Chronic pain and how to treat it.

[East Bay Rider]

I had spinal disk fusion surgery back on April 24. The surgery included fusing the L4 and L5 disks with rods and screws, scraped the arthritis out, repositioned the nerves out of the way and added a titanium spacer and cadaver bone.
The MRI tells that I'm healing properly but it's 5 months out and I'm still experiencing a lot of pain. I've met with the PAC who worked for the surgeon (my surgeon has passed away) and the PAC of the other Dr in the practice. She takes notes of what I tell her and orders MRIs and x-rays but hasn't been able to really offer a solution only tell me that usually other patients feel better by now. Sitting more than 2-1/2 hours upright in a chair becomes unbearable. Reclining is good though and provides the relief that most people get from normal sitting.
Due to job security concerns I'm trying to return to the office but in a limited, part time capacity of no more than 4 hours per day until I can handle full time again. After working for 4 hours I go home and recline for a couple of hours to "recharge" before I can get up and move around again.
I was on Meloxicam for 10+ years but I've stopped taking it due to the NSAID concerns but I'm popping quite a bit of Tylenol which isn't good either. I'm looking for ideas for something else that might help. My company does quite a bit of military/government contract type work so I won't consider marijuana or anything else risky to being tested for. Someone suggested Kratom which I'd never heard of before but upon reading about it seams like a bad idea.
I am interested in hearing about any other pain remedies that are safe and legal to help me get back to a normal life.

[Dubshack]

Sounds like rough going. Sorry to hear.

I never had back issues as bad as what you have, but one thing that did help me was acupuncture. However this was more to reduce inflammation and increase mobility versus outright pain. Hope you find something to help.


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[pickettt]

Is your office large enough to accommodate a zero gravity recliner?

[goin camping]

You won't like this answer...

Had a condition that led to very brittle bones which meant that I broke my back in six places picking up my German Shepherd.

Condition had me hospitalized twice. The first time the Dr.'s said they'd handle the back later. (If I lived.) When later came they said. "We'll give you opiates for your back for the rest of your life."

After 18 months I can now lift things weighing up to 40 pounds and like you I tire out and need to rest my back.

Upshot is this. I started undertaking the pain pills and frankly just got used to it. Pretty amazing since at the beginning I was a whimpering in pain person.

I now take at most two pain pills a week. I was amazed at how the body will adapt. Rough at first but just fine now as long as I don't overdo.

Best of luck to you. Back pain is brutal.

[CortlandtPT]

Hey there, sorry to hear that you’re still having pain. Besides the pain meds, have you been attending physical therapy or done any other intervention?
The timeframe is just the norm, like an MSRP for watches, There’s no set timeframe for recovery because each individual went through a different circumstance that led them to having surgery. So don’t try to compare your recovery to others, it would just add to the frustration. I’m a DPT with 20+ yrs of experience and have had patients who recover fast and there are just some who took their dear old time.

How was your condition before the surgery? Seems you had a chronic problem before the surgery (taking pain meds > 10 yrs). Did you have a strong core muscle before the surgery? Chronic spinal pain sufferers usually have weakened their multifidus muscles which plays a major part in stability.

This opinion I’m giving is just based on your anecdote, Usually when the surgically repaired spine is still hurting after a sufficiently amount of healing time when in an upright poaition (muscles active), the core and spinal muscles are not giving enough support to the injured part and most probably contributing to the pain, that is why they feel relief when in a reclined position (muscles are not active).

Active releases/Deep Soft tissue work should help together with proper strengthening exercises. You should also be aware that some problems like instability re-occur after some years because the spine has to move and since 2 segments have been fused, the segments below and above the fused spine would compensate for the lost movement which would eventually lead to them becoming hypermobile, if there isn’t enough strength on the spine the end result is instability again.

Ask your medical professional for good rehabilitation center where they can refer you.

Good luck and I’m hoping you’d heal soon.



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[CortlandtPT]

One more thing, lessen the pain meds (if you’re still taking it), It just perpetuates the problem.


