Writhing in pain, nothing helps. What to do ...
February 7, 2017 5:43 PM   Subscribe

Typing this in fits and bursts, as I am literally writhing in pain. In short, I have severe sciatic pain in my right leg. Worst pain is in my right foot, which feels as if it's in a vice that has been heated with a blowtorch. YANMD, but need suggestions on how to get through the night. Complications = no RX pain meds available.

I'm a 56 yo male. After 2 back surgeries in 2 years which have failed to correct the sciatic pain, I'm approved for a spinal cord stimulator (SCS) implant. It's been a 8-month-long process at a well-known pain clinic in Boston, but the reality of it is, I'm still a month away from even the trial run of the SCS.
The foot pain is constant, agonizing and, if that is not enough, has really ramped up in the past few days, to the point where it is difficult to walk for more than a few minutes at a time. Leg and lower back pain are tolerable, most likely because they pale in comparison to the foot pain.
Other treatments besides surgery (fusion at L5-S1, and a laminectomy at same level) have included epidural injections, drugs like gabapentin and Lyrica, and several bouts of PT; all have failed to lessen the foot and leg pain. I've used opioids when things are at their worst, but we're talking 5 or 10 mg of oxycodone at a time, and even then, only to help me sleep. I've also used CBD oil orally, and occasionally smoked an MJ strain high in THC and TBD. The latter (CBD oil & smoking) has usually been enough to take the edge off and let me relax. However, since Sunday night that has not been the case.
I also have Rx lidocaine gel for topical use and ice. Both provide temp relief but the rebound pain afterwards gets very burn-like and unpleasant.
Thus far this evening, I've had some CBD-infused tea and smoked a few hits of MJ with no pain-dampening effect. I'm loathe to do more, as I've found from experience that there seems to be a fine line between smoking enough for relief and smoking enough to make me hyper-aware of the pain and, consequently, even more miserable.
I've used the last of my 5 mg oxy capsules and doubt I'll be able to get more. The pain clinic's policy has been to NOT prescribe opiates for pain. They've told me to go to the ER if the pain gets unbearable. (Shortly before Xmas, I did go to the ER one particularly bad night; the doc there took pity on me and prescribed me 20 5mg oxy capsules. But she told me I probably should not come back as "the ER is not the place to treat chronic pain." Duh.)
Bottom line: I need to get through tonight. I hope to touch base with my GP in the morning, but I'm practically in tears as I type this. I'm pretty stoic, but this is breaking me. I've been dealing with this for too long and I'm physically and emotionally exhausted.
Ideas? Encouragement? Should I just give in and go (back) to the ER?
posted by jrchaplin to Health & Fitness (10 answers total) 2 users marked this as a favorite
Should I just give in and go (back) to the ER?

IANYD, but what you're describing is an emergency
posted by philip-random at 5:53 PM on February 7, 2017 [13 favorites]

the ER is not the place to treat chronic pain

True, but you're not looking for it to be your permanent solution. You're trying to get through the next month. Go to the ER.
posted by The corpse in the library at 5:55 PM on February 7, 2017 [5 favorites]

Print out this question and bring it to the ER.
posted by Dashy at 5:55 PM on February 7, 2017 [1 favorite]

Hi, I used to do public health research in emergency care settings. This internal struggle you're having--should I or shouldn't I go to the ER?--is one of the most commonly reported reasons peoples' conditions graduate from being "urgent" to "genuinely an emergency." If you need permission from someone to ignore this nagging worry, you have it from me! If you can get yourself to the ER, or if someone else can get you there, tell the intake desk and any physician you see just what you said above:

The pain clinic told me to go to the ER if the pain gets unbearable. IT IS UNBEARABLE.
posted by late afternoon dreaming hotel at 6:13 PM on February 7, 2017 [21 favorites]

I can't comment on your specific case, but here are some commonly accepted guidelines for best practices on treating chronic pain exacerbations in the emergency department. This can help to set expectations for a typical ER visit.

you're not looking for it to be your permanent solution. You're trying to get through the next month. Go to the ER.

