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Misc The Pain Management Mega Thread version 3.0

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I have complex regional pain syndrome type 2 stage 4 and a butt load of mental health problems snapped lumber ligaments and now a torn shoulder muscle too which is going to need yet more physio

What is your condition i know you have all the metal in your back?

It sucks being so young doesn't it. But Im starting a learn from home degree that i can do in bed so Im really excited for that it will keep me distracted from my pain. Meditation helps loads too but never to below an 8.



Wow I had no idea we were roughly the same age. If you don't mind me asking, what condition do you suffer from? Scoliosis?
 
I have complex regional pain syndrome type 2 stage 4 and a butt load of mental health problems snapped lumber ligaments and now a torn shoulder muscle too which is going to need yet more physio

What is your condition i know you have all the metal in your back?

It sucks being so young doesn't it. But Im starting a learn from home degree that i can do in bed so Im really excited for that it will keep me distracted from my pain. Meditation helps loads too but never to below an 8.

After herniating my disc at L4-5 during sex with a stripper, I underwent a laminectomy that failed. I then fell down the stairs over thanksgiving '09 which exacerbated my DDD, arthritis and destabilized my vertebrae to the point where my disc was no firmly on top of my sciatic nerve and I was experiencing worsening pain and weakness.

That's when I had my first fusion, back in march of 2011. I was off all narcotics by august until january 2012 when I developed worsening pain and throbbing shooting achy-type pains. I was dismissed as a drug seeker by my at-the-time new PM Doctor and it wasn't until my primary care MD ordered me CT and PET scans as well as repeating my MRI that it was determined there was a significant buildup of fluid which was suspected as osteomyelitis.

Well it turned out that it was osteolytis which apparently is different from osteomyelitis. At this point I had been in the hospital 17 days for pain control waiting on my neurosurgeon to get back into the country from a teaching trip to Seoul, South Korea.

My equipment was found to be loose, on the point of completely dislodging, and had several fractures in the surrounding vertebrae. My surgeon had his fellows and students do some research on the issue for him and found my case to be a 1-in-10,000 cases malfunction. So, fusion #2 occurred which didn't entirely resolve the issues and fusion # 3 came 3 months after #2 and as of now (90 days post-op) the new hardware implanted from both the anterior (front approach on #2) and posterior (#'s 1 & 3) appears to be fusing together so far, albeit at a far slower pace then my surgeon is accustomed to.
 
Can anyone give me hints on how to relieve pain while I wait for my next surgeons appointment. He dropped my medication so I could gauge the effectiveness of the cortisone shot I got last week. The pain has increased, I'm not sure if I should call my surgion and risk looking like a drug seeker, or to wait and be considered healthy enough to be opiate free. I really need them, especially so i can keep fit and control my pain induced anxiety.
 
You can buy a tens unit online cheap. Mine really helps.

The only other option is not so legal.
 
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Can anyone give me hints on how to relieve pain while I wait for my next surgeons appointment. He dropped my medication so I could gauge the effectiveness of the cortisone shot I got last week. The pain has increased, I'm not sure if I should call my surgion and risk looking like a drug seeker, or to wait and be considered healthy enough to be opiate free. I really need them, especially so i can keep fit and control my pain induced anxiety.

I would suggest going to your nearest emergency room and explain the situation and let them page your doctor and let him decide if he wants to admit you to the hospital for pain control or have the ER write you a prescription to hold you over until you actually see the doctor face to face.
 
It's chronic pain, I don't need the er bills right now. I can't even afford an MRI...
I'm just wondering if I should let my surgeon know how pain is doing, earlier than he ordered. I'd rather not ruin my relationship with him.
 
What do you mean zoey?

Auto correct, every time I put so the word do comes up. Aggravating.

I mean you will have to find something from a friend, off the street, go to the er or urgent care clinic.

It sucks because if drs don't treat or under treat pain then what other options do we have? The streets.

I don't condone this because of all the legal stuff if you get caught. But when you are hurting you will do anything to make it stop.
 
