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

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chicpoena said:
Cane2theLeft,

Thank you for your support. Sorry if I came off as defensive... most doctors are unwilling to even consider that an SSRI can do nerve damage but that's what seems to have happened to me. It's rare, but it is recognized that SSRIs can cause nerve damage when abruptly discontinued. The fact that the muscle twitching in my face occurs with the pain makes me think I have trigeminal neuralgia. My PCP diagnosed me with it and she was the only doctor yet who I felt has really listened to me. I avoided getting this treated for so long because no doctors ever believed me... once I told them why I thought I was in pain they dismissed my pain entirely. It's really dumb that I never got it treated when it first occured because now long-term potentiation has set in and I'll have to deal with this irritated nerve for the rest of my life. Corticosteriods are the only medicine, besides opioids, that have worked so far. I'm looking at trying a TCA or anti-convulsant next.

I am evaluating getting admitted to a pain clinic because I want a multidisciplinary approach to my pain. Its affecting my relationships, caused the loss of my job and is ruining my life. I don't just want to be doped up on narcotics, I want a doctor who listens to me and understands the effect it's having on my life. My fiance wants to be involved as well to make sure that I am compliant. Do you have any suggestions for how to choose a pain doctor, or is it just trial and error?
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You sound like me a couple years ago. I had an un-relenting sort of dull pain that was on the right side of my face all the time and then on top of that the smallest little stimuli like wind, or even a foggy morning would make the pain turn into a shooting, stabbing, type of pain that is so frustrating to treat.

While my pain is a result of a surgery that went wrong in some respects I can sympathize with the fact that you think your sudden discontinuation of your SSRI medication could have contributed to your pain as well. While I don't have any scientific evidence to prove it, I was more or less a human guinea pig through my late teens when my parents just wanted a kid who was easier to manage I guess; so I was given SSRI's and a host of other psychotropic drugs in an attempt to curb my unbound creativity :p. Like a moody teenager I stopped taking the medication cold-turkey and experienced an increase in the flare-ups that I was having related to the jaw-surgery as well as an increase in intensity.

Right now I think I have it under control with medication, as well as taking classes for things like hypnosis, body-imaging and other pain-relief exercises. The best regiment I have found so far is to take the medication Lyrica (pregabalin) everyday (I'm personally at the maximum recomended dose of 600mg/day) taken with 60mg of Methadone broken into 3 doses of 20mg each throughout the day, but every other pain sufferer knows that not everyday will have you taking the same amount at the same time.

Just remember that at least someone out here knows what you are going through. Post any questions that you have or anything you want to say.

Edit: I would just like to offer you a link to a disease that seems to fits the descriptors you have given us. I personally thought I might have had this disease until I was seen by a specialist in pain and neuropathy. http://en.wikipedia.org/wiki/Trigeminal_neuralgia

"Trigeminal neuralgia (TN), tic douloureux[1] (also known as prosopalgia) is a neuropathic disorder of one or both of the trigeminal nerves. Its nickname is "the suicide disease" because it causes one of the most severe pains that a human being can experience, and is not easily controlled or cured. It causes episodes of intense pain in any or all of the following: the ear, eye, lips, nose, scalp, forehead, teeth or jaw on one side of the face.[2] It is estimated that 1 in 15,000 people suffer from trigeminal neuralgia, although the actual figure may be significantly higher due to frequent misdiagnosis. TN usually develops after the age of 50, more commonly in females, although there have been cases with patients being as young as three years of age [3].

TN brings about stabbing, mind-numbing, electric shock-like pain from just a finger's glance of the cheek or spontaneously without any stimulation by the patient. Cold wind, high pitched sounds,loud noise such as concerts or crowds, chewing, talking, can aggravate the condition, and for the worst cases, even smiling or a scarf or the wind or hair on the side of the face is too much to bear."
 
