Image by Charles Thompson from Pixabay
Let’s Talk About Pain Medication
I get asked a lot of questions about pain meds:
“What medications were you prescribed after surgery?”
“How long did you take pain meds post-op?”
“Is it okay that I’m still taking pain medication at __ weeks?”
First, let me emphasize that I’m NOT a doctor, a medical professional, or any type of expert on this subject. Decisions about medications are very complex and unique to the individual, and they should be made with your doctor. But with that said, I’m happy to share my own experience, as well as a bit of what I’ve picked up from talking to other spinal fusion patients over the years. My intention is not to serve as a reference point or for comparison – it is simply to share the perspective of someone who has been through it.
I want to start with my pre-surgery pain management, because I think the medications we take before surgery can impact our physicians’ decisions about our post-op meds. For instance, if you are on high doses of opioids before your surgery, you may have developed some tolerance, which means that you may require higher doses or stronger narcotics to properly manage your post-op pain. (This is conjecture, not fact.)
In the months leading up to my surgery, I primarily used ibuprofen for pain relief. I took 800 mg 2-3 times a day to manage both pain and inflammation. It worked pretty well, but it wreaked havoc on my stomach (an issue which I’m still dealing with today).
My doctor prescribed hydrocodone, but I only took it once or twice. It made me feel sleepy and sort of woozy, but it didn’t do much to relieve the pain in my hip and back.
Immediately After Surgery
During my 2-day hospital stay, I was given Tylenol and morphine for pain control. I didn’t have a morphine pump in the hospital, but I know other people who did. I was discharged from the hospital with two prescriptions: Robaxin (methocarbamol) and Percocet (oxycodone + acetaminophen). Robaxin is a muscle relaxant and is not a narcotic. Percocet is combination of an opioid (a narcotic) and acetaminophen (Tylenol).
I was prescribed one Percocet every 4 hours. Unfortunately, it seemed to wear off quickly, which left me in significant pain for an hour or two while I waited for my next dose. I tried to stick it out, but after my first few days at home I called my doctor in tears and asked for his help. He said that I couldn’t increase the frequency of my Percocet because it would exceed the maximum daily dosage of acetaminophen. (The FDA warns that exceeding this limit can put patients at risk of severe liver damage and/or allergic reaction.) Instead, he gave me a new prescription for oxycodone with no acetaminophen, which gave me a little more flexibility with my dosing schedule.
People kept telling me to “stay ahead of the pain,” a phrase I’d never heard before. Essentially, this means to take your medication on a schedule (as prescribed). In other words, don’t wait until you feel pain to take it, because the medication doesn’t work instantly, and you’ll first have to wait for it to take effect, which means more pain for you while you wait.
I took this advice to heart, and for the first 2-3 weeks of my recovery, I stuck to a medication schedule. I kept a little notebook next to my bed, where I wrote down each dose. I even set my alarm so that I could take my meds in the middle of the night.
I believe I began weaning myself off of the opioids after about two weeks. At first I started spacing out my doses, supplementing with Tylenol as needed. Next, I stopped taking pain meds in the morning and early afternoon but still used them in the evening and at bedtime (although no longer on a schedule). Eventually I was only taking oxycodone before bed, and this continued until maybe about 6-8 weeks post-op. I continued taking Robaxin regularly during this time and in the following months.
I didn’t have a hard time stopping my pain meds, primarily because I didn’t find them especially helpful in managing my pain. They made me feel sleepy and sort of numb everywhere, but they didn’t do much to relieve the residual surgical and nerve pain. Personally, I found Robaxin to be much more helpful in managing my pain and discomfort.
I believe I’d quit taking oxycodone altogether by the time my kids went back to school in mid-August, so about 2½ months after my surgery. By that point my pain was pretty manageable with just Robaxin and Tylenol, with the exception of an occasional rough day, in which case I’d take pain medication before bed.
The First Year and Beyond
After the initial recovery period, I managed my pain almost exclusively with Robaxin, Tylenol, and/or NSAIDs. On the rare occasion that I needed something stronger, I took one of the pills that I had left over from surgery. I still had some pain, but it was relatively mild. After those first few weeks, I focused less on managing my pain and more on getting back to normal; that meant coping with things like stiffness, swelling, and mobility issues – things that opioids didn’t really address.
