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Chronic Pain
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Posted 3/31/2011 5:54 AM (GMT 0)
So, as I sit here, 8 weeks post op from my 2nd cervical fusion in 7 months, I have had more than plenty of time to contemplate pain relief. For the last 3-4 years, my primary doc has dealt with my pain issues, and doesn't have a problem doing it, but everytime I have something new or something changes, he just increases my doses or adds another med. My Neurosurgeon was shocked (to say the least!) when he saw my med list. He did up my doses for the first month after surgery, but has me back down to where I was when I first went to see him. At my last follow-up, I asked him if he had anythoughts on how I could get better pain relief (my current meds aren't working) without just increasing my dosages. Right now I take 3-60mg Oxycontin/day, 4-6 10mg Percocet/day, up to 8-4mg Zanaflex, 300mg Effexor XR/day, 4-10mg Valium/day and Phenergan 25mg-4-6 times a day. To say the least, I have finally come to the conclusion that there will never be a "pain free" anymore, but am only 37 and am concerned about the effects of all this on my body. So to make a long story a little shorter, I am hopeing that pain doc will start trying a different combo, with lower, less frequent doses. I am allergic to Morphine, so does anyone have any suggestions as to what might be a possibility to ask about to start weaning me off the Oxycontin? I take so much, and since they changed it, cannot seem to get relief. Like I said, I know I won't get pain free, but would at least like to experience pain bearable....any suggestions would be greatly appreciated!
Posted 3/31/2011 8:34 AM (GMT 0)
Oh dear, I take oxy extendend release 20mg am and 20 at night i do have break through meds vicodin but i don't like to take it. one because narcs tend to give me migraines if i take to often so do any benzodiazapines. I do have some suggestions that have helped me a ton. Physical therapy and massage. i go one time weekly, or every other. I have SLE (lupus) rhuematoid arthritis, fibromyalgia, gerd, ibs, problems from serving in the persian gulf, mild depression and i am sure there are more i just can not think of right now. I do take methotrexate and it is a chemo drug and i do an infusion one time monthly and that helps better than not doing it.

chronic pain sucks because it is a vicious cycle. I have been in bed for three days with a flare. yesterday still feeling crapty i got up put my tennies on and begged my daughter to go for a walk with me my husband just got back from a run... we went for 10 minutes i was beat. but i felt a bit better this am, did my physical therapy, luckily my pt lives a mile from me as i am not good enough to drive right now she came to my house to torture me. I still don't feel good but I feel hopeful, 2 days ago i didn't.

I would maybe lower the dose of the oxy if it is an extended release stay on it. get off the break through meds. other wise you are constantly chasing the pain.

I personally would be more concerned with the percocet and the valium. Klonipin works similar to valium but is not nearly as addictive you could take at night to help sleep better. percocet is great for after a surgery but to take constantly you are building a tolerance to it. your dose of oxy seems quite high I too have a high tolerance to medicine and take more than the average bear, but i noticed i was taking it and it wasn't helping so i chose to go off a lot of my narcs. Have you tried Ultram? for breakthrough pain? or any Nsaids, like anti inflamatorys ie: aleve, motrin, aspirin, I am tired it is 2:19 am busy brain and a pain i can't kick.... I am fortunate to live in colorado there are tons of walking paths and recreation centers with tracks and pools. I would also recommend going to a pool that is for Arthritis people... the water is warmer and just walking a bit or do a water fitness class or along that lines. it is great because you put less strain on your spine and such. I would suggest that physical therapy is a must esp coming off a fusion surgery, massage as well because you probably compensate for the previous pain you had in your c spine. I know i do. 3 injuries in my spine and each week they ask me why i am so tight in those same spots... and i do my exercises they tell me ... i amjust wound super tight... I am allergic to morphine as well. i would be honest with the dr. you are seeing and explain to him that you don't want to cold turkey go off meds but youa re concerned... you would like a slow release all day pain med or patch, like the oxycotin extended release, you would like to take no narcotics for break through but you would like something for breakthrough pain, and the valium is for anxiety and nervousness and explain that is there anything that is less addictive in nature. Don't change too many things at one time. don't beat yourself up over meds either. if you need them take them. also ice packs and heating pads can be your best friends. Don't underestimate the simple things.

