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

[kovus]

It shouldn't take that long to get in to a pain clinic though depending on their schedule. My doctor just told me that he was closing his current practice to take over for a physical rehab doctor and thus will no longer be doing pain management.

He wrote my referral out (takes all of 15 seconds) and his staff will fax my records over. I called the new clinic and told them that I was being referred by the first doctor and that I needed to setup an appointment for an evaluation/assessment. I have an appointment in two weeks (and may have been able to get in sooner, but that was the week I requested).

There shouldn't be any paperwork involved. The hardest thing would be faxing your records and that isn't done by him, but his staff and even that shouldn't take <that> long.

I mean I guess the situation may be different there, but as many times as I've had referrals done that was all it ever took. Sorry you're having so many issues overall though.

 

[LightTrailz]

xyther: Why will it take so long to make an appointment? I know that often it takes a long time to get in because places are booked, but you should be able to at least setup the initial appointment.

It seems your doc is providing the patch simply because they feel it has the least abuse potential. I couldn't stand fentanyl myself either. I never threw up on it, but I certainly felt nauseated.

How long have you been on the patch? Is it possible you are just adjusting to it? Usually affects like nausea will go away after a week or two. Everyone is different of course.

If it is going to take so long be seen at a pain clinic is it possible to see the other doctor you mentioned or even another "normal" clinic? You'd have to explain an awful lot considering your getting the patches from the current doctor, but as long as you aren't getting new scripts from both there shouldn't be a problem.

2mp: You can try a muscle relaxant of course, but there is not telling how well it will work for you. Most have done nothing at all for me except a few which simply made me fall asleep. If you've never been on them before here is what I've thought of a few of them:

Skelaxin: I believe one of the weaker ones it didn't do anything....at all... for me.
Flexeril: This would help, but at the dose that helped, I also was useless because I was so out of it
Baclefen: Never really noticed much from this one and I read somewhere that it may decrease the affects of some pain medications. I'm not sure if that is true or not.
Soma: Always here a lot of good things about this one (though usually about it's abuse). I wasn't on this one too long, but I think it worked alright.

I'd go ahead and ask your doctor about it and give one a try. You may get good results from them and the odds are they won't hurt you any.

Baclofen believe it or not is actually quite useful as a muscle relaxant but it has to be given time , its not something that can be compared to valium where you take it and it gets you totally fubared. and its also a very subtle muscle relaxant , the effects are most noticeable when lying down or sitting down .

I notice is has great synergy when taken with my oxycontin and usuallly lasts about 4 hours or so . the only thing that does suck is you dont get much benefit from it over 80mg and i was at that point not too long ago and voluntarily changed my dose to adjust. and if i forget that i took it and end up taking my break through medication i can be all sorts of fucked up.

Dont forget either that certain benzos also hold decent muslce relaxant properties . i also happen to be prescribed Temazepam for sleep and use as a major muscle relaxant . and i can tell you G damn does it put the baclofen to shame in the relaxant department. but the thing youd have to be concerned about is tolerance to the effects and then having to wein off a benzo later down the road . i dont use them all the time which helps . Valium is also another good one for muscle relaxant properties as well as Lorazepam from what i have read.

I would also say to look into either gabapentin or lyrica , while normally indicated for nerve pain i have read numerous reports of people using it that have had CP , FM and RA with great success . i still have a bottle of gabapentin sitting in my lockbox so i cant comment on its effects , but maybe someone else could.

Another medication that my doctor and me talked about was Cesamet or Marinol in the US. he was concerned about the legal implications of me buying and smoking actual marijuana (but didnt judge nor gave a shit , he actually partially condoned it indirectly) and said i should try the above medication out to both boost the effects of any pain medication i may be taking , he said i may even get muscle relaxant and sleep assistant properties from it . I havnt tried it yet though , i have 6 sitting in my closet that have been there since last may everyone tells me they vary from person to person .

