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Suffering from back pain. MRI showed herniated disc with fibromyalgia. How to get relief from this pain?

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Practicing since : 2005
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I have already posted this question a couple of days ago and wanting another opinion. I have received a fabulous respose from the original dr who answered my query but also wanting another so I can print it out and take along to my appointment with my new dr.The more responses from different dr's than the better the chance I have of someone listening to me. In the last 6-12months I havne't had any respose from my dr whom I've been seeing for the last 3.5yrs and this site has been fabulous, it's finally nice to have a doctor who is willing to take the time to answer my questions. This is my original query that I posted before:

I had my usualy weekly/fortnightly apointment with my GP today and after today's appointment I've decided I'm changing dr's plus I'm needing some advice. I got home and have spent the afternoon in tears about the whole appointment and even upset over points of view from some fellow members of a local support group. I've had a long and complicated history over the last 3.5yrs and very sorry for the long story.

I hurt my back just over 3.5 years ago, as I as getting out of bed I stretched and twisted the wrong way and ended up with a very large central L4/L5 sequestrated herniated disc. I've had back pain since I was 12 years old and has gradually gotten worse over the years until I hernitated it badly which in the end required surgery and Im still having ongoing leg, nerve and back pain. Herniating the disc also triggered off Fibromyalgia (wasn't diagnosed until Aprill 2011) so have been suffering badly since that day. I've had to give up my job, ended up leaving the family home as I was having ongoing issues with family regarding my health, became homeless, had to declare myself bankrupt and struggled but finally got on a Disability Pension but have managed to get thru it all witha smile on my face.

My issue to day is that I saw my GP regarding a pain management course that my pain specialists adviced me to attend (well rudely told me he was going to make sure I did it). I live in the country at the moment and the nearest big hospitals or pain clinics are in the city and for me that's about 3hrs travel (200km) just to get there. I had spoken to a pain specialist from the city via a telehealth appointment via video conference. He advised me to attend a 2 day pain management course run by the clinic and also made changes to my meds which I thought were rediculous at the time but agreed to try. I really wasn't 100% sure that I would be able to attend the pain course at that time due to suffering from bad fatigue and exhaustion from the FM, I can't sit it a car for a long amount of time, plus when I drive to the city now I have to take someone with me otherwise I fall to sleep while I'm driving. I have no family or friends in the area or that I could stay with and financially unable to pay for accomodatoin. After receiving the information about the course I found out that the course is run over 2 days, 8 hours each day over a Tuesday and a Thursday. For me financially and physically it was just not something I could do and my dr's were fine with that. I found out that my local hospital also run a pain management course but have no pain clinic itself. I got a referral from my GP and had an interview last week to see if I was suitable for the course. This course is run over 6 weeks, 3 days a week (Mon-Wed) and approx 3 hrs each day). The trip to the local hospital is about an hours drive for me plus I'm moving in 15 days so that is going to be physically stressful enough for me. I met with a Physiotherapist and Mindfullness/Wellbeing Coach and basically told me what's involved in the course. I said straight out that I would be unable to do the course as I'm moving in a few weeks and would not be able to handle the course aswell. I also said that if I was not moving then I still wouldn't be able to physically complete the course. They only want committed people to attend the course who can attend every session over the full 6 weeks. I told them with my Fibromyalgia I struggle with the fatigue badly. I only go out once or twice a week and that is to appointments, visiting or shopping. These appointments are usually only 3-4hrs XXXXXXX and always exhausted by the time I get home and take a day or 2 to recover. A trip to my local GP takes approx. 40mins to get there, when I move it will be only 6mins. So between appointments and the recovery time I struggle to fit in basic housework. I'm actually getting government help with some household jobs as I'm struggling to keep up by myslef. I'm single, live by myslef and have no family or close friend support. I have started a local Fibromyalgia Support Group which has been fabulous. Anyway between my usual appointments and housework there is no way that my body would be able to cope with 3 full days a week attending the pain course and not for 6 weeks. Plus they only want people to attend if they are comitted to attending the full 6 weeks.

