The Pain Management Mega Thread v2.0

[Neepanoid]

You need to get your shit under control man. How do you expect a doctor to treat your pain when you don't know what you need? It sounds like there isn't a specific diagnosis either. From the discription, it sounds like wide-ranging CRPS, or CPD. Howve your doctor check into those possiblitities.
PM me if you have questions about this (But remember I can't help you with scamming doctors, etc... only give you solid advice on what to try.)

You are correct. I DON'T know what I need. I didn't go to pharmacological school so that is why I pay my Pain Mgmt Dr. every month or two so that I can hope to lead some quality of life instead of laying in a bed or chair writhing in pain.

There are a few points to this whole fiasco that really P*SS me off and so far, I am at a loss to find a single solid answer, only because there isn't a single answer.

Cause:
Crohns: Complications and stricture caused me to almost die of sepsis but after cutting out 6' of intestine, lots of antibiotics and months of visiting nurses at home, I only have a little abdominal pain but not bad since surgery. Now I don't absorb food well, or oral medicine. Doctors call it short gut. Like having gastric bypass, but not.
Spinal Stenosis - My spinal canal is narrowing and osteophytes are growing on most of my joints. Shoulders, AC, Cervical spine(C4-5 & C6-7 facet joint). Confirmed by MRI and X-rays. This causes most of my pain. Upper back, shoulders, neck. Right now it feels numb/tingly from my bicep to my right sideburn.

Lumbar Spine. L5/S1 Aching pain in lower back as well as numbness and hot shooting pains in right thigh to buttocks. This changes with position but never gets relief.

Knees: With age and abuse, my knees are shot from years of working in a garage, kneeling on concrete to set the racks, crawling under alignment racks. I've had lido/cortisone shots to try to stave off the pain, but all that did was deteriorate my knees even more. I am too young for TKR. Most days I can barely walk. Every step is agony.

Effect: Doctors are throwing all different kinds of treatments to try and help. TENS, Acupuncture, Physical Therapy, pool therapy, and drugs. Lots of drugs. Over the years, I have taken Vics, percs, norco, lortab, dils, flexeril, soma, xanax, bupe, methadone, opana, gabapentin, and more morphine than I have ever seen anyone take at one time. At my highest was taking 800mg msir, 4 somas, 5 norcos a day and not getting but maybe 30 minutes relief, if that. I've never gotten that 'euphoric' feeling from any pain medicine, ever. The doctor shook hios head after I took methadone for 2 weeks and all I got was hungry. Even with 200µg/h of fentanyl and 48mg dills for BT pain, I am not in the least bit 'noddy' and still in a lot of pain. I don't understand.

Lastly, I don't want to 'scam' my doctor. I just want some F*cking pain relief. At this point I would do almost anything not to hurt. But so far, nothing is helping. I don't expect you to understand or believe anything I say, since you don't know me from jack. That's OK with me.

 

[oh-pana321]

im 19 years old and have RSD from a gunshot wound from when i was 16 and was seeing a PM doc up until exactly a year ago. in those 3 years ive tried everything from narcotics to nerve blocks and in the end i only get relief from oxycodone and lyrica. ive decided that i want to go to a pain doc again, but will i have to work my way up from the bottom again?

 

[dokomo]

im 19 years old and have RSD from a gunshot wound from when i was 16 and was seeing a PM doc up until exactly a year ago. in those 3 years ive tried everything from narcotics to nerve blocks and in the end i only get relief from oxycodone and lyrica. ive decided that i want to go to a pain doc again, but will i have to work my way up from the bottom again?

Why did you stop seeing the pain doctor? If your medical history is documented, you should be able to just make an appointment and see him (or another doc, if you bring your records) and start from there. They'll be able to see your medical records, past treatments, and you can work with them to find a treatment strategy that works for you.

 

[muvolution]

All you people in this thread need to keep seeing your pain doctors, tell them what is wrong, and show them the documentation, and if you make a concerted effort to get better through diet, exercise, acupuncture, physical therapy, and medication, then no doctor is going to "not listen" or not take your problems to be serious/true. If this is happening alot, I would step back and re-consider how much pain you actually have.
I wish everyone the best, but there is a time to decide whether you want to improve or not.