And i have also heard good things about the lido patches , are they truley prescription down there? thats crazy over here you can buy them right over the counter in 2 size patches or you can buy it in a gel that you can rub on the affected area . I believe there like 24.00 for the big patch and 12.00ish for the small . The gel is about 7.00 dollars.

 

[iSamurai]

I have varying levels of daily pain from my bladder and stomach problems, pain that varies with my menstrual cycle from the endometriosis, and then acute episodes of pain from my kidney and bladder problems. I was pain-free for a few months after laprascopic surgery, an anti-inflammatory diet, and a year on a bladder medication called Elmiron which tore up my stomach. So I stopped the Elmiron, was fine for a while, but then the daily bladder pain came back recently; now I'm back on it and the stomach problems are back too.

Aneurysms are scary; I'm sorry to hear about your diagnosis. Good luck keeping everything under control!

And I totally get everybody that's sick of being told they're too young for all these health problems and medications. I'm 22 and was first diagnosed with this crap at 19! Whenever I had to get tests done, the nurses used to do a double take at how many / how much medication I was on. I'd be like, I know I'm too young for all this, but what am I supposed to do? I definitely didn't choose it.

I went around the anti-depressant merry-go-round as well before doing opiates. I couldn't handle the mood swings; I think I am just very susceptible to that kind of stuff and while it dulled my pain for some time, that stuff made my life hell. The less medications I can manage on, the better I feel.

Thanks, I was diagnosed a year ago, I'm 19 now. I have kidney pains that come and go but I'm not allowed to take NSAIDs (ibuprofen), and am hesitant to take acetaminophen. I usually just try to deal with the pain. I am also reading of recurring headaches PKD people have experienced that fit my symptoms. I'm going to try to stay away from meds though.

 

[macbrown21]

Lidocaine patches work pretty good for me I have chronic back and neck pain and messed up knees from former sports injuries. Years of pounding and jittering my back and knees. If i put two on my back with a heat pad and take a couple tylenol it works pretty good. I'd say as good as taking 5mg of hydrocodone. Patches i got (no insurance) were pretty pricey though. At least i can get a few hours of sleep with them though. Though i'm also prescribed xanax and take pretty regularly, i think that has something to do with helping back pain just by relaxing mind and probably muscles. I've heard quite a few people say xanax in combination works good for chronic pain

 

[Darkprogramer]

Hi, everyone.

Kitty I feel sorry for you and hope you get releaf. I understand you position as I also suffer a great deal with chronic pain. I have a high tolerance also. I tried injecting and got put into the hospital last week for a week. I just got out yesterday.

Not being able to pm bites. lol

 

[2muchpain]

bump

 

[Rexeh]

Anyone ever tried Magnesium tablets? I use them for my back and I have to say that it actually works pretty good for muscle pain / sore, hard muscles. Now this might seem like a shameless *bump* but I want to gather some opinions from other people to seem if this is placebo or not.

2muchpain: how are you doing ATM? my back has been killing me the last few days sadly and I have surgery tomorrow (all my teeth are going out since they are FUBAR ). Hope you are doing better than me.

I will be hanging on BL a lot after my surgery so expect to see my (teethless) face a lot more in here

Peace o/

 

[2muchpain]

i've never tried magnesium before and never even heard of using it for pain, but i'm going to get some now you've mentioned it. Is it expensive as a supplement?
I'm not feeling too bad at the moment thanks. I'm always in a lot of pain but it's at a bearable level at the moment.
Hope everything goes well with your teeth op and it'll be a pleasure having you around more while you get better.

Anyone ever tried Magnesium tablets? I use them for my back and I have to say that it actually works pretty good for muscle pain / sore, hard muscles. Now this might seem like a shameless *bump* but I want to gather some opinions from other people to seem if this is placebo or not.

2muchpain: how are you doing ATM? my back has been killing me the last few days sadly and I have surgery tomorrow (all my teeth are going out since they are FUBAR ). Hope you are doing better than me.