I'm side traking here for a moment but after hurting my back I was on painkillers but didn't have a good reaction to some and was put on Endone ( Oxycodone) about a month before I had surgery (Sept 09) on my back. I continuted to take Endone after my surgery and for about a year and a half aftwards. I had been taking both but at one stage I did stop the Endone due to bad itching and later went back on it as the pain was getting unbearale with Tramadol which has really has never done anything from day one for my pain. Three months after having the surgery I was feeling very unwell and in a lot of pain, my blood tests come back with my ESR of 104 and dr's had thought I had an infection. Luckily there was no sign of infection but was having body pain plus back pain so I was also put on a Duragestic Patches. After having ongoing pains in body, back and joints my Rheumatologist decided about a year and a half later of having the ongoing pains through out my body and back and my high ESR results to stick me in hospital and run tests to work out what was going on. I was in hospital for a week of tests and that's how I got my diagnosis of Fibromyalgia but they still no idea what was causing the high ESR. I was then taken on the Duragesic patches when I was diagnosed and then about a month later the Health Dept stopped my Endone as according to them I had been on it too long and as it was an immediate release pain med and was not indicated for long term chronic pain. I was basically taking the Endone for the back and joint pains at night and was the only thing that was actually helping. I basically haven't found any meds that have helped a lot with my FM pain either so asked my Rheumatologist if I could get anything stronger for the pain as the Tramadol was doing nothing but was all my dr could prescribe for me. He wrote to the Health Dept but he adviced me that the only chance of me possibly getting anything is to go through a pain clinic.

With my appointment today I basically explained the situation to my dr and didn't get a very good response. He said that taking pain meds was no way to control my ongoing chronic pain and is not good for longterm. I can totally understand that but for the last 18 months since the Endone was stopped I have been in pain!! I basically had a near normal life when I was on the Endone and the patches and now Im struggling to do everyday things, nevermind actually doing those things that I like and can't because of the pain. He said that's why I need to attend this course to learn to cope with other ways to control my pain and not to rely on pain meds as he doesn't want me to become and addict. I've not had good pain control since hurting my back and have always thought that my dr hasn't taken my pain seriously. I was only taking the Endone at night to help with sleep and for those days that really required it. The Tramadol was doing nothing for my daily pains so I really had no good pain relief throught the day. As Endone is an immediate release med I only had relief for about 3 hrs so was needing to take more over that period at night to help. I was really after something that was longer lasting. I'm now on Tramadol SR which I've found a lot better but still does nothing really for my pain. I was nearly in tears the whole time as I thought that he didn't listen to a thing that I was actually saying today. I re-injured my back on Friday just gone and have been having really bad back spasms and asked if there was anything I could take that would help. He gave me the whole lecture about needing to learn to control my pain in other ways. I can totally understand that but at the moment I'm not getting any pain control with what I'm taking. I then mentioned that I hadn't been getting any relief from the tramadol since day one (which I've mentioned lots of times) and what the changes that the pain doctor has advised with my pain meds hasn't helped, in fact it has made things worse plus he wsa really rude and arrogant when he spoke to me. I asked for another referral to see another pain specialist but got the whole lecture again.

After todays appointment I basically left and have pretty much been in tears all afternoon. I've been seeing my GP nearly every week or fortnight for the last 3.5yrs and over the last 12months things have basically not improved and not gone anywhere. I'm also having ongoing problems with my blood tests and ESR. I've been mentioning that when my ESr goes up, that's when my joint aches get worse. He recently went away on holidays for a month and I saw a lovely new dr that has just started at the surgery. I had mentioned that my pains had gotten worse and about my ESr. Asked him to do another blood test an my ESR was really high and my CRP was also up. He put me on steroids for 9 days and of the last 3 days, I had no pain and stiffness in my joints which I can't remember when i last felt like that. Had mentioned that to my dr when he came back but never said anything. I also have family members on my dad's side that have autoimmune conditions, 2 have Ulcerative Colitis and one has Lupus so I know I have something else going on besides the Fibro. I also know that FM isn't an inflammatory condition and doesnt' cause my ESR to rise. I have an appointment with my Rheumatologist and will be discussing this along with the pain clinic with him this coming friday and hope he does some more investigatinos to why my pain increases when my ESR does also. It' sbeen going on too long and I've had enough. Iv'e also been having issues with my left knee since I was 10 years old. I've played a lot of sports since I was a kid and through my teenage years and have alsways had pain and the feeling as though my knee is going to give way. Plus i also have night time pain behind my kneecap and a horrible grinding noise. I've also mentioned this to another online dr (Orthapedic Surgeon) plus the ERS issues and he too believes that this needs to be investigated more as soon as possible. I've been telling my dr about my knee problems and he has just says that it's just inflammation or jsut to do with my Fibromyalgia and looked no further into it. When I have appointments with him now he basically sits at his computer and just types, if I ask him questions he sometimes doesnt' answer or just says its all to do with my overall pain syndrome. I've also been having ongoing stomach, indegestion and heartburn problems aswell. I was endoscopically investigated last year and was told it was all fine. I;ve mention this to the new dr that I had been seeing and he has suggested things I should try and changed my meds which has helped a lot. He said if things don't improve over time then would more then likely need another endoscopy to see whats' going on. I recently looked at the report from the last endoscopy and it has said that I had mild acid refulx and gastritis. The new dr has suggested things to help with this, answered my questions and yet in the last 6 months that I've been mentioning it my old dr, he's basically said nothing and never mentioned the mild reflux or has said what could help.

