Harm Reduction The Pain Management Mega Thread - for all your questions on dealing with chronic pain

i have been working with my D.O. trying to find some relief for my chronic pain. what i do is take all the research i have found on medications and write down what meds people on other forums with similar pain issues have found helpful....i just ask her about them and she has most always said that she will not script addictive meds.

funny thing is, she is all too willing to give me a boat load of tramadol (which is addictive) and cymbalta. the cymbalta cannot be stopped without withdrawal affects. i do not understand the reasoning here. what she has given me is technically addictive...i need to stop the cymbalta because i am having some pretty serious side affects, but her nurse is taking her sweet time on getting back to me. so frustrating

i hope i do not come across as a drug seeker. i am truely a pain relief seeker....i do have a lot of tattoos and i worry that this may affect my ability to get appropriate pain relief.

she recently referred me to a pain clinic but i cannot get an appt till january...i am worried that i will have to jump through all the same hoops over again....

you will alicat, they will have you sign a drug contract with them.

papasomni said:

you will alicat, they will have you sign a drug contract with them.

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right. and i read that they will do urine test at every appt. to see if i am abusing. thing is i know i will not, so that doesn't worry me. i worry that it's gonna take another year of being on tramadol to get the pain doc to understand it does not work

Okay, sorry for the late response, but I appreciate your advice. I am a biology/biochemistry major, and work in 2 pharmacies (hospital, and retail), so when suggesting something, and not by name, wouldn't that make me look like I do'nt know what I'm doing, because I do know most of the medication taken for pain, and he knows I am starting pharmacy school next year and work in 2 pharmacies. I will suggest something stronger with less apap, hopefully.

Secondly, working at a retail pharmacy I see a lot of the local doctors, and I noticed a particular DO that likes, or seemingly likes to fill narcos (120 percs, 180 vics, etc.). Should I go to this doctor for a third opinion? I went from a PA, to a ortho specialist, and a DO would be a new experience, any thoughts on that?

alicat72 said:

right. and i read that they will do urine test at every appt. to see if i am abusing. thing is i know i will not, so that doesn't worry me. i worry that it's gonna take another year of being on tramadol to get the pain doc to understand it does not work

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It depends on the clinic. I have been at mine for 6 months and I have never had a drug test or a pill count. But, they do say in the contract that they could test at any time.

Pain clinics are up on this stuff. I doubt that they will give you tramadol. they are usually aware of the fact that because you were refered to them, that you have already been down these roads and they will be ready to treat you with something else.

papasomni said:

It depends on the clinic. I have been at mine for 6 months and I have never had a drug test or a pill count. But, they do say in the contract that they could test at any time.

Pain clinics are up on this stuff. I doubt that they will give you tramadol. they are usually aware of the fact that because you were refered to them, that you have already been down these roads and they will be ready to treat you with something else.

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thanks papa! i suppose i should have a more optimistic expectation of the clinic...

papasomni said:

It depends on the clinic. I have been at mine for 6 months and I have never had a drug test or a pill count. But, they do say in the contract that they could test at any time.

Pain clinics are up on this stuff. I doubt that they will give you tramadol. they are usually aware of the fact that because you were refered to them, that you have already been down these roads and they will be ready to treat you with something else.

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I am not using a pain clinic but just a PCP but I can relate. My first PCP was with me when my issues first started and up through the first year so seeing him monthly, he knew exactly what was going on. He saw my deterioration with the pain and always trusted me. When I told him the pain was unbearable he scripted morphine ER and 2 weeks later when I told him it didn't help much he doubled the dose. He was caring and wonderful- I didn't abuse him and he truly managed my pain.

When he left, the doctor I got hadn't seen what my first doctor saw- she just saw a 22 year old kid on oxycontin, lorazepam, norco, lyrica, etc. who seemed fine. Well I seemed fine because my pain was finally managed appropriately after twelve months trying 2 dozen meds. I worked out other pain management and discontinued the oxycontin and lorazepam myself and before this I signed an opioid contract. I think these 'good faith' measures have showed her that I am not abusing my meds and I am genuinely in pain and my regimen is working. I have yet to be piss tested or anything since signing the contract almost a year ago.

