Question
I am a RN, I sustained a low back injury @ L5-S1 in 2008. I have been thru the gauntlet of surgeries, procedures, and injections to try to live a more "normal" life. I have a Medtronic spinal cord stimulator with 2 percutaneous leads. The stim unit only worked for a year and a half, since then it only gave error messages and wouldn't charge or run. I am in the process of scheduling removal surgery. The pain in the area where the doctor left a large coil of wires is causing unbearable pain a lot. It feels like a large drill bit that is on fire is drilling into my spine. Lido patches help, as well as my oral medication regime.

On the most current X-ray, the coil of wires looks very different, it has a sharp point visible in the wires now. Do you think it is possible that during a fall I had the leads pinched together and have been shorting out and causing this increased pain and torment?

I am praying that having it removed will restore me to the chronic pain I will live with since I caught a falling patient and injured it 5 years ago.

One more thing. I take exalgo, and norco for breakthrough pain. I have heard that a long acting form of norco is going to be available soon. When do you foresee it hitting the market, and will it be as effective as the short acting version?

Thanks for your time!

Amy

Answer
On the most current X-ray, the coil of wires looks very different, it has a sharp point visible in the wires now. Do you think it is possible that during a fall I had the leads pinched together and have been shorting out and causing this increased pain and torment?

***You said that the stim unit is unable to charge (presumably since mid 2010?) - if that is the case there is no remaining energy to short across the wires.  If the fall and the damage to the coil of wires that you describe are to blame for the increased pain you are suffering it will be because of the interaction they have with the surrounding nerve tissue not with each other.

One more thing. I take exalgo, and norco for breakthrough pain. I have heard that a long acting form of norco is going to be available soon. When do you foresee it hitting the market, and will it be as effective as the short acting version?

***You already have a long acting medication - the norco that you are using is supposed to be short acting.  Exalgo is a potent Schedule 2 extended release pain reliever and it is unlikely you will be able to replace it with a long acting hydrocodone formulation if and when one comes to market.  IF the Exalgo is not dealing with your pain it probably means you need a higher dose.  Ideally you should NEVER have to take all of your breakthrough pain in a given month (or day for that matter) if you do your basal (or long acting) pain medication needs to be higher.  Fentanyl patches are good options for chronic pain because they last for so long.

Best of Luck
Dr. Cappuccilli