Monthly Archives: August 2014

Pain Management for Sciatica, or lack thereof…

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Part 3. The hyperlinks below will take you to the Educational Resources page. Scroll down until you see the word or phrase.

I was a candidate for the Percutaneous Disc Decompression, but lack of insurance coverage for a one-time use piece of equipment was routinely difficult to obtain, so the MD didn’t do them often. I never had one of those. I didn’t get any relief from the Facet Blocks, so that disqualified me from Radio Frequency Ablation, as well.

By early November, I had to stop with the injections because I needed to be available to help my husband, who was about to have surgery. I saw the anesthesiologist a couple more times for different medication—nothing was helping me. He had started me on NUCYNTA (r), which didn’t really help in the long run and he and I were concerned about the medication. He also warned me that he was concerned about my cervical (neck) spine stability and believed that if I didn’t have that attended to properly that I could be paralyzed from the neck down, should I be involved in a(nother) automobile accident. He referred me on to a spine surgeon in late December.

Between Thanksgiving and New Year’s Day 2013, the pain began to subside on its own! It was a gradual thing; I became more independent from my cane and the ice packs over the six weeks.

In Part 2, I told you that you’d see what I meant by the connections and here they are: I saw Dr. P at the end of December and he told me that he’d found the location of the cause of my pain. At L5, the ligamentum flavum was pressing down on the L5 nerve root. He also discovered that I didn’t have equal great toe strength on my (R) foot. I was unable to keep my great toe raised (or unable to keep him from pressing it down), like I could do on the left (L) side. The ligament was the culprit. This is not crucial strength, not as critical a problem as ‘foot drop‘. He also told me that the L5 problem doesn’t fully explain all of the symptoms I reported to him. He asked if I had FM and I confirmed that I did. He felt that I was NOT a good candidate for the Percutaneous Disc Decompression, because the disc was not the problem here, the ligament was. He also felt that surgery to decompress the ligament would provide only about 30% pain relief. He shared that if he was in my position, he would have the surgery if only to get the 30% relief and to regain toe strength. He warned against lumbar fusion surgery because it sometimes doesn’t provide the pain relief people need and can cause more pain than before.

He wanted me to get a second opinion, so he gave me a referral to another spine surgeon connected to Johns Hopkins.

I went to see Dr. K in early January. He was more concerned about my cervical (neck) condition than my lumbar condition and felt that I should have surgery ASAP to prevent paralysis should I be in another automobile accident. It was time to LISTEN and ACT: TWO DIFFERENT MDs, who don’t know each other said almost exactly the same thing about my cervical spine within months of each other. I made arrangements to have the surgery at the beginning of February 2013. The day after surgery the pain was GONE!

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Pain Management for Sciatica, or lack thereof…

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Part 2. Thirdly was chiropractic. I was in an enormous amount of pain by July 2012, was walking with a cane and was taking a lot of medication for pain between the FM and the SCI. Two-three days per week, I drove in the opposite direction from home in rush hour traffic, to be ‘tortured’ by the chiropractor (CHIRO). Dr. B. is a very nice woman and a very good DC (doctor of chiropractic), but she was not gentle with her adjustments and most of the time her treatments hurt like hell. Sometimes, they created even more pain than I had been experiencing and I got several bruises out of it, too. The bruising she warned me about, and I already had the problem naturally—which was worsened by the LYRICA (a listed side effect)—so that was less of an issue. She did however, provide me with TENS and heat treatment, which helped after the adjustments were over or to warm and loosen up my back and hips before the adjustments.

I do not want to scare people away from chiropractic. It works for many musculoskeletal and other issues, it just did not help me with the SCI.

Fourthly, I tried lumbar injections from an anesthesiologist. I returned to Dr. H., who had given me epidural injections for my neck in February-March 2012, which worked very well. He told me that my back issues were causing my SCI, but I didn’t believe him and felt that they were separate issues. This is a case of “not being able to see the forest for the trees” for me. As it turns out, what he said is absolutely true. I didn’t and couldn’t understand (despite my nursing background) that this was all connected.  You’ll see…

Between the third week of September and early November, I received a total of seven (7) injections in my lumbar area, none of which afforded me any lasting pain relief. Here and there, I got 4-7 days and once up to 10 days of relief.

Pain Management for Sciatica, or lack thereof…

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Chronic Pain Barbie  Photo: Chronic Pain Barbie

Part 1 of 3. At first, I tried resting—no walking or standing for a while—then applying heat on my lower back, which had previously helped for the back pain itself. A colleague shared that he had been troubled by sciatica (SCI) for over two years–I couldn’t imagine that hell at the time and cringe now when I think of the chronic pain other people endure. He also strongly recommended ice over heat, since a physician recommended it for him and it worked. Heat evidently exacerbates sciatica, making the pain worse! Who knew??

When I left him that day, I went right to the drug store and bought one of their dual function gel packs that can be microwaved for heat or placed in the freezer for at least 1-1/2hrs for ice treatments. I love these packs because they can get very, very cold when left in the freezer for between four and eight hours, and they come with a pouch so that the pack can be worn around your body—under your clothing, if need be. It made a big difference over the long run and I rely heavily on ice now for relief, although heat has its place, too.