 

[Cane2theLeft]

^being pain free isn't a reasonable expectation. Generally getting below a 5 or 6 on the pain scale is.

 

[BlueLightBeam]

And why isn't being pain free reasonable? What crappy societal construct is that?

 

[muvolution]

I gotta agree. Most pain doctors shoot for a 5 which is unacceptably high. Good pain doctors try to get you to a 5 by non-pharmaceutical options, and will then bring you down from a 5 to a 2-4. The drugs are alot more effective when used with other treatments, including holistic approaches and alternative medicine, diet, exercise, ecd

 

[Neepanoid]

In my experience there is no such thing as 'pain free'. Although it is a brass ring that we all reach for, it is not realistic in the pain management arena. I would gladly take a 4 or 5 most days, it's just something that has illuded my PM team so far.

Everyone's pain is different and doctors must operate in a restrictive set of guidelines across the board for everyone. Thanks to bureaucracy.

It is frustrating especially when finding yourself in the upper ranges of pain. That is when we turn to unconventional means. As bad as that seems, it may be the last line between making it tolerable or just giving up and dying.

Neepanoid

 

[MrRoot]

Here we use a scale of functioning without only trying to make decisions by pain scale. It has a fancy name which I cant remember. Will ask about it tomorrow when I renew my script. In general with young people getting less than 90% of functionality means you need pain management. The less the functionality the more amount and more powerful medication you are going to prescribed. Also the timeframe needed the painkillers affect the decision what kind of medication you are about to get. For example codeine/APAP combos are only prescribed short term and in longer need they prefer oxycodone.

The backside of this is that if you are in need of long term strong pain meds you need to go inpatient treatment until they find the correct medications and dosage as they need to check how your functionality improves.

For me it took three days of treatment to get OxyContin 20mg for three times a day + lyrica 150mg twice a day. And I need to go see a fysiatrist every month to renew my prescription as they need a prescription base that is numbered and has a hologram. And it is also electronically transfered to a pharmacy too.

 

[halfoz]

inasmuch as we talk about opiate-naive people, i think there are also pain-naive people.

and had i not been through a physical trauma that led me to become the pain mgmt patient i am, then i would never have imagined what it could be like. i would probably be joining those thoughtless few who are essentially saying "suck it up, get over it".

i don't choose pain, pain chose me. i don't let pain dictate my mood or how i live my life. we got past that in early one on one counseling at my first pain mgmt program, but to deny that i live with pain is stupid. i work hard on everything i can control, but the trauma my body experienced was severe. my nerve specialist said that the nerve damage i experienced alone would likely take 2-5 years to recover. and that pain was likely during that.

ok, i can accept that. and i don't insist that pills are the answer, but pills are in fact, part of the answer. i've learned to live with a moderate level of pain that i would never have accepted as normal before, and i'm thrilled that when i'm having breakthrough pain, and all the PMR, biofeedback, meditation, breathing practice, CBT, distraction techniques, physical therapy, psychological therapy, adjunctive medicinal treatments, stretching and flexibility training, weightlifting, et isn't working that i can take a safe analgesic that will reduce my immediate pain and allow me to get back to living my life.

i've fought hard not not be a victim of my pain. until someone has walked in my shoes, they have no credibility when making judgmental comments. i know precisely how much pain i really have. please take your worthless opinion elsewhere.

 

[scottd420]

Hey guys, I've got a question for you about the scenario that I'm in.
Background(injury): Damaged nerves(possibly pinched) along the spine and sprained most of the area(not a superficial bruise haha, this is more serious).

Currently I'm taking HydromorphContin for this. In the past I had been IVing my dose because what my doctor gave me was simply not enough to dull down the pain. However, I am stepping away from this ROA for a while/for good and I am having a hard time receiving the analgesia I need from just snorting the crushed beads(which is uncomfortable to say the least). I was wondering if plugging could be my interm solution until my tolerance drops enough to go to intranasal again, then oral.

Please don't hold back; tell me everything you can think of. I need some advice, especially from other pain patients!

 

[amapola]

Hydromorphone-- 5-8 times as potent as morphine, intranasal- 52.4%, Rectal administration 33% ,Oral-30-35%,

Bioavailability/Half-life MEGA Thread

Looks like nasal is your best bet. Try breaking it down into solution beforehand perhaps?

