Chronic Pain Treatment Step by Step

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Chronic Pain Treatment Step by Step

Steps to getting treatment for Chronic Spinal (Cervical, Lumbar and Thoracic) Pain
There exists a standard of care when it comes to treating chronic spinal pain. Each of the steps listed below is pretty standard across the board, age is not a factor in these steps.

You first start to experience pain in one part of your spine. This goes on for a period of time and can be the result of some trauma and something you are not even aware of. How long do you wait before seeking treatment? So much depends on the individual. Everyone has a definite threshold for pain, so that always comes into play. Only to be used as a guideline, if after 10 days and you do not see any improvement in your situation, you are almost ready for the first step. If you feel the situation is getting worse, than go directly to step 1 and get started. But please, for many a peace of mind is very important. In those cases start step 1 now.

Step 1 – Your Primary Care Doctor

Visit to your primary care, who may or may not send you for xrays to check for fractures and standard alignment of the spine. Your PCP may prescribe some anti inflammatory medications, and muscle relaxers. If the problem has existed for more than a week or so or may prescribe short term pain medications on a temporary basis. Depending on the results of these treatments, the next step may be started.

Step 2 - The Specialists

Depending on your insurance coverage, you may or may not require pre approval or referrals to see either a board certified orthopedic doctor or a neurosurgeon who specializes in the Spine.
Consult with Spine surgeon or physiatrist includes examination of your spine, reflexes, discussion of where the pain is located to help rule in and out areas that may be of concern. You may be given a prescription for an MRI. A Magnetic Resonance Imaging study shows the soft tissue of the spine, as well as the hydration of the discs between the vertebra, and the alignment of the spine. It can show if there are areas of compression of either the spinal canal or the exits for the nerve roots as they pass through the foramen between each vertebra. Additional diagnostic tests may be order. One could be an EMG Electromyography procedure to assess the health of muscles and the nerve cells that control them (motor neurons). As with each step, a review of your progress may determine the following action.

Step 3 – The Beginning of Conservative Treatments

For so many, a referral for physical therapy ( usually 6 weeks or so in duration.) could be setup. The therapist report back to your doctor in terms of progress, good or bad. For many, this could be the end of any additional steps or actions. This does not mean you are fine and can go back to doing anything you want. More than likely you will have a set of exercises and restrictions which you need to follow.

For those that still need more help, there are many other conservative treatments available.

    Pain medications
    Additional Diagnostic tests
    Epidural Spinal Injections
    Trigger Point Injections
    Traction
    UltraSound / Tens
    Massage
    Aqua Therapy
    Acupuncture
    Pain management specialist
    Etc

If none of the conservative treatments provide you with improvement and your MRI indicates a problem that needs to be addressed surgically, you may be scheduled for surgery.
Other testing that may or may not be done, based on the exam and findings on the MRI.

CAT scan - computer aided tomography- this is done to look at the bony structures of the spine. Vertebra and other bony overgrowth, as well as the canals through which the nerve roots pass.

Myelogram or CT/Myelogram - this test is done to see if there is compression of the nerve roots and to check the severity of it.

Discogram or discography- this is done to determine if there is fluid leaking from a disc with an annular tear. An annular tear, depending on the severity can cause the disc material to leak outside of the disc.

Consult with pain management if surgery is not warranted.

You may again be asked to return to physical therapy for more exercises and core strengthening. Even when physical therapy is discontinued, it is very important to continue the exercises given to you during PT since they continue to strengthen weakened muscles and help to protect your spine from further injury.
You may also be scheduled for a series of injections- this is done if there are findings on the studies and exams that show areas of concern. These injections serve two purposes, the first being that it helps to determine if a suspected area of concern is in fact the source of your pain, and there is also a therapeutic component . In many cases, the medications in the injections soothe inflamed tissue in the spine and can relieve pain. You may find that if the first injections do not relieve the pain , that the doctor suggests that you have more injections but a different type. This is also to determine if an area is in fact a pain generator, and to see if there is any therapeutic benefit to the injections. If they do not work, after usually two in a series, the doctor may determine not to continue them.