I apologize in advance as this question may have been asked previously above but I'm in substantial pain NOW and I can't make it through all thirty something pages of this thread. I have fibromyalgia, Rheumatoid arthritis and was in a car accident where I was hit by a tractor trailor this evening. I'm in SEVERE pain and all I have on hand in vicoprofen 7.5/200. The ER doctor did not want to give me anything for my pain because I'm under the care of a pain management dr but I've only been under his care a short time and rather than start me where my primary care doctor had me he's starting me at the very bottom and working me up which is excrutiating. Is there anything I can do to get maximum relief from this medication? Should I take it with milk, not take it with milk, take on an empty stomach, take with an allergy pill - I'm at the end of my rope and I don't want to call and wake my doctor up at 3am - please help!
 
Go to the ER and explain to them that your pain management coordinator just wants TO BE INFORMED if you are administered any stronger medication, but that doesnt mean that it is a complete non-issue.

Maybe if the ER is not an option you can wait it out until the time when urgent care appointments are taken?

I've been in this situation before and the ER staff has always been good to me. It really depends on the doctor with what pain meds you will be getting but be sure to STRESS that you are already on other pain medications but you are having an uncontrollable flair-up that needs tending too.

EDIT: Depending on how many of those Vicoprofen pills you have on hand you could do what is called a cold water extraction that will let you be able to have more active pain killing ingredient compared to the toxic ibuprofen in quantities that actually can help you. If you want to go this way it will probably result in a total yield loss on your medication by probably 15% but its pretty much the only way I can get anything at all from weak as fuck norco's etc.
 
I am so appreciative of this thread. It makes me feel sad that all of us suffer with these conditions. Being in constant pain is so debilitating.

The past two years have been medical hell. I had a hysterectomy, shortly after, at the age of 38 I discovered I had severe scoliosis. My husband always said I had a bump in my back, but it never caused me any pain so I didn't pay much attention to it.

After yoga one night, I was in such sever pain I could barely move. I went to urgent care, thinking I could just get some vicodin and muscle relaxers and would be fine. They gave me an x-ray and I was horrified. My back looked deformed.

An MRI and 2 doctors visits later, I learned that I had a 45 degree curve multiple bulging discs, degeneration and a torn disc. I was very naive and didn't realize at the time how shitty the doctors were. They would prescibe me no pain meds and I went to a pain management clinic (a real skeevy one) and got a ton of vicodin and soma.

Within 3 months, I began to feel better and resumed being very active - I was always physically active and couldn't imagine changing that. Another 3 months passed, I was off the pain meds and one night sat down funny and heard something snap.

The next day I could no longer walk and ended up in the ER on a Fentanyl drip. Another MRI and more Dr.'s visits. I found out in the ER that they switched my primary care physician which turned out to be a real stroke of luck.

This Dr. was the first one that listened to me and explained the seriousness of my situation. He wanted to give me morphine sulfate but I had a terrible reaction to morphine in the hospital when I had my hysterectomy where my blood pressure dropped so low that I almost died. I was uncomfortable with morphine, so he put me on oxycontin.

He also referred me to another neurosurgeon. The one I went to before told me I didn't qualify for surgery, yet put in my chart that surgery was recommended (asshole). This neurosurgeon told me that my secondary problem was sever degenerative disc disease along with arthritis and to top it all off, my MRI showed a compression fracture and I hadn't had ANY trauma to the area.

I have been working with both doctors in terms of pain management and want to encourage all of you that, if possible, don't take no for an answer when you are in pain. I have had injections, which only helped the ligament pressure from the curve but not the underlying problem. I am now most likely going to have a spinal fusion, my next neurosurgeon appt is in March, where he will give me the final verdict.

I found that for me, the oxycontin only helped part of the problem, so I went back to my primary care doc and explained to him that I really needed a different kind of pain management. I tried amitriptilyne, which was the best thing for the pain but made me incredibly depressed, then was put on nortriptyline which did nothing.

