What is a good medication for severe chronic back pain?

[jad982]

I have a broken back and neck since 2002. Senen thoracic vertebrae are fused (T4 thru T10) with titanium rods and two cervical are fused (C1 & C2) with three screws. I see a pain management specialist regularly. My problem is that I am prescribed 90 Percocet 5-325 per month and am still overwhelmed with severe chronic back and neck pain. My pain management doctor is reluctant to give me anything stronger, he claims due to my age (I am too young - only 27.) I really don't know much about pain medications, but am thinking that if I suggest something specific he might be more likely to give it to me. I just don't know how to deal with the doctor I guess. Should I just press him harder for something stronger? Is there a specific drug I should ask about?

[SD3562]

Hi I am a 52 yr old women, I had a ACDF on c4-c7 on 3/15/13 they removed the hardware on 8/1/13 due to the fact it was impinging on my esophagus and then in 11/27/2013  I got rear ended at a light, now I have 1 herniated disc in my neck my fusion is no longer fused and  the herniated disc in my neck is on my nerve root. my lower back is herniated as well. I can seem to find a good set of pain management pills I am now on the Fentanyl patch 50m and 4mg of dialaudid  can any one help me

[jad982]

Thanks for the suggestion of googling different long lasting paing meds. I have not tried that. I think that I will give that a shot and try to learn a little more about my options. I will probably hold off on taking the list to my PM doctor unless I can't get results in another way first though. I definetly don't want him to think of me as a "drug seeker" when all I want is to controll my pain.

[jad982]

I started on the 30mg of Cymbalta as well. I was moved up to 60mg after about two weeks. I have been experiencing severe sweating also, but the Cymbalt has been working well and my psychiatrist basically asked if I could stand the sweating for the advantages of the medication. I decided that a few extra showers is a small price to pay for a medication that is doing well for me and so I have stayed on the 60mg. I understand what you mean about pain management being "trial and error" but it is almost like my PM doctor is unwilling to try new medications for fear of error. I am so overwhelmed by pain recently that I can't seem to find the motivation to get anything done, even the things that I am usually able to do with the pain. My pain is progressing and I feel that my pain meds should be moving with it to some extent regardless of my age. I am thinking I may print out this list of forum posts and take it to show my PM doctor at my next visit.

[Tuckamore]

Just another thought I had. Have you searched or goggled long acting pain opiates? This should give you a list of the choices. Read through them. It will take a while but it will provide you with some good information.

Write down a few and take them with you on your next visit. Than you can say that you did some research because you feel you pain is simply not controlled or tolerable. Audrea had a good suggestion of asking for a long acting pain medication.

Some physicians will respond well to that approach while others will not. On my last visit to my PCP we had some time to chat. She told me that patients come in with lists of medications and often their own diagnosis. According to my PCP often patients will say, "I have This and I want That." She and her partners react very negatively to that approach. That is one of the reasons I hesitate to encourage anyone to ask for a specific medication.

In addition to that some physicians will look at patients requesting a specific medication as drug seekers. Much depends on the relationship you have with your physician.

I also agree with Kelsgor, pain is pain rather you are 18 or 80. It knows no age limits. Given your history you certainly have reasons for chronic pain. It's just unfortunate that you have to have pain at such a young age.

[kelsgor0422]

You could always make an appt with an NP at your PM practice, if they have them. Maybe, one of the nurse practioners might be easier to talk to. Has the cymbalta helped at all? There are still higher doses. I started out on 30 mg and then they moved me to 60 mg. I couldn't handle the 60 mg because started sweating profusely all the time. I found out, it was due to the higher dose of Cymbalta. A lot of pain management is, "trial and error". I can totally understand about not relying on anyone and being independant. I am very much like that and I am 38 years old. My parents are in there 70's and had to come and shovel my snow for me last week. I felt so bad just standing there inside and watching them. It takes time to get used to letting people help or even asking for help. I won't even ask for the help most of the time. I just will let it go and not do something. Good Luck!