RFA - radio frequency ablation- this is a procedure done to burn the nerves in the facet joints when the facet joints are believed to be the cause of pain. It involves a heated electrode which is inserted into the facet joint and the nerves are heated for a short time, and burned. This relieves the pain in the effected areas. It may be done at several levels if necessary and is usually done at 6 month to 1 year intervals when successful. This procedure can be performed multiple times if necessary.

EMG is a test done to check the condition of the nerves as they travel from the brain to any area of the body. The test is done to check the speed of the nerves ability to transmit the signals and to determine if there is damage to those nerves.

TENS TENS is transcutaneous electrical stimulation. It is a machine that is commonly used in PT to help ease muscle spasms and for some eases pain.

Medications may be trialed- however there is a sequence to those medications. Usually the starting medications include things like prescription based anti –inflammatory medications ( such as Voltaren , naproxen or ibuprofen), muscle relaxants ( tizanadine, Relafen, baclofen and others)- possibly some nerve pain medications such as Topamax, Lyrica, or Neurontin (gabapentin), anti- depressants used off label work wonders for neuropathic pain, and you may be trialed on a medication for pain such as tramadol /Ultram. It is important that you give each new medication a proper trial……….it can take a few days to several weeks before you see the benefit of a medication so it is imperative that you wait at least two weeks, preferably a month and at least one dosage adjustment before saying that a medication is not helping. This applies to all medications that are new to you, but especially with some of these particular medications. They take some time to build to a therapeutic level so you may not see a big benefit for a week or more after each dosage adjustment or introduction to your treatment plan.

OTC Use of over the counter remedies- ice, heat, rest, walking, topical over the counter pain rubs all contribute to the over all pain relief, so continue to use them, every day if necessary, but especially during days that the pain is higher than normal. Staying physically active- even if it is just walking, do it, several times a day, even short distances will help your muscles to stay stronger, and to keep your spine from worsening. The WORST thing that you can do is to stay in bed, or become inactive. Modify your activities, since this is a chronic condition that you are facing, you are going to have to learn to modify your activities and how you do things. Don’t make the mistake that using pain medications in whatever form you are given them to try to compensate so that you can continue doing what you did prior to your injury. This sets you up to fail in many ways.

Opiate medications at some point, it may become necessary to add an opiate to your other medications. It is vitally important that if and when this happens, you follow the exact prescribing directions of your physician. Some medications work better than others, depending on your particular metabolism, and what is causing your pain. However, there are several things that you need to remember- the first is- you have survived this long into this journey without opiates, not necessarily functioning at your best otherwise you wouldn’t be here, but you have managed so far and it is important to have the pain treated however,you have a long time to continue to live, so look at using the least amount of medication that you can get by with, because at some point, as you age, your condition will worsen. If you go too high on medications early on, you leave yourself no where to go once they become no longer effective. All of us, at some point after being on medications for some time, will find that the current dosage is not as effective as it once was. This may mean that you require a dosage adjustment. Again, less is more when it comes to managing the pain.

Set realistic objectives when it comes to your pain levels and what you can live with. If you are reporting that your pain levels un-medicated are at a 8, then a realistic goal is a reduction of 50% using pain medications and other modalities. This is the goal that almost all PM doctors use when treating pain.
Use ALL of the other modalities, because each” tool “ that you use regularly adds to your PM toolbox and together they add up to more efficient and better overall pain control. Use your breakthrough medications if you are given them sparingly. Not for every single pain flare. Try ice, heating pads, hot showers, stretching, biofeedback, guided imagery, swimming or just plain resting for a bit to deal with flares first. If those don’t work, call your doctor and ask him what else you can do to ease the pain.

