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Thread: Pain control' 12 days postoperative - what works?

  1. #1
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    Pain control' 12 days postoperative - what works?

    Having severe pain. In rehab facility. What works?

    Oxycontin, sustained release oxycontin, gabapentin, ibuprofen, ice, TENS, heat... all with inadequate duration and/ or efficacy. (E.g. 20mg oxycodone provides maximum 90 minuted relief). Dilaudid gave almost adequate relieftogether with long lasting, strong hallucination.

  2. #2
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    Quote Originally Posted by mkatz View Post
    Having severe pain. In rehab facility. What works?

    Oxycontin, sustained release oxycontin, gabapentin, ibuprofen, ice, TENS, heat... all with inadequate duration and/ or efficacy. (E.g. 20mg oxycodone provides maximum 90 minuted relief). Dilaudid gave almost adequate relieftogether with long lasting, strong hallucination.
    Hi mkatz,

    I hope you find some pain relief soon-hang in there. I noticed you had ibuprofen on the list. Thought that was prohibited after fusions? It can interfere with the fusion process- I was told not to take it...

    -Spring
    Surgery Jan 6, 2014 at 38 yrs
    Posterior Fusion T10-L4, osteotomy 1 lev.
    Pre op-Thoracolumbar Curve-50 degrees

  3. #3
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    Hi Mark,

    Hang in there - this is the tough part.

    At 12 days I think I was taking oxycontin (long-acting) 10-20 mg twice a day, plus oxycodone 40 mg every 4 hours around the clock, plus valium 5 mg every 8 hours around the clock, plus tylenol 1000 mg three times a day. all on schedule. I would set an alarm at night to awaken and take meds.

    I too am worried to see ibuprofen on your listÖplease check with Dr Hart's office about that.

    I would recommend upping your doses significantly at this point. Your body needs adequate pain control so you don't waste all that energy on being in pain. Oxycodone 20 mg is not very much at this stage. Try adding in valium for muscle spasms. I think it helped me a lot in the early days. Also, generic oxycodone does't seem to work for some people. You could ask to switch to Percocet which also contains tylenol and an apparently more effective/available form of oxycodone.

    I hope you can get better pain relief soon. Take care,

    Gayle
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  4. #4
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    Quote Originally Posted by mkatz View Post
    Having severe pain. In rehab facility. What works?

    Oxycontin, sustained release oxycontin, gabapentin, ibuprofen, ice, TENS, heat... all with inadequate duration and/ or efficacy. (E.g. 20mg oxycodone provides maximum 90 minuted relief). Dilaudid gave almost adequate relieftogether with long lasting, strong hallucination.
    I also heard Ibuprofen is not to be used for at least 6 months because it prevents the formation of new bone. Apparently we need inflammation to do that, and Ibuprofen reduces the inflammation. But I did take 500mg paracetamol with my Oxycontintin. My surgeon told me that it helps the Oxycontin work in two different ways.

    Can I also say, your dose of Oxycontin is a quarter of what I was on at the same point in my recovery. I wonder if you can get an increase? I think you heal better without pain.

    I feel for you. Hang in there, it will get better.
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  5. #5
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    Error correction: intended to write "acetaminophen". I haven't used ibuprofen in about 3 months (and infrequently at that).

  6. #6
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    Take meds at the most frequent interval possible at the highest end of the range that you can. When you find out what really works, take that level for at least a month and then consider decreasing slightly. Decrease the dose before you decrease the frequency. Ice bags and positioning worked for me. But keep up with the drugs. Sorry that Dilaudid gave you hallucinations.

    Hang in there. Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  7. #7
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    Oh boy...

    I was on Oxycodone and it wasnít cutting the mustard. My surgeon then put me on Percoset 7.5/325 1 to 2 tabs every 6 hours. No Gabapentin at that time.

    Hot water soaks are the ticket for nerve and bone pain. 106 degrees F. Pain relief in 10 seconds. I took multiple hot soaks per day for 3 months. Drink plenty of water if you do this.

    I also have a deep and wide tub and didnít bend my spine. I managed to get into a floating position from a kneeling position in deep water.

    I donít think a standard bathtub will work, its not deep enough. Hot tubs will work, but donít fall.

    Ask to take a hot shower ....they also help.

    Oral pain meds are overrated, nothing like injectables.....

    Hang in there Mark, it will be hard for a few weeks but time passes quickly.....

    Ed
    49 yr old male, now 61, the new 61...
    Pre surgery curves T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  8. #8
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    I am so sorry about your severe pain!

    This is why scoliosis surgery patients need to ask their surgeons for a pain management doctor to manage their pain starting right after leaving the operating room till about two months later. Many people don't know that this is an option, neither do a lot of surgeons. Before my last surgery, I told my surgeon: "You will not be in charge of my pain management. Instead, you will find me someone to handle it from the moment the surgery is over." He replied: "No problem, the anesthesiologist who will be doing your surgery has just done a fellowship in pain management, he can be in charge." I met with this guy in advance, and he wrote all the pain orders in the hospital. He saw me every day in hospital, and/or sent in one of his guys to see me. I can honestly say I had hardly any pain after this surgery.