Ali- Its a tight rope to walk trying to get pain relief. Have you heard the term pseudoaddiction? If you watch the show House, when he was cut-off before his trial it was a perfect example. In his desperation for pain relief he tried to go to a clinic and say he had a broken face and eventually stole a dead patient's oxy script.

He wasn't looking for a high (although he did overdo it at the end), he was just trying to get pain relief. Pseudoaddiction is where someone behaves like an addict in their desperation to get pain relief, a desperation rivaling people with large habits. The difference is that when the pain patient finds relief, this behavior stops but it generally doesn't for the addict.

Some doctors understand pain management, addiction, pseudoaddiction and other related topics while others do not at all. I saw one doctor who told me I was an addict because I took tramadol and 2 vicodin daily- some are just uneducated or biased.

I have always felt like I was walking on a tight rope with my pain management and just 1 strong gust and I could fall really far down. If you need relief you need to find a doctor who will give that to you, if you can. I really hope you can find relief by January, but hopefully sooner. You should have hope for the pain clinic because its a much better shot that they'll REALLY treat your pain, unlike your doctor. I really hope you find relief!

^^wow.I can say that your post was 100% correct and sadly a reality in a lot of people's lives who have to deal with chronic pain.

Couldnt have put it in a better paragraph myself !

I go to a pain clinic and have been since 5 months into the excrutiating pain of trigeminal neuralgia. Really f***ed up face pain. They had me on tegretol, lyrica, baclofen of these the baclofen works a bit.
Before I went to the PC I was on Oxycontin and had 80% of the pain reduced but when I went to the pain clinic they took me off it and said it wouldn't work even tho I know it does. So the hospital made me do a double blind trial on opiates. they gave me 4 infusions 1 was saline the others were Fent , Lignocaine and another one. I got relief from the Fentanyl but they ignored that and said we still think your too young for opiates (I'm 27). They also told me that the reason most people leave my Pain Clinic is through suicide. I asked why and the doc said because people are in too much pain.
To me it sounds like the pain clinic is doing somthing wrong if more then 50% of theyre patients top themselves. I was aware of this because everyday I struggle to survive.
The pain unit I'm at is also supposed to be the best in my state ...South Australia. I'm not planning on moving... Unless it's to Canada, Mexico or Malaysia. hehe maybe the A.C.T
I recently got another opinion. The second opinion was that I should be taking something to relieve the pain. Opiates if it must be I believe they said. But they are a smaller pain unit.
The neurologists scratch they're heads and tell me my only real option is brain surgery. I declined it and asked for a nerve block injection in my face but no one in my city will do it and my city is well known for good neurosurgeons.
I have know Idea how to survive with this pain???
Any Ideas???
Paranoid Android has helped me immensly with dealing with the pain and the doctors. For that I'm thankful with all my heart.
Any more info or ideas would be great.
Thanks BLs,
You've all kept me going.
Peace,
NW

I gotta say, I love my pain doctor

I'm 19, and all I had to do was explain to him the situation and when medications I had tried in the past

He put me on Lyrica and sent me home, saying it would take about a month to take effect.

I called him the day after I saw him, and told him I've been in pain for 2 years, and I'd like temporary relief until the Lyrica started to work. He immediately scripted me 6 Vicodin a day

Well the Lyrica ended up work, so he decided we'd just stick to strictly opiates. At 19! When I said Vicodin didn't work, we tried Fentanyl patches. When that proved inconvenient, we switched to Morphine.