First, I am sorry to hear about the lengthy series of complications you have endured. Living in pain that long? That's close to hell on earth. It's been ten years for me and I get so frustrated and depressed because I simply cannot do the things I used to. I was an athlete through High School into College, found a good career and worked as long as I possibly could in horrible pain. Some days I would have to have taxi come and wheelchair me out to his car. I worked at a hospital. Then he would have to help me up the steps to my door. That was it, end of career, hello SSD.

To your situation, sorry this is about you not me but we are all in the same fucked up boat so to speak. You have been on pain meds for a loooong time. I do not believe in permanent tolerance. I think you are under medicated. Morphine ER 15's are about as strong as Tylenol to some. I assume you take them as you should and swallow them. That is the problem with morpine. It has an extremely low bioavailability (BA) when used in any way other than IV and I doubt you want to go there (IV). Morphine's oral bioavailabilty is around 20-35%. Oxycodone has an oral bioavailabilty of around 80%. Bioavailability plays a large role in medication management.

I was started on oral morphine nearly 7 years ago. I thought, my God, morphine. They must think I am in deep shit. I found out pretty quickly that it didn't do squat for me and I was completely opiate naive at the time. Maybe they are starting you low to see if you truly need something more and it sounds like you do. I will let the doctors to the rest. I could roll out a bunch of different meds and combinations but your doc is going to have the final say.

That is about it. Is your primary doc a pain specialist? That combination doesn't exist in my neck of the woods.

Yeah I've read that it's pretty shit orally, but I'm not really willing to go the other routes even though they are superior. I used to take 5mg Oxycodone for breakthrough years ago, but that level like the 15mg morphine didn't do much.

I've only had Oxycontin once and it was before my knee surgery, it worked swimmingly but that was also before I started on the morphine as well. Back in those days Percocet/Vicodin/Tylenol 3 at their lowest levels had me drooling on myself and floating on Cloud 9. That feeling doesn't happen anymore as is the case with most people.

From what I've read, the new formulation of Oxycontin doesn't work well because they've messed it up to deter abuse. The name would probably scare my doctor (and no he's just a Primacy Care Physician who's going on recommendations of the pain clinic) and make him think I was a drug seeker.

I make it a rule to never ask for specific drugs because I feel like they see that as a red flag. I may ask for something different though, except Fentanyl because it didn't work for me at all and I got violently ill. The ER said it wasn't because of the Fentanyl but why else would I have become that sick on the same day I switched to it?
 
Auto correct, every time I put so the word do comes up. Aggravating.

I mean you will have to find something from a friend, off the street, go to the er or urgent care clinic.

It sucks because if drs don't treat or under treat pain then what other options do we have? The streets.

I don't condone this because of all the legal stuff if you get caught. But when you are hurting you will do anything to make it stop.

I think pain is more over-treated than under. If people really want pain relief that bad they'll opt for marijuana when opiates aren't available and its overall just as effective. People who aren't adequately treated usually abused their medication in the past.
 
Ho-Chi that is just not true. Marijuana actually increase my level of discomfort and joint pain. I find it counter productive as far as pain management. Also, prior abuse of medication should have absolutely no bearing on whether or not you can be provided with adequate care. Physicians and medical professionals are obligated to properly treat each patient, regardless of drug abuse or not. It would be inhumane to deny someone of medication they need just because they misused or abused drugs in the past. Your mindset on the issue is dangerous.
 
Yeah I've read that it's pretty shit orally, but I'm not really willing to go the other routes even though they are superior. I used to take 5mg Oxycodone for breakthrough years ago, but that level like the 15mg morphine didn't do much.

I've only had Oxycontin once and it was before my knee surgery, it worked swimmingly but that was also before I started on the morphine as well. Back in those days Percocet/Vicodin/Tylenol 3 at their lowest levels had me drooling on myself and floating on Cloud 9. That feeling doesn't happen anymore as is the case with most people.

From what I've read, the new formulation of Oxycontin doesn't work well because they've messed it up to deter abuse. The name would probably scare my doctor (and no he's just a Primacy Care Physician who's going on recommendations of the pain clinic) and make him think I was a drug seeker.

I make it a rule to never ask for specific drugs because I feel like they see that as a red flag. I may ask for something different though, except Fentanyl because it didn't work for me at all and I got violently ill. The ER said it wasn't because of the Fentanyl but why else would I have become that sick on the same day I switched to it?

