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  • TammyFP
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    Hello, I have a reversal of c-spine curve that shows on both an MRI & CT that were done 4 yrs apart. I had severe neck pain with a herniated disc at c6-7 during my 20’s. I underwent a battery of facet blocks, injections with a long needle (positioned under x-ray) through the front of my neck/throat as well as c-spine epidurals, occipital nerve & other trigger point injections & years of physical therapy that included iontophoresis, ultra sound, heat, stretching, traction & exercises. I became pain free for about a year & a half then I was in a horrific mva (t-boned) that blew out my SI joint & caused bulging disc at l4-5 & l5-6 which resolved after 6 months of PT. My SI, however, kept slipping out periodically after, initially, healing so I had SI nerve blocks done with PT for another 3 months a year after it, initially resolved. I had two more serious (total loss) mva’s after being t-boned in 2005. One in 2008 & another in 2012. The one in 2008 took out the bottom of my vehicle & from that moment on the pain in my left foot (which I had previously after being t-boned but it stopped after the discs resolved) never left/stopped. The accident in 2012 was another total loss (of my vehicle) when I was hit from behind by a truck while I was stopped at a red light. With that accident my seatbelt broke one of my “true ribs” on the left side. When I went to ER the doctor told me that my SI joint was “bone on bone.” I had just moved & hadn’t set up a primary doctor or anything &, since the accident happened 2 wks to the day after relocating – the ER was my only doctor. When I went in the day of the wreck I presented with severe headache & lower back/leg pain. The idiots at the ER only x-rayed my low back (that when I was told SI bone on bone) but they didn’t x-ray my neck or do any study for headache. After having had recurrent kidney stones/infections in left kidney prior to relocating, when I was having severe pain in mid-back on left side I went to ER thinking it was my kidney. I told them to x-ray my neck because I was still having severe headaches. They x-rayed my t-spine & found broken rib but didn’t x-ray c-spine so I went back 2 days later with headache, they x-ray c-spine & told me it was “clear.” By this time I had a doctor who referred me to a pain clinic. That doc ordered an MRI of my c & t-spine. The c-spine showed the abnormal curvature (that my chiropractor found back in 2005 after my t-bone accident) as well as some issues with my t-spine. Although I had told the pain doctor I had severe low back, left leg & foot pain he didn’t order the l-spine to be scanned when he ordered MRI of c & t-spine. Since it took 3 ER visits to get my entire spine x-rayed & then the MRI was ordered, my PIP from auto insurance was exhausted, which prevented me from getting any PT (I didn’t have private insurance at that time). So I was given narcotic pain relievers until I got on medicaid & went to a doctor requesting subutex to get off the oxy. Well, I got off subutex after a couple months, but y low back/si joint pain, leg & foot pain continued off & on causing me to go on & off oxy for years. My neck hadn’t been giving me much problem (at least none that I could feel through the oxycodone). That is, until I fell this past July, hitting my head & jacking up my already messed up neck again. I have been off work for 3 months on medical leave. I fell at home so it’s not a work related nor an auto related injury. Since I hadn’t had any issues for several years concerning neck pain & have been treated for low back sciatic pain only the ER ordered a CT of my head & neck when I went to ER after my fall. The CT showed the abnormal curvature that the MRI in 2012 showed. The CT, also, noted a moderate right c2-c3 & c5-c6 facet degeneration. It showed a moderate anterior disc space degeneration at c6-c7 as well (which is where I had the herniation/facet issues back in my 20’s (1990’s) but had resolved. I have been on oxycodone, fentanyl patches, oxymorphone, oxycontin & such so long that my tolerance was through the roof. I was anticipating getting one of those neuro-stimulator implants in my low back prior to my fall, but found out that doesn’t resolve low back & sciatic pain entirely anyway. I wanted to pursue getting the I-Fuse implant to fix my SI joint because that bone on bone contact is continually causing me to not be able to bear weight & because I can’t walk swiftly or slowly for very long due to the bone slipping and grinding as well as my foot killing me I have gone from 120 to 180 pounds since 2008’s accident. I am a train wreck & because of my opioid tolerance I got back on the subutex along with a butrans patch (same drug, I know) & have undergone more trigger point injections at occipital nerves & shoulders again. I want to know what I can do to permanently fix my lower back/si joint as well as my c-spine problems so that I can be done with the “chronic pain” management doctors, narcotics (subutex/butrans isn’t controlling pain as well as opioids – only stopping withdrawals) & injections. I want to be done with this drama. I’m only 48 yo & I have at least 20 years of working left in my life & I’m tired of not being able to perform adl’s on regular basis/being on medical leave from the first job I’ve had since 2012 accident. I’m too young to live the rest of my life in “chronic pain clinic” where they NEVER prescribe strong enough or large enough quantity to keep me out of pain from one month to the next. My tolerance is too high & it freaks the doctors out to prescribe what my tolerance requires to keep me out of pain – that’s no way to live. I want a solution. I’m tired of band-aids. Please help me.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8660

    You have made a mention of a number of things I would like to address. First comment “When I went to ER the doctor told me that my SI joint was “bone on bone”, this is difficult to interpret on an X-ray and the ER is probably not the place to make that diagnosis. SI joints rarely cause pain (3-6%).

    “The CT showed the abnormal curvature that the MRI in 2012 showed. The CT, also, noted a moderate right c2-c3 & c5-c6 facet degeneration. It showed a moderate anterior disc space degeneration at c6-c7 as well (which is where I had the herniation/facet issues back in my 20’s (1990’s) but had resolved”. Neck pain can occur from a number of structures including the facets, discs, instability and even nerve compression. The reversal of the normal lordosis may be a factor but there are many patients I have with reversals and no pain. You need a careful step by step evaluation of your neck.

    You note; “I have been on oxycodone, fentanyl patches, oxymorphone, oxycontin & such so long that my tolerance was through the roof, too young to live the rest of my life in “chronic pain clinic” where they NEVER prescribe strong enough or large enough quantity to keep me out of pain from one month to the next. My tolerance is too high & it freaks the doctors out to prescribe what my tolerance requires to keep me out of pain”.

    Unfortunately, you are habituated to narcotics and this is a real problem and hurtle for treatment. Chronic high dose narcotics changes pain perception and sensitizes the brain to pain over some months to years. You will need to get off narcotics to get to the real sources of your pain. This will be the biggest challenge to you as the side effects of withdrawal initially hypersensitive the brain and body to pain so you think initially you are going in the wrong direction. It can take as much as three months to get off and the withdrawal symptoms will make you think I am crazy for suggesting that you get off these medications.

    Unfortunately, your “being on medical leave from the first job I’ve had since 2012 accident” also intensifies this dilemma as you have no co-workers to help you and little direction without demands that working responsibilities entail. I would first see if you can get into a rehab program and substitute other non-narcotic mediations for the narcotics. You will need a schedule to follow to get of these medications and a support group of therapists to help with the hard times.

    Once off narcotics, you can then go through a work-up program of SNRBs, possible facet blocks and maybe even discograms to determine your pain generators (of course along with a thorough physical examination). A surgical plan then can be generated.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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