The dr. then wanted to give me neurontin but I was petrified as I have heard/read awful things about it.... I started at 900mg and am now on 1800mg a day plus 45 mg Percocet.

This combination has allowed me to have somewhat of a normal life... I use that term loosely as I am no longer able to excercise or walk for long periods. Neurontin has helped with pain that opiates won't touch and works well with the Percocet. The nerve pain is so bad that without the Neurontin I cannot walk in the morning because the pain goes from my back all the way down to my feet and I can't put any pressure on my feet.

The point I want to make is that I had to take a certain kind of responsibility in terms of getting help. I do/did enjoy opiates, but I also have to keep my job up until the surgery and the amount of oxycontin I needed to relieve the pain did not allow me to really function and drive and never really addressed the worst of the nerve pain.

I had to accept that I most likely cannot expect 100% of my pain to go away and I had to be real honest with myself about my liking of opiates. One thing I have found is that in the absence of the most severe pain, my desire for an opiate high disappears.

I don't say this or mean this to be any judgment on others AT ALL. What works for one person won't necessarily work for others and I completely understand and can relate to a desire to feel better by any means possible.

I have just felt better psychologically when I decided to be proactive. I did have to 'prove' myself to my dr. - urine tests, etc. but once that understanding was reached, he has helped me along the way, even telling me that if/when I want, I can go back on the oxy which in turn made me more willing to experiment with other meds.

Thanks to all who have posted in this thread, it is really therapeutic to know that I am not alone in dealing with this.... before this new dr. I had multiple experiences of being treated as a pill seeker etc. and the pain and humiliation was very isolating. Unfortunately 4 weeks ago a lump was found in a routine mammogram and after another mammogram and ultra sound it has been determined that it is suspicious of malignancy and I have a biopsy scheduled for next thurs. The thought of spinal surgery was scary enough, now I don't know what is going to happen, but have to just trust that every thing will be ok
 
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Scoliosis11, may I ask, what was the problem [or what were the problems, if there were more than one,] you encountered with morphine? How does oxycodone compare, in your case? I ask because I find myself in a similar position to your good self. I'm currently on MS-Contin and am considering making the change to OxyContin, which in my case would mean me taking around about 200 mg of OxyContin and IR oxycodone all-together daily. I've never taken oxycodone, not even in one of the combination [with APAP] meds. I've read a lot, which I know can't substitute for my personal experience, which is why I'd like to try something with oxycodone in it. I was thinking some IR tablets (tabs) (is this called OxyIR or similar to that?) would be helpful, this way I could stay on MS-Contin for my main pain relief and take IR oxycodone (oxy) tabs for break-through-pain (BTP.) If I find the IR oxy tabs are working better for BTP than the IR morphine was, I'll then strongly consider changing from MS-Contin to OxyContin.

Any of your thoughts are welcome, as is any advice or thoughts from anyone reading this thread. If you (scoliosis11) or anyone else (especially pain patients (sp?) like us - in particular, chronic pain patients.) Take care, God bless [delete as appropriate] and stay well. :) Peace all. <3 ISD ~ I Stay Dead.

I stay dead
Until you veil my scars and say goodbye to fate
Before it's too late.​

Lyrics taken from: http://www.azlyrics.com/lyrics/him/playdead.html %)
 
I_Stay_Dead said:
Scoliosis11, may I ask, what was the problem [or what were the problems, if there were more than one,] you encountered with morphine? How does oxycodone compare, in your case?l
Click to expand...

For some reason I am really sensitive to it, and on top of that it is not a very good pain reliever for me. It took 2 hours with a nurse sitting by me with a syringe / IV to get my pain under control immediately after surgery using morphine.

Then, when I was hooked up to the morphine pump, I pressed it continuously because I just couldn't get comfortable. In the middle of the night, I felt myself slipping out of my body and the next thing I knew a nurse was sitting me straight up in bed telling me my blood pressure was severely low. I can't remember exactly but it was something like 80 / 47.

