Pain Management in Australia

[razdaddy]

Great info

 

[SKR]

^Yeah, it blows at times. I've had chronic pain for almost ten years now, & on opioid therapy the whole time.

To the extent now that I an insane tolerance to opiates, which has in & of itself has created a dual problem. I'm prescribed a dose strong enough to kill a horse, & my pain mgmnt has reached a point where they're past their upper prescribing level & comfort zone.

Like plenty of other BLs, I take more than prescribed, for pain, & have periods constantly & consistently where I run short. I've written plenty before, but I'll say it again, my secondary issue is that each time I run out, obviously I go into wd. I cushion this ok with lyrica, but it's not a great situation.

Just a warning to others to try everything before opiates. My pain is very difficult to treat, hence the ketamine infusions.

SKR, what is the origin of your pain? What meds have you trialled so far?


Rtp

Hi RTP, I appear to be experiencing some sort of neuralgia. The pain originates in the thoracic region to the right of my spine, wraps around my ribs and terminates on the opposite side where my ribs insert into my sternum. So I feel like a spear is run through me from back out through my chest with pain around my ribs. I have sciatica which appears to be due to some bulging discs in my lower spine which all began from a car accident 15 years ago, all exacerbated by weight lifting and sports in my younger days but I have managed those issues with massage and exercise - I accept them as part of my life and not the reason I sought out treatment.

It's the nerve problem that has me on meds. I'm prescribed oxycodone ER and IR and pregabalin, the pregabalin is being tapered with a view to coming off and commencing amitriptyline. Yes my doses of oxy far exceed what I am prescribed to try and better manage my pain but I'm trying to taper down for a while so that they become more useful again. I'm caught in that losing battle of opiate tolerance versus relief. I'm fortunate to be able to get enough oxycodone from a source other than my GP but this is not sustainable and of course illegal. I'm not having fun but none of us are by the sound of it.

 

[Runtoparadise]

I'm sorry to hear of such pain. I know nerve pain of any origin is damn awful!!

Amitriptyline May or may not be helpful, just a heads up, high doses can interfere with your vision to begin with. I found out the hard way..

Have you had any sort of nerve block performed?

Rtp

 

[SKR]

They've had a couple of goes at cortisone injections, nerve and facet joint. Only the anaesthetic that comes along with that procedure gives me any relief albeit brief. I'd sign up for a shot of anaesthetic everyday if it was feasible, as uncomfortable as the shot is it's nothing compared to the 24/7 pain. Like I've said before, if it wasn't for my wife and my son I'd be checking myself out of this life in hope of some rest from it all. I'm a bundle of joy these days.

 

[Runtoparadise]

Chronic pain is a miserable life, especially when we can't get the relief we need.

Are you near melb by any chance? I've had excellent pain specialists who have absolutely stood up against other health professionals regarding my oxycontin dose when other methods have failed.

And these doctors tried EVERYTHING for my pain. As much as I still suffer greatly at times, they've really put me through every possible procedure.

Rtp

 

[SKR]

No I'm in Brisbane RTP. Yeah Oxy helps but its a losing battle with regards to tolerance. I think it mostly serves as a distraction mentally from the pain but having to take 100+ mgs for an hour or two's relief is no good.

 

[Runtoparadise]

^Will your GP not allow a dose increase? I'm prescribed a total of 200mg per day oxycodone/oxycontin. As I've said though, I do take more. Tolerance sucks.

What about Jurnista(long acting hydromorph)? Has your doctor ever tried opiate rotation? I've tried it twice but unfortunately it's much more sedating for me, though I know others who've had success.

Oxys great for improving mood, my pain dr told me it might help mine lol.

I forgot to look at the start of your thread, you're not in pain management yet right? I'm gonna pm you something I don't wanna share here that you might like to look into

Can't yet pm, sorry

Rtp

 

[CfZrx]

I'm sorry to hear of such pain. I know nerve pain of any origin is damn awful!!

