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Hello, I Suffer From Chronic Lower Back Pain , Numbness

Posted on Sun, 10 Nov 2019

Question: Hello, I suffer from chronic lower back pain, numbness and tingling in my legs and feet, and chronic headaches/migraines from a mild TBI and right orbital fracture from an assault. I have just seen a pain management doctor about these issues. I am scheduled for two epidural steroid injections at the L5/S1 site and the left SI joint. The doctor prescribed physical therapy which I am eager to attend. Medication-wise he prescribed me Lyrica 150mg Qbedtime. The problem is that Lyrica and it's generic are both non formulary drugs that my insurance refuses to pay for. It is not a matter of prior authorization. They merely won't pay for the drugs. My question is, why not put me on a similar regimen as my old pain doc did: 10mg Percocet Q6 hours and MS Contin 4mg BID? At least then my insurance would pay for the medicine and wouldn't be hung out to dry and in constant pain. I have no history of drug abuse and I don't drink alcohol. My personal, though obviously non-professional opinion, would be that a long acting opioid would be beneficial because I need around the clock pain relief. I would be fine with a simple small dosage of MS Contin BID, perhaps 15mg or so. How do I approach this doctor with these concerns and ask for this type of medication? I wouldn't be at a pain clinic willing to give frequent, random UA's, and submitting pill counts, if I wasn't aware of the inherent risks associated with these medications. You could easily classify mine and most others' behavior in these clinics as drug-seeking, but there's a reason: it works! Opioids have a role in medicine and I believe that providing pain relief for those who've exhausted other options and need help pushing through pain to utilize services like physical therapy is just that place. Am I way off here? Any recommendations? Thank you so much for your time.

Answered by Dr. Sudhir Kumar (13 hours later)

Brief Answer:
Lyrica would be preferable for long-term pain.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted your clinical details. I agree with your doctor that lyrica (pregabalin) is the best drug for treating chronic low back pain. However, I have also noted that you are unable to use it as your insurance would not pay for it. As a result, you are suffering from disabling pain. In this situation, I would agree with you that Percocet and MS Contin can be prescribed for a short term. You should approach your doctor stating the obvious facts- that you are unable to use lyrica due to insurance not paying for it, and you need alternatives to manage with your disabling pain, at least for a short term basis, for a few weeks to few months. After follow up, a call can be taken regarding long term pain medicines. In place of lyrica, other drugs such as gabapentin or duloxetine may be used, later on.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 hours later)

Hi thank you doctor. How gracious of you to offer so much help with follow up questions etc, I appreciate it.

The other point I want to make is that I do not have an attachment to a specific drug combo such as Percocet/Ms Contin. I just want round the clock, long acting relief. Doesn't matter to me which medicine.

Follow up: Dr. Sudhir Kumar (0 minute later)

Is it possible for you to tell me what my TX PDMP NARx score is? I think this may be an issue

Answered by Dr. Sudhir Kumar (12 minutes later)

Brief Answer:
PDMP NARX score is used to predict the risk of unintentional overdose death

Detailed Answer:
Thank you for getting back.

I agree that pain relief is of utmost importance. This is specially true for neuropathic pain, as the pain becomes more and more difficult to treat if effective pain treatments are delayed.

TX PDMP NARX scores are used to predict the risk of unintentional death due to narcotic overdose. PDMP refers to prescription drug monitoring program and its includes analysis of doctor's prescriptions, number of doctors consulted by the patient, number of pharmacies used, number of overlapping days of prescribed medicines, etc.

Based on the information provided, it is not possible to calculate your PMDP NARX score.

Best wishes,

Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Prasad