At 3 years post-op, I do still occasionally take Robaxin and/or Tylenol for back pain. I had to stop taking NSAIDs because of stomach issues, which is unfortunate because they worked best.
Image by Steve Buissinne from Pixabay
Final Thoughts About Managing Your Post-Op Pain
Stay ahead of the pain. When you get home from the hospital, take your pain medication as prescribed by your doctor, and stick to a schedule. Write it down, use an app, or set an alarm. Don’t try to keep track of it in your head because, well, you’re on pain medication. Your brain may not be at its sharpest at that moment.
Don’t suffer needlessly. Let’s be honest – you’ll probably be in a decent amount of pain after your surgery, and you may still feel pain even after taking your medication. Some pain is expected. But in my opinion, unnecessary pain doesn’t serve any purpose. It may be harmful to your body, and it’s certainly harmful to your spirit. Now is not the time to be “brave” or “tough.” If your doctor prescribes something to help with pain, and if your medical history allows it, take the medication.
It’s okay if your pain meds make you want to sleep all day. I mean, where exactly do you have to be anyway? Your job after your spinal fusion is to heal, and your body needs sleep in order to do this properly. Bonus: on top of making you drowsy, pain medication may also help you position yourself comfortably enough to get a few hours of sleep.
Don’t be afraid to call your doctor. If something doesn’t feel right, call your surgeon. Sometimes a minor tweak to a medication regimen can make a big difference. Also, follow your doctor’s instructions about weaning yourself off pain medication. If you feel like you can’t do it on your own, there’s absolutely nothing wrong with asking your doctor for help!
Use non-drug methods to manage your pain. While opioids will help relieve some of your pain, they’re not a viable long-term solution. Non-drug methods will be important when it comes time to wean off pain meds, and even more so once you begin transitioning back to your normal routine. For me, these methods included TENS therapy and ice/heat. For other people, they might be meditation, massage, essential oils, etc. As long as it’s okay with your doctor, do what works for you.
Hey everyone. This blog has been very helpful, so i decided to post a little of my story..
Im 4 months post l4-l5 fusion. I had a minimal invasive surgery, an endoscopic percutaneous fusion. I was supussed to be doing normal activity in 1 month.
Well.. as i said, its been 4 months and im feeling better and recovered from the surgery itself but i still cant sit for longee than 20’ minutes or walk for longer than 45’ minutes.. I’m seeing improvements by months, but its so desperate not to be able to sit, because that kills all kind of social live. I had a degenerative disc and spinal instability, and after trying everything and not being able to deal with the pain i had the surgery.
Im just wondering if anybody else had this huge problem with sitting and did it disappear over time???
Its a really hard rode we have to go. I manage my pain ocasionally with tylenol and advil. I do pt in the water and walk about 2 miles a day! But not painfree, thought i feel a lot better in the morning than in the afternoon when the days goes by..
Tamie Benito says
I am 16 weeks post L4-S1 fusion. I was significantly better until I returned to work at week 13. I have a sit stand desk but I’m still now having different pain than before in my recovery. I have pain in both sides of the very low back and today I have searing, burning pain into my left groin. I feel like something is wrong. Had anyone else had this issue?
Krish Krishnamurthy says
It is 4.5 months since my surgery. It is about 2 months since I posted an update. I definitely have improvements. The pain comes and goes. It is almost like I have a 3-4 day cycles. I am good for 3-4 days, walk 2 miles a day and do my PT. Then I hit a day or two of pain. Most of the time the pain is in my hip area and stiff back. I am able to manage with Tylenol. Have not taken Norco since I left it almost 3 months ago. Recently weaned off from gabapentin as well. Interestingly there are days I can sit long periods without pain, but cannot lie down on my back. On other days I can rest well in bed but cannot sit. There is no pattern. My surgeon’s office (and my son, who is a neurologist) keep reminding me that I am recovering after a major surgery and should expect such surprises. My physical therapist is great. She adjust my exercise routines to accommodate my pain cycle. Overall I think I am progressing – but I wish it could be faster (don’t we all). Patience and positive thinking is the key. I have another x-ray and review next week. Fingers crossed. Will be back with another update in a month or so.
Thanks to everyone for sharing their experiences – this is the best way to support each other.