He's explicitly stated that he plans to keep me on opiates for the rest of my life. He's always been understanding, and never hesitated to give me relief in whatever way works. He even makes me feel involved, giving me a big possible list of options and letting me chose the med I want

He's truly a Godsend, and I owe my quality of life and sanity to him

wazawaisuru said:

Is it possible/likely that the Fentanyl patch would be prescribed in conjunction with lidocaine? I'm on the 100 mcg Fentanyl patch, and I'm still in incredible pain. I can't take any oral narcotics because of GI issues. I have Flexeril and Zanaflex available to me, but they really put me out (like the Fentanyl doesn't take care of that on it's own :S ) and don't necessarily help all that much. I was just wondering if anyone here had some input before I bring it up to my pain doc--I don't really see why she would have any problem with it, but I'm not all that knowledgeable about either one yet. Any replies would be greatly appreciated. Thanks.

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wow. i cannot imagine that 100mcg's fentanyl would not help....if this is the case, then you must need some sort of surgical help....that is the highest dose (i have heard of) even for cancer patients.....

to get to your question about lidocaine patches....sure they would be scripted with the fentanyl as long as you don't put them on the same spot or location....lidocaine is very area specific....it only helps with pain in a specified area.....say a painful disc or a tenderpoint.....

i wish my insurance would cover lidocaine patches!! i'd have them bitches on my knees every night i work....

Desdenova said:

He's explicitly stated that he plans to keep me on opiates for the rest of my life.

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You're only 19 and he originally only scripted you Lyrica so whatever it is probably isn't that bad. Not trying to hate but why would you want to be on narcotics every single day of the rest of your life? After a couple years whatever your script is the dosage is gonna have to be increased and you'll be cycling through meds all your life. If you don't mind me asking what kind of pain do you have?

wazawaisuru said:

Yeah, see, I'm waiting for a spinal fusion, but when I went for the pre-surgical consultation, they discovered I have a raging UTI, kindey stones, heh, and ulcers. So I have to wait until all those issues can be resolved so I'll be healthy enough for the fusion. In the meantime, I've been on the meds-go-round, and I thought the patches were really a good solution, but all of a sudden, last night, the pain just roared back into life, and now I'm freaking out, because the last time it was (almost) this bad, I ended up frozen in the fetal position, being carried up the stairs by EMTs who were really nasty about it, ie. implying that I was a drug-seeker. So I don't know what to do; I just know that narcotics aren't working and I can't take NSAIDS because I take lithium, and, ohhh, gee, my life is a mess. Thank you so much for your reply though--I appreciate the help.

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well...i know a lady on my FMS forum that has a norspan patch (Buprenorphine)...maybe that would treat you a little better? some people just react differently to certain meds....i hope you find some relief....

^ is Norspan available in the U.S.? i thought transdermal bupe was only marketed in europe atm.

oh...not sure...never thought to ask if she was in the states....

will do a bit of research...

I went to my pain clinic appointment yesterday and found out that they have brought back generic oxycontin again. After I had to pay 583.00 last month for the name brand. WTF? don't they realize what that costs people like me or don't they give a shit? I'm just out that 250.00 extra I had to pay last month.

^seriously? Big Pharma is the single most profitable industry in this country, they don't give a shit if you have to break the bank. They know meds are necessary, they are some of the most inelastic goods- you NEED them so they know you'll pay almost anything within some reason.

papa^^ hey brother.what do you mean by generic oxycontin being brought back again?Im confused. I am Rxd the Purdue Brand name Oxycontin. I know there are Tevas and other types of Oxycontin out now. But I just dont understand your statement about bringing them back again??....

Not trying to flame you bro or anything!!!!

They were taken off the market because IIRC it was argued that increased availability and reduced cost would contribute to more diversion and abuse, so a year ago or so they pulled all the generics off. I was taking it at the time and always got ABG's but then I had to get the name brand. I didn't stay on them long so I don't know what happened beyond that.

^I just thought that there were no genrics of Oxycontin. I mean like just the Teva Oxycontin is out. Maybe im the one thats confused....highly possible that is but how probable is that one....