I will be hanging on BL a lot after my surgery so expect to see my (teethless) face a lot more in here

Peace o/

 

[Rexeh]

^Thanks for the support, I needed that.

As for the Magnesium, this page has all the information, references, everything you want to know about it basically: http://ods.od.nih.gov/factsheets/magnesium.asp

Magnesium should be available at a fairly cheap price, I got it from a doctor when I went to the ER because I was having too much pain in my back. He said it kinda 'loosens' your muscles IIRC, just have a look at the link above.

Peace o/

 

[kovus]

Rexeh: Curious since you mentioned it, how do they go about that these days (removing all the teeth)? Are you planning on getting implants or going another route?

I ask because despite my age my teeth are... well bad. They always have been. Poor dental hygiene...all my fault. Oddly enough I don't actually have bad breath at all - my girlfriend can attest to that.

Just wondering how much it's going to cost me when the time comes and I have to go through that and get the whole titanium implant thing. My brother's a dentist, but he wouldn't handle such an operation. Still, I loathe bringing the topic up to him though I know I need to.

Anyway, that was a bit off topic. Well I'm hoping to get my refill(s) tomorrow, though I may have to way another day or two. I'm both not sure if my scripts will be post-dated (the doctor is on vacation so I'm just picking up the scripts from the receptionist/secretary. Then of course I have no idea if insurance will let me get it though I think most will fill 3 days early though I have very little experience filling a C2 script. Anyone here know the answer to that?

As for the Magnesium I had heard once a while back of it being used as a potentiator, but it wasn't backed up by anything that I know up. I bought some at the time - it's no more expensive than any of the other single element vitamins you see at the pharmacy. Anywhere from $5-9 for a bottle of 100 250mg (63% daily value) tablets. I tried it a few times when I first got it (back when I was on hydrocodone), but never noticed anything in that aspect. I'll give it a try again and see if I notice anything.

 

[Eagleman]

Fractured Jaw

Due to a car accident in 2003 I have suffered a fractured jaw and cheekbone which was never successfully repaired (and cannot be). My only option is to treat the pain.
For chronic daily pain I have found the fentanyl transdermal patch to be the best. TRUE round-the-clock relief with little breakthrough pain at the correct dosage. For occasional breakthrough pain I use the generic equivalent of Actiq (oral transmucosal fentanyl citrate).
In the past I have tried OxyContin and MS Contin with Vicodin or T3s for breakthrough. Good drugs, but too damn many pills to keep track of and I have had better luck with the fent patch.
That's my story.

 

[Eagleman]

And Kovus, most insurance allow refill when at least 80-90% of the medication is used up. It will vary greatly depending on how flexible / fussy your insurance is. So let's say you got sixty pills, you take two a day, so that's a thirty day's supply. When you're down to around ten pills or so, a refill request will probably go through. When I get my Adderall refilled, I usually still have about ten pills left and the refill goes through fine.
This is just a tidbit of info to think about, obviously I have no clue what your insurance situation is like.

 

[Cane2theLeft]

Rexeh- are you sure you are talking about JUST magnesium and not magnesium salicylate? I've used the latter as its an NSAID very similar to aspirin. It is commonly found over the counter (one common brand is Doan's).

I searched for words like pain in the NIH link you provided and didn't find anything related to use in back pain.

 

[I_Stay_Dead]

I'm currently on the 50 mcg/h fentanyl patches, with IR morphine for breakthrough pain (BTP.) The fentanyl for background pain works well, generally. It doesn't kill all of my pain (hence my need for morphine / a med for BTP.) Morphine IR doesn't work; the dose is 30 mg up to six times daily, every four hours. It just doesn't work! Would my fellow chronic pain suffering Bluelighters recommend increasing the dosage or morphine further, or switching so some-thing else such as hydromorphone IR etc., (hydromorphone is just an example by the way, so long as it kills the BTP I don't care what the med is.) I know there are melt-in-the-mouth fentanyl tablets, perhaps these would be helpful, since I'm already taking fentanyl. ??? Another option would be to increase the fentanyl patch dosage to 75 mcg/h., and perhaps increase the morphine IR dosage too. However, I'm happy staying at 50 mcg/h for now. BTP is the main issue.

