Long-term Pain Management

Hey all. I am new to this forum and I am sure this question has been asked loads of time, but I will give it a shot....

I have had 9 foot surgeries over 5 years (not related to any disease, my ankle was collapsing due to no arch in my foot). My foot Dr sent me to pain management who put me on Gabapentin (pretty sure 300x2/day) and Nucynta ER (200x2/day). I had to stop this treatment because the drugs had me feeling like I was on narcotics 24/7 and I couldnt drive or function properly.

So my question is what have you all tried that worked? I definitely need to be on something since my foot Dr has said there isnt much else that can be done to alleviate pain other than to sever nerves which I will not do.

Any advice?

Other things I have been on:

Lidoderm cream & patches (mild help)
Hydromorphone (post surgery, was told I can not be on this long-term)
Compounding cream (didnt really seem like it did much)

I was on the Gabapentin for about 3 mo. Honestly I think it was more the Nucynta that was messing with me, because after this last surgery my foot Dr had me take gabapentin for 2 weeks to help with recovery. granted it was only half the dose as before, but this time I had no real ill effects.

I tried Lyrica years ago with no noticable effect, but who knows maybe it will help now. I'll bring the list of what you recommended the next time I see the Pain management Dr ad see what she says.

Thanks!

Let me suggest Tramadol / Ultram ER. Some of my pain is nerve-related and I find that it helps with both it and more muscle-based pain.

It has only a low affinity with the mu-opioid receptor and much of its benefit comes from its serotonin (and perhaps other) neurotransmitter regulation.

I've tried Lyrica, Gabapentin, Cymbalta, Savella, and other meds that work on neurotransmitters, but Tramadol is the only one that has made a difference. Unlike SSRIs and SNRIs, it is suppose to work by releasing serotonin vs. downregulating its reuptake receptors. That means fewer side effects and immediate benefit vs. a 3-6 week period before it kicks in. Also, unlike other pain meds, it doesn't have (for me) any negative cognitive effects.

I take 300mg ER daily and have recently added 50mg x2 IR. The latter takes about 45 minutes to start working (unlike oxycodone which takes more like 15min), but lasts longer (5ish hours).

Others find Tramadol ineffective, but it has been great for me. BTW, it is a Schedule IV med, and is even sold over the counter in many countries. So, it will more likely be something a doctor is willing to prescribe.

Something you should know about Fentanyl, since you live in Florida you cannot wear them & be out in the heat, it will release too much medication. Hot showers are out of question when wearing a Fentanyl patch. They are a 3 days patch but sometimes they will only work 2 days. When I was on Fentanyl because of the heat by day 3, I had little left in the patch & was having withdrawal problems.

I do hope you can fin something that will work......Susie

I know the problems I have had with Doctors is they look at me as a broken down car. All they want to do is change my oil, or replace a broken part get their money and cut me loose. None want to take the responsibility of treating the whole person, How does this effect my life, what treatment will allow me to this and that? It's like they don't want you to know too much, that way if they mess up they hope I won't know any better. As you can tell I don't carry a very high opinion of Doctors in general, so remember my opinion is very bias.