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A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 14927
Experience:  Board Certified NP, MS, RN. Private practice & hospitalist
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Since April 2012, I have been on 6 10/325 Norcos a day, through

Customer Question

Since April 2012, I have been on 6 10/325 Norcos a day, through my pain management doc, for bulging and torn discs (L4, L5, and L6), along with severe sciatic pain. I've had 4 epidural steroid injections and a nerve block, but most times he can't get all of the medicine in, due to the swelling around these discs. He even told me i have the most delicate back he's ever worked on, so he knows the pain i am in. Without the medication, i cannot function in my daily life, due to the pain. I go in each month for a check-up, and to get my refill. He's tried me on other meds, such as Methadone, Diluadid (?), ER Morphine, and the Fentanyl patch. So far, what works best for me is the Norco, so I can take it as needed, because I don't want any long-acting, sustained medications in my system. When I went for my appt in March, he cut me back to 5, then in April to 4, then with my May appt, down to 3. He said the reason he was doing this was because the DEA has new regulations, and by law, he is not allowed to prescribe more than 100 pills a month, or they will shut his practice down. I've been doing some research, but can't find any information on this subject. Three pills a day is not providing enough relief, and I do not want to go back on the Fentanyl patch he had me on before, it was just too strong for me. I work full-time, and am a mother of 5. I just need to be able to get through my day with minimal pain, and not become dependent on a patch which is 80 times more potent than morphine. Help!
Submitted: 1 year ago.
Category: Health
Expert:  A. Schuyler, NP replied 1 year ago.

Hello,

Answers provided are for informational use only and do not confer patient-provider relationship. My name is XXXXX XXXXX I do whatever I can to try to help you,

 

Six tablets of Norco 10/325 per day is the maximum dose. I am curious as to why the back has not been repaired surgically to eliminate the pain. Is there some reason you cannot have surgery?

 

Looking forward to hearing from you,

 

Schuyler

 

Customer: replied 1 year ago.
My pain management doctor is trying to avoid surgery, and only as a last result. He has given me four epidural spinal injections, as well as a nerve block. I've even requested having the nerve burned, as I've heard other people have had done, but my doctor told me the nerve causing the pain is a motor, not sensory, nerve, or he would have already done that. The nerve also causes tingling and numbness, all the way to my toes. I do not believe my back pain will decrease, since I also have degenerative disc disease and osteoarthritis in my lower back, which was diagnosed 14 years ago. It is very difficult just to make it through each day.
Expert:  A. Schuyler, NP replied 1 year ago.

Goodness, I am so sorry to hear you're having all this trouble and at such a young age.

 

Conservative treatment for bulging and herniated disks can usually be tried for even as much as 6-12 months, although if it is going to be effective, the back is usually better much sooner than that. But when it isn't getting any better, you have reached that place of last resort, and it is time for surgery.

 

I would suggest a consultation with a neurosurgeon. The sciatic pain is from compression of the nerves where they exist the spinal cord in the lumbar region. The swelling from the bulging disks puts pressure on the nerves causing pain and can even result in loss of function so that the limb collapses under you. People will have numbness and tingling in their legs as well as pain. The exact area where the pain is felt depends on exactly where the nerve is being compressed as it leaves the spine.

 

There is a copy of a dermatome map in the following link. You can see the areas of the body that are covered by L3, L4, L5. These are the possible areas where you would have pain and numbness. http://www.apparelyzed.com/dermatome.html

 

There is no regulation from the DEA that tells you how many tablets you can prescribe per month of a medication for any individual patient. We do know that 6 tablets per day is the recommended maximum for 10/325 hydrocodone/acetaminophen (Norco).

 

Any prudent provider will know what is too much. That is why we all take pharmacology courses. The DEA does look at overall prescribing practice and why the medication is prescribed. Of all providers, pain management is given the most leeway. I don't know, but I expect that your pain management provider realizes that conservative treatment has not worked, and that just continuing narcotic pain relievers is the only thing that he is doing without your getting any better. He is trying to wean you from 6 tablets per day to fewer than that. A neurosurgeon will be able to tell you if surgery will elimiate the underlying cause of the pain so you can get along with your life pain-free.

 

Please let me know if you have questions.

 

 

Kind regards,

 

Schuyler

 

 

A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 14927
Experience: Board Certified NP, MS, RN. Private practice & hospitalist
A. Schuyler, NP and 9 other Health Specialists are ready to help you
Customer: replied 1 year ago.
Thank you so much for the information. My doctor had told me he was no longer allowed to prescribe more than 100 pills per month because of new DEA regulations, or his practice would lose its license. Sounds like I'll need to have a heart to heart with him at my June appt, and discuss surgical alternatives, especially since I've read that repeated epidural steroid injections can further weaken bone tissue, and since I do experience issues with my leg buckling under when walking.
Expert:  A. Schuyler, NP replied 1 year ago.

I'm glad you are willing to discuss surgery, but if pain management isn't forthcoming on the issue, I'd still consult a neurosurgeon on my own. It isn't as risky a procedure as it used to be and most people do get relief from chronic debilitating pain.

 

We will only give steroid injections every 3 months for just the reasons you mentioned. You're too young and active to have to put spinal disk problems as the top priority in your life. Best to get the problem fixed and move on so you can enjoy those kids!

 

Thanks so much for the accept and the generous bonus.

 

Best of luck to you. If you have questions in the future, we are always here to help.

 

All the best to you and your family,

 

Schuyler

 

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A. Schuyler, NP
A. Schuyler, NP
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14927 Satisfied Customers
Board Certified NP, MS, RN. Private practice & hospitalist