Thanks in advance.

 

[TheMatador]

^^^^^^^^^^^^^^^
Ahhh I just wrote such a nice long response and it all got deleted with one wrong push of the button, ahhh!!!
I'll try to recreate it as best as possible, anyways ...

It's good to hear your 50mcg/hr patch is working well I'm sorry to hear about your BTP though
Sooo, your scripted 30mg of morphine 6x/daily, with that how many episodes of BTP are you having a day?
And do you always have to take your full 180mg of morphine (30mg 6x/daily) everyday for your existing BTP?

If so, and the BTP persists, you might want to try something else instead of just raising your morphine dose as that might incur some side-effects if you got into the higher dosage range (which your already on the way to) that are unneeded if you were to try another medication, that's the route I would go if I were you, but I'm not so it's up to you of course. Just remember there is nothing that is going to kill all your pain, some people think there is something out there that is going to do that, but there is always going to be some degree of pain. Getting the pain down to a reasonable level and getting back our quality of life to the best it can be is really all us chronic pain patients can ask for at this point.
(I just feel a need to say this, I'm sure you know already being a chronic pain patient and all, but it's for anyone else that might be reading this that has that notion)

Anyways,
There are a variety of choices for BTP medication, here are a few just off the top of my head for now.
OpanaIR (oxymorphone) would be one option, Dilaudid (hydromorphone) as you mentioned would be another, raising your morphine dose, IR Oxycodone, and then there are the "melt in your mouth" fentanyl tablets as you put it .....
Fentora, the buccal fentanyl citrate tablet, is available in 100 mcg, 200 mcg, 300 mcg, 400 mcg, 600 mcg, 800 mcg strengths.
There is also the transmucosal lozenge Actiq(fentanyl citrate), that come in 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg and 1600 mcg strengths.

In my experience, and from experiences of others staying on the same medication for around-the-clock pain management and BTP can be very helpful and is favored by many doctors and patients alike, some people need another strategy and take two different meds, but this practice is very common. For instance my doctor favors that method so I am on Oxycontin for my around-the-clock pain and then IR Oxycodone for my BTP and it works quite well.

(Although I've been thinking about switching to fentanyl patches for awhile now for convince and possibly better analgesia so I can just put on a patch every 48 or 72 hours instead of taking Oxycontin 3x/day + IR Oxycodone for BTP, your post and reading Eagleman's above post, along with others here on BL has me thinking it might provide better analgesia for me, i know there is only one way to find out (try it) but, what is your opinion between the fentanyl patch and other ER (extended release) pain meds you've tried? and if anyone else out there is reading this that has experience with chronic pain and fentanyl patches compared to other ER (extended release) pain meds please chime in )

In the end it's ultimately going to be up to you and your doctor, and you should be able to find a medication that is going to work better for you then morphine, hopefully in a timely manner. Maybe you simply need to raise your morphine dose, or maybe you will choose to try a new medication, it's you and your doctors decision. I hope you will be able to find something that will help your BTP more than the morphine your on now. There are some pretty great analgesics on that list, you should definetly be able to find something that helps you out. Personally OpanaIR and IR Oxycodone work the best for me, although I imagine Fentora or Actiq would be great for me and on the top of my list as I've tried the fentanyl transdermal system (Duragesic) and it worked great, but have yet to try the IR form.
Good luck with everything, you should be able to get it figured out in a timely manner, and always remember, you are your own advocate.