-There are two types of opiates used to treat chronic pain. When someone is new to taking opiates, the usual course is to use what is called IR immediate release medications- hydrocodone, Percocet, oxycodone ( no Tylenol) , morphine or dilaudid. These medications release all of their medication within an hour of ingestion and then the blood levels slowly fall over the course of the next 4-8 hours, depending on your metabolism. At some point, your doctor may add something called an ER extended release medication. These medications typically are dosed every 8-12 hours with one being dosed once a day, as well as patch versions of some medications. These medications for the most part are exactly the same as the ones that are immediate release , however they are made to release the medication over a set time interval. If the dosing schedule is 12 hours, then for those 12 hours, you will have constant levels of medications in your system. What you may not feel is the onset of the medication as you did with the immediate release or short acting versions of the same medication. This is NORMAL and does not mean that the medication is not working.

Always as I mentioned earlier, give any new medication or change to your medication dosage at least two weeks , preferably a month before calling and telling your doctor that it doesn’t work. A newly added medication may require at least one dosage adjustment, maybe more, so be patient.

Never take more medication than you are allotted per day. NO matter what. Call your doctor if the pain is out of control. If he feels that your taking extra is okay, he will tell you.

Proper use of breakthrough medications- they are not to be taken on a regular basis. They are there for those days when you do something that causes your pain to suddenly spiral out of control. Try the other modalities but if the pain does not settle down soon, then it is time to take the break through meds. However, every little increase in pain does not require the treatment to be reaching for the pill bottle. Doing so only raises your baseline medication dosage so after a short time, your body will signal that the pain is escalating, when in fact it is trying to convince you to take those extra meds. Doing this adds to creating what some call tolerance issues when it is not that at all, it is simply adding to your baseline pain medication dose that your body has become acclimated to.

SCS - Spinal cord stimulation- Sooner or later , for many of us facing chronic back pain, you may find that you are asked to consider the spinal cord stimulator trial or permanent implant. It may not be for all of us, but for those who have nerve related pain, it is most likely coming up during your treatment. I suggest that you do tons of research into them, the various models out there, talk to patients who have them and who had them removed as well. All of that being said, there is no reason NOT to at least go for the consult. Ultimately, it is the decision of the patient whether or not to go ahead with the trial, and the permanent implant, but a well educated patient is his/her own best advocate when it comes to treatment options.

Pain Pump this is the end of the road for many of us when it comes to the treatment of chronic pain . The spinal cord stimulator and the pain pump are both implanted devices that are meant to interrupt the pain signals or to deliver the medications we need directly into the spinal fluid.
Not everyone can deal with the idea of having a medical device implanted permanently in their bodies, but at some point, many of us will find ourselves facing the possibility of having to make this decision.

The treatment of any chronic condition is a journey, much of which is trial and error until we can find a combination of modalities that works for us, but remember that there is still the rest of our lives to deal with this , so if you can keep your medication dosages as low as you can early on, you save yourself more heartache down the road and leave more options available for those years when our conditions will worsen.

One last thing, it can take weeks and even months or years while the doctors we pay to treat us are working with us to come up with a plan that reduces the amount of pain, yet allows us to function at the best level that we individually can. Be patient, and work with your doctor, form a partnership. You will find that you have a caring physician who wants to see you do well, and he or she will have a patient that they feel is trustworthy and reliable.

Step 4 – Aggressive Actions
This could be surgery. It is not within the scope of this thread to go into any details regarding the various spinal surgeries, pros/cons, risks, outcomes and more.

written by former Spine-Health Moderator - Sandi

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terror8396
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good job

now as i have mentioned before, there should be no questions as what to do or what to ask or how to ask with patients and chronic pain. those who want meds, see the step by step procedure that is needed where one goes 1 to 2 to 3 to 4 to... instead of skipping step 3 and going right to 4. these steps are what is sorely needed on the site. for too long people have floundered when it comes to treatment for pain. it gives them a clear cut idea of what to do. if they are not sure then they can be referred to this site and sandi's site. i commend the both of you for the hard work you have done to maintain the credibility of the site. so there should be no more questions or arguments about what is expected, i know wishful thinking.
thanks again
jon

I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.

