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Surgery complicated by pain treatment

DEAR DR. ROACH: I am a 78-year-old with severe back pain due to compression of the nerve. My activities are more and more limited, and my quality of life is suffering. I am told I need a back operation. However, when I consult with the anesthesiologist or pain management doctor about post-operative pain management, I always get vague and unsatisfactory answers. I am highly intolerant of opiates. I get violently ill, feel like my body and brain are turned inside out, perspire profusely and vomit.

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? — F.W.

ANSWER: Because opiates are a problem for many (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. Pain is controlled with a combination of: 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 who noted that for back surgery in particular, it is difficult to avoid opiates entirely, but that you could work toward minimizing the amount. You would need a pain specialist who really understands your concerns.

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. 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 thisplastic? Are copper pipes safer, or do they also have risks also? I am in the process of building an apartment in an old barn, and the question came up 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? — 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.

(Roach is a columnist for the North American Press Syndicate. Write to him at 628 Virginia Dr., Orlando, FL 32803.)

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