Good luck bro, and please come back soon if you have any questions before your appt. and if not good luck and tell us how it goes afterwards, talk to you soon,

-TheMatador

 

[2muchpain]

it's starting to drive me mad. Went to my doctors and she's just got me on a level that is not at all satisfactory but i don't want to kill myself from pain anymore. I understand the never being pain free thing but i'm still on a level 7 at the mo down from a level 9 and i think i should at least be allowed a 5 or something! But cause i'm in the uk she just won't put me on anything stronger which rules out all the round the clock medications. Just thought i'd vent.

 

[TheMatador]

^^^^^^^^^^^^^^
I'm sorry to hear that man, at least your pain isn't at a level where you want to kill yourself though, when pain is at a 9 constantly those thoughts become pretty common, at least its lower but you should be able to get it lower than a 7.
What is your pain regimen right now? Do you see a General Practitioner or a Pain Management Doctor/Specialist or what? Do you always take them as prescribed, or do you run out early sometimes because of your lack of pain relief?
I've seen you as an active member of Bluelight and the Pain Management Mega Thread for quite some time which is nice to see people participating actively, but I've never read/remembered much of your chronic pain background, if you could share that would be great and then hopefully I/we can give you some good answers to point you in the right direction to getting your pain down to something manageable like a 5 as you said.

Talk to you soon,

-TheMatador

 

[2muchpain]

thanks the matador, i'm going to pm you a copy of something i sent someone re my situation recently. But i have to access bl on my phone until a few days time cause i'm getting a new laptop tomorrow but it might take a few days to get delivered and set up on internet and anti virus etc.

 

[Artificial Emotion]

If you made an 'attempt' to commit suicide and then explained to the hospital that you did it because you were in so much pain and were refused adequate pain relief by your doctor because of being labeled a 'drug seeker' at some point in the past, would they be more willing to take you more seriously?

I don't suffer from chronic pain, but I do get flare ups sometimes and was wondering what would happen if it gets really bad and my doctor ignores my pleas for help.

 

[RainingDownOxy]

I'm currently on the 50 mcg/h fentanyl patches, with IR morphine for breakthrough pain (BTP.) The fentanyl for background pain works well, generally. It doesn't kill all of my pain (hence my need for morphine / a med for BTP.) Morphine IR doesn't work; the dose is 30 mg up to six times daily, every four hours. It just doesn't work! Would my fellow chronic pain suffering Bluelighters recommend increasing the dosage or morphine further, or switching so some-thing else such as hydromorphone IR etc., (hydromorphone is just an example by the way, so long as it kills the BTP I don't care what the med is.) I know there are melt-in-the-mouth fentanyl tablets, perhaps these would be helpful, since I'm already taking fentanyl. ??? Another option would be to increase the fentanyl patch dosage to 75 mcg/h., and perhaps increase the morphine IR dosage too. However, I'm happy staying at 50 mcg/h for now. BTP is the main issue.

Thanks in advance.

hey dude, this actually reminds me of how similar your situation is to one of my experiences. I was on the MSIR tablets as you, started out at 15mg PO TID, then later, QID. For longterm Im on Oxycontin which works pretty well and at a relatively lower size dose. So yea taking Oxy. and MSIR for BTP. My doc had his own reasons for having me on the MSIR, he just really like the med, but after having to increase the doasge again and agian, which I eventually got up to taking 2 30mg tabs 3 times a day.. When that still didnt feel like it was doing that well for the agonizing BTP that we all know what it feels like to some degree, he decided to switch out the morphine for Roxicodone. The roxi, from the very 1st dose, which I up until that moment I had never tried roxicodone, it significantly lessened the pain. Found out later that taking 15mg 1 every 4 to 6 hours depending on how bad the pain is, was a good doseage for me.

Of course everyone is differant and will respond differantly to medications, no one can know for certain which path would best be suited for you, you are that shot-caller matey. I just say go with what you and your doc come up with. Look at all the options on the table and dont be afraid to ask questions or in a polite professional manner question your doctor if you are curious or for whatever appropraite reason you deemfit.

Hope it all works out in your favor!!!