Okay, I see your situation with a little more clarity. I am glad to hear you take the meds via the (ROA) Route of Administration they are supposed to be taken. You are right again about asking a PRIMARY doc for specific drugs like oxycontin. Not a great idea unless you have a great relationship with the doc and he knows you are not a drug seeker, you are simply in a lot of pain.

I do not know how things are where you live but it is becoming more and more the norm for Pain Management Doctors to operate as a specialty outside of General internal or Family medicine. If your doctor is getting recommendations from the pain clinic why not get a referral to the pain clinic? Primary care physicians in my area would not even touch prescribing morphine unless there was a barrier preventing you from being seen in a pain management setting. They stay away from prescribing the types of medications you seem to need due to new laws, regulations, the DEA, etc. etc.

I think it is wrong but it is due to doctors that were prescribing meds like oxycontin without monitoring their patients and some patients began abusing them, selling them, what have you which led to a dramatic increases in OD's and addiction problems. Huge lawsuits were filed against the manufacturer -Different subect.

Doctors will usually use whatever worked for you in the past without much hesitation. If vicodin worked before then hint that you might need something a little stronger for acute flare ups but go with Norco which is the same drug only less acetaminophen than Vicodin. Tell them about your experience with Fentanyl and your desire to stay away from it. Percocet is just oxydodone with acetaminophen (tylenol) and I think acetaminophen is one of the most hepatotoxic medications out there. I use oxy without the Tylenol. I am trying to get away from oxy because of the rapid tolerance I seem to develop and I am tinkering with Buprenorphine, another opioid that is usually only prescribed at pain clinics.

See, I told you I would start throwing a bunch of medications at you. Sorry. I have been through a lot since entering pain management. My orthopedic specialists had exhausted all of their tools to help me and they gave me my first referral to a pain clinic about 7 years ago. I do not know if it is something you want to look into but I will give you a general overview of pain management.

If you can get a referral to the pain clinic then take it if your insurance will cover it. The best pain clinics I have found are run by doctors with an MD in Anesthesiology and further certification in pain management. They can offer injection therapy along with other comprehensive treatments including medication management. They have far more power to prescribe meds like Oxycontin or Opana.

You usually have to be a good little patient and pee in cups randomly and in my case bring my flipping meds in and have them counted randomly. The latter has never happened yet and probably will not as long as I pass all my UA's. But I do not rule it out. I could go on about why things have become so strict but that doesn't help you much. Pain clinics specialize in treating chronic pain and try to focus on the entire individual as relates to the pain they are encountering.

It is up to you to be your own advocate and say "Hey man, I am in living hell and the medication is just not doing the job". I am rambling so to conclude I want to clue you in to this bit about oxycontin not being the same. It most definitely isn't. I remember taking it before the reformulation and it took the pain away faster than anything I have ever used but it made me manic so I stopped using it. They reformulated it for the reasons you mentioned. It can no longer be smoked crushed into a fined powder or manipulated the way it used to be.

After I had been through methadone, hydromorphone, hydrocodone, combining this with that and not getting sufficient relief, my pain doc finally went with Oxycontin, the new OP version. IMO it is not as effective as it was before but it is still, for me, the most effective baseline (extended release) med. I just wish its analgesia would last longer and not create tolerance as quickly as it does for me.

I wish you luck as chronic pain can completely ruin one's life. Again, be your own advocate and do not let the doctors take complete charge of your care. If something isn't working then speak up. Sorry for the megapost. I should have gone into law where rambling is the norm.
 
Hey, can you guys help me out with a few suggestions? I have been weaning off of the super high amount of opiates that my primary care so easily prescribed with the help of my back doctor, who is also certified in pain management and is not an idiot at all....he knows what he is doing.

Quick background...am in chronic pain from a ruptured disc at L5-S1 that causes pain radiating to both legs and sometimes interrupts the signal to my bladder, causing me to either void or have to self cath. Also have 5 other ruptured discs, with two more pressing on my spinal cord. And severe chronic migraine.

Anywho...I have finally tapered down to MS Contin 15 mg once a day (down from 60 mg twice a day) and am about to jump off. I have also decreased my oxy ir from 30 mgs five times a day to 10 mgs twice a day. Huge decrease, it has been hard.