I'd speak with your doc. Maybe try adding on something like tramadol or gabapentin to deal with nerve pain. Some muscle relaxants might help as well.

 

[scottd420]

Hey Amapola, thanks for the reply! I can't believe I over-read the plugged BA, I know I've read a thread of people talking about the availability being mistaken for the rate of absorbtion. I was trying to get around nasal if at all possible because the beads break up into what seems like fucking gravel. The solution is a great idea! Thank you.
I've spoken to the doc about adding things on and they just gave me naproxen EC's because they didn't wanna add anything more sedating. I do have a naturally high tolerance and they are trying to get around giving me more by anyway possible. I've tried pregabalin, gabapentin, COX-2 inhibitors, everything OTC and obviously use a TENS unit. I'm just getting to my last rope, I'm so tired of being in pain, and it sucks because the only way I get good relief is how I don't want to take it--I'd be in shit. If only I had a butterfly line haha. (joking) Thank you for your input, it helps greatly!

 

[bluebird052106]

I am in desperate need of any and all advice and tips on pain management please!
I have Ankylosing Spondylitis which was brought on by some sort of Inflammatory Bowel Disease (Not to be confused with irritable bowel syndrome, a completely different thing).

For those who don't know, Ankylosing Spondylitis is a severe form of arthritis found in the spine. It brings forth chronic-severe pain, along with the possibility of full spinal fusion (the vertebrae becoming fused together). The inflammatory bowel disease also gives me semi-chronic pain, but pain that is exponentially worse. There is days where the IBD pain is so much that I can not even stand and am literally forced to crawl myself across the floor to the bathroom.

I have been seeing my doctor on a weekly basis, to no avail. We all know how doctors work, pharmaceutical companies give them really nice vacations at Caribbean 5star+ resorts, paid for, as a bribe to prescribe THEIR meds.

I really need people to give me any and ALL suggestions on medications, techniques, ANYTHING, that will help me manage these 2 conditions. Its getting to the point where its becoming unbearable. Grades is school are falling at an accelerated rate. Pills, regimes, OTC supplements. I am ready to try anything.

Just a side note (medication wise): The dr has put me on 300mg tramadol, butorphanol nasal spray, lyrica, indocid for the spondylitis pain thus far. At doses of 600mg+ daily tramadol pain was still very much there and very strong, so we added lyrica (first try) and indocid (2nd try), each for a week taking up to 6 capsules of lyrica (25mg caps) a day, then we scratched all of those and he moved me on to butorphanol nasal spray, saying its what they diagnose to people who FRACTURE their spine. Prescribed dose was 1-2 sprays once daily when needed. For the first few days I stuck with that dose, despite the fact it wasn't working. I even tried 4 sprays one after the other in the morning a few days, which also didn't help. My mother, doctor and I are currently in the process of filling out all the required forms in order for me to get my Medicinal Marijuana license, one which will allow me to possess and grow.

I need something for the NOW as I am in very hard courses at school (Calculus, Physics, etc.) and it is my senior year, final semester. I really just want to get the school over with, but its becoming harder and harder.

THANK YOU in advance to anyone and everyone who is able to help me out in anyway.

I has AS as well. I went to may different Drs over many years. Once I got a diagnosis and got a rhuematologist he immediately began giving me vicodin. When that no longer worked he moved me to 5/325 percocet, then 10/325's then added oxycontin. I just had to look around to find a good Dr who knew what he was doing & took the time to listen. This particular Dr is one of the best in my area & so he has a lot of experience with AS. Any Dr that does should manage your pain sufficiently. Also look up the laws in your state. Many require that Drs adequately manage your pain. If that is not happening you have a right to seek a second opinion.

 

[Space_Cadet]

Help in Firing PM Doctor

I'm new to the forum but I have been to see a PM specialist in the past. I had the same doctor from when I was injured in '03 to just after my last surgery. I've had three lower back surgeries (1 on L4/L5 disc and two on L5/S1 disc and surrounding area) for bulges and ruptures to discs and well as removal of scar tissue. My last surgery was approx. a year ago and even though I've still had constant pain I didn't go back to the pain specialist because my ins doesn't cover him any longer and I got married and moved much farther away from him. I actually don't even like opiate pain medications because they all make me incredibly itchy (I've tried everything and nothing helps the itching) but I'm at the point again where the pain effects every aspect of my life. In the past I have always taken as little as possible because of the itching and because of alcoholism on my fathers side of the family. I was an extremely good athlete before my accident (Full ride to a big D1 school for track) and I have an unusually high pain tolerance so I've put off looking for a new PM doc for as long as I physically could. I finally broke down and saw someone and it was the worst experience of my life.

