While treating patients with spinal problems, the initial medications should, without good reason otherwise, always be mild and non-addictive. This is important so as not to mask any serious pathology which could worsen in an imperceptible way due to suppressed perception. Dilaudid is a very potent opiod narcotic typically used for end-stage cancer patients. It is one of the most powerful oral narcotics, and is a very addictive pain medications. As such, it is reserved for serious pain and spinal conditions. Percocet is more commonly prescribed than Dilaudid, but still is reserved for the treatment of chronic, persistent pain after initial work-up and diagnosis. Without compelling reason, prescribing Percocet or Dilaudid--much less both at the same time--before definitive spinal diagnosis will severely mask pain, thereby impacting the ability to make a correct diagnosis, and unnecessarily exposing patients to the risk of addiction. If a patient is in sufficient pain to warrant Dilaudid and Percocet, they should be worked up immediately and potentially hospitalized. A patient cannot have a normal neurologic spinal exam and be validly given Dilauded and Percocet.
Spinal pain medical expert witness specialties include neurosurgery, orthopaedic spine surgery, neurology, pain medicine, interventional radiology, and addiction psychiatry.