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Suggest treatment for chronic back pain

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Posted on Fri, 25 Jul 2014
Question: I am a pain management patient of three years for chronic back pain. I get regular epidural injections and I am on a medication regimine. I'm in a huge amount of pain now even on my meds. I don't think my last shot helped or my medication isn't working anymore. Is it possible for the pain meds to stop working?
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Answered by Dr. Luchuo Engelbert Bain (2 hours later)
Brief Answer:
Possible, use morphines and NSAIDS

Detailed Answer:
Hi and thanks for the query,

I di understand how disturbing it could be to be on drugs that really do not help. However, it might be important to note that a careful clinical review, and every effort must be made to identify the cause of pain before an appropriate treatment is given.

Have you undergone a proper check up to identify the cause for this pain before? X rays of the lumbar spine, a Ct scan and a Magnetic rasonance scan (MRI) shall be of utmost importance to appreciate the integrity of the spine and suggest possible causes of pain. If not done, it might be advisable for you to get this done.

Doing an erythrocyte sedimentation rate, an intradermic reaction and C reactive protein shall help in identifying a possible infection that could cause chronic back pain (Spinal tuberculosis, other infection).

Stronger pain management medications , morphines like Tramadol, associated to anti inflammatory drugs and simple Analgesics like Acetaminophen could be helpful. Increasing the dose of anti inflammatory drugs, morphines would require clinical supervision, especially for the start. The dosage, number of drugs and dosage depend ll on a proper clinical review. I suggest you see your doctor,

Dr Bain
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Luchuo Engelbert Bain (2 hours later)
I have rods in my back to correct severe scoliosis. I have also had a spinal fusion as well. I should have included that information. I've been told there is nothing further they can do, but control the pain. My specific question is whether or not it is possible for the medication to stop working. I suppose I should see my pain management doctor regarding a medication change. I hate being on all these narcotics.
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Answered by Dr. Luchuo Engelbert Bain (5 hours later)
Brief Answer:
you can develop tolerance to some pain medicines...

Detailed Answer:
Hi and thanks for the update,

I do understand how disturbing it really can be to be on narcotics. You are absolutely correct for its the ideal to reduce the amount of medication one takes to the minimum especially when it comes to narcotics. However one may develop tolerance to pain medicines especially the narcotics over a period of time. The key would be to change drugs constantly. Your pain medicine specialist will know about it.

Its urgent and important to get the serious pain in which you find yourself in now relieved. I am afraid narcotics might be unavoidable at this point to control the pain. I really think it should be a major concern now for you should for sure take them for a short while and when the pain is controlled, other pain control measures could be employed. If effective, the dosage can be greatly reduced or discontinued.

I buy your idea of meeting your pain management doctor for a management plan. Regards,

Dr Bain
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Luchuo Engelbert Bain

General & Family Physician

Practicing since :2009

Answered : 3092 Questions

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Suggest treatment for chronic back pain

Brief Answer: Possible, use morphines and NSAIDS Detailed Answer: Hi and thanks for the query, I di understand how disturbing it could be to be on drugs that really do not help. However, it might be important to note that a careful clinical review, and every effort must be made to identify the cause of pain before an appropriate treatment is given. Have you undergone a proper check up to identify the cause for this pain before? X rays of the lumbar spine, a Ct scan and a Magnetic rasonance scan (MRI) shall be of utmost importance to appreciate the integrity of the spine and suggest possible causes of pain. If not done, it might be advisable for you to get this done. Doing an erythrocyte sedimentation rate, an intradermic reaction and C reactive protein shall help in identifying a possible infection that could cause chronic back pain (Spinal tuberculosis, other infection). Stronger pain management medications , morphines like Tramadol, associated to anti inflammatory drugs and simple Analgesics like Acetaminophen could be helpful. Increasing the dose of anti inflammatory drugs, morphines would require clinical supervision, especially for the start. The dosage, number of drugs and dosage depend ll on a proper clinical review. I suggest you see your doctor, Dr Bain