I made an appointment and brought everything going back to when I first started have problems; MRI's, etc. I had also discussed going back to pain management with my orthopedist and asked him to send my records to her. I the same with my neurosurgeon and contacted my old PM doc and asked for my records to be sent to this new doctors office. I just wanted to start off right with her and make sure I didn't forget anything; etc.

Well right off the bat she told me she was suspicious of me because I was so thorough with my records and not to expect her to "dish out drugs to you (me) so I can take them for fun." I calmly explained that I really wasn't even looking for pain meds, that I would like to start off with an anti-inflammatory and take things from there (Viox really worked well for me in the past) Then she was drilling me on why I had waited this long to find a new PM doctor and didn't seem to believe that I was just toughing it out after seeing the MRI's and how much difficulty I have walking. I was basically lectured to for over an hour and she didn't even prescribe me anything any anti-inflamatories. I was told that I wouldn't receive anything until I saw a Psychologist or a Licensed social worker. I also signed a contract and took a piss test before I left.

I was so caught off guard with her attitude at the time and didn't really get angry but now it's been a couple days and the more I think about it the more it pisses me off. I didn't walk in there looking like an addict and I don't even want opiate pain medication. I wanted to explore what we could do to avoid pain medication for as long as possible but instead I was treated like a junkie. I never had to deal with anything like this before because my PM doc was great. He had even suggested we increase the oc I was taking because I was still between a 5 & 7 (pain wise) constantly. I pride myself on being able to mentally control my pain and all I looking to do was build a relationship with her so that if it gets really bad she has a baseline to work from. I just need to be mobile and not in so much pain I cant function. I'm asking for a miracle or to be dopped up all the time. The state of pain management in this country is disgusting. Doc over prescribe pain meds for those that don't need them but will turn around and won't prescribe those same meds for someone that really does need them. Or worse yet, they will prescribe medication that is completely inadequate for treating the level of pain someone is experiencing.

So, I never really read the pain management contract (I know I should have) she gave me because I never abuse my medication, take it in a way not prescribed, take more of it than I should, or anything else irresponsible. What is standard in those types of contacts? Can I fire her and find another PM specialist or is there some sort of law against that? Will I be blacklisted if I do? I didn't even get medication from her yet so would the contract even be valid? And where can I look for a reputable PM doctor? My insurance company isn't much help in that dept. I'm sorry for all the questions but I'm not sure where to go from here and I don't want a repeat of this experience with my next doctor. I just want to know what my rights are in this sort of situation..

Thanks everyone!

 

[muvolution]

I have a lot of posts on this topic in the PAIN MANAGEMENT megathreads, so go back and look at what i've written.

Simply put: yes, you can and should fire her if you are not satisfied with the service you are receiving. You are a customer, and she is there to serve you. If you aren't satisfied with the product, change doctors.

A pain contract is designed to keep people from Dr. shopping. Just call her, tell her she's fired (you haven't received any rx's yet, so there is nothing they can do to you. Find a new doctor and send them your records, then go in to see them. It should be rather simple if you had financial reasons for not seeing a doctor.

 

[kenai_kings]

I'm A Bonehead

I have been using percocet to relieve severe back pain for about 9 months. On that ridiculous 1 to 10 scale it has been a 10 several times, but hovers between 5 and 7 most of the time with the meds, PT, TENS etc.. I've had 16 knee surgeries as well and one of my knees is pretty much in constant pain. I've also got a TENS unit, go to PT several times a week, and have had two steroid injections that helped a little but didn't last. For the past 4 months or so I've used about 12 5/325 a day, pretty much following the "take one or two tablets every 4 to 6 hours" on the RX. I've been getting 80 of them every 7 days. I've also had a couple of Medrol Dospak steroid RX's.