Amitriptyline May or may not be helpful, just a heads up, high doses can interfere with your vision to begin with. I found out the hard way..

Have you had any sort of nerve block performed?

Rtp

RTP, what is your source of pain?

 

[Runtoparadise]

^Arthritis, crps, central sensitisation & maybe fibro,- though my pain dr calls it widespread musculoskeletal pain, which I personally prefer. Same thing. I get awful bone pain too.

Three types of arthritis, no one can tell me why though:/ I'm a bit of a mystery case. Though it's the flare ups of neuropathic pain that floors me.

Remind me of yours, neck?

Rtp

 

[Erikmen]

I feel a little of this in one of my fingers. Does it get worse during cold days?

 

[Runtoparadise]

^No surprisingly, but the bone pain travels from my lower back into my legs on bad days. Feels like a drilling into bone kinda pain.

Rtp

 

[SKR]

^Will your GP not allow a dose increase? I'm prescribed a total of 200mg per day oxycodone/oxycontin. As I've said though, I do take more. Tolerance sucks.

What about Jurnista(long acting hydromorph)? Has your doctor ever tried opiate rotation? I've tried it twice but unfortunately it's much more sedating for me, though I know others who've had success. Oxys great for improving mood, my pain dr told me it might help mine lol.
I forgot to look at the start of your thread, you're not in pain management yet right? I'm gonna pm you something I don't wanna share here that you might like to look intoCan't yet pm, sorryRtp

Yeah no PM's yet apparently, I'm sure I can get the post count up though.

No I'm only just now going to be referred into PM. I have to consider private or public, not sure how covered I am with my health fund. Had a bad last 12months with regards to financial investments so I have to consider my options whereas before I would have just gone private without any consideration.

You sound like an idiopathic nightmare for your Dr's, I'm a bit the same. Diagnosed with idiopathic pancreatitis - resulting in the removal of my gall bladder, diagnosed with MGUS which appears to be a completely idiopathic condition - after seeing a bunch of unusual blood results I guess they had to give people like myself a name of a condition so Monoclonal gammopathy of unknown significance (MGUS) is what they came up with. May turn into Myeloma, may turn into nothing....Oh brother, it's like waiting to die in a car accident I suppose, not much point in worrying about it.

So back on topic - No I'm yet to go into PM and there is plenty of room to increase my oxy dose (Which I have done myself), but my GP would rather someone else take responsibility for that which I understand.

 

[Runtoparadise]

My permit required a subsequent application, I could've just gone to any specialist to get my file stamped each year, but yes,- I am a nightmare for doctors so I wanted to explore pain mgmnt.

I go private, as it was the fastest route, but I'm also on the public waiting list to see if they might help in some other way. My doctor bills my ketamine infusions as rehab so my health fund covers 100%.

I've found through observance that if a patient has one diagnosis, they quite often have/develop other ailments/disease/pains.

Sorry to hear about your MGUS, that would be scary to be informed you might potentially develop a blood cancer in the future. Let's hope not.

Rtp

 

[SKR]

Actually these cold days devastate me with regards to pain, and it's not even cold yet really, not compared to Melbourne anyway. I'm due to see my haematologist soon and with how my hips are hurting atm I'm wondering if my auto immune condition is developing into arthritis of some sort.

RTP - with regards to your arthritis I'm assuming you have sets of blood results that reflect this? Is it auto immune related or something more general? The thoracic doc I was seeing started to consider fibromyalgia for me but the fact that my pain is asymmetrical should rule that out. Hopefully. Appears to be a bit of a dead end diagnosis when they start talking about fibro.

 

[SKR]

My permit required a subsequent application, I could've just gone to any specialist to get my file stamped each year, but yes,- I am a nightmare for doctors so I wanted to explore pain mgmnt.

I go private, as it was the fastest route, but I'm also on the public waiting list to see if they might help in some other way. My doctor bills my ketamine infusions as rehab so my health fund covers 100%.

