Jim Jacobson, a 42-year-old salesman in Orange County, spent most of his days driving from appointment to appointment and evenings spending time with his kids usually doing sports. A former college athlete, Jim excelled in many sports and was an avid basketball player not only in college, but on the weekends as well.
Over the last several years, he noticed increasing back pain that originally was better with ice and anti-inflammatories, but his low back pain began to become more and more of a daily issue. Seeing his family practice physician, he was prescribed Vicodin for when the pain was severe and also given oral anti-inflammatories to take on a daily basis.
After several months, Jim realized that he needed the Vicodin in increasing frequency and increasing doses. His primary care physician complied with this, and after 1 year of using the Vicodin, he was now taking 6 per day, had poor sleep, increased irritability, and essentially no benefit from the pain medications.
When Jim was seen in our office, we explained the limitations of oral narcotics and how in some cases using increased doses of pain killers can actually make the pain worse, a phenomenon that is called opioid-induced hyperalgesia.
Jim did not understand exactly what those words meant, but he did know that his current approach to treating his pain was not working well at all. An MRI was performed, and he was found to have in addition to some degeneration his lumbar disks also some significant arthritis in the facet joints in the low back as well. He underwent fluoroscopically guided facet injections and obtained significant immediate relief. This relief lasted several weeks, and when the relief subsided, he underwent a minimally invasive procedure called radiofrequency thermocoagulation. An RFTC is a minimally invasive procedure that deadens the pain nerve that goes to the facet joint. Following this, the patient was able to wean off all of his opioid medications and is now back to playing basketball on the weekends and driving daily for his work.
He still has twinges of pain, but with rest and ice, he is able to mitigate the symptoms, and most importantly he learned a valuable lesson as to the pitfalls of narcotic medication.