Re: Medical pain management

[Guest guest]

,

It can be hard to find a good doc to manage pain. I have had the best luck

with physiatrists rather than actual pain docs (typically

anesthesiologists). I found that the pain docs like injections more and

really stay away from narcotics. But, when that's the only thing that

provides relief and you have a MRI that documents a condition known for

causing these kind of pain issues, it shouldn't have to be a fight. It has

been my experience that physiatrists (also under " Physical Medicine and

Rehabilitation " ) take a more holistic approach to pain management. Their

goal is not only to decrease pain, but to make you as functional as possible

with any permanent limitations. They also do injections (when warranted) and

prescribe oral pain meds. My physiatrist does accupuncture. He has a

wellness clinic in his office with a personal trainer. They refer to PT and

OT. I just find them to be much more comprehensive when it comes to

treating the condition as a whole - not just the pain aspect. I was lucky

that I found my physiatrist first shot. I have been seeing him for probably

close to 10 years. I was just there today, in fact. My appointments are

pretty quick now days. The RN checks my vitals. Asks if there are any new

problems (no). My MD comes in. Asks if I have any new problems and refills

my Rx. Once a year, I take a UA and that's that.

I cannot believe that other doc had you on extended relief morphine and then

just stopped you cold turkey. That is SO dangerous. That is a med that has

to be tapered to avoid withdrawal. Stopping MS suddenly is just plain

malpractice, plain and simple (IMO).

As far as if surgery would alleviate you pain, there is no way to know.

Generally, I think that untethering surgery shouldn't be done just for pain

management, but that is just my opinion. I guess I should qualify that. I

don't think someone should do surgery for pain, as long as the pain can be

managed medically. Some people are in so much pain, or their pain has

increased, to the point that no amount of meds can control it to a

reasonable level. At that point, surgery becomes a realistic option. Again,

that is just my opinion. Especially when the first surgery is as an adult.

There is some research to say that if you made it to adulthood then your

body has accommodated the nerves. And while surgery may put the cord and

nerves in a more " normal " position, this change in position can cause even

more pain.

When neuro decline is involved, that is a different story. But, surgery is

to stop the neurological decline - not to get back what was lost. It may

happen that after surgery, you get functional return, but that should just

be a silver lining in the cloud - not the reason to do surgery to begin

with. And the longer the function has been gone, the less chance that it

will return.

That said, the filum tether has the easiest and least risky surgery to

correct. But, that is still neurosurgery on the spinal cord. So, " easy " is a

relative term.

Its just a decision you have to make for yourself. Personally, if Frim said

don't do it - I wouldn't. I trust Frim's opinion implicitly. But, again,

this is just my opinion. Maybe people who had a filum tether that was

untethered by Frim can share their experiences with you. Compare your

symptoms with theirs and whether they thought the surgery was worth it -

what benefits and what costs the surgery had for them.

I wish there was an easier way to make the decision. There is always

flipping a coin, too - LOL

Best wishes,

Jenn

>

>

> Dee,

> I have the " fatty filum " type. Actually the NS said that I should not do

> this for pain reasons as he doesn't think things will improve that much. My

> pain doc said she things my pain will totally disappear. Hence my worry.

> I have both regular pain and nerve pain. I have nerve pain in my legs and

> take Neurontin 300mg x 3, the morphine is for severe back and groin pain.

> There were many times when I had no adequate pain relief and hubby was

> trying to stick me in the car to go to ER. I am just too cheap I know

> they will do nothing and we will end up paying a hefty price.

> I have taken oxycodene- unfortunately I could not urinate at all while on

> it and was taken off. I had great results with diludid and morphine, but I

> lost a lot of weight (from 140 to 122lbs!) so a bit worried about going back

> on that.

>

" ....then he put me on morphine. When I went in to get a med check, he

REFUSED another script and told me to take Advil. "