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[yoniman]

Originally Posted by East Bay Rider

I had spinal disk fusion surgery back on April 24. The surgery included fusing the L4 and L5 disks with rods and screws, scraped the arthritis out, repositioned the nerves out of the way and added a titanium spacer and cadaver bone.
The MRI tells that I'm healing properly but it's 5 months out and I'm still experiencing a lot of pain. I've met with the PAC who worked for the surgeon (my surgeon has passed away) and the PAC of the other Dr in the practice. She takes notes of what I tell her and orders MRIs and x-rays but hasn't been able to really offer a solution only tell me that usually other patients feel better by now. Sitting more than 2-1/2 hours upright in a chair becomes unbearable. Reclining is good though and provides the relief that most people get from normal sitting.
Due to job security concerns I'm trying to return to the office but in a limited, part time capacity of no more than 4 hours per day until I can handle full time again. After working for 4 hours I go home and recline for a couple of hours to "recharge" before I can get up and move around again.
I was on Meloxicam for 10+ years but I've stopped taking it due to the NSAID concerns but I'm popping quite a bit of Tylenol which isn't good either. I'm looking for ideas for something else that might help. My company does quite a bit of military/government contract type work so I won't consider marijuana or anything else risky to being tested for. Someone suggested Kratom which I'd never heard of before but upon reading about it seams like a bad idea.
I am interested in hearing about any other pain remedies that are safe and legal to help me get back to a normal life.

Ask your Doctor about endo- cannabinoid. There are hemp oil with out the THC.

Cheers


It's just all about health, happiness & family. The rest are just necessary inconvenience we have to deal with.

[yoniman]

Originally Posted by Dubshack

Sounds like rough going. Sorry to hear.

I never had back issues as bad as what you have, but one thing that did help me was acupuncture. However this was more to reduce inflammation and increase mobility versus outright pain. Hope you find something to help.


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Acupuncture worked well for my insomnia and back pain.
Then I discovered the pleasures and palliative benefits of indica and wine and other legal poison such as craft beer and whisky on a moderate amount Highly not recommended.

Best to ask your doctor.
I never did. I just FYI him.

Cheers


It's just all about health, happiness & family. The rest are just necessary inconvenience we have to deal with.

[NateInBama]

I feel your pain...


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[TK-710]

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I know a little bit about what you’re going through as well , however I was fortunate in that I had a quick recovery. I was 32 at the time so that might have had something to do with it. Ten years later and I have the normal aches and pains expected of someone who was in the military for 11 years and now LE for 12 but overall I’m doing just fine.

I never take anything stronger than extra strength Tylenol or Advil so I can’t help there but walking was the best thing for me. That combined with a ton of PT focused on the core.

I used to run between 5 to 8 miles a day before my surgery and that’s the only part of my lifestyle I cut out as it’s the only thing that bothers my back for a few days after. Oh and after last week I might be cutting out the deadlifts too or at least dropping weight.

But I can’t stress enough the walking. My doctor released me from the hospital and told me he wanted me walking 3 miles a day by the end of the following week. Day 1 I couldn’t make it to the mailbox but by day 24 I reached his goal and have walked just about every day since. I do it with a 40lbs ruck now.

I was back at work in a modified capacity less than six months but it was just about a year before they let me back full and strenuous.

I tell you all this because I don’t think you’re too far behind where I was and to tell you it does get better. My quality of life is not that of an 18 year old but I don’t think it’s any worse than any other 40 something who has been knocked down a few times. Arthritis is going to be there. It’s something you just have to get used to. I wouldn’t be looking for stronger pain meds. Walk, get a great physical therapist and strengthen your core.


Did they use a bone growth stimulator? Are you still wearing a brace?

I had to wear that stimulator for months and always wonder if it did anything. Never heard of anyone else with spinal fusion that wore one.

[Jamie1111]

Eat less inflammatory foods.
Eat more anti inflammatory foods, especially lots of turmeric.
Strengthen the muscles as they provide a great deal of support.
Use perfect posture.
Walk lots.


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[locutus49]

I go to Pilates class and take low level opiods, prescribed by a pain management specialist.

[East Bay Rider]

Originally Posted by goin camping

... I started undertaking the pain pills and frankly just got used to it. Pretty amazing since at the beginning I was a whimpering in pain person.
... Back pain is brutal.

