missing pain pills increases pain?

[Sjoggie]

Hi,

If I don't stay on a schedule for pain medications does that then mean that I will wind up in more pain or behind the pain for some period of time?

I have just been switched up on pain meds and I have noticed that if I don't take the pain medication within a 4 to 5 hour window I wind up with extreme pain and it can take me most of the day to get back to the point where I can handle the pain.  I don't know if this is just me or if something else is going on.  I did have a steroid injection right before the switch and although it only gave me relief for a couple of weeks it really lessened the pain.

I have basically just been told that I had a spinal fusion, which was the wrong dx, and I'm going to have to go through a series of diagnostic tests to figure out (hopefully) what all is causing my pain.  So far the L5 nerve appears to be one of the culprits, but there could be a facet involved as well.

The point of this is that I really don't want to take the medications continuously if I may actually be able to fix the pain.  I have done withdrawal once and am not looking forward to that again, so it would seem to be smarter to try to stay on as minimal of a dose as I can to handle things or it is really not going to make any difference when I have to go through withdrawal again?  Should I just go with being able to function for a  couple of months and assume the withdrawal is just going to be bad no matter what?

I can't use NSAID's to help with the pain and in fact there are a great number of meds I cannot take.  I assume this is from having something called sjogren's syndrome.  I can't take Neurontin, anti depressants and the list goes on.  The back is not sjogren's related.

Thank you for any help you can give me.

[femmy29]

Taking pain medications on a schedule over an extended period of time does produce withdrawal symptoms regardless.  Taking a larger dose of opioid pain medication has the potential to produce more severe withdrawal symptoms when discontinued abruptly (aka cold turkey).  Working with your doctor on a taper plan can help significantly reduce the withdrawal symptoms and your doctor can provide additional medication to help ease the withdrawal symptoms.

If pain is interfering with your normal daily function and sporadic dosing isn't putting a dent in the pain, it seems to me the most logical choice is to increase your dosing of the opioid pain medication to the limits prescribed by your physician.

Dee is absolutely correct.  Taking an opioid pain reliever after the pain has gotten severe is the wrong way to take the pain medication.  You should take a short-acting opioid medication before a strenuous activity to keep the pain from getting out of control and you should take it also at the onset of breakthrough pain.  I am not sure if you are on a long-acting opioid pain medication, but if not, it would help control your baseline pain level which will result in less severe breakthrough pain.

Additionally as Dee mentioned, adding adjuvant therapies such as a muscle relaxer, anti-depressent, valium or other anti-anxiety med or sleep med, an anti-convulsant like Neurontin or Lyrica can help lower your pain level as it will augment the opioid medications.  I have problems at the L4-L5 level too (if you are interested in knowing more read my profile) and the opioid pain medication barely touches the sciatic nerve pain it produces and I am on Fentanyl Transdermal.  The generic of neurontin (aka gabapentin) works much better at relieving nerve pain.

Before jumping into a fusion surgery thinking it will make you completely new again, understand that fusion surgeries do not guarantee pain relief...instead there is a 50/50 chance of your pain getting worse, staying the same, or improving.  Fusion surgeries are more for spine stabilization to prevent loss of feeling and function in a limb due to severe nerve compression and to prevent other severely disabling conditions.  Unfortunately, back surgery is not a "fix-it-all" solution.  I'm considering a discectomy in the future that requires a very small incision to remove some of the disc material that is compressing my nerve.  This will provide temporary relief for about 5-10 years...maybe, as I have spinal stenosis at that level as well such that the spinal canal could press on the nerve after the disc material is removed.   I am not at all considering a fusion surgery at this time and probably never.  Your case may be different but typically you want to be in a situation where things can't get any worse before opting for a fusion.  In other words, exhaust all conservative therapies first.

I hope you feel better soon.  Take care.

femmy

[Dee1956]

From what I understand, when in pain, you have to stay on top of it or it gets worse. i.e if you get in to too much pain it takes longer for the pain meds to works because you are tensed up.  Can  you take a muscle relaxer to augment the pain meds?  Can you take neurontin to see if that would help in case you are having nerve pain?
Best of luck to you
Dee