Chronic Pain

hi -- i'm new, obviously.

my questions are about my husband's chronic pain. he would never come to a forum to ask anything.

he's 38 -- was diagnosed with 2 lower deteriorating disks when he was 22. no doctor has ever done much for him but send him to physical therapy which did nothing for him -- then he gets discouraged and won't go back to them. he's had all kinds of mri's & cat-scans over the years. the last doctor said he was confused because the pain seemed to be on the wrong side compared to what the mri/cats showed. they did try a spinal block. my husband said the pain from that was worse than the back pain and it never really helped anything. sometimes he has shooting pains down his legs and sometimes some numbness.

this past march, he had a motorcycle accident and was thrown 30 ft. he had facial fractures, all but 3 broken ribs, 2 punctured lungs, broken wrist, knee injuries, and a crushed ankle/foot. the foot was basically turned inside out within his boot and they thought they would have to amputate. he has almost a complete foot -- did lose a toe -- but the foot will never be the same again.

the dr's are cutting back on his pain meds -- i guess they're worried about addiction. but i have to say that the 3 months that he was on 2 30 mg oxycontin's a day -- never took more, sometimes only took 1 -- was the best painwise that he's been for years. recently, they cut it back to hydrocodone and not only does it not work so well, it seems to make him really grumpy. i would say that's withdrawel, but over the years he's taken hydrocodone for other issues (chronic tendonitus he finally had surgery for which was a great success) and it's always made him grumpy.

i'm wondering how it's going to be living with him with chronic back pain & chronic foot pain with no relief if his foot doesn't heal better. we're seeing a bone on one side of his foot start to protrude -- it's a scary sight. he went 3 months with his achiles tendon showing and several other open wounds.

he sees the ortho doctor tomorrow -- not sure if they'll even give him the hydrocodone refills. we once overheard his dr tell another patient how pain was his friend and he's told my husband he'll have to work through some pain. and he's done that, he keeps doing things even with the pain, but 24X7 pain starts to wear on you.

anyway -- i'm thinking it's time for pain management -- he's thinking they're just going to tell him it's all in his head and to get over it. to be honest, he does get depressed from time to time over the pain -- who wouldn't? but we have a son who has clinical depression and it's very different.

so -- sorry for the long ramble. what should he expect to happen if i can get him to go a pain management specialist? will they automatically want to do a mental evaluation -- i don't think that's a bad thing, i wouldn't have a problem with it -- but it'll just make him walk out & never come back.

is taking 2 30 mg oxycontin's a day too much? is that asking for an addiction problem? or look like an addiction problem?

any opinions -- good or bad -- are fine. if it sounds like drug seeking behavior, i'd rather hear it here than in a dr's office.

Hi slw,

Welcome to ChronicPainConnection! Your husband has really been through a lot. It's not surprising he would have chronic pain.

It does sound like it's time for him to look for a pain management specialist. While two 30 mg OxyContin a day doesn't sound like too much given his situation and pain level, I'm not surprised that his current doctor switched him to hydrocodone. Most doctors who are not pain management specialist are extremely uncomfortable prescribing anything stronger than hydrocodone on a long-term basis.

It certainly doesn't sound like your husband has exhibited any drug-seeking behavior. And taking the OxyContin as prescribed is not asking for an addiction problem. Anyone who takes opioid medication regularly will develop a physical dependence on it – meaning they will have to taper off of it to avoid withdrawal – but it's rare for someone who has real pain issues to become addicted. Here is an article that will help explain that better: Opioids: Addiction vs. Dependence

I don't know that a psychological evaluation is necessarily a requirement for pain management treatment, but I can think of two good reasons they might ask for it:

1) Doctors who prescribe opioids are under intense scrutiny by the DEA. I can understand why they might want to identify people who have an addictive personality that could potentially be drug abusers.

2) Chronic pain affects the whole person – physically, emotionally, socially and intellectually – and can affect how someone responds to treatment. It's understandable that they might want to see the "big picture" when treating patients.

If they do ask for a psychological exam, it absolutely does NOT mean they think the pain is all in his head.

Here is a link to a good article about pain management doctors and what they do: http://www.asahq.org/patientEducation/managepain.htm

One think your husband needs to be aware of if he goes to a pain specialist is that he will most likely be required to sign a treatment agreement. I strongly encourage both of you to read this article before going: Treatment Agreements: What You Need to Know Before Signing

I hope some of this is helpful. There's no reason your husband should have to continue to suffer as he has. I hope he is able to find a pain management specialist who can help him find the best treatment plan for him soon.

Best,
Karen

thank you so much for the information. i'll be sure to read it all.

it's always nice to know what you're getting into. i had seen some other things about agreements & such at other sites, but no advice about them.

Funny that I got your message today. Saturday night my back became more painful than ever. Even before my fusion when the sciatic nerve was messin' with my legs. I was basically paralyzed with the most. Extreme pain I have ever, ever, ever felt in my life . Like someone stabbing directly into my spine and turning it. Plus.... The burning feeling was intense. I could not move a half inch anywhere without this pain . I would fight through it with my wife scared out of her mind at 330 in the morning. Every time I moved I as hit with this and began thinking of calling an ambulance to gurney me down the stairs and out the door. I even started speculating that my vertabrate or fusion had broke. Paralysis and wheelchairs were scary thought racing around my head.
My wife stood at the edge of the bed and I was able to scoot down to the edge where she grabbed my hands and pulled me up straightly and slowly. Thankfully the vicodin was working a bit and I was able to fight off the pain.
On the couch I put out an emergency call to my ortho and his ass. Called me back and told me if I was not getting pain down my leg or experiencing incontinence than I shpuld b ok. Thanks for the help jerk! He told me if the pain is intolerable and vicodin is not contrlling it then go to the emergency room. My pain managment jerk said the same. Luckily I have an appointment for a steroid shot tomorrow. I will make it but my kidneys may never recover from the pills I took over 2 days.
It is so hard to get people to truly understand the pain and how bad it actually feels. Do you feel this way?
I am laid up on my couch so venting is all I can do . Sorry for the long email. U probably won't read this from a stranger but it made me feel better to just write. Thx

Hi Scooby,

I hate to hear that you had such a painful weekend. I agree that it's extremely difficult to get others to understand how your pain feels. Unless they've experienced severe or chronic pain themselves, they don't seem to be able to grasp it.

I remember sitting in my church group several years ago, listening to a young man who was a teacher talk about his experience with an ingrown toenail. His point was that even though he had a painful ingrown toenail, he managed to get through the day teaching his class, so there was no excuse for anyone not pushing ahead and working in spite of pain. I remember thinking, "You jerk! I've had an ingrown toenail and if you think that is bad pain, you don't know pain at all."

My point is, people only seem to be able to really relate to something they've experienced themselves. I'm afraid that's why so many doctors just don't get it. I wrote an open letter to people who have someone with chronic pain in their life to try to help them understand a little better. If you'd like to read it, here's a link: Understanding Chronic Pain

I hope the steroid shot today helps. You're welcome to come here and vent anytime. We all need to do that from time to time.

Karen