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i feel good

no not james brown, but feel good as to the direction of the site now. it is now a mellow place to come and to vent or to ask questions. hopefully this will continue especially with the posts that you 2 posted.
jon

I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.

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Thanks

Thanks Jon. I hope that is a road map of sorts to give patients a guideline of the progression of the treatment of chronic pain. Of course, there will be variations due to other factors but for the most part, it should allow new patients and old to understand that there is a process in place to treating chronic spine pain, and we all have had to follow that same road map.....I hope that it does that anyway.
Ron, thank you for the bolding and bbc coding and the additions that you made....it is a work in progress.
Sandi

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Many thanks to Sandi

She put this all together earlier this morning. As Jon pointed out, this was a piece that was missing from Spine-Health. We have all the medical articles and videos, but simple to understand "Where do I start, where do I go" was always missing.

When pieces like this are written by folks who have been through it, it makes so much more sense and is so true. I thank all the technical and medical writers who put together articles on this site. They are some of the best....

But still, to me, having someone who has walked the walk.... says it best..

Sandi, again, thank you for putting this together for everyone on this site.

Ron DiLauro Spine-Health System Moderator
I am not a medical professional. I comment on personal experiences.

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Your welcome and thank you

Your welcome and thank you both for the comments. I did it to help, so I hope that it does.
Sandi

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THAT WAS HELPFUL ALOT

thank you sir, that was really helpful

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Welcome Burdea

I am sure that you will find your time on Spine-Health very rewarding. This site is a powerful and integrated system that is dynamic and continues to grow.
Here are just some of the highlights:

- Detailed medical libraries of Articles and Videos that address almost every Spinal Conditions and Treatment

- The Wellness section contains articles, tips and videos to help patients after surgery and also to help people avoid surgery.

- Under the Resource tab, there is a section Doctor Advice Health Center which can be invaluable.

- As a bonus, Spine-Health provides these patient forums. Here is where you can meet thousands of other people who understand and can relate to your situation. You will soon become part of the Spiney family who provide comfort and the advantages of a Support System. You are now part of this family that is approximately 20,600 International members and growing daily.

- It is very important to understand the Forum Rules to make sure all of your posts do not violate any of the rules.

- As a new member, it is helpful to understand the 'makeup' of these forums, how to make posts, tips on adding images and much more. You should read Forum FAQ

Here are some you should take a look at:
Read before you post
Tips for Newcomers
Understanding the rules

All of this will help make your threads better and improve the times and quality of responses you will receive.

If you have any questions or need assistance, you can use the Private Message facility to contact any one of the Moderators on my team:

dilauro

tamtam

Liz

Sandi

JellyHall

***********************************************************************************************

Hi Burdea,
I'm glad that you found the Chronic Pain Treatment Guide helpful. I just wanted to welcome you to Spine Health. If you need any assistance, please feel free to click on one of the moderator names above and we will be happy to help.
Sandi

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Make sure you know the difference!

This article is great! Really good information. The only thing I would add is that make sure you and your doctor discuss the difference between chronic and acute pain. Both are bad but are usually treated differently.

sandi wrote:
Steps to getting treatment for Chronic Spinal (Cervical, Lumbar and Thoracic) Pain
There exists a standard of care when it comes to treating chronic spinal pain. Each of the steps listed below is pretty standard across the board, age is not a factor in these steps.

You first start to experience pain in one part of your spine. This goes on for a period of time and can be the result of some trauma and something you are not even aware of. How long do you wait before seeking treatment? So much depends on the individual. Everyone has a definite threshold for pain, so that always comes into play. Only to be used as a guideline, if after 10 days and you do not see any improvement in your situation, you are almost ready for the first step. If you feel the situation is getting worse, than go directly to step 1 and get started. But please, for many a peace of mind is very important. In those cases start step 1 now.

