Experience with Chronic Pain Management Therapy

I was wondering if anyone has gone through chronic pain management therapy. I’m considering a program like this one. If so, would you please tell me about it?

I have migraine/chronic daily headache and lower back pain and leg pain due to a herniated disk. The migraines have been out of control for a year and a half. I am working with an excellent neurologist, but thing haven’t gotten much better. I also had an acute recurrence of back and leg pain starting last week, after an initial problem in 1998. I also get extremely depressed from time to time, depending on how much pain I’m in and how much it’s preventing me from living my life.

There are pros and cons to narcotic pain management. You should only discuss this with a doctor that knows you and your problems.
If you and he or she do decide to do it, I would definitely recommend a specialty pain management clinic for it, rather that going through your PCP or Neuro.

My sister–relatively suddenly–developed crippling pain, probably origininating in her spine. She’s had CAT scans, MRIs, steroid shots in her spine, more tests (some involving withdrawing spinal fluid, which were excruciating): nothing’s definite and nothing’s worked. She still hurts, fairly constantly. Some days are better than others but she’s rarely without pain. On good days it’s just dulled to a bearable but lurking background presence. On bad days she’s white-faced and suffering every seond.
She’s sure gone the rounds of doctors, and heading for another. They’ve done their best but none of 'em can seem to determine exactly what’s causing it. They know a critical nerve is being pinched, low in her spine, but there it ends. Since surgery seems distinctly iffy, maybe pain management is the way to go. She’s even considering accupuncture, just on the off-chance it might alleviate the pain.

I’m so sorry you’re still going through this, porcupine. Best wishes to you.

Veb

Not a doctor, but I’ve had chronic back pain for a few years. I’ve had every test known to man, but no MD has ever figured out why. My experience sounds like what your sister’s going through, TVeblen. I’l list what’s helped me.

Regular exercise – I have a desk job so most of my day is spent sitting on my butt. Sitting on your butt all day is bad for your back. I try to lift weights and do cardio at least 3-4 times a week. Doing leg exercises seems to really help, though I prefer Nautilus to free-weights. It’s easier to strain something when I do free-weights. If I am in too much pain to work out (which happens from time to time), I go for a really, really long walk (like 2-4 hours), everyday if I can. I’ve found that walking is the best thing for back pain. It won’t cure it, but it seriously reduces the symptoms.

Chiropractor – This isn’t the place to discuss whether chiropractors are serious health practioners or quacks. I’ll just say it’s helped me a lot. A whole lot. Maker sure he/she uses x-rays. Don’t be afraid to try more than one if the first one you try doesn’t seem to help. They’re like everyone else, some are really good, some are horrible, and most fall in the middle. I’ve always had good experience with ones from Life College, the Logan School, and the Palmer Institute, but the best thing to do is ask friends and co-workers to suggest somebody. Yes you may habve to go back every week, but if it helps, it’s worth it IMO, and better for you than popping pills everyday.

Yoga/Pilates – It 's helped me at times, but it can also make me feel worse. If you try it, take it slow and don’t push yourself; I usually feel worse after I’ve pushed myself too hard… If one of the exercises hurts, don’t do it.

Anti-Inflammatories – I try not to take them unless I’m desparate, but you gotta do what you gotta do. I personally prefer Voltaren (prescription).

The usual disclaimer: talk to a doctor before trying anything, though an MD will most likely try to convince you not to go to a chiropractor.

I know what it’s like, and I feel for you. It can be really depressing. Don’t be afraid to talk to a shrink, if you need to. I hope this helps.

Oops, one more thing. Good Posture. If you don’t have good posture, develop it, and never let yourself slouch. I found that good posture was something I had to learn, so if you need to, have your doctor (or somebody w/ excellent posture) explain to you the proper way to stand up straight.

My mom has bad arthritis in her back, and goes to the Cleveland Clinic’s pain management clinic for treatment:

http://www.clevelandclinic.org/painmanagement/eval_treat/

She gets nerve blocks, which do help, but as time has gone on they’ve helped for shorter periods of time.

The typical clinic has a number of options they can consider for you, and it certainly seems like it would be a good idea to get an appointment and be evaluated. You won’t know if anything they can recommend for you will work until you try it.

The point of this entire thread was to ask about experiences with pain management clinics, not taking narcotic painkillers. While it might not be 100% obvious from what I wrote, it should be fairly obvious from the link, which in part reads:

Thanks to everyone who’s contributed. Please keep it coming.

Chiropractic isn’t a cure-all, nor is it appropriate for everyone. I’ve got congenital spinal stenosis (narrowing of the spinal canal) in my neck, which causes nerve compression. Chiropractic adjustment could’ve made the compression much worse. It might’ve made things better, but it’s not a risk I was willing to take.