Yes it is.
I have a pretty high pain tolerance. Following the surgery I was only in the hospital 3 days and rehab 3 more. Unfortunately when I got home I developed a DVT blood clot. I gritted and grunted my way through that for a week before finally getting it diagnosed and proving my family right.
That was the hardest part.
I never wore a back brace. They did show me one but I didn't purchase it. Since I work sitting down it didn't stay in position so I guessed it wouldn't help.
I'm 52 and overweight. I'm sure my core needs strengthening. I was doing PT until I fell out of the shower and tore my rotator cuff. That was in July. Still hurts but Dr gave me exercises to help with that.
It sounds like walking longer is needed. I usually walk the dog a few laps around the block every day. That equals about a mile.
I could add some laps and maybe even do it twice a day as time allows.
I find that when I start I'm walking pretty tall but by the time I end I'm hunched. Maybe the cane would help with that for a while as I gain strength?
Does walking help build core strength by itself?

[77T]

Walking doesn’t build your core. Swimming might be a better choice for now, combined with elliptical.

As for the pain management, I can’t recommend one pharmacy over another.

But there are a couple of considerations - each case is unique so what I’ve been doing for years may not work for you.

Have you tried inversion? If you have room for a Teeter kind of machine it could become a big part of your therapy at home...



Next, have you begun any light work on your back and abdominal muscles? Something as simple as light weight and improved focus on your core could help...



Lastly, for weight management, you could consider a combo elliptical and recumbent machine.



Generally speaking, these things are a longer range strategy. Before you buy anything you might try a gym or YMCA that has such equipment to test the waters for your particular situation.


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[superdog]

I am sorry to hear about your pain. I can relate, but likely on a lesser degree.

I have a rod in my leg since I am 22 and that is painful to this day.

I also have had two epidurals and a discectomy on my back. It hurts every day. Two weeks after my back surgery, I was rear ended.

I tend to take moderately good care of myself.

Recently I realized that if I do not start doing something more, it is simply going to get worse.

I quit the booze and upped my workouts. I am aloud doing a LOT more core strengthening activities. I am also watching my diet.

As you say above, start with walking. Sometimes activity hurts, but for certain, inactivity also hurts and is worse for you.

I also have started meditating. I have found it is helpful for me to stay more focused and it reduces the chance for additional injury though absentmindedness.

Walking itself can help. But you need to engage your core. Meaning, pull your belly button in. If that is painful, do it in short intervals of 5 seconds at a time.

Good luck, don't quit. Don't ever quit.

[123Blueface]

Man, so sorry to hear.
Wife and I have both had the same surgery, same levels, same fusion with titanium fixation of two rods and six screws.
We have been blessed that we still have an occasional flare up but nothing like pre op. The likelihood of 100% relief is nil but the idea of surgery is to improve your quality of life, which in our case it did.
Sometimes the contributor to ongoing pain is scar tissue. I would consult with a top notch Neurosurgeon as a follow up to see what he opines.

[123Blueface]

Mine and wife’s

[ltmgeller]

Taking little to no pain meds is helpful. Keep moving and exercising. If you are still in PT do that. Hire a personal trainer. Inversion tables are good but you must make sure you are properly hydrated before you go on them. I had 3 spinal fusions L3-S1 before my motorcycle accident 2+ years ago where I got really F'd up. Among other injuries I was fused from T10-L2 with a slight spinal cord injury. After 5 months in a wheelchair I'm now walking with a can and will eventually be able to walk unassisted. The only time I take a pain pill is at night so I can sleep. I hurt a lot less when I'm moving. When I stop, I lock up and spasm briefly. I'f you try all of this and it doesn't work, you might need another surgery. Try an orthopedic surgeon that works on major league athletes. They tend to be the best. Good luck. Being in pain sucks.

[CamSLC]

My experience with chronic back pain pales in comparison with what a lot of you folks have been through. These X rays make me cringe!

I had a slipped disc a few years ago, I was/am very active and just over did it. I would get home and be unable to get off the floor after skiing. Bed ridden myself for about 3 days.