I've been thinking over the last 6 months of changing dr's but havne't as I"ve had a long complicated history. Since seeing this new dr a couple of months ago and actually listening to me and after today's appointment, I've decided not to see my old dr again and to go with the new dr. My support groups are also on Facebook so we chat everyday and I had mentioned what had happened and how upset I was over the whole situation and things haven't gone so good either. I mentioned to them that physicallly I would be unable to commit to doing the full 6weeks of the pain course when I'm struggling everyday jsut to keep up with everyday living. They have also agreed with what my dr has said and told me that I would end up as a drug addict and inthe long term that stronger meds such as with the opioids, I would end up with more health problems longterm. They've told me to do the pain course but I know that I wouldnt' be able to do the full 6 weeks and they onlly want people who can commit to do the full 6 weeks to attend the course. I'm just totally devestated about today and have no idea and need advice or just a professional opinion. I've been trying for over 18months to get some stronger pain relief that acutally helps with my pain so I can have a near normal, comfortable life again. i know my life is never going to be painfree, I've been living with pain since I was 12 years old and have learnt to deal with that and what works best for my body. I also asked and recieved the course booklet with information about what's involved in the course from the 2 day clinic that run by the pain specialist. I've read the 81page book and what is written is all what I've read before. I spend my days researching and finding ways to cope and things that help with Fibromyalgia so it' snot as if I know nothing. I'm jsut totally confused as what to do next with pain meds and the course. I'm seeing my Rheumatologist on friday and just hoping that he is understanding and I don't have to go through what I went through today.
Posted Mon, 20 Aug 2012 in Back Pain
Answered by Dr. Prasad 40 hours later

Thanks for the submitting a detailed account of your medical problem/s. I have gone through it with diligence and I am sorry for you. I understand you been suffering with enduring pain for so long and fighting against it with a smiling face. I appreciate your efforts here.

I see the options given to you by your previous doctors have limitation primarily due to your medical condition. So let me try to provide you with some information which I hope are useful to you.

1. I agree with your previous doctors comments that you shouldn’t be taking opioid analgesics for long term. Opioid dependence and withdrawal can pose difficulties to your already stressful life. However working closely with a good and cooperative doctor can balance medications with other therapies to control fibromyalgia. I am happy that you’ve finally found a new doctor who listens to your concerns and takes steps to address it.

2. High Erythrocyte Sedimentation Rate is bit concerning. In the back ground of family history of autoimmune diseases, there is a strong possibility that you could have a coexistent autoimmune condition. It needs to be explored by consulting a rheumatologist. Perhaps you need further autoantibody detecting tests such as Antinuclear antibody and extractable nuclear antigen antibody along with C-reactive protein, lupus as well as Rheumatoid factor. Discuss further about these with a Rheumatologist.

3. I hope the disc herniation is taken care off, by your surgery. I see you’ve consulted with an orthopaedic. Discuss with your current treating doctor about it.

4. Lastly about fibromyalgia which is ruining your life, I see you’ve have extensively read / researched and consulted many doctor about it. I may have very little to opine about it now. But have you read or tried alternate medical practices?

