5 weeks today since RFA

[Cindylou]

It's been 5 weeks today since my radiofrequency lumbar ablation. As I am trying to decipher pain levels and relief levels from this procedure, here is my best guess of what is going on with my back currently:

I do believe I am beginning to receive some benefit from the nerve pain relief, but I continue to have so much spasticity and tightness in my mid back, that it is baffling. There has to be some reason (s) why my back is still so "guarded" and "locked up." (still traumatized from latest surgery?) I especially don't understand how I can wake up in the morning and nothing is relieved. Why aren't my back muscles relaxed in my sleep? I just don't get that. Perhaps, you Justin, can offer an explanation on this.

I really don't think (could be wrong) that the gabapentin is helping, other than making me very foggy. Consequently, I did not titrate up another 100 mg to the full 300 mg a day, and will tell the pain management doc this at next visit. I also want to get off it, and will discuss w/ doc too. That leaves just the Oxycodone, 5mg, that I am taking 2 times a day, and Zanaflex, 4 mg (muscle relaxant), 2 times a day, prn, for pain management. The Zanaflex at 4 mg is a low dose I believe, so may ask to up that, as all it is doing presently is making me tired too....not breaking up the tightness. Of course 8 mg will likely make me more tired, but hopefully after an adjustment period, I can get past that. Right?

What I am concerned about for my next pain management appt., is that Oxycodone is a short acting opiate, and I know they want you on a long acting one. I just don't get any relief from the long acting ones. So, if anyone has any suggestions or advice on this, I would really welcome it. I know back spasms and tightness doesn't sound painful, however, I find it very disabling, especially after I do go out to run some errands and am on my feet walking. I always return home before completion of errands and get off my feet and put ice/heat on it. Some days I sit in my chair the remainder of the day after errands.

Now 1 day last week I walked for an hour w/ my neighbor, which felt wonderful. However, I sure paid for it that afternoon and next day. But, keep walking, right? I mostly do 20-30 minutes on the treadmill 3-4 days a week. Sometimes only 2 x a week.

So, right now I am hoping the muscle spasms can get resolved. I think I honestly need weekly massage (acupunture?) for this, if I can swing it $$. Maybe my back muscles "forgot" how to relax?

[ajj1001]

Why don't you try the full prescribed dose of your gabapentin then at least you can tell doc whether it works or not. 300mg is not all that large a dose so your doc might want to increase it further anyway. It does take a few weeks to work and for the side effects to lessen. They might then suggest switching to pregabalin (lyrica) to see if that has any better effect on your nerves. Getting the right medications will help your body to relax and thus your muscles to have a rest.

[Katie]

"Maybe my back muscles "forgot" how to relax?"

I think you may have hit the nail on the head with this one. I've often asked my Chiropractor why we need repeated treatments and he said a similar thing,that the muscles have a memory for the way they've been for a long time, and it takes a while to reprogram them. My back is almost always tight in the morning and I have a top of the line mattress with a memory foam on top. When we travel, the muscle spasms are almost unbearable because of sleeping on a strange bed.

Have you tried a chiropractor much, more for muscle release, which is what I'm having done now, rather than joint manipulation? Of course, a massage may do just as well, but the chiro is cheaper for what I'm having done. I also found accupuncture to do wonders, but the best I've found is over an hour's drive away, so the trip home ruins any benefit from that.

Keep at it, my friend. You will find a way through this misery.

[Justin]

Hi CL,

It's great to hear that the RF ablation is giving you some relief. In terms of the muscle tightness in your mid-back (thoracic spine), it is probably related to compensation for your altered lumbar spine mechanics. This is especially true if you have weak abdominal muscles. The best intervention I have personally found is massage therapy to "release and break through" the fibrotic tissue. I have also found Osteopathic techniques (muscle energy, soft tissue work, etc.) helpful. Unfortunately, a lot of these fibrotic tissues take a long time to work through, as they are used to being tight and easily stay in that "familiar" state.

