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i need help, please!!!!

Hi, I'll do my best to keep this concise. I'm 31 and got into a car wreck 5 months ago that resulted in a herniated L5/S1 disc. I also have some spinal stenosis. I ended up seeing an orthopedic back doctor who referred me to a pain management clinic for epidural injections. He gave me 3 injections over 2 months and also wrote me a prescription for Lortab- #120 7.5 mg with 2 refills. He said that would be the only prescription he would write. I have 1 refill left and I'm still in a lot of pain. My orthopedic doc said a spinal fusion is my only surgical option and that he won't do that until we've explored other options. I've had the injections, use an anti inflammatory daily, went to PT, use a tens unit, and wear a back brace. My ortho doc won't give me pain meds because I was in pain management and the pm doc wrote one script with the refills and that's it. I went to my primary care yesterday to see if she would refer me to a different pain management clinic. She wants me to see a neurosurgeon. She also asked if I have tried a butrans patch. I said no and she said she would see if my insurance covers it. I looked it up after I left and it sounds like a good option to me since the pills don't work that well. I called her office today to see if she would write me a script for it and the nurse I spoke to said she would not because of the amount of lortabs I've been prescribed. It sounded like the doctor was angry. I was upfront about the lortabs and didn't even request anything from my primary care doc- she suggested the butrans patch in the first place. I thought I was supposed to take the lortabs as prescribed, based on what my pain management contract stated and from what I've read on these forums. I'm confused as to what I did wrong, scared that my pain won't be managed in the future, and unsure of what to do next.


  • LizLiz Posts: 9,699
    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

    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 or liz


    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • dilauroddilauro ConnecticutPosts: 12,395
    For starters, your MRI (I assume was done) identified a disc herniation at L5/S1 level. There are many degrees of herniation, each has their own general action plan.

    Pain medications Its always best to have only one doctor prescribe them. Even what may seem harmless to you and other, might be viewed differently by the medial professionals. (ie recommended the patch, but later she said no based on your existing pain medications). Also keep in mind, that pain medication is only one type of pill that could be used. There are others, nerve, muscle relaxers, etc. All of this needs to be discussed with your pain management doctor who
    provided you with your first prescription.
    Always keep in mind, pain medication is NOT going to eliminate your pain, its used help manage your pain.

    Conservative Treatment The best doctors will always recommend the non aggressive-treatments first. The Physical and Aqua Therapy, Ultrasound, Traction, Massage, Tens, Acupuncture, etc. Many times besides doing all of that, they may suggest some repeat treatments. This is a good sign. Your therapist do the initial evaluation and the mark your progress as the sessions go on. Some insurance companies allot only X amount of sessions, while others continue coverage until the therapist says []i] "No further progress has been made"

    Surgery That should always been done as the last option (unless your doctor indicates surgery is needed quickly).
    When surgery is recommended, it is always wise to get a second opinion. You want to make sure at least two medical professionals view your situation the same and have the same recommendations.

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  • Ron,

    Thank for taking the time to read my post as well as responding to it.

    I did have an MRI done. At the L5/S1 it showed "a fairly prominent disc protrusion/superior disc extrusion with an AP depth of 6.5 mm in its superior extension behind the L5 body by 5.5 mm with no thecal sac effacement." It also says that the central canal is not compromised, facet hypertrophy is modest, and there is a mild narrowing of both foramina.

    As far as the pain medication goes, I can't discuss it with my pain management doctor because we agreed right off the bat that he would write me just the one prescription, with 2 refills, and that's it. I'm not seeing that doctor anymore because he has given me all of the epidural injections that I can receive for now. That is why I was trying to get a referral to a different pain management doctor. I told my primary care doctor that I don't feel like what I'm taking is very effective, particularly that it doesn't seem to last very long. I'm definitely going to go to the neurosurgeon that she refers me to but I'm concerned with pain management in the meantime.
    In the past year I've had 2 orthopedic surgeries on my wrist and I think I may have developed a bit of a tolerance to Lortab. I have discussed this with every doctor I've seen but it hasn't made any difference so far. I would prefer not to take any pain medication, especially narcotics, but I have a lot of trouble functioning without it due to my back pain. I have a fairly active job- I transport patients in a hospital, which means that in addition to pushing and pulling weelchairs, stretchers, and beds I sometimes have to pull a patient from a stretcher to a bed and vice versa. I have tried to find a less strenuous postition within the hospital but have been unable to do so. I'm terrified of losing my insurance because I've been told that I may have trouble getting new insurance now because of my back and it being considered a pre-existing condition.
    I'm just so frustrated with this injury and scared of what my future looks like. I've read a lot about back surgery and it seems that even with a successful surgery a lot of people continue to have a lot of pain. I want to go to nursing school but I'm not sure if that is a viable option for me anymore.
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