I've found through observance that if a patient has one diagnosis, they quite often have/develop other ailments/disease/pains.

Sorry to hear about your MGUS, that would be scary to be informed you might potentially develop a blood cancer in the future. Let's hope not.

Rtp

Yeah it knocked the wind out of my sails that's for sure. But after undergoing a bone marrow biopsy I was negative so far, so that was a relief. But a strange set of stats comes with MGUS - apparently for every year after a diagnosis there is a 2 - 10% chance it will develop into something sinister. What are you supposed to do with that lol, anyway.

Yes I will look into both Private and public, good to hear your Dr gets crafty with your health fund. Nice.

 

[Runtoparadise]

The arthritis doesn't show in my bloodwork, so it's a clinical diagnosis based on nuclear scans where dye is attracted to problem areas. I've had around ten by now, & it's a progressive disease process that apparently is in the pattern of differing arthritic bone changes.

I've been on prednisone, anti inflammatories, five disease modifying agents,-one a cancer treatment, & of course the opiates from the beginning.

I'm pretty much with you that I feel fibro is a wastebasket term when doctors are stumped. No offence intended to anyone out there.

Rtp

 

[SKR]

Well I guess it's the arthritis that gives you horrible pain but not so much direct death? Well that's something I suppose, you poor thing. And did I read earlier you've been a pain patient for many years or do you mind me asking how long you've been treated at the level you are now with respect to your prescriptions and other treatments?

 

[Runtoparadise]

^pretty much nothing has changed for the last couple of yrs, in regard to my healthcare. My opiate dose was actually higher previously, but with a new GP & the ketamine infusions from my pain specialist my scripts have actually lessened slowly.

Is there anything in particular I can answer?

Rtp

 

[SKR]

Thanks for sharing. I'm certainly interested in the Ketamine infusions if you don't mind me asking. What is the process/procedure with regards to those K treatments RTP?

 

[Runtoparadise]

Well I guess it's the arthritis that gives you horrible pain but not so much direct death? Well that's something I suppose, you poor thing. And did I read earlier you've been a pain patient for many years or do you mind me asking how long you've been treated at the level you are now with respect to your prescriptions and other treatments?

No, nothing terminal going on with me,- instead I've been dealt a life sentence of chronic pain. Ah, that's a bit grim. I need to remember that we live in a progressive society & that there's always going to be new medicines & treatments evolving.

Not to mention self help.

My arthritis pain is relatively contained now. Not actually controlled or managed, but reasonable around fifty percent of the time.

What really kills me is the bouts, or flare ups of neuropathic,- not joint, pain which in all this time I've never been able to figure out the trigger. So I can never plan for the next week or month as I myself won't know how I'll be feeling.

Which is where the ketamine infusions came into play. As I mentioned earlier, I felt it was a procedure to save for when I had exhausted all possible other options.

Ketamine infusions are performed by a dose of said drug mixed in saline & subcutaneously fed into the patient over a period of at least four days via a Niki pump. I've seen Ketamine is used in a variety of ways, eg: for addiction,- to come off opiates altogether, to help to lower, or maintain a low tolerance, or for severe pain to mention a few.

Not to oversimplify, (but this is turning into an essay lol), the infusion is started at a very low rate & titrated or stabilised each 24hrs. To begin with a nurse will take obs every 15mins, & the patient is monitored extremely closely for adverse effects the first four hrs of each dose titration.

Ketamine works via the mechanism of NMDA receptors. With my pain the plan was for the infusions to dampen down these receptors in an effort to give me relief from my CNS basically going haywire. Whether it was the ketamine or the bed rest & quiet time, or just time that assisted my recovery as an inpatient has never been clear. A few times I literally had no change, or extremely little, even at the maximum dose my specialist is willing to administer,(to anyone, not just me personally).

I'm typing on my phone, & worry I may suddenly lose this extensive post SKR, so I'll fill in some details next time.

Sending positive vibes,

Rtp