Hi Jennifer,
thanks for your extensive comment which provides me a lot of information.

I really feel for your condition. I can see that you are a battler and wont' give up.

The last week whenever I lie down in trying to sleep, the left side around C6/C7/T1 I believe, I get a really tight knot. Feels as if something is stabbing deep inside. The pain becomes unbearable therefore I get up to reduce the pain because for me standing helps in mitigating the pain. But then I have a sleepless night.
I have been taking the recommended pain medication which is made of Endep 10mg , Lyrica 25 mg and Diclofenac 50mg. Currently this medication is hardly helping me in dealing with the pain. The only tablet that helps is Targin 10/5. I am bit worried taking it because of the possible interactions with the other tablets.

This an excerpt of my pain management specialist to my local GP:

MENTAL HEALTH
Alfred demonstrates significant anxiety, feeling “on edge”, depression, frustration, and despair which
he mainly attributes to worsened pain since August 2022. Domestic stressors include 2 children with
special needs. He is currently requiring diazepam prn.

ANALGESIA
• Diclofenac 50mg bd.
• Endep 10mg nocte – side effects including morning sleepiness.
• Pregabalin 25mg nocte prn.
Previous medication trials include Pregablin 25mg (not effective; side effects included mild nausea
and sleepiness), and Targin (very effective for pain management, side effects included “passing out”).
During our previous consult, I initiated Norspan patch 10mcg/hr and Clonidine 50mcg tds. Alfred
trialled Norspan patch for 1 week but found it ineffective. He has trialled 2 tablets of Clonidine only.

PROGRESS
Since last review, I referred Alfred for CT SPECT and bone scan and repeat MRI cervicothoracic spine
(given severe change in neck pain since November 2022 cervical epidural injection). (It was actually 1/12/22)

Bone scan reported:
• Some increased disc degenerative activity at C5/6 with less-marked disc degenerative activity
at C4/5 and to a minimal degree at C6/7.
• No increased cervical facet joint activity; slight increased activity in the left T2/3 facet joint.
• Lumber spine – marked increased disc degenerative activity at L2/3 and L5/S1, slight
increased activity at right L4/5 and left L5/S1 facet joints.

MRI cervical/thoracic spine reported:
• Mild-to-moderate C4/5 and C5/6 central canal stenosis.
• Right C4/5, left C5/6 and right C6/7 foraminal stenosis.
• Thoracic upper and mid facet joint and costovertebral degenerative changes.
• Left paravertebral mass distal to the left T2/3 neural foramen (nerve sheath tumour is most
likely).

Alfred’s worst pain complaint is left-side lower neck pain, between midline and 4cm left of midline,
described as burning and stabbing, improved when standing, and worse when lying supine and with
most activity / physical task. Alfred describes some periods of minimal pain (only when standing up) , and other periods of excruciating pain. Given that pain is worse when supine, sleep is greatly affected.
Other complaints include hand and feet numbness, intermittent left hand pain, and low back pain.

Differential diagnosis include:
• Left C7/T1 facet joint pain, given MRI report of moderate left C7/T1 facet joint arthropathy in
the setting of 2mm C7/T1 anterolisthesis.
• Left T2/3 facet joint pain, given bone scan report of increased activity in the left T2/3 facet
joint.

Today my pain management specialist called me after me complaining about the ineffectiveness of the medication and he proposed that I have the following in the next few days:

CT guided left C7/T1 T1/T2 T2/3 facet joint steroid injections

I am so scared of the cortisone injection now because when I took it on 1 Dec 2022 it caused more pain that I never had before the injection. Did they do it right? . The cortisone injection (Transforaminal C6 nerve root) was not proposed by my current pain management specialist, but it was recommended by the Orthopaedic Clinic of the Alfred Hospital here in Melbourne Australia. after I presented myself at the emergency department the week prior due to excruciating pain.

I also requested a booking to see another neurosurgeon in a couple of weeks to get a second opinion.
Currently I do not know if I suffer from facet joint syndrome or my C nerves are being compressed by the discs or else.

The anxiety is always high when I am in pain and I have thoughts that I might not make it. Every doctor tells me that I can't die from pain, but quality of life is 0 at the moment. I can't shift my focus off the pain. I tried to meditate but it is extremely hard when the pain at 10 out of 10, 24/7.

I am not sure if I should go ahead with the above cortisone injections because I know they may not last long and am worried I may get more pain. I would have thought that maybe medial branch nerve block injections would have been more suitable for identifying the culprits.

Best regards

Alfred

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