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Non-opioids pain meds -- looking for some options

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Posted 8/21/2013 3:57 PM (GMT 0)
Howdie all,

My pain really has been out of control lately. My recent foree into chiropractic care has given me some immediate relief (i.e. for 30 mins or so) but that's it. In fact, the "manipulations" with my scholiotic spine seem to have instigated some new problems.

I'm using my tens all the time -- but even that is giving me a problem, as I now have a rash in the area where the pads usually are.

I addition to my daily Ultram ER, I'll take 20mg of BT oxycodone most days (sometimes up to 40mg, rarely less than 15mg). While this does help significantly, at the higher doses, I also begin to experience some cognitive impact (esp. short term memory issues & sleepiness).

So, I'm looking for some further options.
Here though, is a list of non-opioids I have tried in the past (so that no one needs to post about them): neurontin, lyrica, flexor patches, lydoderm patches, all the OTC analgesics, "blue stuff" & many other such rubs, cymbalta, savella, wellbutrin, mobic, celebrex. I exercise regularly (stretching, stationary bike, and bowflex home gym). I work ergonomically -- zero gravity chair, etc.. I've been as well to an acupuncturist --- horrible!

What else is there at this point? I can't tolerate SSRIs or SNRIs -- but would be very interested in other meds prescribed off-label for pain. That, in particular, is what I'm now hoping to find.

I see my PM on Monday and, though I'm sure he's frustrated with me as I haven't had a settled routine of meds for over a year, I need to find something that can help without clouding me. The daily pain is just too much lately.
Posted 8/21/2013 5:37 PM (GMT 0)
I would suggest Nucynta ER. It's Tapentadol.It's a Sched. 2 Drug.It's very good for my pain.

I really don't think it's a real opiate.I say this because I went through some serious withdrawals when I switched over to it.

Some people on here,I believe,had bad reactions to it and were taken off it.If you can tolerate Tramadol you should be able to take this.

Post Edited (tidalmouse) : 8/22/2013 10:00:52 AM (GMT-6)

Posted 8/21/2013 6:18 PM (GMT 0)
Thanks -- tried it. I had expected it to be something like a ramped up version of Tramadol, but unfortunately, it made me too sleepy.

That may have been due to its NRI effect -- as others in this class also make me sleepy (as well as depressed and nauseous).

Has anyone here tried Lamictal for pain? It is a mood stabilizer that, according to wiki, is also prescribed for CP.
Posted 8/21/2013 6:32 PM (GMT 0)
That's my complaint with it.Meant to put that down.I'm giving serious thought to asking them to switch me to something else.I've figured I'd have to switch to something stronger and I think that time has come.

I've been taking Nucynta ER 150 x2 a day for 4 months.Nothing for BT pain.Previously I was taking Lortab 10 x4 a day.I'm sure it wasn't real good on my vital organs but I don't remember sleeping all the time.
Posted 8/21/2013 6:38 PM (GMT 0)
There is Acupressure. It uses hands and fingers on pressure points instead of needles.
Posted 8/21/2013 10:09 PM (GMT 0)
Just going to throw this out at you… "Mobic" …for inflammation.

A possibility? Yes?….No?

SE wink
Posted 8/21/2013 11:04 PM (GMT 0)
Ampitriptyline....

Topamax.....

Valium....

Muscle Relaxers (Soma, Flexeril, Zanaflex, Baclofen, Robaxin, etc). My muscle relaxer is as important for pain reduction as my opiods.
Posted 8/21/2013 11:14 PM (GMT 0)
Cogito --

If you don't mind me saying -- you might want to consider something. What about using the dose of meds that help you (it seems in the upwards of 40mg of oxy).... and just staying on a stable dose for several weeks.

I think that there could be a possibility that continually switching your dose around.... is putting your body in limbo. Also, if you stay on a stable dose - there is a chance that the side effects may go away or, at least, lessen (the drogginess and memory issues).

I would say it's worth a try since you are pretty close to exhausting the list of possibilities.

To me - I would try the idea I mentioned. You might get surprised that if you stay on something for weeks (maybe even months) - your body will "adjust" and stop the side effects.