Step 1 – Your Primary Care Doctor

Visit to your primary care, who may or may not send you for xrays to check for fractures and standard alignment of the spine. Your PCP may prescribe some anti inflammatory medications, and muscle relaxers. If the problem has existed for more than a week or so or may prescribe short term pain medications on a temporary basis. Depending on the results of these treatments, the next step may be started.

Step 2 - The Specialists

Depending on your insurance coverage, you may or may not require pre approval or referrals to see either a board certified orthopedic doctor or a neurosurgeon who specializes in the Spine.
Consult with Spine surgeon or physiatrist includes examination of your spine, reflexes, discussion of where the pain is located to help rule in and out areas that may be of concern. You may be given a prescription for an MRI. A Magnetic Resonance Imaging study shows the soft tissue of the spine, as well as the hydration of the discs between the vertebra, and the alignment of the spine. It can show if there are areas of compression of either the spinal canal or the exits for the nerve roots as they pass through the foramen between each vertebra. Additional diagnostic tests may be order. One could be an EMG Electromyography procedure to assess the health of muscles and the nerve cells that control them (motor neurons). As with each step, a review of your progress may determine the following action.

Step 3 – The Beginning of Conservative Treatments

For so many, a referral for physical therapy ( usually 6 weeks or so in duration.) could be setup. The therapist report back to your doctor in terms of progress, good or bad. For many, this could be the end of any additional steps or actions. This does not mean you are fine and can go back to doing anything you want. More than likely you will have a set of exercises and restrictions which you need to follow.

For those that still need more help, there are many other conservative treatments available.

    Pain medications
    Additional Diagnostic tests
    Epidural Spinal Injections
    Trigger Point Injections
    Traction
    UltraSound / Tens
    Massage
    Aqua Therapy
    Acupuncture
    Pain management specialist
    Etc

If none of the conservative treatments provide you with improvement and your MRI indicates a problem that needs to be addressed surgically, you may be scheduled for surgery.
Other testing that may or may not be done, based on the exam and findings on the MRI.

CAT scan - computer aided tomography- this is done to look at the bony structures of the spine. Vertebra and other bony overgrowth, as well as the canals through which the nerve roots pass.

Myelogram or CT/Myelogram - this test is done to see if there is compression of the nerve roots and to check the severity of it.

Discogram or discography- this is done to determine if there is fluid leaking from a disc with an annular tear. An annular tear, depending on the severity can cause the disc material to leak outside of the disc.

Consult with pain management if surgery is not warranted.

You may again be asked to return to physical therapy for more exercises and core strengthening. Even when physical therapy is discontinued, it is very important to continue the exercises given to you during PT since they continue to strengthen weakened muscles and help to protect your spine from further injury.
You may also be scheduled for a series of injections- this is done if there are findings on the studies and exams that show areas of concern. These injections serve two purposes, the first being that it helps to determine if a suspected area of concern is in fact the source of your pain, and there is also a therapeutic component . In many cases, the medications in the injections soothe inflamed tissue in the spine and can relieve pain. You may find that if the first injections do not relieve the pain , that the doctor suggests that you have more injections but a different type. This is also to determine if an area is in fact a pain generator, and to see if there is any therapeutic benefit to the injections. If they do not work, after usually two in a series, the doctor may determine not to continue them.

RFA - radio frequency ablation- this is a procedure done to burn the nerves in the facet joints when the facet joints are believed to be the cause of pain. It involves a heated electrode which is inserted into the facet joint and the nerves are heated for a short time, and burned. This relieves the pain in the effected areas. It may be done at several levels if necessary and is usually done at 6 month to 1 year intervals when successful. This procedure can be performed multiple times if necessary.

EMG is a test done to check the condition of the nerves as they travel from the brain to any area of the body. The test is done to check the speed of the nerves ability to transmit the signals and to determine if there is damage to those nerves.