The pump was removed, they gave me toradol which I had a terrible reaction to, and at one point had no pain meds. It was fucking awful and I was screaming in pain.

I am sensitive to many different types of meds, it has taken a while to figure out what works. I am shocked that Neurontin is a perfect fit for me.

In terms of the Oxycontin/Oxycodone: I have been on both the time release and the immediate release. I liked the immediate release because the pharmacy near me had it in tablet form and I could cut them up and take 1/2 if I wanted.

I like Oxycontin for pain, and for me there is no comparison between morphine and oxy for pain relief but it turns out that most of my pain is neuropathic, so a heavy dose of opiates isn't the best solution for me, although they do help with the deep bone pain. If I wanted to, I could get Oxycontin instead of Percocet (oxyxodone) but I find I react better to a non-time release medication and I can get effective relief from the oxycodone since I still have to drive/work.

If you have a good relationship with your doctor, then by all means try the Oxycontin. I think the relationship with a doctor is key. Good luck to you
 
i've been thinking about asking my doctor about Modafinal for studying purposes and all round my lack of attention. i'm not even going to humour him with the prospect of an amphetamine.

has anyone else on pain management had much luck with Modafinal for studying and attentive purposes? no recreational shit - it's not even recreational, i'm not looking to get high.

there is some mention of this earlier in the thread so i though i'd ask for some current opinions as well.
 
^I'm not sure if you've seen this, lefty.

STUDY OBJECTIVE: The purpose of this study was to assess the efficacy of modafinil in combating opioid-induced sedation. DESIGN: A 1-year retrospective chart review of all patients receiving modafinil, a wake-promoting agent, to treat opioid-induced sedation. Opioid-induced sedation was measured using Epworth Sleepiness Scale (ESS). SETTING: Outpatient, private practice. PATIENTS: Eleven adult patients, six female and five male, being treated with opioids for chronic, nonmalignant pain. RESULTS: A significant decrease was observed between pretreatment and posttreatment ESS measurements during modafinil treatment. CONCLUSION: The results suggest an improvement in opioid-induced sedation in patients treated for nonmalignant pain. SOURCE
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cheers cane, i'll deifinitely have a read of that shortly. if that's what you linked earlier in the thread, i apologise for making you repeat yourself;) repeat yourself. repeat yourself...i feel like a broken fucking record after walking into this place this afternoon. i need to get high pronto to deal with it:(

i haven't even begun to do any research yet, just thought i'd throw it out there for the bluelighters too.

the conclusion sounds good though:D
 
^idk if I posted that before but I always recommend modafinil for OIS because it very effectively counteracts the symptoms and doesn't carry the vast majority of the liabilities that amps do. Also, generally doctors are far more willing to prescribe it.
 
yeah, if its succesful in OIS it would be good for what i'm after. i've had my meth problems in the past and the last thing i need with being dependent and addicted to opiates is that shit on my back again. i don't even want to give myself the chance.
 
Please help, I'm new here and didn't get any response to my other question.

I think my pain management dr. is a jerk. He so wants to implant a neurostimulator he can hardly restrain himself. He's an anesthesiologist but wants me to have a paddle from a distant doctor who's considered "the best". For some reason to do with medical politics, neurosurgeons don't come here to Sonoma County. Which I doubt. I just don't think he knows any.

I've learned a lot reading here. My pain must be neuropathic since my MRI doesn't look that bad -- some disc degeneration and bulging, osteoarthritis, healed 50% spinal compression fracture with a bone fragment pressing on the nerve, general wear and tear. My physical therapist says his MRI probably looks worse.