Wishing you days filled with less pain, more joy, and less meds...God knows it can break our banks, tire our livers and do there own wear and tear; yet i thank God above for the technology and that i live in a country that has meds to help me. Do what you think is best for you. You know your body, you know your pain, If you have a live in spouse or whatever human touch releases natural endorphines.. (i just read that today at my lung dr.) so simple shoulder and back rubs can alleveiate
some pain just by relaxing with someone who is willing to give you 15 minutes of their time, and in return or you give them 15 minutes first. Make it a date night. lol
best wishes...
more joy than sorrow...

diana
Posted 3/31/2011 3:46 PM (GMT 0)
Finally you would do better with a long acting rather than short acting meds for pain control. You have to keep in mind with short acting pain meds their peaks only last 1-2 hours, so that is not really the way you need to go. If you have been taking the percocets all along with the Oxycontin then your body is needing it as your base line meds too, meaning it is no longer working as a BT medication. Between the amount of Zanaflex and Valium you are taking which both work as a muscle relaxer I don't know how you can function, that is like doubling your muscle relaxer.

Sounds to me now is a time to be asked to be referred to a pain mgt dr, someone that has the experience working with meds to get you better pain control without so much medication. It really sounds like your body has just become tolerant to all of this and that is why you are not getting the relief you need. Continuing to keep increasing your meds obviously is not working. Yes, you are so right, you will never be pain free but with the right medication you can get better pain control and have some quality life too.

I hope you can get to feeling better.
Posted 3/31/2011 9:56 PM (GMT 0)
finally

 

With everything you have been through and the amount of pain meds you are on, I agree with straydog it is time you were under the care of a pain management doctor. You know I would just about think that maybe you might be better off with an implanted pain pump! I know that is a drastic step, but you are really on allot of meds, and if they are not working, I just can't help but think that maybe a pain pump would be the answer to giving you better sustained pain relief?????  I do know that it takes allot less pain mecication to give you adequate relief. In any case you need to be under the care of a pain management doctor!  I sure wish you welll Finally and I hope they you can finally get some adequate pain relief!

 

Good Luck to YOU

 

White Beard

Posted 4/1/2011 3:24 AM (GMT 0)
Finally,
It is really far too early to decide whether or not the surgery worked and will relieve your pain and what your pain levels and pain medication needs are going to be , for the long term. You may find that if you reduce the medications that you are taking now, slowly, that you don't need as much as you are currrently taking. It may take a month or more before you get a true picture of what your pain levels actually are, but I firmly believe that you only really get a true picture of what your pain levels are post op , when you periodically reduce the dosages for a short time to see where you are.
You are only 8 weeks out of a 2nd fusion, and your body still has some healing to do before you can decide what the picture will be long term.
If you want to change your medications around, then how about trying methadone? It is cheap, works really well for both mechanical pain and neuropathic pain and can be dosed once, twice or up to 4 times a day if you find that one dose or two doses is too much for you, it can be split up into 4 times a day, and smaller doses.
You are not supposed to be taking zanaflex up to 8 times a day, in fact, no more than 3 doses, every 8 hours is supposed to be taken in any 24 hour period.
http://www.rxlist.com/zanaflex-drug.htm You should also have your liver enzymes checked periodically to make sure that it is not causing damage to your liver.
If I were you, I would start by finding a reputable pain management doctor. While I think your GP is trying to help, it's pretty obvious he doesn't know what he's doing when it comes to overseeing pain medications for long term use and what he is giving you could be doing you far more harm than good. With the right doctor treating the right condition, I'm pretty sure that you could have far better pain relief, with lots less medication dosages to keep track of.
Best of luck to you,
Sandi
Posted 4/1/2011 5:05 PM (GMT 0)
All of your answers convinced me that I am making the right decision by going to the pain management doc. I have considered the pain pump and would be really interested if it would allow me to not have all these pills to swallow! I have pretty muc come to the conclusion that as well as my primary means to be, the amount of narcotic and muscle relaxants I am on will kill me at a way too early age. I just want to get a handle on my meds, because I am realizing I am taking them because it is time to, hoping that this time they will help some. As I said I know that there will probably never be a "no pain" time for me, I just want to be comfortable enough that I am fun to be around again! Seeing the pain management doc Monday for a consult to see if he as any ideas, and what he thinks the best options for me are.....I LOVE my primary doc, as he helped me many years ago when nobody else would listen or believe what I said about my pain, but I think this is getting out of his area of expertise, and I need someone to look at te whole picture and this pain doc has a great bedside manner and he LISTENS....something that alot of docs have forgotten how to do! Thanks for all your input...I will let you know how things turn out Monday
Posted 4/1/2011 8:06 PM (GMT 0)
i have never heard of zanaflex before for that matter could somebody tell me what opana is. is opana a narcotic med. i agree with whomever suggested methadone taken as directed, for me it was the best pain relief med i have had. clearly i am behind the times as i do not know these two meds, anyway the only trouble with methadone, it finally became unbearable for doctors, emts, etc. to first look for track marks on my arms, between my toes etc. good luck and, hoping u feel better
Posted 4/1/2011 9:29 PM (GMT 0)
Opana is oxymorphone and is a really good pain medication. It is probably the 2nd best pain medication that I have taken during my years in pain management.
It is a relatively new medication, having only been out now for the last two or three years I think.
Zanaflex is a muscle relaxant used to treat spasticity. It is a good muscle relaxant, and has fewer side effects than some others.
The downside of a lot of these medications, is that we need to stay on top of our bodies functions and read about the side effects to make sure that we follow up with our primaries regarding any recommended testing. Zanaflex can, albeit in a small number of people cause problems with the liver, so having your liver function levels checked when you have your yearly physical is a good idea.
Sandi
Posted 4/1/2011 11:30 PM (GMT 0)
opana er 10 mg- I take that drug twice a day and for breakthru pain i take opana 5mg this is the working ticket for me. I started it 2 days ago and I feel a big difference already. It is morphined based and er is extended release.it has alot of side effects and You need to take it on an empty tummy otherwise ypu get nauseated, which I dont have that. i believe the longer I use the more it will help. I hope so.