[Mollyrae]

I can understand the hestiation in throwing out names of pain meds but with my Doctor and because he knows me well...I have thrown out names with him.

I was taking Oxycontin and Oxycodone as breakthrough and it just wasn't working anymore. During my visit and as we were discussing other options, I told him that I have heard of a medication that worked around the clock by the name of Duragesic. I asked him what the pro's and con's of the medication was and proceeded to ask him if this was a possibility for me. He said yes, that it may control my pain on a more regular basis and prescribed it.

So, in my opinion, this is an acceptable way of asking your Doctor about different medications that might work better and be better for your pain.

Every Doctor is different and most are compassionate and understanding. I feel that you just have to throw it out there...have an open discussion with him. Don't be afraid of discussing things of this nature with your Doctor, especially if you have a close relationship.

Well wishes,
Mollyrae

[jad982]

Thank you for the info,
I am actually already seeing a psychiatrist in another office that is prescribing me the 60mg of Cymbalta and 2mg of Abilify per day so I feel that I am already covering both the psychological and the physical aspects of my condition. It is really difficult for me in that I have always kind of been the person who keeps to myself and only relies on myself and no one else. Now I need to be able to ask for help and and share my feelings and sificulties with my doctors. It has been difficult for me, but I am gradually getting used to being more open with everyone in my life.
Thanks again.

[nurseaudrea]

I understand your pain and the age issue, however I disagree with the saying that "you are too young." I had a fusion at 21 and have been on pain meds ever since and am now 35. You are already on a "strong" pain med. I would not go in asking for a specific med either but maybe suggesting a med that works for a longer period of time like an extended release in a low dose to start off with. If you have a good relationship with your pain man. doc you should be able to discuss this openly. I would not ever have felt comfortable with a doc I could not discuss my pain man. with openly. The above poster is correct in stating that maybe you need a cocktail of meds. That is the direction in which my pain man. went, but after the years passed by I reduced my need and completely came off of anti-depressants as I learned to deal with the pain. It really is a physical and psychological approach. I hope you and your doc. figure out what you really need and your pain becomes under better control.
Good luck and God bless.

[kelsgor0422]

Sorry to hear about your pain and situation at such a young age. I couldn't even imagine having 2 fusions. I do work for a pain management practice and you do not want to go in requesting a certain medication or throwing out names. That will throw up a red flag. I will not suggest the scs because I know how you feel about that. Our docs believe in treating the patient as a whole. We have psychologist, neurologist and pain docs. They believe that patients with chronic pain, also have a form of depression and anxiety. Our docs will not only treat with pain meds but with anti-depressants and anxiety meds. They schedule patients to talk with the psychologist to help them deal with the pain a little better. There is such a wide range of pain meds and I understand your docs thinking. But, living with the pain is hard. Maybe, if they put you on a "cocktail" of different meds, they might find a combination that would work. A "cocktail" could include your Percocet, an anti-depressant or anxiety med, and maybe a med for the nerves such as Cymbalta or Lyrica. Have you had any steriod injections at all?

[Tuckamore]

Hi Jad,

Welcome to the Pain Mangement Forum. I am sorry to hear that you are experiencing chronic pain, especially at such a young age.

I understand your PMP concern however pain is pain no matter what age we are. Often our conditions deteriorate with age and time. His concern I am sure is that the least amount you can get by on the better it will be in the future.

Suggesting another pain medication will more likely cause suspicion than just asking for more pain relief. Certainly what works for one does not always work for another. Finding the right medication for pain management is often a trial and error process.

Just be open and honest with your PMP. Inform him of your pain levels and how it effects your daily life and ability to function. Ask him for suggestions.

I wish you the very best. Please let us know how you are doing. Our community is supportive and informational. We are here to assist you however we may.

Take Care,
Tuck