A warm bath followed by stretching is also very helpful.

I hope you see continued relief from your radiofrequency ablation.
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[Cindylou]

Thank-you for the replies you guys. Alison, that was a good idea, to at least go up to the full 300 mg of the gabapentin to see if it will help. Of course, it's 2:25 a.m., and I have been up since 4:15 a.m., so almost up 24 hours, and I am not tired in the slightest.....don't know if that is a side effect of gabapentin, but will look into it.

Katie, I have not even considered a chiropractor because my understanding from Dr. Bertagnoli was that was a big no-no after lumbar adr surgery. However, you mentioned muscle release, for a chiropractor, so possibly I could investigate that. I really liked the massage therapist I had a week ago, as he seemed very educated and knowledgeable about myofascial massage and release, which I think my body needs. And it was probably one of the best massages I have ever had in my life. If I could afford it even twice a week I would do it. I am not sure of the long term benefit I am getting from it, by going once every 4th week, you know? (which I haven't hardly even done that)

Justin, yes, I think from what you said then....my muscles have forgotten how to get in a relaxed state. (they are staying in that familiar, tight state, absolutely) I am just so discouraged as I was really hoping I would be feeling really good by now. I feel like I just need someone to follow me around and make me stretch more, and make me walk more, and drag me to that therapy pool more regularly. Discouragement does beget more discouragement.

Is it possible to get on some kind of steroid pack to reduce my inflammation and give me a break from the pain? Maybe I need to get my meds upped somehow, if my pain management clinic will cooperate, so I can feel better and hence, want to move more. Sorry. I am just thinking out loud. Days like this I am just so resigned to the pain, and believe I will never ever really feel good again. Like, this is it. It's never going to get any better,Cindy. And that resignation makes me just not want to wake up one more morning like this. It's been 8 1/2 years. I just don't get why God seems to think I need more of this pain crap. I want to scream, I get. I get it, ok? Now let me feel good. Is that asking too much?

[Katie]

What about a Tens machine or just plain anti-inflammatories like Naproxin, etc? As I said, my chiropractor is much cheaper than the massage therapist, and he works to release the tension in the muscles, with great success.

I've had lots of luck with acupuncture as well, as long as I don't have to drive great distances there and back for treatments. Would any of these be feasible for you?

I am so, so sorry that you are still having to endure the pain. Mornings are often the worst time of day for me, when in the old days before all this garbage, they used to be my favourite.

Have you ever tried posting pictures of your favourite things on mirrors all over the house? How about if I send a picture of our house and village, full of tulips as a reminder of the trip you'll be taking next May? The power of positive thoughts may overcome the dark clouds that are hovering right now. Hang in there, my friend.

[Cindylou]

Thank-you Katie for such a sweet and thoughtful response. Sorry. Sometimes I just have my down days. I think it was from baby-sitting Tully the night before so all my sons and husband could have a guys night out. And go hear some music. Tully weighs 20 pounds now so lifting her over and over is demanding on my spine, even using good body mechanics. She'll be walking soon, so that will help. But I think when the pain flares up after something like this, it can just bum me out and remind me of this long, slow journey trying to get out of pain and back to living and doing.

I would love some pics of your village tho Katie and of your tulip festival. (and yes, even the dates we are locking in for the visit....I forgot to write them in my daytimer)

I did have another myofascial massage last night that was wonderful. This guy is unbelievable. I have had alot of massages over the years, but I think these are the best I have ever received. I try and get the 1 1/2 hour one, because a 30 min or 50 min one doesn't even begin to do the job. I am committed to turning this cycle of pain around as best I can. I still have alot of right hip issues and can't help but wonder if this hip is still putting a huge strain on my back. Don't know. My right hip flexor is extremely tight, even when I try and stretch it.

I meet with pain management tomorrow and am hoping we can increase my pain meds so I can get out and move more. As far as anti-inflammatories go: I have a bad stomach from all my years on Celebrex. It did work wonders on all my inflammation, but kinda messed up my stomach.