TENS TENS is transcutaneous electrical stimulation. It is a machine that is commonly used in PT to help ease muscle spasms and for some eases pain.

Medications may be trialed- however there is a sequence to those medications. Usually the starting medications include things like prescription based anti –inflammatory medications ( such as Voltaren , naproxen or ibuprofen), muscle relaxants ( tizanadine, Relafen, baclofen and others)- possibly some nerve pain medications such as Topamax, Lyrica, or Neurontin (gabapentin), anti- depressants used off label work wonders for neuropathic pain, and you may be trialed on a medication for pain such as tramadol /Ultram. It is important that you give each new medication a proper trial……….it can take a few days to several weeks before you see the benefit of a medication so it is imperative that you wait at least two weeks, preferably a month and at least one dosage adjustment before saying that a medication is not helping. This applies to all medications that are new to you, but especially with some of these particular medications. They take some time to build to a therapeutic level so you may not see a big benefit for a week or more after each dosage adjustment or introduction to your treatment plan.

OTC Use of over the counter remedies- ice, heat, rest, walking, topical over the counter pain rubs all contribute to the over all pain relief, so continue to use them, every day if necessary, but especially during days that the pain is higher than normal. Staying physically active- even if it is just walking, do it, several times a day, even short distances will help your muscles to stay stronger, and to keep your spine from worsening. The WORST thing that you can do is to stay in bed, or become inactive. Modify your activities, since this is a chronic condition that you are facing, you are going to have to learn to modify your activities and how you do things. Don’t make the mistake that using pain medications in whatever form you are given them to try to compensate so that you can continue doing what you did prior to your injury. This sets you up to fail in many ways.

Opiate medications at some point, it may become necessary to add an opiate to your other medications. It is vitally important that if and when this happens, you follow the exact prescribing directions of your physician. Some medications work better than others, depending on your particular metabolism, and what is causing your pain. However, there are several things that you need to remember- the first is- you have survived this long into this journey without opiates, not necessarily functioning at your best otherwise you wouldn’t be here, but you have managed so far and it is important to have the pain treated however,you have a long time to continue to live, so look at using the least amount of medication that you can get by with, because at some point, as you age, your condition will worsen. If you go too high on medications early on, you leave yourself no where to go once they become no longer effective. All of us, at some point after being on medications for some time, will find that the current dosage is not as effective as it once was. This may mean that you require a dosage adjustment. Again, less is more when it comes to managing the pain.

Set realistic objectives when it comes to your pain levels and what you can live with. If you are reporting that your pain levels un-medicated are at a 8, then a realistic goal is a reduction of 50% using pain medications and other modalities. This is the goal that almost all PM doctors use when treating pain.
Use ALL of the other modalities, because each” tool “ that you use regularly adds to your PM toolbox and together they add up to more efficient and better overall pain control. Use your breakthrough medications if you are given them sparingly. Not for every single pain flare. Try ice, heating pads, hot showers, stretching, biofeedback, guided imagery, swimming or just plain resting for a bit to deal with flares first. If those don’t work, call your doctor and ask him what else you can do to ease the pain.

-There are two types of opiates used to treat chronic pain. When someone is new to taking opiates, the usual course is to use what is called IR immediate release medications- hydrocodone, Percocet, oxycodone ( no Tylenol) , morphine or dilaudid. These medications release all of their medication within an hour of ingestion and then the blood levels slowly fall over the course of the next 4-8 hours, depending on your metabolism. At some point, your doctor may add something called an ER extended release medication. These medications typically are dosed every 8-12 hours with one being dosed once a day, as well as patch versions of some medications. These medications for the most part are exactly the same as the ones that are immediate release , however they are made to release the medication over a set time interval. If the dosing schedule is 12 hours, then for those 12 hours, you will have constant levels of medications in your system. What you may not feel is the onset of the medication as you did with the immediate release or short acting versions of the same medication. This is NORMAL and does not mean that the medication is not working.

