Back surgery complicated by post-op pain management

DEAR DR. ROACH: I am a 78-year-old with severe back pain due to compression of the nerve. My activities of daily life are more and more limited, and my quality of life is suffering. I am told I need a back operation, and I agree that it is necessary. However, when I consult with the anesthesiologist or pain management doctor about post-operative pain management, I always get vague and unsatisfactory answers. You see, I am highly intolerant of opiates. I get violently ill, feel like my body and brain are turned inside out, perspire profusely and vomit until I feel as if my stomach is coming out of my mouth.
       Besides my back, I have no other health problems. Can you tell me what I can take for pain after a back operation other than opiates? Whom should I consult with to have my problem taken seriously? — F.W.
       ANSWER: Because opiates are such a problem for many people (due to intolerance, like yours, or a past history of abuse), there is increasing interest and expertise with performing surgery and treating post-operative pain entirely without them. Instead, pain is controlled with a combination of several treatments: non-opiate pain relievers, including anti-inflammatories and Tylenol; topical and regional anesthetics to block nerve fibers; and non-pharmacologic treatments including massage and meditation.
       I spoke with an expert in the field, who noted that for back surgery in particular, it is difficult to avoid opiates entirely, but that you could work toward minimizing the amount that you take. You would need a pain specialist who really understands your concerns, which it doesn’t sound like has been the case until now.
       I can’t say that this will be easy to find, and it may require you to travel. I do know of several hospitals that have expertise in this area, including Virginia Mason in Seattle and Hospital for Special Surgery in New York City.
       I should note that your back pain hopefully will be better after successful decompression of the nerve. It’s getting through the first few days to weeks after surgery that will require expertise and planning.
  

    DEAR DR. ROACH: I just read your recent column about the safety of plastics and food. This one was especially interesting to me, as I have a question concerning the safety/risks of the plastic pipes we use in our homes to carry water to us. Should we be concerned about this plastic? Are copper pipes safer, or do they also have risks associated with them? I am in the process of building an apartment in an old barn, and this question came up just yesterday about which type of pipe we should use. The plumber also said that certain types of copper are better for well water than others, but plastic may be the best. So, are plastic pipes safe to use in our homes? — C.M.
       ANSWER: The plastic pipes that have been used for decades for water in homes and businesses are safe. Both PVC (polyvinyl chloride) and CPVC (chlorinated polyvinyl chloride) are safe for cold water, but CPVC must be used for hot water.
       Copper has advantages in terms of strength and flexibility, but it can corrode, especially in homes with iron or other minerals in the water. PVC pipes do not corrode easily at all, and generally have been the choice for in-home water pipes since the 1950s.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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