Finally, my question. This last decrease has brought an enormous increase in the pain I am feeling. I know I was over medicated. I am now finally feeling the daily pain that my back has, and sometimes it is quite intense. I need to get some epidural injections again as they worked well in the past, but I have no insurance and they are $500 each.

In the meantime, has anyone taken any non- narcotic pain relievers that have helped? I borrowed a few mobic from my cousin and they really seemed to help. Does anyone have any experience of anything else? I take prescription strength naprosyn, and that helps to a degree, but I need something stronger.

Also, what about ultram? I have no desire to be physically dependent on anything, it has caused too many problems, does tramadol cause physical dependency issues?

Thanks for any help....I will mention that I also utilize stretching, massage therapy, hydrotherapy and accupuncture but would love any and all suggestions of stuff I could research before my appt. that may help to cut this severe pain a little.
 
I'm so proud of your taper beachcat! That was no easy feat, I know you've been working so hard to get where you are today. I would highly recommend against Tramadol/Ultram, it has negative interactions with damned near everything, and the risk of seizures or serotonin syndrome don't seem worth it for such a tiny amount of analgesia.

Naproxen works pretty well for me too. Hydrotherapy has also been incredibly helpful to me, the weightless sensation works wonders for my back and neck.

I think pain is more over-treated than under. If people really want pain relief that bad they'll opt for marijuana when opiates aren't available and its overall just as effective. People who aren't adequately treated usually abused their medication in the past.

That's an incredibly arrogant thing to say. I'm a CPP who relies on both cannabinoids and opioids, and I assure you my pain is not over-treated, quite the opposite, which is why I appreciate cannabis as a supplement so much.

I am thankful for cannabinoids for many reasons, hash restores to me a significant quality of life. They work incredibly well at some things, however cannabis isn't an endless pros list, there are cons. It doesn't work for all types of pain, it's not some universal cure-all or panacea. You think cannabinoids are on the same playing field as opioids in terms of analgesia?
Your pain may be over-treated, but you can't speak for anyone else, it would be great if all of us could take some hash and not feel pain. I've been a medicinal cannabis patient for many years, I utilize high potency cannabis extracts daily primarily for it's positive effects on my damaged GI tract, in addition to relief from nausea, constipation from the opioids I require to manage the bulk of my pain, and stimulating my virtual non-existent appetite.

Cannabinoids certainly possess immense therapeutic value, but in no way does that mean cannabis is the superior/ultimate analgesic for everyone, or even for most people. What is your pain condition Ho-Chi-Minh?
 
With your GI situation it seems like you NEED cannabinoids. They are a god send for condition, but no panacea. The US has a very dangerous culture of under treating pain for fear of litigation or incarseration.
 
I think pain is more over-treated than under. If people really want pain relief that bad they'll opt for marijuana when opiates aren't available and its overall just as effective. People who aren't adequately treated usually abused their medication in the past.

Chronic pain is notoriously under treated. Read a few pages of this thread and you will see that.
 
Hey, can you guys help me out with a few suggestions? I have been weaning off of the super high amount of opiates that my primary care so easily prescribed with the help of my back doctor, who is also certified in pain management and is not an idiot at all....he knows what he is doing.

Quick background...am in chronic pain from a ruptured disc at L5-S1 that causes pain radiating to both legs and sometimes interrupts the signal to my bladder, causing me to either void or have to self cath. Also have 5 other ruptured discs, with two more pressing on my spinal cord. And severe chronic migraine.

Anywho...I have finally tapered down to MS Contin 15 mg once a day (down from 60 mg twice a day) and am about to jump off. I have also decreased my oxy ir from 30 mgs five times a day to 10 mgs twice a day. Huge decrease, it has been hard.

Finally, my question. This last decrease has brought an enormous increase in the pain I am feeling. I know I was over medicated. I am now finally feeling the daily pain that my back has, and sometimes it is quite intense. I need to get some epidural injections again as they worked well in the past, but I have no insurance and they are $500 each.

In the meantime, has anyone taken any non- narcotic pain relievers that have helped? I borrowed a few mobic from my cousin and they really seemed to help. Does anyone have any experience of anything else? I take prescription strength naprosyn, and that helps to a degree, but I need something stronger.

