Ive had surgery in 08 for L4/L5 ruptured discs. Now have a torn disc and a bulging disc. Done gabapentin left w grogginess and memory loss. Lyrica made me violently ill. Lortab for yrs but doesn't work now. Relefen for inflammation now on diclofenac. Looks like epidural or nerve root block is next. I'm petrified. Any feedback would be greatly appreciated.
Nerve related pain is a very tough one to treat... as I'm more than certain that you are very well aware of (I also became extremely naucious from Lyrica. It helped with the pain, but I wanted to keep my lunch down as well as treat the pain!). Most Opioid type medications don't even help with this type of pain. It does however make you care less about it, but most don't find this to be exactly the best approach.
In regards to the Lortab, they are known for loosing their effect with time causing a need for an ever increasing dosage. If I'm not mistaken, Lortab is a form of hydrocodone and is combined with something on the lines of tylenol (acetaminophen). If taking a medication for a long time, anything that contains acetaminophen is usually a bad idea simply due to the damage that can be done to the liver over an extended period of time.
Tramadol is a fairly week Opioid drug that also falls under the class of SNRI type medications (SNRI drugs are often utilized as antidepressants). It is one of the few Opioids that help with nerve related pain, although it isn't nearly as powerful as Lortab. I have read that Tramadol as well as Codeine effects different people in different ways simply due to a persons chemistry and how effective it is at converting the medication into its Opioid form (if I'm not mistaken - you may want to double check this as there has been additional research done on the topic... ). There are also other SNRI type medications that help with nerve pain such as Cymbalta, although most find them to help in a very minimal sort of way. I may be bias on this as it was my personal experience, and I don't have any numbers to support this claim.
For my chronic pain, I personally take Methadone, a very potent Opioid, and one that has gained a bad reputation due to it causing more deaths than does Cocaine and Heroin combined (as of late). This is due to the abuse of the medication in the vast majority of cases (and in a few, it is actually the doctor's fault who simply thought that it could be prescribed like Lortab). The pain relieving effects last only for four to six hours, however the peak effects don't actually occur until the following day. When taking a large dose of the medication followed by another inappropriately large dose the following day, it can often put a person underground, especially if increasing the amount. It is after all like taking two or three large doses of the medication at the same time. Methadone takes time to build up in the body, and to work at its optimum.
When Methadone is prescribed, starting at a low dose (and also getting an EKG to ensure that it will not cause any heart problems), and increasing the amount very slowly, it can be a very effective medication for nerve related pain. It is also effective for long term use due to it not needing an ever larger dose and generally does not cause much of a felt tolerance. It in many ways may in reality create a tolerance, but due to the drugs ability to build up in the liver (this causes no damage btw), the longer that the drug is taken, the larger the dose is that the body experiences. 35mg in the first year would have a totally different equivalent dose to morphine than would 35mg five or even ten years later (of course translating to a severely increased equivalent dose of morphine vs. when taken initially).
While this medication has many upsides to it when taken properly (you really can't mess with this one unlike other opioids), the largest downside is the fact that it is a commitment that very well may last a life time. Stopping this drug is unusually difficult due to its severely long half life causing withdrawals to last not just a week, but for at least two weeks, and sometimes if done via cold turkey, months. While it may not be as intense as something like heroin, most find it to be much worse due to the endless withdrawls.
I hope that this is of some help to you, and while Methadone has been a saviour for me and my chronic pain, I at the same time know that I'm not going to be getting off of that drug anytime soon! I also know that many people are very skeptical of this medication, not only due to it's bad reputation, but due to some of the reasons that I mentioned earlier. I pray that you find a solution that you're comfortable with and are feeling better sooner as to later!
Nerve blocks and epidurals aren't bad, really. Ask to be sedated if your Dr will do that. It makes it much easier and helps you relax. I have had many of both, epidurals and nerve blocks. I never had much in the way of results either though. Maybe a few weeks relief and that was it. I do know some people who get 6mos to a year or more's relief so it is worth trying, for sure. They are especially good for pain running down the leg (sciatica). The majority of my pain is localized to my low back. I dont have a great deal of sciatic pain so I think that is why they didnt help as much. It is a quick procedure. They should do it under fluoroscopy which is live xray so they can visualize where they are going. Dont let the doc do it without doing it under fluoroscopy! When they get the needle in the sore spot you get some brief pain but thats it. It is nothing compared to the daily pain you are already in.
You can expect a little generalized tenderness at the injection site for a few days. The best thing to do is go home after the injection and ice it down 20 minutes of every hour during the daytime hours. Dont let the ice stay on longer than 20 minutes so that you dont freeze the tissues and cause frostbite damage. In other words, dont fall asleep on ice. Be sure someone is with you to wake you after 20 minutes or set an alarm if you are by yourself. Just relax and take it easy the day of the injection. Dont over do things even if you feel great! By the next day, you can return to your normal activities. A nurse should call you prior to the procedure and go over all your instructions like whether or not to eat or drink before hand, what meds to take and what meds NOT to take and that sort of thing. Write any questions that come up down so when she calls you can ask her or him.Good Luck! I hope you are one of the lucky ones who gets great longterm relief!
Sonmer: I hear where you are coming from. I've had back pain for years. I have had a lot of steroid injections in my back to kill the pain but they were so temporary.
Finally, my pain doc recommended radio frequency ablation. What that is he goes in and basically kills the nerves that are causing the pain in my back.
It was quite painless. He used a fluoroscope to guide him as he did with my steroid injections. He killed the nerves that were next to my L3, L4, and L5 vertebrae.
The results are fabulous!!! I no longer have aches and pain in my back. I can really function better. I still have DDD, FM, OA, RA, etc., but I don't feel as bad as I did.
Right now I'm dealing with heel spurs and plantar fasciitis.
Asked about radio frequency ablation under a fluoroscope.
You and I have the same spinal condition in the same place. Gabapentin was my worst nightmare with the memory loss it caused. That drug should be taken off the market in my opinion! I did have a nerve block treatment 10 years ago that was incredibly effective; I had absolutely no back pain for seven years. I am going in for another nerve block treatment in two weeks and am really looking forward to the relief from pain. I'll take the nerve block treatment over surgery any day the week.
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