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Pain Mgt,
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shadyt57787 posted:
I have been refered to a pain mgt. specialist for chronic pain due to two hherniated cervical disk. I have been treated by my primary care MD for several years but he has been spooked by recent DEA activity in his office. He has me currently on ms contin 60mg every 12 hours. I get about 6-8 hours relief then return to baseline pain status.
My appt. is Thursday. Any suggestions on meds to request?
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David Maine, MD responded:
Thanks for your post. I would recommend going into the appointment with an open mind. Your goals are pain relief and the medications may not be the best or only way to get there depending on the pathology. There are a number of treatments that can be used to treat neck pain. It all depends on what your symptoms are, your exam, and how it all correlates with the findings on imaging. Good luck.
 
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zenjan replied to David Maine, MD's response:
Please, I need help and don't know what to do anymore. My T-12-L1,L2-L2,L2-L3,L3-L4,L4-L5,L5-S1 are herniated. I have neuropothy in my right leg, I guess thats what causes my foot drop. I have been fitted for a brace to help the foot drop but have not received it yet. I do go to a pain management clinic. The doctor there has just gotten me to have a new mri. She keeps giving me anti-depressants. She gave me paxil and klonapin, they made me do things that I do not remember doing. Its not until the next day that my mother tells me the things that I did. Several of those things were extremely dangerous and I cannot thank her enough for saving mine and others bodily harm. She took me off soma and gave me norco,neurotin, and zanaflex. the zanaflex dosage is once at bedtime. This treatment is not working. Please help me figure out what to try next. I'm very tired and my pain level is running at atleast a nine. I just really at a loss for what to do. Please help me.
 
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cweinbl replied to zenjan's response:
Wow! You must have been in a very bad accident. It is exceedingly rare to herniate all of those discs. I'm sorry.

Anti-depressants can reduce pain by inhibiting the reuptake of bloodstream Seratonin. I would take this as an axiom. However, if you have moderate to severe pain, it likely would not be up to the task. Paxil is an older but widely used anti-depressant. There are few major side effects.

Neurontin is also not a pain medication. It's an anti-convulsant with some efficacy for neuropathic pain. If you have nerve-related pain (pain that transitions down a leg or into a hip), then it might help. Klonopin is also an anti-convulsant. You must never take these drugs together.

Zanaflex is a muscle relaxer. It is not a pain medication.

Ironically, "zenjan," you are not taking ANY pain medication, except the very mild pain reliever, "Norco." That is strange for someone with chronic pain. Have you asked your doctor why he or she has not prescribed a decent-strength pain medication? Most chronic pain patients respond much better to using a long-acting opiate (Kadian, Oxycontin, Fentanyl Transdermal, etc.). Then, if you still have breakthrough pain, you can use it in addition to the long-acting drug.

If you are also in a pain management program, you should try each of the following options:
a corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, injection of steroids and anesthetics, non-steroidal anti-inflammatories, cortisone, rhyzotomy (radio frequency denervation), spinal cord stimulator, intrathecal infusion pump, off-label medications (anti-depressants, anti-convulsants), combination of long-acting pain medication with breakthrough meds, counseling, hypnosis and meditation. I can reduce my pain by at least 20% with biofeedback alone. That's in ADDITION to using your pain medication and other off-label drugs. In fact, if one or two of these options works well, you won't need as much pain medication.

Good luck.
cweinbl
csw2@bex.net


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