If not - the best advice I can tell you is use the meds that work when you don't need so clear minded (perhaps late afternoons/evenings) -- that way you can be clear during the day to write/work. You might have to endure more pain during the day but at least not the cognitive stuff.

The good thing is that there DO seem to be meds that work for you.... they just bring a couple of annoying side effects. You'll just have to find the right balance of when you use your meds and when you need to be clear to work/write/drive and so forth.

Good luck.
Posted 8/22/2013 3:13 AM (GMT 0)
Thanks SE and Tina -- I've tried all your suggestions except for Topamax and Ampitriptyline. The latter, I understand, makes one drowsy -- and that's too much of an issue already.

But I'll look into Topamax.

Tina, your point about switching around is well-taken, one option I'm considering is returning to oxycontin. However, it affected my short-term memory -- would that go away in time?

Sadly work is the primary cause of pain, and so when I need the meds. But when I take enough to really impact the pain, it gets more difficult to work. That is the trap I'm in -- back when I was taking Hyrocodone for pain, it helped and didn't interfere with work. But now, the dose I need to deal with pain ends up giving me a headache.
Posted 8/22/2013 3:23 AM (GMT 0)
I wen to the ER again today they are trying me on another NSAID for my pain. I am hoping it keeps it at bay becasue I msyelf was just caught off (not my own doing ) my opiates.

I do not have a muscle relaxer that works right now. The methocarbonal was helping me.

I have been diagnosed so far: Chronic Migrines, Back and Neck Spasms, TWO Herniated Disks, Two Protrusions, Arthritis, Cervogenic Headaches.
Posted 8/22/2013 2:21 PM (GMT 0)
Thanks Tirzah,

That really is a great booklet! I've gone through it and noted a few more options -- longshots as the booklet itself states, but still some new ideas.
Posted 8/22/2013 2:53 PM (GMT 0)
I have just given in and realized that for me, my choice is to be tired all the time, a bit of a slug...or be in terrible pain. I also have tried switching around different meds to avoid the sleepy all the time feeling but then I am left in pain. I am in pain now at work and totally dosed up and drowsy on the meds. I just keep a 5 hour energy around so that when I really need a boost I can drink half of one, and that seems to help out as needed. Does anyone else use something like that to help counteract the sleepy the pain meds cause?
Posted 8/22/2013 3:13 PM (GMT 0)
Sore2theCore,
First, you need to talk to your dr about these side effects. Usually the sleepy side effects get less after you've been taking the meds for a few months. It may also be a combination of meds. Look up the side effects of what you're taking in the am. If you're taking 2 in the am that make you sleepy, try not taking one of them for a few days and see if it gets better. Also, if you take meds at night sometimes they can leave you sleepy in the am and taking other meds that make you sleepy on top of that just makes everything worse.
Posted 8/22/2013 3:40 PM (GMT 0)
Mercy&Grace

Thanks for the tips. I have unfortunately been dealing with this stuff for over a decade now. I wasn't so bad when it all started...it was an occational flare, like mabe once or twice a year it got really bad. I was on intermittent pain meds until about 2004, when I finally had to go on a full pain management program. Started with methocarbinal and vicodin, then transitioned to flexeril and oxycodone. I stayed on that for a while then nortriptaline was added to the mix. I had bad side effects with that, so then it changed to gabapentin and oxy, I was able to stop the flexeril. Then I weaned off all medication, was good for about 6 months, had a major flare, and I havn't been the same since.

I have been taking different things to find what works, fighting insomnia, etc. but what it boils down to is that I am the sole provider for my family, I have the high income job. I cant stop working. I am barely able to tolerate working, and the only way I can make it is with the meds I am on. I have managed to do very well career wise even being medicated...but as I get older, my issues and resulting pain is growing. If I do not take the medications, I can barely hold up my head. I have 4 herniated discs in my neck, 4 levels with each having varying degrees of narrowing from mild to severe...I have arthritis at the level of what would be expected on someone twice my age. They do not know what caused my back issues...only that I have significant issues. I hav been able to avoid surgery thus far.

Unfortunately, the meds that work for my pain are also ones that make me incredibly sleepy. My doctor is aware of it, but there really is no alternative at this time. He just added the Cymbalta to see if that can help out but I just started it last week. It also has an effect of making one sleepy.