Always as I mentioned earlier, give any new medication or change to your medication dosage at least two weeks , preferably a month before calling and telling your doctor that it doesn’t work. A newly added medication may require at least one dosage adjustment, maybe more, so be patient.

Never take more medication than you are allotted per day. NO matter what. Call your doctor if the pain is out of control. If he feels that your taking extra is okay, he will tell you.

Proper use of breakthrough medications- they are not to be taken on a regular basis. They are there for those days when you do something that causes your pain to suddenly spiral out of control. Try the other modalities but if the pain does not settle down soon, then it is time to take the break through meds. However, every little increase in pain does not require the treatment to be reaching for the pill bottle. Doing so only raises your baseline medication dosage so after a short time, your body will signal that the pain is escalating, when in fact it is trying to convince you to take those extra meds. Doing this adds to creating what some call tolerance issues when it is not that at all, it is simply adding to your baseline pain medication dose that your body has become acclimated to.

SCS - Spinal cord stimulation- Sooner or later , for many of us facing chronic back pain, you may find that you are asked to consider the spinal cord stimulator trial or permanent implant. It may not be for all of us, but for those who have nerve related pain, it is most likely coming up during your treatment. I suggest that you do tons of research into them, the various models out there, talk to patients who have them and who had them removed as well. All of that being said, there is no reason NOT to at least go for the consult. Ultimately, it is the decision of the patient whether or not to go ahead with the trial, and the permanent implant, but a well educated patient is his/her own best advocate when it comes to treatment options.

Pain Pump this is the end of the road for many of us when it comes to the treatment of chronic pain . The spinal cord stimulator and the pain pump are both implanted devices that are meant to interrupt the pain signals or to deliver the medications we need directly into the spinal fluid.
Not everyone can deal with the idea of having a medical device implanted permanently in their bodies, but at some point, many of us will find ourselves facing the possibility of having to make this decision.

The treatment of any chronic condition is a journey, much of which is trial and error until we can find a combination of modalities that works for us, but remember that there is still the rest of our lives to deal with this , so if you can keep your medication dosages as low as you can early on, you save yourself more heartache down the road and leave more options available for those years when our conditions will worsen.

One last thing, it can take weeks and even months or years while the doctors we pay to treat us are working with us to come up with a plan that reduces the amount of pain, yet allows us to function at the best level that we individually can. Be patient, and work with your doctor, form a partnership. You will find that you have a caring physician who wants to see you do well, and he or she will have a patient that they feel is trustworthy and reliable.

Step 4 – Aggressive Actions
This could be surgery. It is not within the scope of this thread to go into any details regarding the various spinal surgeries, pros/cons, risks, outcomes and more.

written by Spine-Health Moderator - Sandi

Link removed, it is not permitted.Please read the Forum rules
Post Edited by The Spine-Health Moderator Team

Kyle

dilauro
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Thanks

There is a major difference between Acute and Chronic pain.
The only difference I have seen over the years is the timeframe to be classified as Chronic.

In the past it was at least 6 months... Now, that has been changed to 4 months. Honestly, considering various treatments, etc, I would think that the time frame could be increased., perhaps to 9 or 12 months.

Ron DiLauro Spine-Health System Moderator
I am not a medical professional. I comment on personal experiences.

menoopaws
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Joined: 02/25/2011 - 7:07pm
Failed Neck Surgery Syndrome BAD