YMMV, of course.

Robin

I haven’t formally gone through pain management counseling, but I’ve read up on it. One key thing I learned was that the fear of pain makes it worse. You can learn to accept the pain and learn to see it as part of the background. That makes it drop to the bottom of page one of your thoughts instead of being a BIG FAT HEADLINE.

I also learned that anti-inflammatories and analgesics work much better if you take them early, or even before pain starts.

Some over-the-counter anti-inflammatories can be safely taken at higher than label doses. For example, I routinely take 4 generic Advils a day, with my doctor’s approval. He says I can safely take even more, but he wants to know about it.

I’ve had chronic back pain for almost two years as the result of a car accident. I’ve tried electrotherapy, chiropractic theapy, massage therapy, and drug therapy. Nothing has helped.

My doctor now has scheduled me for a procedure which involves spinal injections. I’m kind of scare, to tell you the truth, because it sounds painful, and carries a slight risk of paralysis. :eek:

Has anyone ever had this done, or know the name of it, so I can do some online research?

I’d say try everything. Life is too short to live in constant pain, if it can be helped. (Truth be told, I’m starting to get a little pessimistic about my chances for recovery.)

Given that I’ve had migraines my entire life and back pain for 6 years on and off, I think I’ve already learned to do this to some extent (not that I can’t learn more, of course). I wouldn’t say I fear it, because it’s been a fact of life my entire life, and a near daily occurence for the last 18 months. It’s only the more acute episodes that cause major problems. I think I’m functioning at a fairly high level despite the chronic pain - as long as it’s at a moderate level I go about my business as much as possible.

Lissa, is your doctor talking about epidural steroid injections or spinal nerve blocks or something else. I’ve had about 8 epidurals in the last 6 years, which have mostly been very helpful. I’ve never had a nerve block.

Here’s some info on both: Spinal Injection / Nerve Block Therapies for Back Pain

Good luck to everyone dealing with this kind of problem.

In the past I’ve tried acupuncture, chiropractic, and biofeedback without much success. I’ve also tried yoga. Lots of different things at different times. I’m hoping a more unified whole body and mind approach might be beneficial rather than seeing one person for one problem, one doctor for another, etc.

It’s probably some sort of nerve block. Here’s a list of them:

http://www.clevelandclinic.org/painmanagement/eval_treat/#thera

My mom gets them - hers are a combo of steroids and anesthetic. She’s never complained about the injections being painful at all - though I’d imagine by the time you need something like that, the pain of an injection is pretty small potatoes compared to the pain that’s being treated.

Slightly OT, but…

I’m a chronic back pain sufferer and I have found that the best advice I ever got was from a wonderful chiropractor who told me, “the body was designed to move”.

So, resist the temptation to crawl into bed with the pain. Don’t lay in bed for long after you wake up- this will throw your back into spasm. Trust me, I know this from experience. Move. Whatever you can do. If all you can do is a couple of minutes of light stretching, do it as often as you are able. The more you move, the more your body will be able to move.

Also, jacuzzis rock. I’ve been known to sit for as long as a half hour with the jet trained on a spot where the muscles are knotted up, and it works wonders. Then I get in the pool and swim and do exercises. Come inside, belly dance for a few minutes, then the yoga.

Also, yoga takes time to work, and it’s not that great if you’re stretching cold, stiff muscle. You’re liable to end up with microtears, which then mean sore muscles afterward. A few minutes of light aerobics to warm up the muscle tissue will make the yoga much more effective. Again, experience talking here.

All I got from my doctor was a rather vague description. I’m still waiting for the new doctor to send me my pre-registration pack, which I imagine will have more information.

The doctor I saw was a back specialist, and he used the term “epidermal injections” but then talked about an x-ray machine which would assist the doctor in “burning the nerves.” He mentioned a slight risk of paralysis, which is a word I didn’t particularly wish to hear.

Pretty much all I think about this is: spine+needle= :eek:

I have been receiving chronic pain therapy since 1995. My problems are several: I have old injuries to my neck and low back, which occurred on separate occasions; the one in an automobile accident, the other in a slip-and-fall. My SI/pelvic problems are probably related to a patent (born that way) malformation of the neck of my left femur, which the ortho who did my hip replacement said probably wrecked first my knee, then my hip.) And, just to complicate matters, I have DISH (Diffuse Idiopathic Skeletal Hyperostosis), one of the nastier forms of osteoarthritis (it gradually destroys the discs, while it calcifies muscle & tendon insertions). The rheumatologist who diagnosed it said that “it usually isn’t painful,” but trust me to do/have two or three sigma differences from the norm. <sigh>

Oh, and I used to have migraines. Do you by any chance have TMJ? If so, have you ever seen a dental specialist about it? If you do a web search on migraines, you’ll discover that treatment for TMJ frequently reduces (both frequency and severity) or eliminates migraines. Now my TMJ is worse than it ever was, but I don’t have bad migraines anymore. Just more of my body’s weirdness, I guess.