Soft Hugs

Betsey Ross
Posted 4/3/2011 3:19 AM (GMT 0)
I am surprised that you are taking zanaflex and valium, and wonder how u stay awake , taking both?I believe you might find the answer with methadone, as it has such a long half life, and if you find the dose that works for you, you will have less need for so many breakthrough meds. Taking the same med in short acting and long acting, acts on the same receptors. Methadone is so cheap, and it works really well for so many who have tried everything. I was on 100mcg of fentanyl patch, and Vidcodin10mg/500 for breakthrough, and went to Methadone 50mg a day, but actually found it to be too much at the time. You will not be able to evaluate the effectiveness of methadone for about a week or week and half, as the half life is so long, that it builds on itself. I got to the point I took all my dosage about a hour before bed, and it last without any signs of withdrawal at 8, 12, 16 hours, etc. It is a suggestion before anything like a pain pump that is invasive. Also, your meds are being potentiated by all the zanaflex, and valium, and effexor. Good luck
Posted 4/3/2011 11:56 PM (GMT 0)
I suggest the Fentanyl patch. I started on 25mcg changed every three days. That didn't work enough, so the doctor increased me to 50mcg changed every three days. I take oxycodone 5mg every 8 hours for breakthrough pain. I agree that you do need a long acting med, so you don't have to keep chasing the pain. I know before I got on the Fentanyl patch, I couldn't get any relief with just the oxycodone. The meds I am on work very well except when the weather decides to change like today. A few weeks ago, I was in extreme pain but the dr. wouldn't increase my meds. Now I'm glad she didn't. For some reason, my body calmed down. I guess I was having some kind of flare or something.

I wish you good luck with your appointment tomorrow. Take care. I hope you're having a low pain night.

love and hugs
Loretta
Posted 4/4/2011 7:52 AM (GMT 0)
I think it is a good idea to see the pain doc. For me the pain doc has dealt more with pain control then my gp,neurologists etc. There are other treatments you may have not even thought of that may give you better long term relief. I was dx zanaflex before. I also have tried other muscle relaxants but not sure it helps my condition. I think yes my muscles feel tight but it is from the nerve pain and also lack of range of motion. Good luck today at the apt I hope it brings you relief
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