mild scoliosis. There was a tentative Dx of SIJ pain from pain mgmt and I'm sure I did have some at the end of my pregnancy because i had the pain you describe of the outerleg and hip but it dissapeared. that dx changed when I had my son and came in about 2w after my csection. They never gave me an actual diagnoses and were not willing to do an MRI of any kind not even any new imaging like xrays which is why I left pain management.


my pain is on the right side of my back, just above the SIJ area so not hip involved and it goes up about 4-5 spaces. I have literally a 6inch x 6inch area that hurts, just below my last rib (that can be felt) and just above my hip area. The pain always starts there and it never involves the left side of my back or spine.  

As I mentioned when I had my csection and they tried to place my spinal (can't remember what level they place it maybe l3?) but they were hitting the exact area my back hurts and it flared in pain really bad exactly where my normal pain is. They hit those same spots when they kept moving up a space w/the spinal. They eventually had to numb me higher up than normal and I nearly blacked out on the table and had a hard time breathing.

Any tips on getting those things done from pain management?   They don't seem to be the best listeners at the one I go to and there's only 1 other office I can go to but I'd have to wait for the referral and that can take months.


I'm going to contact my PCP about an MRI with contrast to see if we can at least check for spinal problems.


I've tried TENS but only one or two times. I'm wanting to ask my dr about getting one.  I have some misalignment because my right leg is about 1/2 inch shorter than the left so I limp when I walk. (ppl often assume I hurt my foot or something because of it but I havent) so I do have a lift I can wear that I got from the chiropractor and I've seen them and had my spine manipulated multiple times but I don't see any real relief.

Your reply regarding rebound pain seriously makes me think that this is DEFINITELY where at least some of the pain is from because although it's been 3 days without any regular doses of pain medicine I had been on lower and lfewer doses for a week prior to that.
What causes rebound pain? Is it the opiates?

my normal pain medicine is Norco. The prescription says 1 every 4 hrs but I usually end up needing 2 every 6. Since I decided to try and see if my pain was rebound and got on the darvocet for a couple weeks I'm going to start the norco again as prescribed. or less.

I know the results of the studies on darvocet, lol. I take aleve, and motrin and all and I do find a little more relief from the darvocet than just by motrin/aleve alone.

thanks for replying, Sorry I type so much, I'm long winded lol.

Cindie

[Tuckamore]

Hi Cindi,

Welcome to our Pain Mangement Forum. I am so sorry to hear about your chronic pain, especially when you have to care for two young children and one with special needs. My heart goes out to you.

What is your diagnosis? Do you have one? Exactly where does your pain originate? Sorry that I am not completely understanding the location.

The reason I ask is because I went year undiagnosed with pain in my SIJ near my coccyx, very low lumbar pain and occasional hip and outer leg pain. I was told it was everything from muscular to in "my head". I was finally DX with severe SIJ (sacroiliac joint dysfunction). SIJ problems are more common in woman during pregnancy and can linger long after delivery if not treated.

This condition often goes unrecognized and undiagnosed. An MRI will not reveal SIJ problems. So I just wanted to suggest that you consider this option if you have similar symptoms.  

In my opinion rebound pain can be significant for four-five days, even up to a week. It can be every bit as severe as the original pain. However after that time period it should start to dissipate.  

If you have a spinal structure issue an MRI with contrast should be your best diagnostic procedure. At least it is a very good beginning. X-rays, as I am sure you know are not the best at diagnosing much more than a fracture.

It sounds like you have followed the usual treatment regimen. I think you are correct for requesting newer DX testing before you begin injections. I'm sure you know that research and studies conclude that Darvocet is the least effect narcotic pain medication. These same studies claim that prescription strength Ibuprofen has been more effective than Darvon/Darvocet. But if it is effective in treating your pain that is all that matters, regardless of research results.

Have you tried acupuncture, a TENS Unit, Pilate's or been evaluated for the possibility of misalignment by a Doctor of Osteopathy?  I find that Osteopathic Manipulation Therapy bring me great relief and it key in my pain management.

Everyone is different and what is successful treatment for one may not be effective for another.

I hope you will keep us informed of your progress. We will look forward to hearing from you again soon. If you have additional concerns please feel free to post them. I hope you will be successful in finding a diagnosis and good treatment options.

I know you are a very busy Mom but don't forget to take care of yourself too.

Peace,
~Tuck