Right now I'm on MS Contin (morphine sulfate extended release), 115 mg 3x day; oxycodone 30 mg every 3 hrs, but I increase that to 60 usually and cut down at night. I.e. I stay at the 8 per day limit. I've also added some leftover MSIR (morphine sulfate immediate release) but will soon run out of those. I've started on nortriptyline at 10 mg at bedtime, tried to increase to 50 mg but had palpitations at 30 mg, so my doctor cut me back. I use Soma and benzos to help with the spasms and stiffness. Of course I'm very sedated. I get no highs and only "feel something" (a ghost of that wonderful narcotic effect I used to get with Vicodin or Fiorinal when I only had migraines) at about 60 mg of MSIR plus some oxycodone.

I want to add gabapentin -- that's neurotin, right?

What I'd really like to know is what would happen if I crush up one of my 15 mg MS Contin with lemon juice and swallow it. Or even cut it in half and take 7 mg. I don't want a high but I do like to feel a sense that the pain is decreasing slightly. Which is doesn't on my current protocol.

We'lve tried a lot of combinations and nothing seems to help, because it's "just nerve pain and all in your head". E.g. my physical therapist said he had an 80-y-old woman whose MRI had his jaw on the floor and she was bouncing around playing tennis. I feel so blamed and shamed by all these people.

Anyway, the narcotics converter, very helpful though it is, doesn't include extended release morphine. I just want to know what is the MSIR equivalent to MS Contin. How much morphine is in one of those 15 mg extended release pills?

Or, what would happen if I added another 10 mg of methadone to the mix? I don't want to kill myself.

My paiin manaagement doctor is away for a week and when I called his nurse told me snottily to see my GP, as if she could or would do anything.

I'm going to start with the gabapentin and show my dr. the article on topical ketamine gel. Other than that, I can't read all 30+ pages of this thread either, I need something now! Can someone please respond? I can't respond to PMs since I'm new...

Thanks
 
I_Stay_Dead said:
I'm currently on MS-Contin and am considering making the change to OxyContin, which in my case would mean me taking around about 200 mg of OxyContin and IR oxycodone all-together daily. I've never taken oxycodone, not even in one of the combination [with APAP] meds. I've read a lot, which I know can't substitute for my personal experience, which is why I'd like to try something with oxycodone in it. I was thinking some IR tablets (tabs) (is this called OxyIR or similar to that?) would be helpful, this way I could stay on MS-Contin for my main pain relief and take IR oxycodone (oxy) tabs for break-through-pain (BTP.) If I find the IR oxy tabs are working better for BTP than the IR morphine was, I'll then strongly consider changing from MS-Contin to OxyContin.
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I have been on both methadone and MS Contin for chronic pain, also on methadone and MSIR (morphine sulfate immediate release), and now back on MS Contin with oxycodone, 30 mg tablets, up to 8 per day for 'breakthrough' pain. (I have no breakthrough pain, just pain, period.)

This was my first experience with oxycodone also. By the way, they just write oxycodone HCl on the bottle. Since there is no generic for Oxycontin, I guess there's not a need to distinguish. Just saying oxycodone is sufficient, it seems.

It's hard to compare since I'm in SO much pain regardless. I didn't find the methadone very helpful at all. I would tentatively say that the MS Contin with oxycodone for BTP could probably help you. Oxycodone is certainly stronger than MSIR orally, though morphine is still the gold standard IM, IV, and parenterally. Just based on that, it'll probably work better. For me, it doesn't help unless I increase the oxycodone to 60 mg at a time and cut it out at night (thus staying at 8 per day, as prescribed).

I wonder if your doctor will give you both Oxycontin and oxycodone. I know my doctor raised an eyebrow when I came to him with a existing pain protocol of methadone and MS Contin, since both are "long-acting" -- MS Contin intentionally; methadone just works that way. If s/he will, I'd say you would definitely benefit. I would love to be able to try Oxycontin and oxycodone.
 
this may be a silly question, but i've been searching all day with no conclusion. Is it safe to take a low dose (50mg) of tramadol while on the fentanyl 25mcg/hr patch for breakthrough pain? My doctor gave me the option of either a long term med or short term, but not both? The patch is working great but i only have access to tramadol unless he will be willing to prescribe a breakthrough medicine next appt (this will only be my 3rd appointment, so i'm wondering if this is a common things PM docs do at first or not?)
 
