3mths post lumbar fusion - pain management advice

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6 years 2 months ago #20979 by galah_01
Hello everyone,

My father (49 yo) has reached the 3 months mark after a L5/S1 lumbar posterior fusion. He is certainly much better than before (couldn't walk, in lots of pain, lots of mechanical pain). He is improving and is quite involved in a good walking and physio program. Yet, he is still having energy issues and the occasional stiffness as is to be expected. When he wakes up he is stiff and by about 7pm he is completely exhausted. Most of his exercise/activity is between 7am-3pm.

I need your expertise and advice on how to progress with his pain management.

* He is currently on 1 x 75mg Lyrica (morning) with 2 x 5mg Endone (oxycodone) morning and evening. Takes panadol osteo 3 times a day (probably doesn't help).

* It was originally 2 x 20mg Oxycontin and 2 x 75mg Lyrica pre and post surgery and he has been tapering gradually.

* He tried to cut out one dose of Endone (evening) but it was quite unbearable in terms of pain and the withdrawal. We are quite confused on how we should taper if at all. He needs to get rid of the painkillers so he can work again (if given green light by surgeon in 2 weeks).

* It looks like his GP is swamped and cannot really offer any alternatives in terms of tapering and alternative solutions.

It has taken a bit of time to get used to the concept of pain management and we're still a bit confused about it at times. I just want to know if there is anything else we can do? I guess he can try to cut out the morning dose of Endone and see how that goes. However, it's obviously horrible to see Dad go through the withdrawal symptoms.

I have no idea if the Lyrica (which is supposed to be somewhat long lasting compared to the endone) is helping. He probably has more mechanical pain than neuropathic pain.

Sorry for ranting somewhat, I appreciate you taking the time to read it all.

Thanks!

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6 years 2 months ago - 6 years 2 months ago #20980 by Mary
Hi galah,

I think that 3 months is still fairly early days in terms of lumbar fusions. I think that your dad's medication tapering should be done under the guidance of a doctor. If his GP is not interested, then find one who is. Unfortunately we often have to advocate for ourselves. There may be smaller doses available so that he can go down far more slowly.

I know that there are 25mg Lyrica capsules and they are very useful for tapering. I am not sure about Endone. We can't really advise you regarding medications here because everyone is different and we are not doctors so we don't know the present procedures for pain management after spinal surgery.

I know that they handle it very carefully now to try and avoid post operative pain becoming chronic through mismanagement. This is what happened in my case. I did not have adequate pain relief in the early days, due partly to my sensitivity to so many medications. I would work very carefully with a doctor (a pain management specialist if you can) and not be in too much of a hurry to taper and also taper very slowly or as recommended.

It sounds as though your dad's surgery has gone really well and that is a good sign for the future. I hope it all works out really well for him and he can get back to work without too many problems. He may have to take that slowly too though :)

Mary

PS You are not ranting! Ask as many questions as you want. That is why we are here :)

Not every day is a good day, but there is good in every day.

"“It’s delightful when your imaginations come true, isn’t it?” ― L.M. Montgomery, Anne of Green Gables
Last edit: 6 years 2 months ago by Mary.

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6 years 2 months ago - 6 years 2 months ago #20981 by Peter
Galah, I have to agree with Mary. This situation or point of recovery your father is in, is probably not the time to be tapering medication too much. As she said, the lack of proper pain management can bring about chronic type pain.

If your Dad is doing so well after the op, he should just keep plugging away as is, to allow the healing process to complete itself and I doubt that it would be 100% after 3 months. He must be under strict medical supervision to reduce the medication, so be very careful.

Also, you must get through to your Dad and yourself that if you have a GP who can't or won't assist, go find one that will.

As Mary says, we have to advocate for ourselves, which means being pro-actively involved in the management of our pain conditions. So go hunt down the right people to use as your pain management team, which should include physios and clinical psychs who have been trained in looking after people who suffer ongoing pain issues. This should help prevent your Dad from becoming depressed, because believe me, depression will already be knocking on his door. It happens to all of us!

We cannot give you any clinical advice, except to go find the right people for your situation. Once your Dad takes control of his pain management, he will be so much better off. And he needs to do this by first educating himself on all aspects of his pain condition and healing process.

keep us informed on how he gets on.


Peter

I wish the ring (this Chronic Pain) had never come to me. I wish none of this had happened. (Frodo Baggins)
So do all who live to see such times. But that is not for them to decide. All we have to decide, is what to do with the time that is given to us. (Gandalf the Grey)
Last edit: 6 years 2 months ago by Peter.

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6 years 2 months ago - 6 years 2 months ago #20982 by grappers
Hi Galah_01,
As Mary has pointed out tapering should be done under the guidance of a doctor, now regarding the endone, 5mg is the smallest dose, and I would not just stop the dose altogether, it will require a very slow taper, this can take up to 3 months or more, you can also ask the doctor at the same time for a medication called Clonidine 100mcg, this is a blood pressure tablet, but they have found it useful for minimising side effects of withdrawal, you only need to take a 1/4 of a tablet morning and night, I only found this out because of my intolerance to medication, and the last attempt to change meds they wanted to limit the side effects, to find whether I could tolerate a different opiate, with out the side effects getting in the way, it relieves the sweating and muscle cramps associated with withdrawal.


Don
Last edit: 6 years 2 months ago by grappers.

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6 years 2 months ago #20983 by galah_01
Thanks for all the quick responses. Really quite helpful. I am going to try and research some pain management specialists around our area (Westmead, western Sydney) to see if we can get better support for Dad and so that he can understand and manage his pain better too.

So far I have gotten him to fill out a pain diary so we can better understand the pain. His physio is very helpful with his pain and seems to have suggested the same thing regarding tapering. I am proud of Dad of cutting down so much but I think it might be an unhealthy obesession if as you all say it can lead to chronic type pain.

Out of curiosity, could someone explain that concept to me a bit more? Is it that if main is not managed properly (too low a dose eg) then the pain can stay for longer i.e. chronic pain?

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6 years 2 months ago - 6 years 2 months ago #20984 by Mary
Hi Galah,

As I said before, 12 weeks is considered early days after spinal fusion surgery. It is not the kind of surgery where you are back to normal at around 6 or so weeks. Joint replacements are similar. Your dad will find that he will continue to improve for up to 18 months.

The mystery as to why some people develop chronic (ongoing) pain and others don't is still puzzling health professionals. The poorly controlled post surgical pain theory is just one of a number, so doctors are working quite hard to make sure that people are covered as much as possible.

Can the surgeon who did your dad's surgery be of some help here? I think that the key is to speak to someone who is up with all the latest ideas on all this, before your dad tries to taper his meds. any further. It is important during this phase for his pain to be controlled well.

Please feel free to ask more questions if this does not answer your query!

Mary

Not every day is a good day, but there is good in every day.

"“It’s delightful when your imaginations come true, isn’t it?” ― L.M. Montgomery, Anne of Green Gables
Last edit: 6 years 2 months ago by Mary.

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