As regards to this, ER doctors, in most cases, should not be giving a monthlong solution to chronic pain either, nor should we be expected to give refills of narcotics if a narcotic prescription runs out early before it is due to be refilled - that can become extremely problematic. However, we can help to find pain solutions (such as non-narcotic medications) during an acute episode that could help a person get to their next opportunity to urgently see the physician who manages their pain medications.
posted by treehorn+bunny at 7:56 PM on February 7, 2017 [1 favorite]

After you get help tonight, If they haven't already you could look into getting tested for a leg length discrepancy. It can aggravate and sometimes even cause sciatica.
posted by Requiax at 8:06 PM on February 7, 2017

I have had a laminectomy and a fusion (L4-L5). Turns out I am about your age too. The fusion actually helped me for a long while, but that fusion put pressure on the L5-S1 disc and here I am dealing with chronic pain again. I have been in your situation.

This is what I did: I did not go to the emergency room. I cannot refute the good advice you are getting here to go, but I just felt that by the time I got there, was seen and the medication given, it would be close to morning. I felt that if I was going to suffer, I would suffer at home where I was used to suffering. (Strange thing to write.) What I did was first take two tylenol PM to help me sleep. I then iced my back and leg for about a half an hour. Then, after a half an hour of lying on my back with a pillow/wedge under my knees and calves. I took the hottest bath I could stand for a half an hour. Then, I literally crawled to the edge of my bed, said a prayer asking to make it through the night and got into bed with the legs elevated, a hot wash cloth on my forehead and the lights out. I must have lay there for at least 45 minutes before I dosed off. I woke up at about 6:30am in a sweat, but since there was no burning in my toes and no sharp pain in my leg, I stayed in that position for an hour before getting ice to ice my back and foot. Then I drove myself to the surgeon's office that did the fusion and begged for mercy. I had an epidural and a script for Vicodin (5/325).

It sucked. My opinion is that this is going to be a shitty night for you no matter where you go or what you do. Sorry.

If it were me, I would stay home and ice then a hot bath then prayer and sleep. (Btw, I am not religious at all. I guess there are no atheists in a pain situation.)

One other thing, Before my divorce and a move to a much smaller place, I had an inversion table. Hanging upside down really relieved the pressure on my back. If you don't have a heart issue too, I highly recommend it.
posted by AugustWest at 8:58 PM on February 7, 2017 [2 favorites]

I'm sorry you have to go through all this.

I've had back pain bad enough to keep me from sleeping, but nowhere near as bad as you.

In case it's any help though, this book helped me and you can download it, read a chapter and try some things right now (I have no connection to the author any such):

posted by DrumsIntheDeep at 9:46 PM on February 7, 2017

I have sciatica too, and you really have my sympathies. Poor jrchaplin! God damn.

If this pain is something new and you are literally writhing, we may be looking at an actual emergency here. If this is something you've been coping with for a while and your doctor knows about it then it may not be anything dangerous, but even so nobody should have to suffer like this. A few times in the last few years I had pain that sent me to the ER, and nothing helped but morphine. But it REALLY helped, it was like being lifted out of hell and taken up to some nice, numb purgatory. If you are in unbearable agony, something can be done. Know that.

If you have any topical pain killers, slather those on. Try to find a position you can bear, one that relaxes everything. Try lying on your side with a pillow between your knees, try lying on your back with a pillow under your legs, all the classics. Maybe watch something distracting, or soothing, whichever feels most appropriate. Remind yourself that you will not always feel like you do now, THIS WILL PASS, then try to clear your mind and sleep. Don't tell yourself to relax. Just STOP THINKING, make your mind go black. Your brain is not a brain, it is a warm, dull stone in your head.

But if your pain is unbearable, go to the ER!
posted by Ursula Hitler at 11:07 PM on February 7, 2017 [1 favorite]

Yes, ER is called for in this situation. My dad had trigeminal neuralgia several years back and his pain became unbearable/uncontrollable right before his scheduled surgery. We took him in a few days early, and they were able to put him on a morphine drip to get things calmed down enough for the usual meds to work better. There are plenty of things that can be done for uncontrolled nerve pain there. GO. And let us know how you are faring. Best of luck.
posted by jhope71 at 10:06 AM on February 8, 2017 [1 favorite]

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