All my pain treatments back home in Michigan were at a Pain Clinic associated with St. Joseph’s Hospital in Ann Arbor. Here in Mississippi I see a pain specialist in his private office for consultation and trigger point injections, but both my steroid injections (they seem to work best for me as “caudal” injections, i.e., going in through the tailbone) and my radiofrequency (nerve burning) treatments. Both of these are done in the way that Lissa’s new doctor was telling her. The method the anesthesiologist (do not let any other kind of specialist do this to you!!) uses to see what he’s doing is called fluoroscopy. It’s kinda like X-rays, but it’s a real-time video, and my current anesthesiologist also has copies of recent X-rays of the appropriate part displayed where he can look at them, too.

I try to get the steroid injections at least every three months, and I get the RF treatments once a year because this doctor wants to see me in his office after every “procedure”. And Medicare doesn’t permit him to do more than one side and region at a time. :rolleyes: So I get my right cervical RF done, then my left, then my right SI joint (this doctor actually goes around the rim of the pelvis, and burns nerves at between 13 and 18 sites), then the left, then my right lumbar, then the left. As you can readily see, that takes six months to get through. :frowning:

In a lot of ways, the doctor I see here is a PITA, but he’s an excellent doctor with lots of compassion (he’s a real “compassionate conservative”, unlike some pols), so I put up with his idiosyncrasies, and he puts up with mine, and as a result I’ve been able to avoid increasing my pain med dosage for five years now.

I take an anti-inflammatory (hafta rotate at least twice a year between Vioxx, Celebrex, Mobic and feldene {for some peculiar reason it still works for me, and it’s no harder on my stomach than the others, and much, much easier on it than Bextra - go figure} because of what they do to my stomach), a pain med, plus Flexeril at night (I also take both potassium and magnesium supplements to help reduce muscle pain and spasms; it works, folks). And I have a “breakthrough” pain med, too. Fortunately, I can go for weeks most of the time without absolutely having to use it. I also have lidocaine patches (large patches, about 4" X 7") that I can use on specific places. They were a lifesaver after my knee replacement surgery in March. :cool:

To me, the queen of “I do NOT like surprises,” the doctors say afterward that “knee surgeries are always much more painful than hip surgeries.” <AAAArrrgh> :smack: But the pain doc (bless him!) supplied me with patches. Aaaaaaaaahh! :slight_smile:

tygerbryght, thanks for sharing your experience. I actually do have TMJ, but it’s pretty mild - no jaw clenching or teeth-grinding, just popping when I open too far, and you can actually see the “pop-out” of the right jaw just in front of my ear.

Lissa

I’ve had 2 epidural steroid injections,L6 iirc. The procedure was painless and the result was pain free.

I just got a call from my grandmother this evening. One of our relatives has had the same procedure, and says that it was extremely painful and did nothing for her. She says she felt relief for about three hours afterward, and then the pain returned.

As she told my grandma, she “strongly discourages” me from trying this.

Now I don’t know what to think.

I don’t know what to think about any of it. FWIW my sister’s first couple spinal steroid injections distinctly painful, both for the injections and relative to the relief. Her doctor told her it was a “3-injection process”, and by the third shot the pain had lessened notably. Since the shots were staggered, it was a toss-up whether the shots actually did that much or her exhaustion and tolerance for constant pain had worn thinner.
FWIW, now she bears as much as she can, for as long as she can, before the relative alleviation of a spine shot. Small mercies.
A query: Do hot water techniques, such as jaccuzis, help substantially on a regular basis? Alone or in conjunction with other remedies? On vacations, even with triggers like lots of walking and driving, she’s seemed to find some relief in hot water spas. It’s hard to tell, since factors aren’t the same.
Any input?

Veb

My experience with the ESI is that the more pain I am in at the beggining of the procedure, the more painful the procedure itself is, but I also tend to derive the most benefit from those. The one I had last week hasn’t quite worked out as well - I was better for a few days, then started backsliding. I’m getting a second this week. The were particularly effective after I had my first severe attack in 1998. They also helped resolve thing when my problem recurred in 2000. Since then, I had one for some moderate back pain which did not help; it resolved itself on its on (with the help of exercise). This episode has so far prove to be the most difficult so far - it’s nearly as bad as the first one, but it sees like I’m not responding to the injections as well. I will know better in a week.

I have read that ESI are only effective for any back and leg pain caused by a herniated disk, so if you’re having them for some vague back problem where you don’t know the cause, you may want to do so serious research on the whether it’s an appropriate treatment for you.