I began taking a separate cooler to work, just for ice packs! Ice is HEAVY (which I packed around the gel packs to keep them as cold as possible over the course of my workday) and so are the gel packs! I wore a gel pack to work and when it started to equalize with my body temp, I would take it off (I know that this is much longer than the recommended 20 minutes on/20 minutes off, but it provided relief for me). When I left work for the day, I would replace it with the ‘cooler’ gel pack. Unfortunately, the ice packs weren’t able to keep the gel pack frozen, which is the ideal, but ‘very cold’ is better than nothing, so I dealt with it.

Secondly, I had been telling Ms. F, my acupuncturist about this and she treated it as best as she could over three or four months, even up to the use of Battlefield Acupuncture (Battlefield) in my ears [insert a photo of the points in your ear here]. That was the last treatment she had to offer me for this and it didn’t work for me–not for this particular problem (I did have success with it for something else 1-1/2yrs later). My best friend had been trying to get me to go and see the chiropractor she was currently seeing for back pain. I told the acupuncturist (to whom my best friend also referred me) about my plans and she agreed that it was time for me to try something more aggressive.

I had also been getting massages to deal with it since January, when it seemed to begin. They didn’t help as much as I had hoped. Not for this.

If you’ve had sciatica, what has worked for your pain managment?

Photo Credits: Deborah Leigh (Migraine Chick) Chronic Pain Barbie

Chronic Pain Barbie

Menopause-brain and Fibromyalgia-brain

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Are they the same thing?’ I don´t know. They happened to me at about the same time—menopause and fibromyalgia (FM). There are some other terms for the forgetfulness for things you KNOW you know, like your best friend´s name, the correct name of an object you´re holding onto or pointing to, but can´t think of to save your life! You might end up calling a pen a ‘pointer’ because that´s the first thing that came to mind—WRONG—but not entirely. It stll begins with the letter ´p´.

Another example is something that sounds like the thing you can´t remember the name of, like ‘bill’ for pill. Or maybe it has a similar function, like paper towel and tissue—they both clean up something, but, well, you know. There may be other versions of this ‘disorder,’ but those are the only examples I can think of at this time. Let me know if you’ve experienced something similar.

You may also forget to do things you’ve been planning to do for days or weeks and may have even gone so far as to place stickeys around the house or set reminders on your computer or phone and then, FORGET to do it. HOW did that happen? you think.

I know my symptoms still happen occasionally, but were significantly reduced by the introduction of HRT. It made a significant difference in a number of my menopause-related symptoms, such as ‘menofog’.

I made the fibromyalgia-brain connection between articles I was reading or education I was having at the time (in grad school) or attending a psychiatric nursing conference.

Pain as a moving target.

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THIS is a tricky one. My experience with this, especially as it pertains to the FM, is that the pain kept changing. It changed in quantity (scale of 1-10; quality—burning itching, stabbing, aching, pinching, dull, sharp, etc.; frequency—how often I had that type of pain; how often I had any pain at all, and finally the location of the pain. For more information on Fibromyalgia, see the resources page following the blog.

Some days, all of these things changed a lot or a little. Other days, one or two qualities (of the things listed above) would change. I never knew what to expect. It became a real problem when acetaminophen TYLENOL ™ or ibuprofen ADVIL ™) no longer worked on their own and I had to seek stronger pain medication.

My PCP referred me on to a rheumatologist for management of my symptoms. The pain then changed again once I got a diagnosis of FM and began taking LYRICA (r). I’d take the ‘starting’ dose for three weeks. During that time, I had to wait for seven days for the medication to do its job (can you spell T-O-R-T-U-R-E?), get relief for 7-10 days and then the pain would return, seemingly stronger than before. I would have a follow up appointment at the end of the three weeks to see my rheumatologist, who would then increase the dose by 50mgs or so and then the pain management cycle written above would repeat itself. This took about three months.

I went through this until the maximum dosage was prescribed, which is 400mg per day. I couldn´t tolerate that, meaning it doped me up so badly that I couldn´t function. I had to function at a very high level at my NEW job. BE CAREFUL!! Make certain you can function within the limitations that these pain medications create. You don’t want to hurt yourself or anyone else while ‘operating heavy machinery,’ as the medication pharmacy packaging cautions.

I reduced the LYRICA ™by 100mg with my rheumatologist’s approval. Let me iterate here that I don’t shy away from telling my healthcare providers that I am a registered nurse. It lets them know that I am not medically ignorant, that I’m paying attention to what they’re doing and that I may question what they’re doing. On the other hand, sometimes I have to remind them that, while I am an RN, I am their patient—first and a nurse secondarily. In other words, “Tell me what I need to know even if you think I may know it.”

During the time we were searching for the ‘magic’ dose, I told him that the pain really never went away. He told me something very profound at that point that cut me to my core, but is a reality of pain management, for FM anyway, “The goal is pain reduction at a level you can live with, not being pain free.” I have since seen that in print somewhere and I cringe internally every time I think about it.

How Did I Get Here?

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What happens when the nurse becomes the patient?  I’m not talking about when you have a cold or the flu, I’m talking about chronic illnesses or conditions that seemingly keep you locked into this role for months or years.

You have to try to remember to do all of the things you teach your patients to do and learn how to do some new things.  Like, being patient, listening to and following instructions, acting as your own advocate (unless you have someone who can act on your behalf or advise you), asking questions and, of course, keeping your spirits up and doing whatever you have to do to get better!

Read on and find out what I’ve been going through in this role and learn something from my experiences.