This was very helpful. I’m 2 months post op TILF L 3-4-5. I felt Pre good at 1 1/2 months. Then surgeon prescribed a bone growth stimulator, and ever since I started using it I’ve felt much more stiffness, uncomfortable, sometimes painful. I was kinda attributing it to the BGS, but from what I’ve researched there’s no side effects associated with it! Reading your post helps because their right. Recovering from major surgery surprises are to be expected. So I will do my best to quit thinking I messed something up, and have faith that most, and hopefully all my issues resolve with time.
Krish Krishnamurthy says
It is now 2 months post L5-S1 surgery. I am successfully out of Norco. I had a lot of withdrawal symptoms. I was on Norco before surgery (managing spondylolisthesis) for close to 4 months while waiting for the hospital to open for elective surgeries after COVID-19 emergency. my pain is still under control. I do get serious stiff back and stay in bed most of 2-3 days. Tylenol helps. I am walking about 1.5 – 2 miles a day now. My doctor says I can take occasional Norco – but I am staying away from that drug for good. I get a lot of “prickly heat” in the sole of my feet. My son (a neurologist) says that is normal and will take as much a year to go away. I am constantly forcing myself to think positive. I get depressed when I have this “stiff back” episodes and wonder if I did anything to damage the fusion. My wife is very supportive and reminds me that it is a long haul. This blog site is my constant inspiration. Thank you. My goal is to visit Italy next year and walk up mt. Vesuvius. Will keep writing updates on my recovery periodically. I hope my story adds value to this blog site and help others. I have a follow up with x-ray next week – almost feel like “SAT exam results”. Waiting to exhale.
I did very well my first month after 2 level fusion, with the cessation of severe double sciatica. Off of pain meds after a week and back to my regular routine. Month 2 I suffered severe vertigo and had three major falls on the tile bathroom floor, that put me in the hospital. After that I was never the same. I managed my pain with Naproxen and then started on Tramadol. This allows me to be active and manage my pain. I am still in pain by the dinner hour. I go to bed around 6:30 or 7:00. My GP is discounting the Tramadol due to government requirements. This has me petrified. I had my surgery 8 months ago, and wish I was further along with the pain. I am 74 years old and also have a lot of arthritis and osteoporosis. It is just taking me a lot longer to heal. I do not even know where to turn to get help. I will go back to pain management, but I remember before my surgery, how much pain they put me in, rather than took me out of. They do not prescribe any pain meds. I also have the responsibility of taking care of 2 grandchildren after school, days off of school, and occasional weekends. Has anyone else found it worrisome to have so little access to pain meds?
I am told I need spinal fusion L4L5 after three previous surgeries (Laminectomy) 2 years ago with no relief. Pain mgmt gives me very little in the way of pain pills, so yes I do find it disheartening to live in a world of pain
I’m so sorry about your pain struggles. It’s awful ,I know!
I had L4-L5 fused and it worked well for me. I know nerves just don’t always want to heal well or they take so long to heal.
I pray you’ll have a peace about what you should do and that you’ll get much more relief soon. Prayers for you!!
Michele Williams says
I’m 61 and had L4-L5 fused in Oct 2018 an L3-4 fused in May 2020. Misalignment of my spine worsened after my first sugery and caused a disc to slip and created more misalignment. I knew that might be an issue later on but not so soon after the first surgery.
My experiences were really good, I’m happy to say. I had very successful surgeries and relatively pain free recoveries, which sounds crazy when I think about what I had done.
I have some achy places in my back and in my right buttocks, but thankfully they go away when I use a heating pad, or take my tylenol and ibuprofen or avoid driving too much.
I plan to go to the chiropractor to help me keep the rest of my back aligned and allow him to use an activator on muscles in my upper back . I think if I can keep the muscle tension down in my spine I may be able to avoid future surgeries.
Krish Krishnamurthy says
It is 3 weeks today since my L5-S1 fusion surgery for spondylolisthesis. Both anterior and posterior instrumentation. I was in the hospital for 2 days. I am taking Norco (staying ahead of the pain). My pain significantly minor after surgery. I am hoping to start cutting down my pain medication soon. I am very confident it will be ok soon without any Norco.
This blog is incredibly useful – before and after surgery. Thanks to everyone who posted their experiences.