I have a history of chemical dependance but had been clean this time for just under 10 years. The RX was coming from an orthopedic surgeon and my behavior caused him to tell me he would not write for me any longer and he was referring me to a pain management clinic. I AM a dope fiend who first got clean in 1985, albeit one who had not abused in a longtime, and I had got panicky about making sure my refills were ready. I think that was at least partially why I've been dismissed. He and I have discussed my back and I had told him I really didn't want to undergo surgery, I had heard from many people who had undergone spinal fusion it was not worth it, I live primarily on disability but do maintain a part time job which I NEED to make ends meet and was worried I literally would end up homeless as a result of a long rehab. My MRI shows a narrowing he said was causing my pain.

I'm scared to death this clinic will be one that doesn't prescribe narcotics and nothing else has really helped. I'm afraid of the pain being so bad I end up losing my part time job, of just hurting that bad all the time. And I'm afraid of going through the whole withdrawal experience. AGAIN. Because of my history I didn't stress my fear of the pain as much as my fear of the withdrawal experience with his nurse and I'm sure that raised a red flag. I asked what if I couldn't get into this clinic before my current RX ran out and she said to call her if that happened.

It made no difference I haven't been using the stuff to get loaded, I still have a addicts mind and responded just as I used to.

I say I'm embarrassed because I find myself addicted again, even though I had a legitimate reason to use the drug. I'm embarrassed because I think I've screwed the pooch in terms of being able to continue my use of the drug.

Where I live there is one clinic I've been told is somewhat easy to get RX's but they don't take Medicare and I live pretty much on the brink of broke. So this one I'm being referred to is probably the only chance I have.

Any comments that might share light on my chances of salvaging this mess would be greatly appreciated.

 

[SinisterMuffin]

Hi, everyone. This is a mega thread, so I'm assuming it's okay to revive it. I've seen a lot of discussion on fibro myalgia in this thread, but haven't quite found answers to specific questions I have, so I hope it's okay for me to post them.

Basically, I'm a young adult (22) who was "diagnosed" with fibro myalgia about half a year ago, although I have been having symptoms for much longer. So far, my doctor has tried prescribing me with Gabapentin, Nortriptyline, and Savella (Milnacipran). For the first month and a half, she had me on 100mg Gabapentin twice a day, with 10mg Nortriptyline every night.

However, I had really bad vertigo and grogginess with those, so she took me off and tried me on 100mg Savella once a day instead. A day after I started this new regimen, I started having terrible nausea and vomiting. Couldn't even hold water down, and was really weak. She insisted that this was not due to the Savella OR withdrawals from the other meds and had me keep at it. Since I didn't improve within a week (still throwing up, still unable to get any nutrients or drink water, so it was really taking a toll on me) I went to my General Physician who made me stop taking the Savella, as its first two side-effects listed are NAUSEA and VOMITING. About a day after I stopped taking the Savella, I was able to eat and drink again (starting small). So I called my pain specialist, who told me just to go a week without ANY medicines since I had an appointment schedules with her the following week already. It was AWFUL. So hard to get up and move because the pain was so bad...

When I finally got in to see her again, she decided to put me BACK on the Nortriptyline, just this time without Gabapentin. So I'm currently taking 10mg Nortriptyline each night (have been for a month and a half now), and if it's helping, it's only minimally doing so. She wanted me to work up to 10mg TWICE a day, but I admittedly have not done so because it is said to have bad interactions with MDMA which I have done twice since being put on the Nortriptyline. (I stopped taking the Nortriptyline for two days each time I did MDMA so that it would be out of my system. I also don't want to go up to twice a day so that I'll have less likelihood of bad reactions but having less Nortriptyline in my system to start with.)

You guys may advise against me doing MDMA if I'm going to have to stop taking Notriptyline for a couple of days to do it, or because of the risk of bad reactions, but I feel the Nortriptyline is helping minimally in the first place and MDMA DOES help me. If possible, I would do MDMA every day because it has helped with both pain and depression in ways that NO other medication has done for me. Obviously, though, I know better than that because of harm reduction so I can't. Therefore, I want to collect as much advice as I can to possibly find a better solution.

