Advice for intercostal nerve pain

I used to post more often here, then my pain leveled out and there wasn't much to say. I hope to both help and ask for help, again.

Well, I'm back because the nerve pain in my right side is out of control, probably from the intercostal nerves being pressed on by a tumor(s). I'm meeting with the hospice doctors and/or nurses sometime soon, maybe after the holidays, to discuss what to do. The hospice even has a little hospital where I could be an inpatient for a few days to get the pain under control.

My question to you good folks: What should I ask about? What have you found good for nerve pain? What hasn't worked? I realize everyone is different, so I won't necessarily assume something works/doesn't work for me, but am open to any ideas!

Right now I'm taking 135 mg extended release morphine, and 900-1200 mg neurontin per day, divided up per day, plus topical cream.

I've tried...
More neurontin, gives brain fog with no significant pain control.

More morphine doesn't increase pain control much if at all.

Lyrica--more brain fog and less pain control than neurontin

Nerve block--had one, worked great, but took 6 weeks to work and pain was worse for those weeks. Scary, but maybe.

Steroid shot--horrible increased pain for two weeks. No one knows why.

Haven't tried...

Methadone--I know, I know, but does it even work? If I'm dead in six months, long term effects aren't an issue.

Fentanyl--any good for nerve pain?

Levorphanol--never heard about it until googling nerve pain medicines. Maybe really rare? Does it work?

Any injections--I'd love to have a shot that works for 2 days or so. The longer-acting hormone shot was horrible, increased the pain. We've moved to town, and the hospice nurses make house calls. Any shots that last like that?

Any other ideas for nerve pain?

Thank you-all in advance. Just want to be ready with ideas for the nurse/doctor.

Hi James & welcome back. I am sorry to read that you are having such a bad time right now. I went searching through old threads here about intercostal nerve pain & actually stumbled across one of your older threads. Back then you had RF ablation done for this pain & had a little relief eventually. But, I have no idea how long the relief lasted. Is this something you my be interested in repeating, or would your dr be willing to consider it again?

I did do some quick reading on the web as far as treatment goes & there appears be different treatments but it comes down to what works for the patient. You have already done several of the things recommended. Something that stood out was "cold therapy", which I am assuming is "cold laser therapy" which some people have posted having success with. This may be an option for you. Searching the web can be time consuming, lots of bad info above all. Have you gone to the Mayo Clinics website & searched there for treatment? If not that would be an excellent place to check. At least there you will get reliable info.

You mentioned the side effects from Gabapentin when increasing the dose. You do still have room for increases there. I don't think increasing more narcotics will help, as they have little effect on nerve pain. I wish I could given some better suggestions than I have. Fentanyl is a very strong & effective opioid that may be something to consider. Since you have been on Morphine for so long, you have probably built up quite a tolerance & may not be as effective as it once was. I would talk to my dr about Fentanyl for sure. Fentanyl is a very smooth acting pain reliever, very different from oral meds. It is a 72 hour patch but some need to change it every 48 hours, not uncommon at all.

Please let us know what you decide to do & hopefully whatever path you take will bring you relief. Take care.

James, don't forget to look at the Mayo Clinics website & see if there is anything there that may of be of interest.

I think you would be an excellent candidate for Fentanyl. My mother had terminal lung cancer & was put on Fentanyl & it really helped her pain better than Morphine. Granted her situation was different from yours, but it is often used for cancer pain.

Take care.