re: Let me introduce myself......

Hi everyone....I am new here.  I have been reading health boards for years looking for answers but I have never joined because I didn't think after 4 years I would still be dealing with a chronic pain problem.  I guess it is my never ending hope that by now I would have a better life and partial denial that chronic pain is my reality.  I have been seeking help from the medical community and also alternative treatments.  One doctor recently told me that pain is the outward expression of internal rage.  So I guess I am here looking for support since my husband is sick of listening to me and I don't have anyone else to talk to.  Maybe talking to other people in the same situation will ultimately make me feel better.  I hope that is possible....

Now on to my question - I just wanted to get some feedback from others about a few medications.  I know that each persons experience can be completely different.  My problem during the day is the fibro pain in my neck and upper trap and my problem at night is a sort of burning nerve pain that is so intense on both sides that I can't find any comfortable way to sleep.  I take (1) 50 mg tramadol in the morning and that helps my lower back enough to make it through the day as long as I don't stand too long.  I take one 5mg vicodin at night and 20mg of amitriptylne to help me sleep.  I also have this strange ritual of putting 'salonpas' patches on my thighs and piriformis so I can actually sleep because the nerve pain is so bad. I had a laminectomy in 2000 at L4/L5 at age 28 and everything was fine and I returned to work and got on with my life.  In 2007 I had a baby and was told I had an annular tear on the disc under the one I had sugery after the pregnancy.  I had cortisone injections that didn't help.  Another doctor told me it was my facet and had more cortisone injections that didn't help.  The next doctor did a neucleoplasty and burned the disc so it shriveled up and that did nothing.  Then I had double side rhitzotomy at L4/L5 that did very little.  Then I was told it was bursitis in my hips so I had a seriese of cortisone injections which helped a bit but the burning always came back.  I did 7 rounds of prolotherapy because the next doctor told me it was my SI joint that was unstable.  Then another double rhitzotomy at the SI joint level with minimal relief.  In the last few months I have moved onto trigger point injections around the piriformis and thigh and in the upper back (trap/neck/shoulders) along with massage and dry needling and would say that has given me about 40% improvement.  I hate to bore everyone with all this history but not one doctor has been able to tell me what is causing this burning pain through my butt and thigh area and what medication I can take that might help.  I have had several MRI's and discography and they show the damage at the 2 disc levels but not a lot of stenosis which is what I thought my problem might be. My gut tells me it is my piriformis that is in a constant spasm and that is it irritating my sciatic nerve.  I do stretches daily but it makes no difference.

I wrote down a few medications to talk to my pain doctor about tomorrow but I wanted to see what others thought. I want to know if they have helped others for nerve pain or fibro pain in the upper back.  The only one I have tried was neurotin at 300mg and it gave me an ulcer and didn't do much for pain but did knock me out for the night.  Here are the meds:

Klonopin

Flexeril

Neurotin

Mirapex

Any feedback would be greatly appreciated.

Hi Swaye,

I have piriformis syndrome, caused by injuries to my hip, SI, etc. from a car accident about 7 years ago. Someone crossed the highway median and we collided. The seat belt and airbags saved me from most injuries, but when our cars collided, my body was thrust forward and my right knee smashed into the dashboard. That send my femur back, ripping my SI, tearing muscle, cartilage, etc..

I ended up having hip surgery, but also had some very effective injections into my SI that relieved the pain there.

My physical therapist also adjusted by SI twice a week for about 6 months, to try to keep it aligned as the SI ligaments healed.

He also taught me a piriformis stretch, it is hard to explain in writing, but I found it gave me a better stretch than the more common one (where you sit, crossing one leg over the other and gently pull that leg farther). I have long legs and needed something different.

I am assuming the burning pain you get is from your sciatic nerve -- and some percentage of people have that nerve pass through the piriformis. That, apparently, is my case.

Here's a shot at the other stretch:
1) start by being on the floor on your hands and knees.
2) rotate the leg to be stretched inwards (i.e. across your abdomen), pivoting on the knee.
3) then "walk" yourself back using your hands, so that the angle between the rotated thigh and the floor decreases. Don't "walk" straight back, but on a slight angle favoring the side you want to stretch). Alternately, you can try bringing the knee in a bit, so it is closer to your center of gravity.
4) you might need to find just he right degree of rotation and angle, but if you do it right, you'll feel a stretch in your piriformis.

Of course, you might have other medical issues and should check with a professional before trying the above.

If the cause of your burning pain is a tight piriformis, a routine of the above may help. For medications, the only muscle relaxant that doesn't make me feel really crappy is baclofen (or the benzodiazepines, such as valium). Another important tool is ice. I find that it helps me much more than heat (esp. nerve pain). Moist heat may help with muscles, though.

One more idea: I recently got lidoderm patches. I don't think they help much but I believe there are muscle relaxant patches too. If so, maybe one across your piriformis?

I take flexeril 3/day for muscle spasms, still get some doozies. Neurontin is supposedly for the zappy, electrical nerve pain, I think. My fibro pain is more like full body shin splints.

I take klonopin for PLMD, a sleepdisorder where legs thrash all night, like restless legs.

Anyone might be worth a try, all of us are soooo different.

Sorry for your pain-hope it gets better

Maggie

I found a youtube video of the piriformis stretch that I do:
http://www.youtube.com/watch?v=rzZfGwhcFn4

This also looks like it might work, but may be easier:
http://www.youtube.com/watch?v=0Z6jlBsgak0

My guess is that the first will be best, given your height. The guy in the video moves right into the stretch, which I definitely don't do. Instead, after I am on my hands and knees, I very slowly rotate my leg and very slowly bring my body's weight onto it by "walking" back on my hands and sliding the straight leg slowly back.

Also, I don't find that Baclofen makes me sleepy or really alters my mental state, unlike basically all the others muscle relaxants. The only down-side I've encountered is that it has a very short half-life (2-4hrs) and so doesn't last very long.

Swaye, welcome to the board. You will find a very supportive group of people here.

Neurontin is often very good for nerve pain. I took it for a while and it provided good relief, but not until my dosage was 300mg 3x a day.

I found Klonopin to not be a very effective muscle relaxant, but also did not make me sleepy once I had adjusted to it, which took about 3 months.

I take Flexeril at bedtime when I am in a flare. It helps quite a bit. It made me very sleepy at first, but once again I eventually adjusted to it.

Good luck at the PM tomorrow.