I have an appointment with my specialist again on Friday, so hopefully I have posted early enough to get viable information with which to arm myself when I go in that morning. So, yeah...I've had experience with a few things already, which haven't worked or the side effects have been too detrimental/outweigh the good they were doing. Unfortunately, I'm also bipolar and have PTSD, so my doctor has to be careful about which drugs she prescribes me, as many solutions to fibro myalgia have been known to cause bad reactions in patients with bipolar disorder. However, I've heard really good things from people everywhere about Lyrica, so should I discuss the possibility of that even if it's one of those that has been known to react badly with my previously diagnosed disorders, or should I bring up the idea of opioids to her instead, as she may not have thought of that? (It seems she does not have much experience treating this condition.) I do not want these for recreational purposes, so please do not mistake me. I am not trying to scam my doctor. I really just want this pain to be under control so that I can move on with my life. I am young, but it is hard to find the motivation or feel my age when I deal with unimaginable pain daily.

I am afraid that she will not listen to my pleas for help. Even though she has changed my prescriptions previously, it is always with great reserve and hesitation. She seems to think that this is all in my head because I am bi-polar and young, and does not seem to take me or my condition very seriously. As stated before, she insisted that the Savella was not the cause of my nausea/vomiting when I was taking, although it obviously was. She still seems reluctant to admit that.

Every time I go into the exam room and speak with her, she seems bound and determined to blame this on my bipolar disorder and wants me to go to a psychiatrist. While I admittedly have some bad days, I have worked through the issues concerning this and see no benefit from going back to a therapist (I did have one for quite some time until a few years ago) - I think I know my mind and myself well enough to know that I am doing well, that I have not had any bipolar episodes in a long time, and that it would only make things worse for me mentally/emotionally if I were to see a therapist again. She does not want to listen to this even though I have told her it is upsetting that she does not respect my self-evaluation in that regard.

So...now that y'all have heard my life story (sorry, I did not know which details were important and which were not), and have experience with pain management, is there anything you can think to advise me? I greatly appreciate any input y'all can give me. Thank you.

 

[muvolution]

sinistermuffin - look a few pages back at the last couple posts I made in this thread.

Additionally, I will add that you absolutely SHOULD be seeing a psychiatrist, it is standard for someone with documented psychiatric disorders to see one any time they are on a pain management regime. It truly can help immensely.

With PTSD and bipolar disorder, I would not recommend starting opiates. They have the potential to severely exacerbate those problems as well as causing new ones. If you were to take an opie, I would recommend Dilaudid as there are no metabolites, it is one of the least toxic opiates, strong, and works well for pain.

Lyrica is going to be very similar to Gabapentin. I could see how a GABA agonist would help though, so you should ask about Baclofen.
for this
Also, some muscle relaxers like cyclobenzaprine (Flexeril) can be effective sometimes.

You should consider the possibility that this could be related to your bipolar disorder, something like tramadol with mixed opiate/ snri activity could significantly benefit you, so I would ask your doctor about that also.

 

[SinisterMuffin]

Thanks very much for the input, muvolution. I'm going to look up all the information on Baclofen that I can before Friday and consider mentioning it to my doctor.

Also, if she presented the idea of seeing a psychiatrist because it is common practice for someone on a pain management regime, I might consider it more thoroughly. But the only thing she seems to see is "bipolar disorder" rather than listening to the fact that I, in all honesty, feel that I may not even technically be to the point that (if examined now) I would be diagnosed with it! But that is the only reasoning she gives for me to go to one - that I was diagnosed with bipolar in the past (over 8 years ago - have not been treated for it for almost 4 and I am fine, much better than I even was when being treated, other than the pain - mentally I am stable and better).

Sorry...it is hard to explain, but it has been a very frustrating experience and have not been given enough reason to believe or understand how my fibromyalgia could be related to bipolar disorder, and as my doctor has not even tried to explain it to me (or always just fumbles over the fact that I basically can't lead a normal life because of this mental disorder) I will continue to be inclined to not believe they are linked. As soon as she takes the time to actually be a doctor and stop treating me like a disturbed child, I will listen. I know it probably sounds very immature of me to say this, but I have asked her to explain and asked her to respect my wishes and she does not, nor does she give any medical reasoning behind it.

Anyway, sorry for that small rant, but thank you for the recommendation regarding opiates; I will definitely take that into consideration and try speaking with her about other methods first. I am not sure that something like Flexeril would work for me (I was prescribed it before when a previous doctor thought my pain was related to injury from a car accident and it didn't help), but I will try to keep my mind and options open.