I took a lot of measures all at once. I bought a new mattress, started going to a structural integration specialist for an adjustment and improved posture, got very addicted to Yoga (like 30+ classes per month) Cut out anything inflammatory from my diet, added a healthy dose of fruit and veggies. Lost an ample amount of weight (40lbs~) I would say none of those things account for 100% of my pain disappearing, but all of them did their part. There's no magic pill, it's really a matter of lifestyle. Really hope you find something that works. Living in agony is absolutely horrifying.

[JasoninDenver]

Wow. Its like a hardware store here!

As a personal injury lawyer, I have watched dozens of clients go through the post surgical process. Here are some general observations...

1. The healthier and fitter you are BEFORE the surgery, the better the result. Of course, not everyone was at ideal weight. The heavier and more sedentary clients rarely had a great result from surgery. In fact many were worse off.

2. Physical therapy is ESSENTIAL. Those with the best results treated their therapy as a full time job for months after their procedure. This often became a permanent part of their life because it let them become more active and healthy than they were even before their accident.

So, anecdotal advice...

Lose weight. Even a ten pound drop will help you feel better.

Get back on your rehab program. There should be core stuff you can tolerate even with your shoulder.

Start yoga and then progress to pilates.

Find a qualified trainer that can work with you at least once a week to get back in shape.

Start walking. Yes, it can help core strength. A chiropractor friend related once that his clients that go to Europe on vacation come back reporting less pain because they are walking so much more.

[mjclark32]

I'm far from a Dr, but about two years ago I was putting together my soon to be daughters crib and I buckled from lower back pain. I went to my trainer at the gym and he introduced me to Dr. Stuart McGill's Big 3.
It worked really well for me. Best of luck
https://squatuniversity.com/2018/06/...ore-stability/

[swils8610]

The X-rays that are posted here make me cringe looking at them. I’ve been fortunate to not have any back issues at this point in my life. I’d personally get another opinion from another doctor. Sometimes doctors miss things that others pick up quickly. Perhaps more physical therapy. There has certainly been a lot of bad press about opioids, however there are times when they help with chronic pain. When taken as directed they can help with pain.


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[ashbaug2]

I'm 35, and two years ago herniated my L3-L4, L4-L5, and L5-S1 disks while working out. My wife also happens to be a PA for a spine surgeon. I was bad enough that I almost needed surgery, in fact one of the three consults I got recommended it, but said my life would never be back to normal. I'm an officer in the military (13 years and counting) and can't afford that type of time off. I had excruciating pain in my back and numbness all the way down my left leg into my foot. I wouldn't have felt it if someone cut my leg off. I did PT, worked on my core (Superman holds are great for lower back muscles), and walked on the treadmill A LOT at an incline. It hurt. My wife yelled at me any time I twisted too much. It was brutal.

Finally, after 6 months, the numbness started dying away and I was able to start jogging. I still have issues where if I run too much my back and leg start to ache. I started using an inversion table and going to a Chiropractor to get new exercises to help. The new Chiro actually looked at my X-Rays and MRI and helped a lot. I have been taking 3-4 Meloxicam a week since it happened, and I think it helps.

Honestly, I'm not a doctor but my wife deals with this every day. She hates prescription narcotics because most people never get off of them and use them as a crutch. She pushed me to start working out and doing load bearing (light) exercises. Make sure you're drinking plenty of water (it hydrates the disks), and most importantly, give it time. CBD is another good option, I've heard of people having good results with that. Plus, it's not habit forming.

No matter what, good luck. Back pain is not fun.

[Chewbacca]

I feel for you Bill. I know people who'd take loss of a limb over chronic back issues.

Thing to note, the only thing that every ortho surgeon will say after herniated or fused disk work is that the faster you move around after surgery, the better. And, swim, and walk. DON'T JOG or RUN! Just walk and swim.

Its a TOTAL lifestyle change. 5AM laps in the pool and long walks. The more you weigh, the more pain too. So you have to drop weight and change your diet. Not add muscle, just drop weight and change diet, and gradually do crunches and use your abdominal muscles every time you can. Also, 90 deg seating is a killer on the lower back. Change jobs or take a 1yr leave and go hard if you can. If you're worried about the job, sometimes a 1yr away is better than here, not here, gone at noon, etc... People notice that and it becomes an issue. Being away for an extended duration is better in my opinion if you're a job job guy.