Loretta B. says
Thank you for this. I always try to read & learn as much as I can since my 3 level spinal fusion last year did ‘nothing’ for my spine pain & it has continued to get worse. Recently my Rx for pain changed from Tramadol 50-100 mg. tid to Dilaudid 2 mg.q 6 hrs. as well as Tizanidine 2 mg. & Gabapentin 100 mg q 8 hrs. More often than not they do little to nothing for my pain. Been through it all, Rx’s, injections, PT, pain management and as mentioned 3 level spinal fusion. 3 months ago MRI shows (L1-L2 & L2-L3 bilateral facet hypertrophy; L3-L4 & L4-L5 prominent facet hypertrophy; L5-S1 mild desiccation & bilateral facet hypertrophy), I’m getting worse but new ortho surgeon now want CT too. I just want pain med’s to help more often & my back pain to stop controlling my life.
Scott Motter says
I had a mylectamomy and spinal decompression and fusion L-3 thru L-5 and am 9 days post-OP. I am currently only taking ibuprofen and tylenol for what little pain I have. The spent 1 night in the hospital. I went for a walk today 2 miles and I am exhausted. Maybe trying to do to much to fast. I can already tell the surgery worked and I am glad this surgery will be in my past. I had my neck fused 12 years ago 4 surgeries 3 that didn’t work and made me worse and 1 done right and gave me my life back. My advice get the best surgeon you can get it makes a huge difference!!
Bev Walsh says
I’m from Ontario Canada and am 2 weeks post op having underwent Lumbar spinal fusion L3-5 plus 2 nerve decompression.
The first week home after a 3 day hospital stay I was in intense pain! I kept telling my husband that I’d regretted having this done. After all who in their right mind would agree to having an instrument of torture installed in their back?? Now at the 2 week 2 day mark I have little pain but feel like Quasimodo with a lumbar problem. I acutely feel my hardware but especially at night. The top of my 14 cm incision swells and it feels as if the whole gizmo just pushes up over the course of the day causing the top of the hardware to bump out.
I’m off all pain meds (hydromorphone and tylenol) senecot for constipation, a wonderful side effect of the meds. I do still take the gabapentin I was on prior to surgery as my nerve endings still feel so active. I have sensitivity and soreness around the incision and buttock area. I’ve also experienced sciatica in both legs. I’m hopeful this will settle down. I’m up every hour for 20 minutes of walking and one set of mild leg and arm exercises but I do get tired. In conclusion at this point it’s being able to feel my hardware that is most weird and I hope I will eventually not notice it. I am considered slimmer with a small back which apparently can be a problem. I’m a 69 year old female. Great to be able share and read other’s experiences with this.
Loretta B. says
Bev Walsh: I hear you & know exactly what you are experiencing (I had 3 level spinal fusion 4 Mar. ’19). Only difference you are getting better & I never did/I got worse. Bless you dear Lady cont. to improve.
Bev Walsh says
So sorry to hear that. I’m not completely improved at the 6 month point but I can at least walk now. I wish you the best.
Paulette Provost says
I keep snack crackers with my medications so that I have something on my stomach each time I take a dose.
Paulette Provo@yahoo.com says
I’m 4 weeks out from L5/S1 decompression and fusion. I was sent home with Percocet, Robaxin and Gabapentin. Percocet makes me profoundly nauseated. After speaking to my surgeons nurse, she switched me to Norco. It still causes nausea but, not as severe. She added Zofran for nausea. I’m still not able to eat much at any meal.
Decreasing how much Norco and Robaxin during the day but, use it as needed during the night. I have increased Gabapentin during the day to 400mg and take 600mg at night for the burning nerve pain. I’ve also added Melatonin at bedtime which really helps with sleep.
The reality of needing to be on pain meds possibly the rest of my life is a very discouraging thought.
Sharon Wilhelm says
I continued to take Robaxin for quite a while after weaning off the pain meds. My surgeon told me that it was safe for long-term use and non-addictive, so I felt okay taking it for as long as necessary. Not sure about long-term use of Gabapentin…
Hey there! I’m due for a L5-S1 fusion with cage and screws this coming Wednesday and I’m petrified. To the point that I’m wondering if I truly hurt enough to move forward with this major decision.
Of course, my neuro said I have no choice if I wish to maintain that section of spine and hopefully prolong further degenerative changes to “good discs” but I can’t help but be scared!