    Anyway, there are many different oral opiates. Ask your surgeon to send in a pain management doctor to see you if possible. If not possible, consider asking the surgeon for Morphine Sulfate tablets - NOT the extended release. If Diludid/hydromorphone wasn't good for you, morphine can be a good alternative. Adding valium, which acts as a muscle relaxant, although it's not strictly a muscle relaxant like Flexeril, can help too. How about adding in a fentanyl patch as well? This would be a baseline medication, and the orals would be on top of it. But for a simple solution, try the regular morphine in the highest dose for your weight. I pray it works.

    take care.

  9. #9
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    Feb 2013
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    Meds

    I can't believe the amount of meds everyone has been on. I was on 5 mg oxicodone every three hours with 350 mg Tylenol every six hours until day 6. Then went down to 5 mg oxicodone every six hours with 500 mg Tylenol every six hours. At 3 weeks I'm down to 5 mg oxicodone every 7 1/2 - 8 hours with no Tylenol. I was told that goal should be to be off narcotics by 5-6 weeks. I'm fused t-9 to sacrum.

  10. #10
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    Quote Originally Posted by Rise View Post
    I can't believe the amount of meds everyone has been on. I was on 5 mg oxicodone every three hours with 350 mg Tylenol every six hours until day 6. Then went down to 5 mg oxicodone every six hours with 500 mg Tylenol every six hours. At 3 weeks I'm down to 5 mg oxicodone every 7 1/2 - 8 hours with no Tylenol. I was told that goal should be to be off narcotics by 5-6 weeks. I'm fused t-9 to sacrum.
    Rise, I was never told a "goal" to be off narcotics at any specific time. You certainly needed very little pain med postop. I am glad for you.

    One interesting point about postop pain management for me was that at some point postop, and maybe it was 3 months or so out, I was putting on the Fentenyl patches and taking the Dilaudid pretty much on schedule, and I thought, "maybe I could use less". So, I started to decrease it and amazingly I did not have much pain. I had a bunch of meds left after I got down to only occasionally taking the meds.

    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  11. #11
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    Mark, are you using Fentenyl patches? I found that they were a great addition to the PO meds.
    Who will be managing your pain once you leave the hospital?

    Hoping that you are finding some pain relief finally!

    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  12. #12
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    Quote Originally Posted by susancook View Post
    Rise, I was never told a "goal" to be off narcotics at any specific time. You certainly needed very little pain med postop. I am glad for you.

    One interesting point about postop pain management for me was that at some point postop, and maybe it was 3 months or so out, I was putting on the Fentenyl patches and taking the Dilaudid pretty much on schedule, and I thought, "maybe I could use less". So, I started to decrease it and amazingly I did not have much pain. I had a bunch of meds left after I got down to only occasionally taking the meds.

    Susan
    Yes, it definitely seems like I'm on the low end on the pain meds. I definitely feel "withdrawal" symptoms when I step down the dosage. I'm thinking that's why I was given goals as far as getting off this stuff. I hate the way they make me feel. Most of my pain or discomfort seems to be nerve driven. Strangely, I'm finding that my vision isn't as good as it was. Another med side effect?

    Rise

  13. #13
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    Quote Originally Posted by Rise View Post
    Yes, it definitely seems like I'm on the low end on the pain meds. I definitely feel "withdrawal" symptoms when I step down the dosage. I'm thinking that's why I was given goals as far as getting off this stuff. I hate the way they make me feel. Most of my pain or discomfort seems to be nerve driven. Strangely, I'm finding that my vision isn't as good as it was. Another med side effect?

    Rise
    Funny that you mention vision. Mine is occasionally blurred for no reason that I can come up with. It is sad that narcotics have a beneficial side and yet can be problematic when withdrawing. Reactions are so individual.

    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  14. #14
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    Feb 2013
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    Quote Originally Posted by susancook View Post
    Funny that you mention vision. Mine is occasionally blurred for no reason that I can come up with. It is sad that narcotics have a beneficial side and yet can be problematic when withdrawing. Reactions are so individual.

    Susan
    Believe me when I say I understand pain. It is awful and can suck the life out of a person. I just have a problem with the ease that hardcore, ugly drugs are prescribed with little or no concern or guidance on how to get off them. I think it is better to be in some degree of tolerable pain than to be on a higher dose of drugs that have detrimental side effects and/or are a challenge to get off of. On this point I believe the medical community is somewhat negligent. Personally, I can't wait to get off this stuff and get my head back. Sometimes it's true - the cure can be worse than the disease.

    RisŽ

  15. #15
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    May 2009
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    i have found the opposite to be true as far as what doctors prescribe, for whom, etc...
    for example...used to be one could refill hydrocodone...
    NOT any more...a recent change, put thru by the govt, is that
    a new prescription is needed for it every time...
    same for several other pain meds that a patient used to be able
    to refill...
    so people who abuse pain meds are making it difficult for patients
    who do not abuse them...
    same for drug stores...even the ones that know the patient for
    years are now required to see the patient's ID every time...
    even they feel silly about it at times...saying...
    "well, we've known you for some 20 years, but could we please see your ID?"

    jess...and Sparky

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