Hi, sorry to interupt, another newbie question. I have a deteriorated disc in my lower back which is pressing against my sciatic nerve. Have had sciatica for over 2 years now, am currently taking Tramadol, 50mg, 2, 3 times a day, along with paracetamol (or codine if the pain is really bad) and Arcoxia, 90mg 1 daily and also Citralapam, 20mg 1 daily. I'm due to have a cortizone steroid injection on Friday. I'm not sleeping because the tablets usually wear off within a couple of hours before going to bed, during the day the tablets wear off and leave me crippled. I'm posting here because I read that Kratom was good for pain and helped you sleep - I'm not a recreational drug user - but I was wondering if this would help, or would the combination be dangerous?
 
endEMBEDA said:
this may be a silly question, but i've been searching all day with no conclusion. Is it safe to take a low dose (50mg) of tramadol while on the fentanyl 25mcg/hr patch for breakthrough pain? My doctor gave me the option of either a long term med or short term, but not both? The patch is working great but i only have access to tramadol unless he will be willing to prescribe a breakthrough medicine next appt (this will only be my 3rd appointment, so i'm wondering if this is a common things PM docs do at first or not?)
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If you still have pain on top of the fentanyl and are not taking any medications that interact adversely with tramadol (You can use this link to check), then yes it is safe to use them together.

It is pretty common for PM specialists to prescribe an around-the-clock or long-acting drug for baseline pain as well as a short-acting drug for breakthrough pain but I have heard of many physicians who prefer not to do this.

Dreamchaser159 said:
Hi, sorry to interupt, another newbie question. I have a deteriorated disc in my lower back which is pressing against my sciatic nerve. Have had sciatica for over 2 years now, am currently taking Tramadol, 50mg, 2, 3 times a day, along with paracetamol (or codine if the pain is really bad) and Arcoxia, 90mg 1 daily and also Citralapam, 20mg 1 daily. I'm due to have a cortizone steroid injection on Friday. I'm not sleeping because the tablets usually wear off within a couple of hours before going to bed, during the day the tablets wear off and leave me crippled. I'm posting here because I read that Kratom was good for pain and helped you sleep - I'm not a recreational drug user - but I was wondering if this would help, or would the combination be dangerous?
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First welcome to BL and you are SUPPOSED to ask questions here and you did it appropriately by using the right mega thread... so don't apologize for interrupting! You are very welcome here.

The best option for you is to find a sustainable medication regimen as well as explore other ways to manage your pain (biofeedback, meditation, physical therapy, etc.) however if you need something in the meantime, then kratom may be a viable option.

The problems that may arise are less immediate but more long term if you keep medicating yourself and raising your tolerance through using things like kratom. It is always best to be open with your doctor with how you are doing and develop a good relationship with him so that you both trust each other and listen. If you feel he is not being responsive and fully addressing your issues then you should find another physician.
 
so i'm sure this has been asked to death, but, is it genereally "safe" to tell a pain management specialist you've tried street drugs because of your pain?
i mean doesn't it just justify it more?

or do they then "legally" have to deny you narcotices?

im setting up an appointment because i'm sick of being in pain and paying out the ass for it..

dunno, wasted on benzos for the 2nd time ever... i'm so sorry

please forgive
 
^this is something that completely comes down to the discretion and views of the doctor. There is no law or rule that if a patient discloses drug use that you can't prescribe narcotics but most doctors will change their prescribing habits if they know the patients is in recovery, has a history of drug abuse, etc.

The general consensus is to not tell the doctor about illicit drug use because its more likely that the doctor will react prejudicially.
 
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