I’m so afraid of the pain being tons worse than I’m in now. Any thoughts, prayers or words of encouragement are welcomed! I’m 36 years old and this (dr said) for my age was his last resort
Sharon Wilhelm says
Hey. I know it’s totally scary – do yourself a favor and stay off of the spine/back forums online. They’ll just scare you even more. It’s not an ideal situation to be in, and yes – the pain after surgery could be bad. But barring any complications, the post-op pain will go away and you will be left feeling much better than you do now. I was 41 (I think?) when I had my spinal fusion. Recovery was hard, harder than I expected going into it. But I got through it and I haven’t regretted the decision to have surgery even once. You should be prepared for a rough couple of weeks, but hopefully you can find comfort in knowing that it’s temporary and that things will get better. XOXO
Elaine Orlich says
It’s almost 11 weeks since I had major back surgery, which consisted of two a day apart from each other. Anterior approach for laminectomy and then instrumental spinal fusion of L5 and SI. I ended up having to stay in the hospital one week.
I injured my back in October of 2018. I tried everything natural at first, but nothing worked. I ended up having to withdraw from the things I was involved in. Church… and then went on a medical leave from work for 12 weeks. Physical therapy made things worse. I also had three spinal infusions. The third one made my symptoms worsen.
I ended up having to quit my job, which was disheartening for sure.
To try and make a long story short, I continue to struggle with sever pain throughout the day. As the day progresses so does the pain. Since the day of the surgery I have been able to take care of my basic needs, such as showering, getting dressed and personal hygiene. Slow and steady for sure.
At two weeks I was standing straight. Sitting was horrible. I had to eat in ten minutes as that was as long as I could sit. Standing still was horrible as well. Walked in the house, then after 4 weeks walked outside for 10 minutes. Movements were very painful and slow. Just this week I have been able to walk for 15 minutes outside. I can tell when the timer is about to go off as my body informs me I’ve had enough. Car rides longer than 30 minutes puts my body into spasms.
At my six week(?) follow up my surgeon had me have another CT scan as my pain was horrendous. I thought I was dying and certainly had compassion on those who had become addicted.
Others have said that the pain meds really don’t help… it barely takes the edge off. I have as of two weeks ago begun to wean myself off the Oxy 10, which I was taking 4 times a day. I warned myself off the 3:30 am dose, then the following week, warned myself off the 3:30 pm dose. By the 2nd day of that, I was in full swing of having withdrawals. Dear God… the pain was worse than before. I did a lot of crying for sure. And this is coming from someone who has a high pain tolerance.
This coming week I will cut one of the oxy pills in half of my morning dose and then the following week omit the other half.
I am also taking a muscle relaxer as well as gavapenten for nerve pain. I have no idea at this point how long I will have to remain on that.
Everyone said that by six weeks the worst of the pain would be gone… certainly not true!
My incisions healed it seemed within a week.
I’ve had terrible pain from my waist down and into both legs; predominantly in the right. There were times when even my ankles, bottoms of my feet and toes hurt. Goodness even my toe nails would hurt some times. What in the world??
I’ve always been a very active woman. My dr said I was his ideal patient. They did not have to cut my muscles in the back, they only stretched them. I’m also 3/4 of an inch taller now.
I must say I do have done dark moments, but I don’t stay there. My faith sustains me greatly. But even with that, there are those deep valley’s that I have to climb out of.
I have been living with one of my daughters and her family for the past since my surgery, which has been a blessing, being I’m well taken care of and have 4 year old grandson who keeps me very entertained.
But this lady is ready to go home. Unfortunately this particular daughter is very protective, with a high dose of worry.
I know I’m much further in my recovery since I had it, but I just felt that I would be further along by now. I know of some that did not get out of bed for three months. I was up and walking the day I had my surgery.
I’m just concerned with the stiffness, nerve pain, which thankfully is not constant… but still there; as well as the weakness and the fatigue that comes.
They do have me using a tens machine, which is a distraction from the pain. My therapy consists of that, walking, ice, rest and pain meds.
No one told me it would be this painful, nor take this long for recovery.