Be strong.

[superdog]

Originally Posted by JasoninDenver

Wow. Its like a hardware store here!

As a personal injury lawyer, I have watched dozens of clients go through the post surgical process. Here are some general observations...

1. The healthier and fitter you are BEFORE the surgery, the better the result. Of course, not everyone was at ideal weight. The heavier and more sedentary clients rarely had a great result from surgery. In fact many were worse off.

2. Physical therapy is ESSENTIAL. Those with the best results treated their therapy as a full time job for months after their procedure. This often became a permanent part of their life because it let them become more active and healthy than they were even before their accident.

So, anecdotal advice...

Lose weight. Even a ten pound drop will help you feel better.

Get back on your rehab program. There should be core stuff you can tolerate even with your shoulder.

Start yoga and then progress to pilates.

Find a qualified trainer that can work with you at least once a week to get back in shape.

Start walking. Yes, it can help core strength. A chiropractor friend related once that his clients that go to Europe on vacation come back reporting less pain because they are walking so much more.

Agree with all of this.

I would skip the yoga though. Unless you are 100% certain of the credentials of who you are working with AND you make them very aware of your issue. AND it’s not a big class and you can get personal attention.

Most yoga teachers are hacks.

[ashbaug2]

Originally Posted by superdog

Agree with all of this.

I would skip the yoga though. Unless you are 100% certain of the credentials of who you are working with AND you make them very aware of your issue. AND it’s not a big class and you can get personal attention.

Most yoga teachers are hacks.

Yep. Agreed. My neuro/back surgeons who I consulted, plus my wife, all agreed that yoga was a No-Go for a long time. Pilates (as lame as it sounds) was their number one recommendation; it's all core strengthening.

[superdog]

Originally Posted by ashbaug2

Yep. Agreed. My neuro/back surgeons who I consulted, plus my wife, all agreed that yoga was a No-Go for a long time. Pilates (as lame as it sounds) was their number one recommendation; it's all core strengthening.

Pilates was developed by a guy that wanted to exercise, but had back problems. His name was Joseph Pilates. It is truly a great exercise program for people with back issues.

Yoga has too much bending, twisting and turning. Also Pilates instructors tend to be very well trained.

Most yoga teachers sought out yoga to help them with their own issues. Then the owner of the studio convinced them to spend a few grand on teacher training. 5 months after they started with the practice, they are now teaching people yoga.

[Retired Bob]

wife had L1 TO L5 THEN L5 to S1 then S1 attached to her pelvis on in a year and a half. first surgery pain second pain after attaching to pelvis no pain. after your first fusion spine continues to get lower. she's weaning off hydro she was told melox slows the healing process. good luck

[locutus49]

Yeah, pilates is helping my wife with scoliosis and me with posture (I don't want to be one of those hunched over old people). I like it although it is hard, but our instructor is very good.

My opioid recommended by my pain doctor is tramadol, the weakest opioid. It helps with chronic pain and is only mildly addictive (I went cold turkey off of it without a problem). I have kidney issues so cannot take most over the counter pain meds.

Originally Posted by superdog

Pilates was developed by a guy that wanted to exercise, but had back problems. His name was Joseph Pilates. It is truly a great exercise program for people with back issues.

Yoga has too much bending, twisting and turning. Also Pilates instructors tend to be very well trained.

Most yoga teachers sought out yoga to help them with their own issues. Then the owner of the studio convinced them to spend a few grand on teacher training. 5 months after they started with the practice, they are now teaching people yoga.

[ashbaug2]

Originally Posted by superdog

Pilates was developed by a guy that wanted to exercise, but had back problems. His name was Joseph Pilates. It is truly a great exercise program for people with back issues.

Yoga has too much bending, twisting and turning. Also Pilates instructors tend to be very well trained.

Most yoga teachers sought out yoga to help them with their own issues. Then the owner of the studio convinced them to spend a few grand on teacher training. 5 months after they started with the practice, they are now teaching people yoga.

I totally agree. I did yoga off-and-on for over 10 years and had some absolutely atrocious teachers.