I hope I am in the correct place.(this may get a bit long, but please stick with me). About 12 years ago I got hurt at work for the school system here. (First nightmare, they carry their own WC) I also did not know they did not pay in to SSI etc. for part time employees. I admit I was super naive about many things. I had a neck fusion surgery and when I woke up my arm felt like 2 very raw nerves just hanging off my body. I can NOT describe the pain. The surgeon on call after 2 or 3 days, finally did an MRI and said YES something IS wrong, it depends on your DR to handle this. Well, he did nothing, So they kept me going to Chiropractor for the next 3 year, working in horrible pain, ever X-Ray showed crooked equipment in my neck, but they just denied it for 3 YEARS. So then suddenly one day they do come to me and guess what, there was a screw that never did go in and the fusion did not take. ( I had been trying to tell them that for 3 years) So I insist on UCSF this time NOBODY is this town is gonna touch me. So I actually had the head of the cervical unit personally and he said it was bad and I needed surgery. So I went and had an over 10 hr surgery, and he told my family he had never, in all his year (and he was an older gentleman) seen such a mess . Because of course they had been twisting the hell out of a loose neck!!! He said he had bone saws you name it ...everything but the kitchen sink. When I finally come around I am informed that they too did not have enough room to finish connecting and in a few days I would have to have another (just a long) surgery again, or wear a HALO, now I wish I had gone for the halo, because when they cut down the back my neck vertically, it was ALL OVER for me) I think eventually I went back to work for one day, and unbelievably I came up under a built in shelf (teachers came from other rooms it was so loud) I was so angry at myself and everything I marched into the front office filled out paperwork in case anything happened about this, and never went back to work. They paid to have me rehabilitated, doing something I actually love, but can't because I causes pain and I soon just lost desire to do anything. I live in bed! I cry several times a week because the pain never stops, the meds work for a while but not nearly long enough. I have had the same adjuster for all 12 years, I was so stupid, I didn't even have a lawyer, I was not out for (buy a yacht money), just to have all of medical probably forever on this. Well, the first time the judge told my Mother and myself to leave and not come back without and attorney that I was basically getting royally **edited** (maybe not in those words) So I did and have this settled case for this. But after 12 years, she has it set up so every single prescription, even stool softner refills have to be approved by her. So I have to see my DR once a month, get my prescription, take to pharmacy, they turn into some place affiliated with Work Comp, (*Edited*something or other) and then when they get around to it they send to my adjuster (this last week after 4 days I called them) then of course we wait again for my adjuster who lives to torture me, sits on for whatever reason, and then eventually calls *Edited* back and then we wait for them to call my pharmacy back. EVERY single month, I go days without many time (because as you know you can't turn it in too early) It would almost be funny, if it wasn't so ridiculous. Then, suddenly I will get letters they are denying something I have been taking for many years, my lawyer sends the usual form, they send it to some strangers who get whatever info my adjuster give them, last year she told them my Dr was one I had gone to a YEAR prior 3 times, and when he literally screamed to me to shut up several times, and then twice screamed at the girls who work for him that he would find the xxxx who had not let him know I called earlier in the week, TWICE very loud. I NEVER EVER WENT BACK. And she knew all of this. So we keep playing this game. I have a letter from a AME QME whatever they sent me to who said they are responsible for my antidepressants, even after looking at my QME them "other" place denied it. And the same for 2 other stomach meds I have taken suddenly, now are not approved either. Short story long: I need to know if there is anywhere I can go and find something, anything linking my neck to all of these problems, because that was the excuse, "these are not related to her neck". *EDIT*, it's obvious the don't come from being healthy, not on meds, and getting lot of sunshine and exercise!!! And also I was thinking of contacting my attorney and see if I can go back to court and get a supplemental. I have done everything they have ever asked, and they have not lived up to their end of the contract one bit. Sorry this is so long, I just feel that this entire story needs to be told to understand what I am going through and the help I need. Anyone who has stuck it through all of this, THANK YOU, I appreciate it, You are a saint! Oh and another interesting one, I kept thinking I would get better, and when I realized I wasn't I applied for Disability and was denied forever I guess, because I waited too long, and the points I had made before this job didn't even count anymore, so I did not have enough points. I feel like I am being punished for being HONEST on that one.... I will say I am now and EXPERT on what NOT to do if anyone every needs any help with that! Meno~

Post Edited for Inappropriate Language by The Spine-Health Moderator Team
Edited to remove facility name

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