As a medical practitioner with almost no experience in alternative medical practice, I can only present to you possible solutions available with regards to treating fibromyalgia by alternative medicine. They include:

a) Acupuncture – Here, the practitioner inserts one or more dry needles into the skin at specific pressure points. They believe these needles can manipulate production of endorphins and brain chemistry to bring about relief from chronic pain.

b) Chiropractice – Here like acupuncture the practitioner use gentle pressure, stretching, spinal adjustment with the belief that the can induce self healing.

c) Herbal – There are plenty of herbs which are known for medicinal properties. They are studied and practiced by homeopathy experts. Quite a many of them have reported improved pain relief with these herbs.

d) Biofeed back – Here the practitioner uses instruments to teach you how to react in a healthy way towards any painful stimuli or stressors.

e) Similar to these practices massage, ayurveda, yoga, transcedental meditation and other alternative practices are developed in treatment of medical conditions.

You can find one or more of such alternate medical practitioners at your region. With help of your group/organisation you probably may be able to find a suitable expert to work with you in solving this problem.

We can combine the alternative treatments with conventional treatment from your rheumatologist/treating physician for the better quality of life.

Hope you found this useful. I will be happy to provide you with online support if you need any.

All the Best!

Dr. Prasad
Above answer was peer-reviewed by
Follow-up: Suffering from back pain. MRI showed herniated disc with fibromyalgia. How to get relief from this pain? 58 minutes later
Thankyou so much for the reply. I'm trying to get as much help as I can at the moment regarding this current issue to know that Im on the right track and it is greatly appreciated.

I'm also seeing a new dr whom I've seen a couple of times now and he has been fantastic. He has ordered the last few blood tests and the trial on Prednisolone and has actually listened to what I've had to say. He is currently away on holidays at the moment and will not be back for another 2 weeks. I'm hoping to get a lot further in this next appointment with him than I've gotten in the last 12 months with my previous dr. I was suppose to have an appointment with my Rheumatologist today but received a phone call a couple of days ago from his receptionist saying that my appointment has been cancelled. I've been waiting over 7 weeks for this appointment was going to discuss my last blood test results and hopefully he would look further into it. Apparently my previous dr (I saw him on Monday and now I am no longer seeing) wrote a letter to him saying that I have refused all treatment from the pain clinic and refused to attend a pain management course. I did explain to her that I didn't refuse the treatment the pain specialist had given me, it's just that I can't attend the pain management courses. So now I cannot make another appointment with my Rheumy at all as apparently he cannot help me at all. I'm now going to have to wait 2 weeks until my new dr is back from holidays to get a new referral to see another Rheumy. This could take up to 2 or more months before I can get an appointment with the new Rheumy. I didn't have the best of appointmnets with my Rheumy last time so was considering seeing a new one anyway if I didn't get anywhere with the appointment that was suppose to happen today. I was also seeing him to get scripts for my Lyrica which I have jsut run out of but now can no longer get one from him according to his receptionist. The Lyrica didnt' help with my FM pain at all but helped greatly for the nerve pain in my leg which is another problem I have back again.

I'm still dealing with ongoing problems from my back injury. I still have leg and foor pain and permanent nerve damage in my left leg. In the last 12 months I have had increasing pain and sciatica in both legs now. Thankfully I've haven't had any numbness or tingling in that leg yet and hoping I don't but the pain has increased. This is why I'm asking for the stronger meds, for the back and joint problems. I know that the XXXXXXX dose of Tramadol is 400mg a day but I'm taking up to 600mg SR and up to 200-300mg of immediate release for breakthru pain. Tramadol has not really helped me with the pain since day 1 and have been on it now for a few years.

I have previously been tested for Lupus, RA and a lot of other auto immune diseases as my ESR has been extremly high in the past (104) and had numerous tests after test. It rarely sits below 50, the lowest being 33 which is when I was in hospital for extensive testing. At age 2 I have also had TB lymphadenitis and that has also been retested for and all fine. All my blood tests in the past have all come back negative like XXXXXXX and RF. Although the last test for my XXXXXXX came back that it was weakly positive. I have also seen a Haematologist who has come up with no answers either. After a week of testing for the high ESR and pain problems in hospital my dr's (Rheumatologists) had came up with the diagnosis of Fibromyalgia. I know that I do have something else going on besides that aswell but because all other tests have come back negative in the past no one will look further into it. I know that I could still have one of them even though the tests may be negative.

