Question
I am a 33 yr old woman who was in a car accident in 2005 and had 2 back surgeries the next year. My last was a lumbar L4-L5 fusion. I never really got a ton of relief after surgery and now I am in so much pain all the time I don't know what to do. I have been in pain management for about 5 years now and have been on more pills in that time than most people take in a lifetime. I have also had treatments such as...radio frequency , steroid injections, and the most recent prolo therapy injections done with my plasma. Nothing seems to work and I'm on 25 mcg Fentynl patches and Percocet 10/325 as needed for breakthrough pain. It is cold and rainy right now in Georgia and I have been almost in tears at night because this deep knawing back pain is keeping me up. I am up still and it is 5am right now and I haven't been to sleep yet. I am so tired but the pain keeps me up through all medication that would knock a grown man out. My recent MRI showed disc degeneration and arthritis around the fusion area. I was just wondering if you might suggest something new for me to try is there possibly a surgery to correct a bad fusion? My pain doctor thinks that the area where the screws were placed just blew out my facet joints. Thanks for any help you can provide.

Answer
I am going to go against the grain of surgeons here and say i do not recomend surgery. Surgeons cut - that is their answer for every problem. You go to a surgeon you end up with surgery.  It is in my experience almost never "better" after second or third surgery in the same region of the body.  More cutting means more scar tissue, more trauma, more recovery time, potential for life threatening infections and so much more.  I would avoid that until there was no other options available to me at all. In my opinion from your description of the pain you are experiencing your basal or "long term" pain relief medication (the fentanyl 25mcg patch) is simply ot strong enough.  First, breakthrough pain should not be a common occurance. Fentanyl patches do a good job for many people it sounds like your dose is simply too low. Second, fentanyl patches are commonly used every 72 hours but it is not uncommon for patienta to need to change them every 2 days - so if ou are having consistent long lasting pain on day three it may be as simple as going to 48hours instead of 72 even at the same dose.  If you pain is recurrent and you are needing to use breakthrough pain medication as frequently as it is allowed by the prescription you fentanyl patch is too week.  You should talk to your doctor about trying a 50mcg patch - have him write a prescriotion for 1 to try it (pharmacies will nt want to break a box of 5 for you so go to a chain drugstore like CVS and complain to the customer service line if they wont help you.  I think increasing you basal pain medication will improve your quality of life in many ways.  Have a discussion with your doctor about how you are suffering.

Best of luck.

Dr. Joshua

If you get a prescription for 1 patch and cannot get it filled contact me and i will see if i can help influence a local pharmacy based on my review and recommendation.

Ps - spelling errors in this answer are a result of me typing on my iPad instead of a real keyboard!