Also, what about ultram? I have no desire to be physically dependent on anything, it has caused too many problems, does tramadol cause physical dependency issues?

Thanks for any help....I will mention that I also utilize stretching, massage therapy, hydrotherapy and accupuncture but would love any and all suggestions of stuff I could research before my appt. that may help to cut this severe pain a little.

Tramadol will cause physical dependency like any opiate. I think its an amazing painkiller though.
You could try amitriptyline (or other trycyclics) , gabapentin, pregabalin, epilim. I used to find celebrex to work really well. Theres a huge range of muscle relaxers too if they help your back pain. Sometimes I use benzos like lorazepam or clonazepam for mild to moderate pain.
 
Hey, can you guys help me out with a few suggestions? I have been weaning off of the super high amount of opiates that my primary care so easily prescribed with the help of my back doctor, who is also certified in pain management and is not an idiot at all....he knows what he is doing.

Quick background...am in chronic pain from a ruptured disc at L5-S1 that causes pain radiating to both legs and sometimes interrupts the signal to my bladder, causing me to either void or have to self cath. Also have 5 other ruptured discs, with two more pressing on my spinal cord. And severe chronic migraine.

Anywho...I have finally tapered down to MS Contin 15 mg once a day (down from 60 mg twice a day) and am about to jump off. I have also decreased my oxy ir from 30 mgs five times a day to 10 mgs twice a day. Huge decrease, it has been hard.

Finally, my question. This last decrease has brought an enormous increase in the pain I am feeling. I know I was over medicated. I am now finally feeling the daily pain that my back has, and sometimes it is quite intense. I need to get some epidural injections again as they worked well in the past, but I have no insurance and they are $500 each.

In the meantime, has anyone taken any non- narcotic pain relievers that have helped? I borrowed a few mobic from my cousin and they really seemed to help. Does anyone have any experience of anything else? I take prescription strength naprosyn, and that helps to a degree, but I need something stronger.

Also, what about ultram? I have no desire to be physically dependent on anything, it has caused too many problems, does tramadol cause physical dependency issues?

Thanks for any help....I will mention that I also utilize stretching, massage therapy, hydrotherapy and accupuncture but would love any and all suggestions of stuff I could research before my appt. that may help to cut this severe pain a little.

I too have chronic pain related to my spinal issues and the only thing I can add on to what you mentioned is YOGA. It helped me get off all narcotics last year after my first (failed) fusion and was tremendous in terms of giving me a quality of life I never thought possible after having my spine fused.

Unfortunately I haven't been able to return to Yoga practice (going on a year next month :( because of two more attempts at fusing my spine together but I dream of the day of getting back into my practice. It really changed my life in a matter of months and made my back pain tolerable without heavy narcotics.
 
Thanks, guys. Appreciate the insight!

With regards to the marijuana discussion, I think it is a little arrogant to state that people in true pain will opt for cannabinoids. I can tell you that for me, smoking marijuana when I have a migraine intensifies the pain greatly. I tried or a couple times for the nausea and it made each heart beat feel like a jackhammer nailing holes into my head.

On the other hand, it may be an option for the back pain....I tried some the other day, the first time in a very one time, and I was surprised how well it helped me manage my pain...I think once I am off my ms Contin and not relying on opiates so much, I might explore what cannabinoids can do...
 
So I have a couple questions about PM.

My PCP had diagnosed my condition as chronic (due to a car accident I was in) and said she can no longer prescribe me my oxy which WORKS and that she is going to refer me to PM. Is this because she thinks I'm misusing it? I'm not comfortable with any injections, and I'm afraid if I go to PM the doctor will say he cannot prescribe me any opioids based on my age (I'm an adult - 22)....but like I said that's the absolute only thing that helps.

I guess my question is: are PM clinics able to discontinue a medication that is actually beneficial to an actual medical condition? Will I need to get injections, and would they couple them with my prescription for breakthrough pain?

I just obviously don't want to live every fucking day in pain. If I don't take my meds, I'm miserable because of my pain.

I'm not asking how to obtain drugs -- I guess I'm just unfamiliar with the whole PM process.
 
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