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Inpatient pain management for severe cramps and fissures

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Posted 7/10/2011 1:55 PM (GMT 0)
I am desperate. I have been in the hospital for 21 days for a moderate/severe UC flare. The flare caused anal fissures so I am dealing with that pain as well.

They have had me on Dilaudid this whole time and I keep building up a tolerance to it. I am working with a pain management doctor, but she just is not very helpful and won't focus on my inpatient pain, only how to manage it outpatient. Which I'm sorry, but if I am in this much pain outpatient, clearly the underlying cause is still there.

The problem is, I'm not a big pain med person. I simply do not know what is out there to treat chronic, severe, somewhat long term pain in a hospital and no one will discuss my options with me. So I am wondering if you all have suggestions that I can research and bring up to my doctors since they won't bring them up to me.

Any help at all would be so greatly appreciated. As I said, I am desperate and in pain awful pain all the time. I can't take much more of this.
Posted 7/10/2011 2:01 PM (GMT 0)
The last time I was hospitalized, they had me on Morphine. Have you tried that one yet? I hope you feel better soon. Did they do a scope?
Posted 7/10/2011 2:11 PM (GMT 0)
They gave me morphine in the ER the first night I was here. Helped some, not even close to enough. This is actually my third time back to the hospital because they keep sending me home and I keep coming right back with the same problems. So this last time I was admitted, they gave me morphine and admitted me, then didn't call for any dilaudid so morphine was my only choice. That was probably the worst night I've had here because the pain was so severe and morphine just didn't touch it.

They keep pushing oxycontin/oxycodon, hydrocodone, tramadol, etc. on me and while that helps with the fissure pain some, it does absolutely nothing for the cramping. It's as if it just doesn't target visceral pain.

I'm starting to wonder if I am just in that much pain that nothing works on it? Is that possible? They also have me on a fentanyl patch which they have eve increased the dosage on that with no luck. I just don't understand the problem or why this is such an issue.
Posted 7/10/2011 2:31 PM (GMT 0)
I got to a point where Morphine did nothing for me too. Dilaudid I was told is 4 x better than Morphine. I was taking 6mg every 3 hours after my last surgery and it didn't help my pain UNTIL I took it WITH Tramadol. Are you taking Dilaudid and something else? Maybe that would help? Yes, I do believe you can build up resistance to pain meds and then run out of options. I hope you aren't there yet! My next step was going to be the pain patch if the Dilaudid / Tramadol didn't work...
Hydrocodone, oxy's didn't work for me either...
Good luck!
Posted 7/10/2011 4:21 PM (GMT 0)
Gah I posted a huge response and it got deleted. I'm surprised to hear tramadol and dilaudid combined worked for you. Can you tell me what dose you were on of each? I will bring it up to my doctor.

I'm on the following drugs:
Dilaudid
Fentanyl patch
Prednisone
Cimzia (due for it on 7/20)
Simethicome (for gas)
Hyoscyamine sulfate (anti-spasm)
Seroquel (anti-psychotic for the steroid craziness)
Colace (to keep stool soft to let fissures heal)
Lidocaine and a foam spray to numb rectal area

I think that's it. I'm listing this because you might see some interaction or drug interference that I didn't think about. My mom had an idea that I am actually quite curious about. It seems as though the dilaudid stopped working as well when they added the fentanyl patch, then when they increased the dosage on the fentanyl patch, the dilaudid was even less effective and worn off sooner. The fentanyl patch doesn't seem to provide any relief anyway. So I am thinking of having them remove it (I'll have to taper down I think) and see how the dilaudid feels then.

The nurse just came in and said that they are giving me a pump for dilaudid so here shortly, whenever it comes up from pharmacy, I will be able to get up to 4.4mg an hour. Right now I'm at 2mg every 3 hours and it's just not cutting it, so they had to give me a 3mg push a little bit ago.

Thanks for the responses and help so far. I finally have some relief right now but the pain will be back soon if we don't get the pump set up soon.
Posted 7/10/2011 4:35 PM (GMT 0)
Poor thing, I am really sorry. I haven't been in the hospital so I can't really offer much in the way of advice but I can tell you that I am also dealing with fissures and they are truly awful and I feel for you. I hope you find something that helps you quickly.
Posted 7/10/2011 5:12 PM (GMT 0)
Are they giving you something to alleviate the cramping? Like Bentyl?

Hydrocortisone suppositories helped my fissure during my last flare.
Posted 7/10/2011 7:13 PM (GMT 0)
Jennifer, bentyl doesn't work - I swear I'm not trying to be difficult! LOL I tried it 3 years ago when I was first diagnosed and that was before the cramps got unbearable. I tried it again this time around, long before the hospital stay, and again got no results. To try to control the cramping, they have me on Hyoscyamine sulfate which is the anti-spasm and also helps with the anal sphincter spasming I think, and the gapapentin is an anticonvulsant. But I'm still cramping... very very bad.

When I first got the fissures about a month ago, I thought they were hemorrhoids. The doctor called in the hydrocortisone suppositories which did help a bit eventually, but getting them up there was just too painful. Right now, the Lidocaine seems to be helping. They gave me last week that was liquid and burned SO bad. I refused to use it. This time it's an ointment and applying it doesn't hurt, thankfully.

notsosicklygirl, thank you for your empathy. Really. I hate that anyone else has to have this disease, but I'm also glad that I'm not alone.
Posted 7/10/2011 9:25 PM (GMT 0)
I never seemed to have luck with hyoscyamine and bentyl really doesn't do much for the pain either. To be honest sometimes I wonder if there really is anything that will take the pain away. The only thing I can say I have luck with is a heating pad on really high heat.

I know that's probably not what you want to hear, lol. Have you tried it though?
Posted 7/10/2011 10:29 PM (GMT 0)
I do the heating pad every once in a while. I'll ask for that. I've found some relief laying in a hot bath as well, but that's really difficult in a hospital with the IV and stuff. Really not worth the trouble if you as me.

Honestly, I feel a lot better now that I have the dilaudid pump, but I'm eventually going to build more of a tolerance than I already have. Or maybe they should just get to the bottom of this flare up and fix me so that I don't NEED such strong pain medication.
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