I got an amazing email yesterday. I have an overseas client that I've been working with for almost 2 years. He was more severely disabled than anyone I've ever worked with. He had a long litany of surgeries that includes 4 fusion and 1 ADR surgeries. Almost 100% bedridden, the most basic functioning was a huge struggle. This has gone on for years.
As a last ditch effort before undergoing C2-S1 fusion, he went into a new type of pain management program that is designed for patients with long standing chronic pain, or 'memory pain'. The theory is that years of chronic pain develops into a pain disorder and that the inability to disconnect the patient from his 'memory pain' leaves him with the pain disorder, regardless of the status of the pain generators. The patient underwent several weeks of inpatient treatment that starts with a week of a cocktail that includes very high dose opiates and high dose AD's (Cymbalta). After a week of disconnecting you from your 'memory pain', the next few weeks include ramping down on the medications and ramping up on activities and PT.
After 3 weeks he was released from the hospital, mostly pain free. I spoke to him today... now 3 months out. Before therapy, he was in bed 22 hours a day. Now he's riding a bike 10km/day and walking more than an hour day and is pain free and functioning normally. He's still taking low dose meds and will be tapering off of them over the weeks/months to come.
This case has nothing to do with the question at hand except for the coincidence that Cymbalta is one of the drugs of choice at this clinic for dealing with this type of pain disorder. It's an AD that has been found to be VERY helpful for chronic pain as well as depression that is so common in chronic pain patients. There are so many things that we don't understand about the way some drugs work, but off-label use for Neurontin was very important for me in dealing with severe nerve pain. AD's were also very important to me in helping me to cope with years of chronic pain. Side-effects and benefits of these drugs are different for everyone and in many cases, there is experimentation to find the right combination via a 'hit and miss' strategy.
It sucks needing meds... but when we get to a point where our lives are dominated by our spine and chronic pain problems, these meds can be a pathway to a more functional life for many of us.
All the best,
Mark
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