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Suffered fractured pelvis and ruptured disk. Prescribed Opana. Had epidurals, nerve blocks and ablation. Suggestions?

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Spine Surgeon
Practicing since : 2002
Answered : 322 Questions
I was recently prescribed Opana 15 mg E/R. (I was hurt at home, falling 28 feet, in an awkward position, landing on my buttocks. I was quite fortunate to have not been hurt worse or even killed. I did sustain a fractured Pelvis, a partially ruptured disk at l5-S1, a large herniation at L4-L5 and a moderate herniation at L4-5 (although this disk produce the "most severe pain") (All 3 levels were 10/10 and before this test, I had never experienced "10/10 pain ). The pain was described as "concordant" at the 3 consecutive levels. The pain was induced at a very low PSI LEVEL i.e. 16, 23 and 31 respectively and CT scan revealed both annular and nuclear fiber tears ate all levels. There is both central and peripheral stenosis L greater than right.
My pain is virtually 100 % in my Left leg. I have had epidurals, nerve blocks, ablation (Which did help). While I do have left sided radiculopathy of the L4 nerve on the left and the L5 and S1 nerves Bi, I have no evidence of nerve damage i.e. no foot drop, no muscular atrophy, no asymmetries, no "biomarkers" of demyelination.
P.T. was of no value, injections were of no value, as mentioned ablation gave @ 25 % relief for 6 months then began to fizzle (I will be having this done again in @ 3 months), Neurontin (presently at 2700 mg has helped leg pain, honestly, by far the most effective treatment by far was chiropractic treatment which involved no manipulation what-so-ever (Essentially a procedure known as flexion-distraction, coupled with axial decompression, followed by treatment with a 30 watt level 4 laser, myofascial release, a very specific physical rehabilitation program (Which was 10 times more specific than the garbage I received at 3 separate P.T. places and I must admit that it is shocking that some M.D.'S DISMISS CHIRPRACTIC TREATMENT, WHEN I AM VIRTUALLY CERTAIN THAT THEY HAVEN'T THE SLIGHTEST CLUE WHAT CERTAIN ONES DO) and I do @ 90 minutes of home exercise on a daily basis.
I saw a neurosurgeon at XXXXXXX and XXXXXXX and they said that unless I developed neurological abnormalities (most specifically loss of bowel or bladder control, or cauda equine syndrome, obviously a medical emergency, I would be a poor surgical candidate because I had 3 levels affected and neither liked to touch more than 2.
Both surgeons mentioned that consideration could be given to an L3-4 vertebroplasty with an L4-S1 discectomy with a fusion as a "last line consideration". Both advised to continue with this specific chiropractor or any of the "new wave of chiropractors" versus the "old ones" who apparently perform treatments quite differently. Both advised continuing Neurontin. One said to try to bump it up to 3600 mg. The other tentatively said that Lyrica may be more effective, but it is exceptionally expensive and "some questions about it have arisen". Both advised both a short acting and long acting narcotic. Both advised a second ablasion. Both advised to continue to utilize proper spinal biomechanics.
So, my question is primarily about narcotic pain management. It does provide relief of 20 to 30 %.
Fortunately, the chiropractor and the "non-interventional pain management specialist work together".
I presently take oxycodone, 15 mg, 4 times a day. It helps for about one hour. Regarding long acting narcotics, I was given M.S. Contin which I think made me feel less pain, but it inhibits my ability to perform my job (Which is as an executive for a fortune 500 company. I work between 50 and 100 hours a week and travel 300,000 miles a year)
I was given methadone, which quite frankly was embarrassing to get filled and any benefits were hard to perceive.
I received one prescription for Opana ER 30 MG, which helped significantly, but I have not been able to find a pharmacy that either carried it or kept it in stock (Apparently, the tamper resistant coating and limited supply has made it virtually inaccessible).
So, my questions are specifically, I felt significant improvement the one and only time I was able to obtain the Opana E/R. Is there any way which I can obtain this medicine ? I am aware of the other options of Fentanyl Patches and Oxycontin, but this has worked and I would prefer to use it.
Is their any efficacy to these Fisher-Wallace and Alpha Stim 100 units ?
Would a spinal cord stimulator be a viable option ?
Posted Thu, 17 Oct 2013 in Brain and Spine
Answered by Dr. Rahul D Chaudhari 6 hours later
Brief Answer:
Please consult a spine specialist

Detailed Answer:
thanks for writing to us.
Opana er is oxymorphone and it wont be available without doctor prescription. No doctor would like to prescribe these medicines for a longer period. Whats the main complaint now? leg pain or back pain? If possible please upload your MRI report and pictures.
Opiates can not a solution to your problem. It will make you more dependent in long run. I dont think you are no a right path of the treatment. Whatever levels is the problem it can be addressed. need to see clinically in which nerve root the problem is?
Again doing the active intervention only if you developed neurological signs is wrong statement. If you have severe pain and for which you have to take opiates and pregabalin in large doses then I would consider to establish the problem and do surgical intervention. Also vertebroplasty can not be an option at your age. I would suggest to consult a spine specialist rather than neurosurgeon. Thanks.
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