New and would like some suggestions

I am new to this forum--severe facet degeneration at multiple levels, disc disease particularly L5-S1, SI joint dysfunction, frozen shoulder, Sjogrens and arthritis in both wrists and Left knee..also I have mixed connective tissue disease. I have been taking Ultram 100 mgs a day for 15 years, and I started taking Norco 10 mg 3-4 times a day about three years ago. Nothing seems to be really working anymore (including cortisone injections) as my disease(s) progress, and more joints "go south". Recently my Rheumatologist recommended Nucynta and I am not sure if this will help--I am kind of afraid to take it, actually afraid of being in worse pain than I am now. This last 6 months, I find that I can barely stretch or exercise, and I am becoming isolated because I am too fatigued to leave the house (pain). Any suggestions? Also I was born with Spina Bifida Occulta and am wondering if anyone out there knows if this benign deformity can add to arthritic symptoms later in life? (I'm 57) Also--dang SI joint! this started about 6 months ago--had 3 injections but its still killing me!!!!!!!!!!!!!!!! Anyone? Suggestions?
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Hi there...Welcome to HW...

Sorry that you are having so much pain..

If I could ask a few questions to try and better understand a few things....None of us here are Drs. but other pain patients that can offer empathy and suggestions...

When is the last time you have seen an actual Board Certified Neurosurgeon or BC Orthopedic surgeon, (make sure they are Fellowship trained as well), to go over your MRI? And if you haven't had a recent one within the last 6 months to a year, it is best to get another.

They are the best type of Drs. to go over those MRI results and to see if surgery is a possibility that could actually help some of your issues.

As well as recommending that you seek out an actual Board Certified Pain Management Dr. to help with all your pain issues.

It's pretty amazing that you have gone so long with only taking Tramadol and Norco. I wasn't sure if you are saying that you are prescribed both of these right now or did they move you to the Norco?

There are quite a few people on here who are on Nuncynta and it has really been helping them. The issue with asking about specific medications though is you are going to find answers all over the place from it working wonders to not at all.

I have found that it's best to go in with a 100% positive attitude when trying anything new, from medication, procedures, to even surgery. Our minds are very powerful to sway us in either direction.

Most Drs. ask that a patient stay on any new medication for at least a month to really see if it is working. That is of course barring any true allergic reaction. There are side effects to pretty much any medication we take and most of those will taper off over the few weeks or month. They usually consist of fatigue, nausea, or headaches.

With going to see an actual PM...they will be able to work with your Neurosurgeon or Orthopedic surgeon, and even your Rheumatologist to figure out the best possible comprehensive program to help your pain.

Chronic pain is best treated by using as many possible modalities. From daily exercise, physical therapy, aqua therapy, injections, steroids, ice, heat, TENS unit, counseling, nerve ablation, acupuncture, massage, biofeedback, ultrasound massage, eating well and maintaining a healthy weight, not smoking, etc....

And then for medications...many of those with spine or joint issues, Fibro, Sjorgens, or arthritis are on other meds in addition to any type of opiate they may be prescribed.

An opiate is just one piece of the puzzle as it does help for overall pain to lessen it a bit to have us "not care as much"...but it doesn't really go directly after specific types of pain.

For nerve pain issues there are medications like Lyrica, Neurontin, or Cymbalta. Although a few people have been saying that the Nucynta is working to help lessen their nerve pain as well so that is a plus!

And then there are actual muscle relaxers that target spasms. These are Flexeril or Amrix, Robaxin, Skelaxin, Baclofen, or Zanaflex. These are very helpful to take as needed.

Some people with chronic pain also are on antidepressants that help both the emotional side of living with pain but also helps some of the physical symptoms. I continued on with my counseling after my divorce to work on my CP issues and learned some great ways to help deal with my pain. There is nothing to be ashamed of to admit that we have developed depression because of the pain we have. It does sound like with your isolation that this may be a factor for you as well.

The key is that there isn't just one specific pill or modality on its own that will do the whole job of lowering our pain to a decent level (5 or so on the scale).

Having these Drs. work together they can hopefully get you to a better place to where you can at least get out of the house more to maybe walk each day and do daily stretching which is so important to help us physically but also mentally. I am thankful I have a dog that gets me out each night for a nice long walk.

So, these are just some thoughts/suggestions but I would make sure you see a surgeon first to rule in/out any surgery and then go from there to better manage your pain.

We hope you stick around here as it's a wonderful group of people who really understand...

Thanks for sharing more...We are definitely here to listen anytime and about anything. Yes, it can be very frustrating when our bodies start falling apart it's hard to know where to start!LOL

I would think that the Tramadol has pretty much run it's course over the 15 years with tolerance developing and as I mentioned, I am amazed you lasted so long on just that medication alone.

I forgot to ask, is the Nucynta the short acting one or the ER version?

Many PMs will move a chronic pain patient to a long acting/extended release medication and then give you something like the Norco, which is short acting, for "breakthrough" pain that happens every so often.

Sounds like you have a good Dr. with your Rheumatologist. I just think that they are limited in their care and you will be better served by specialists to take a look at everything with a fresh eye and see what can be done to help.

Keep us posted on how everything goes!

If your rheumy doctor is about to retire maybe start looking for a new one, maybe plaquenil might be a medicine to try, if you've not yet tried it. This is a great forum for support and we are like a family, wish I could help you more but others will come along. Make sure to try the best ortho surgeon in your area, for your shoulder, and that probably should be your starting point for 2013 is getting your shoulder taken care of and then worry about the other things...Many well wishes to you and prayers...

I just wanted to say a quick hello and wish you well. My younger sister has spina biffita oculta too, but she seems to have the same back issues as we (her mother and sisters, and late father) have...so I don't think it has ever,been an issue for her really.

I'm sorry I can't help more tonight, but I'll log back on when I'm feeling better. I'm glad you have found us. This is a wonderful group of people for sure.

Just wanted to pop back and say that I'm not sure if it was a typo but you wrote about making an appt. to see a Neurologist for your back. But then wrote Neurosurgeon in another post...

Wanted to make sure that you see either a Board Certified Neurosurgeon or BC Orthopedic surgeon. A Neurologist only has training in the nerves and nervous system.

So, just want you to get the best care possible and apologize if it was just a typo in the last post:)