Sharon Wilhelm says
Elaine, you are one STRONG woman. I had no idea going into surgery how difficult or painful it would be. I think doctors tend to downplay it – not sure why? I’ve read a couple of articles listing the most painful surgeries to recover from, and lumbar fusion makes the cut. What you’re doing is HARD. Just know that you’re not alone. I’m thinking of you, as are others who have (or will) read your post. Sending love <3
Elaine Orlich says
Thanks for commenting Sharon. I wasn’t able to wean myself off the morning oxy. Going to try next week after I see my pain specialist on Monday.
I continue to walk, ice, rest and lift legs as if marching, stretch them, and also do counter top push-ups for upper body strength, etc. I’m still getting terrible muscle spasms here and there and nerve pain. I understand your comment on feeling like you have a brick in your back. I use to be a very fast walker. Now I’m slow and probably guarded with a slight limp, as right hip and leg hurt the most, though the pain has been on both sides as well. I know I’m much further along than I was before.. but still have a long way to go.
Cheryl Dwyer says
I’m nearly 6 weeks post OP and am actively trying to reduce Percocet to one pill a day, at bedtime, and baclofen twice daily. Once I identified the pain as muscular and nerve pain its made it much easier to work at mobility. Walking is slow but steady. My legs feel weak, so i march as much as possible, hoping by actively lifting them muscle tone will return. I’ve asked for PT, but not happening yet. I have a family member undergoing this surgery on October 31, and I’m trying to help them get ccx ready.
That’s interesting you say PT caused more harm than good. That was my experience as well for the most part. At first it was helpful but then my Physical Therapist was frustrated with me because I wasn’t being aggressive enough with my exercises. I did better with walking only. Walking has been the best therapy and walking in a pool is helpful too. It’s a year and a half since my surgery; I’m now finally beginning to move more normally and have less pain. I had a hard time with the pain meds. Tramadol didn’t agree with me and stronger meds gave me low blood pressure to the point of almost fainting. So I took Tylenol until almost a year and then started on Aleve again. Tylenol has seemed to work well since surgery. Only bad thing is now that I can walk faster and for longer periods, my knee is acting up again. My knee stopped bothering me because I could barely walk due to the back pain before surgery and after surgery the slow healing process limited my movement. Sometimes it just takes a long time for recovery, longer than one hopes for. Don’t give up if you’re one of those with a slow recovery. Have hope and listen to your body.
Loretta B. says
Patricia: A year before my 3 level spinal fusion I had pool PT and it was 10 x easier on me than regular PT was. I sincerely believe it helped me much better than regular PT. Only problem my 3 level spinal fusion 16 months ago was a failure, my pain never got better but did get worse.
My lower back pain came on suddenly for no apparent reason, it turned out to be Spondy L4 L5, my back pain came on very fast and very painful. I started taking Aleve, Tramodol and Norco and lived with cold packs wrapped around my waist. I took CBD/THC tinctures which helped for awhile. I found that Norco became useless as did the Tramodol so doc put me on Percocet for breakthrough pain. I took copious amounts of Naproxen and Acetaminophen, Flexeril when it got bad whilst getting Cortisone injections and Rhizotomies, PT, massage, Pilates and Chiropractors…I finally had enough and decided that a Spinal Fusion surgery was my only hope. My surgeon put me on Dilaudid post op because previous pain was not relieved by Norco or Percocet and also caused agitation and insomnia. Dilaudid was a godsend, I could rest, no agitation or feeling strung out, I was out of pain for the most part and recovering very well. I tapered off Dilaudid after 6 weeks, taking Acetaminophen and Ativan in the evening for rest. After 5 months my surgeon allowed 800 mgs. Ibuprofen to the mix which helped a lot but my stomach couldn’t take it daily. For me PT caused more harm than good so I just kept walking and kept busy at work as a hairdresser. I found that after 7 months post op I was in a different kind of pain, my hips, upper back and neck were hurting so my GP put me on a low dose of Cymbalta 20 mgs. And gradually titrated to 50 mgs. daily and 1-2 mgs. Ativan at night. Occasionally I’ll take Tylenol or Ibuprofen when I overdo but I must say that since the Cymbalta kicked in, I turned a corner… I’m hardly in any pain, I’m very active and my mood has improved significantly. I’m coming up on 1 Year post op on Oct. 30th I’m so grateful that I have my life back! Walking helps a lot too! Keep moving! Don’t give up! 🙂