Flexeril is the main culprit but it is also the one that provides the most relief. I use Skelaxin during the day when I am at work and then as soon as I get home it is flexeril and an icepack. I have tried various combos, meds, etc. but unfortunately, this is the only way that I can continue to work. With even lower doses the pain gets so bad that I can barely hold up my head.

He wants to try a nerve ablation but unfirtuntely my insurance sucks and I don't have the couple thousand $$ it would cost me out of pocket to have just the testing done...but that is pretty much the final thing I haven't tried before exploring the surgical route.

Posted 8/22/2013 3:59 PM (GMT 0)
The only other thing I can think of is coffee in the morning when you take the meds. Have you tried not taking the flexeril at all and just taking the Skelaxin ? If you take a bedtime does of flexeril, you could also try taking it earlier in the evening. Sometimes when we take more than 1 med at a time that makes us sleepy, the side effect is compounded. By that I mean taking more than one med at the same exact time. Sometimes spanning the time out over a few hrs helps the side effects.
Posted 8/22/2013 4:14 PM (GMT 0)
Oh I drink alot of coffee...If only I had stock in starbucks lol! I also drink 5 hour energy when I need an extra boost but only every so often so I dont feel like I need it every day.

I have tried not taking flexeril at all but it is the only one (muscle relaxer) that really really helpsthe others are more like a slight dulling of the pain per say...and I do space out the meds...There are some I take right when I get up (gabapentin, and now cymbalta) then when I get to work I take an oxy and then usually within an hour a skelaxin...so on and so forth. It just scares me to even think to take all of them at once. I have tried changing, cutting out, adding too, etc. and all roads lead backto the same thing...tired but (mostly) functioning.
Posted 8/22/2013 4:20 PM (GMT 0)
I'm out of ideas. You would think in this day and age that there would be a way to makes these meds without some of the side effects.
Posted 8/22/2013 5:36 PM (GMT 0)
I agree with Tina. I'd stick with a long-acting medication for a few months, or even a year. I think that the side-effects will lessen. It sounds like you're having a really tough time with your pain.
Posted 8/22/2013 6:17 PM (GMT 0)
Mercy&Grace...I know! It is crazy with everything they can do scientifically and yet...here we are! And I think for those of us who have a myriad of issues that requires that we take a few different meds for relief, it compounds the problem of pain relief without turning to stone. In the beginning it wasn't as bad but as I get older and the symptoms get worse, it is what it is. I have been in denial for a long time and as a result made decisions that I should not have made, but now at least I have the benefit of knowing that I will more than likely soon be disabled and can plan ahead for it now. And it could be worse. Aside from my back issues I am completely healthy.
Posted 8/23/2013 5:23 PM (GMT 0)
Wow, some very nice information here, thanks everyone!

I hope you figure out a medication/treatment that works for you cogito. My doctors are very afraid of opioids being used for my pain since I'd have to use it for the rest of my life, most likely. So I am having issues wondering what to do.
Posted 8/23/2013 5:36 PM (GMT 0)
I am sorry to hear of all your issues with pain and the level of stress you must deal with on a day to day basis.

This suggestion may be "out of the ballpark" but have you considered any of the medications used for ADD/ADHD? I am somewhat familiar with them and their not all stimulants.

Even very small amounts may be helpful!

I hope you find what is best for you!

 

Posted 8/23/2013 5:43 PM (GMT 0)
For what it's worth, I do know someone who has ADHD and also suffers from CP. The ADHD meds help them with the sleepy and tired effects. But, ADHD meds work differently on someone who has ADHD than they do on someone who doesn't.
Posted 8/23/2013 8:23 PM (GMT 0)
Cogito have very good results with a very old "arthritis " Med. Indocin, have used it for years without any side effects especially stomach issues that are notoriously common for these meds.

Tina's idea makes a whole lot of sense!
Posted 8/23/2013 9:53 PM (GMT 0)
I have ADHD and I have noticed it does make a difference when I take the meds. As was pointed out, they do work differently in people with ADHD than someone who doesn't. Have you ever been diagnosed with any type of attention deficit disorder?
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