My recent blood tests with the new dr did come back with high numbers again, ESR 63 and CRP 15. I had asked him to do the tests as when my pain level increases, especially my wrists and finger joints my ESR levels go up. I've been trying to explain this to my old dr for months and he has done and said nothing. Had even mentioned it to my Rheumy and he basically said that it may be what i't slike for the rest of my life and that I may just have to live with it!! This new dr recommended taking the steroids for 9 days and on the last 3 days of taking them I had basically no pain and stiffness in my wrists and finger joints. I can't remember when I last felt like that it's been so long and the day that I stopped taking them the pain had come back but wasn't as bad. After taking the steroids my ESR dropped to 45 and CRP 9. I was hoping to bring this up with my Rheumatologist today, had even mentioned that I wanted to discuss this but told the dr can't help me and I can't make another apointment with him as he's done all that he can for me. This is all thanks to my old dr. I also live in the country and for me to travel to the city (Perth) is 3 hrs' drive to get there and I can't do that as all the Rheumy's are based there. That is why I can't do one of the pain clinic courses, its too long and too far for me to travel. I'm just hoping that there is another Rheumatologist that does come down to the country.

I have tried alternative therapies before. I have seen a Psychologist who has been fabulous in helping me out and with CBT. I can ring him anytime of the day for anything and he has also helped me move house as I've had no one to help me. I've seen a Physiotherapist a couple of times to work on strengthening my my core muscles but hasn't been omuch use to me when I'm too exhausted and just end up spending days in bed. Have also tried XXXXXXX Therapy in the beginning with no luck either, herbal meds and massage. I have recently found a massage therapist who's sister has FM so she knows how to deal with it. I'm yet to try her technique as I'm financially struggling but can' t wait til I can afford it. I can't attend or try a lot of these therapies as I'm on a Disability Pension and struggling to pay for medications, food and bills now. I've had no hot water for the last week as I can't afford the gas. All my appointments are bulk billed with my GP so there is no cost to me but I do have to pay to see specialists which is very hard. I was planning on discussing my blood test results with a Rheumy on this site but can't afford to do that so hoping to get as much advice as I can.

I have been so frustrated and depressed this last 5 days I just dont know what to do at the moment. I can't see my new dr for another 2 weeks and will now have a long wait to see another Rheumy. This is not helping with my pain level at all and I'm really struggling. I've barely eaten in last week and have barely slept for that matter. I just want to curl up and sleep but can't and my pain levels have increased. If they don't improve in the next couple of days, especially the pain levels I will go to my local hospital to see if they can help me.

Thankyou so much for your reply, it is appreciated greatly.
Answered by Dr. Prasad 21 hours later

Thanks again for posting a follow up query.

A cooperative and considerate doctor is definitely important while tackling chronic pain. Patient compliance also is important and I see you are participating in the treatment as much as you can. So continue to participate in the treatment with your new doctor.

High ESR is concerning; but a value under 100 most often isn’t associated with serious medical problems. Many a time in the presence of family history of autoimmune disorder, weakly positive XXXXXXX and high ESR may be associated. I hope your new rheumatologist will explore further on this topic.

Drugs like Lyrica (pregabalin), Cymbalta (duloxetine) and Savella (milnacipran) have been used extensively to control symptoms of fibromyalgia. I see you are already on Lyrica and it’s good to know it partly helped. You have also tried some of the alternate treatments. You probably can try other forms of treatment in the list given earlier if one is available close to the place you stay.

Suffering with this pain for so long, I understand you would have investigated and read lot on this topic, hence I did not mention any of the conventional treatment during my initial reply. Let me just try and give you some tips which you can take forward through your new doctor.

1. Since Lyrica helped in relieving some of the symptoms, I think that’s good news. Why not taking this further with your new doctor?
Perhaps your new doctor may add another drug from this class of medications and hope you feel better.

2. As I mentioned in my last reply, we can combine the conventional medicines with alternative treatments for added benefits. You may talk with your new doctor about it. The goal is to reduce pain, desensitize you to stressful stimuli while minimizing the use of medications.

3. Lastly a few rheumatological conditions are treated with low dose steroids for few months/years. Since you mentioned steroids for 6 weeks did bring about some changes, we may try the same for a while.

Hope this information suffices. If needed I will be available to assist.

Wish you good health

Above answer was peer-reviewed by
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