Pain Management Community

Sorry, bren_bren, I have not been on the computer or missed this post or both, lol.

I found with gabapentin that I continued to increase my daily dose until I did have relief after a week on a steady dose. I got up to 1800 mg. a day, other people have gone higher. Then I went down again very slowly, until I hit 900 mg. After awhile I just asked my doctor to put me on whatever was the closest dose that I could take in one pill. She decided the 800 mg. pill should work for me and it has.

I personally feel that one needs to stay on the dose that works as far as the gabapentin goes for several months, then try backing off a bit very slowly.

I have not had a problem with heat bothering my own nerve pain issues. I sit in my hot tub every night before bed.

I do not have experience with hip labral tears either personally or with patients I have had over the years. I never did much orthopedic work. My husband had a hip replacement four years ago for AVN, he recovered well, and described it as an easy surgery. I would check out various orthopedic surgeons in your area, and on your insurance, make appts. with several that take care of a lot of hips and see who you like the best.

Take care, Annette

PS, the only silly ? is one you don't ask.

Thanks, Annette. I wasnt worried about the delay.

I was concerned more about heating pads increasing nerve pain, or irritation. I've just had quite an inexplicable increase in pain the last few days which led to very little sleep.

Unrelated... Why i was asking about hip labrel tears...I was lying on at hard hot pack a couple of weeks ago, on my stomach, upper leg (quad) and felt some strain/tearing left of my pubis, in the crease of my leg. It has created weird muscle spasms down the front of my leg and groin. Also some pain on my pubic symphisis. Needless to say, I am surprised at how the pain worsened recently. It's not contributing to my heightened pain lately, it's distinct. It could be a minor tear. I just hope it gets better before my next prolo appt 'cause the doc will just stick a needle there too. It would be very uncomfortable in that area. He got my pubic symphisis (L&R) 2 visits in a row and this last visit I said "no more there, please".

*So if anyone has had similar symptoms, which led to a diagnosis, let me know** I'm maxed on imaging this year

Thanks for your time, B

Sorry, Annette, I just re-read your post & "got" that you have no experience w/ orthopedics.

No problem.

Don't let your mind jump to something horrible or difficult first thing. I would assume that laying on the hard pack made you hurt due to bruising or whatever. Mention it to the doctor next time you see him. Or call before then if you wish.

I have learned that belly dancing to a new instructor on my DVDs causes new and different pain in my hips because I use slightly different muscles. After it happened 2-3 times, I understood what was going on. Now I plan ahead and expect the bit of extra pain.

Are you maxed on imaging due to insurance, or because you do not want any more radiation right now?

Take care, Annette

That's right! I remember you stated the belly dancing was quite enjoyable. Do you still practice?

I'm maxed on MRI 's due to insurance. It doesn't feel like a bruise. The pain is above were pressure was applied. I may over extended the ligaments-just surprised at the shooting pain. I jumped to that conclusion (labrel tear) because my prolo doc asked if I had 1, thus ordered an MRI w/ contrast, which showed a "non-definitive" tear. Doc's interpretation: "doesn't mean it isn't there". He explained the symptoms and at the time I didn't have any, but after that incident, now I do.

You're absolutely right. I can easily jump to conclusuions. Though I shouldn't, being in chronic pain for so long w/out a definitive diagnosis can do that to me. Thanks for setting me at ease though; it's just nagging-and annoying.

Finally I can feel a positive difference w/ the Gabapenten! I'm hoping it will reduce my need for opioids, but I'm just experiencing a flare-up this week, which is common on week 3 following the prolo treatments. Geesh, I just want something to get better!! It's hard not to get discouraged these days.

Thanks for the input. Take care, B

Yes, I am still belly dancing. Every night, for at least an hour, sometimes longer. I love it, and it is great exercise. I have lost just over 50 pounds without changing my diet at all. I should, but not yet, lol.

If you are maxed out on MRIs due to insurance, just see a good clinician when you see a doctor. I remember when we didn't have MRIs at all, hadn't been invented yet. They are great when you really need one, but we did manage without. When does your insurance allow it again?

As for the labral tear: another interpretation, might be "doesn't mean it IS there". If the radiologist was not sure, and you had no symptoms at the time, I would not worry about that.

I have FMS as one of my major diagnoses, some call it a garbage can diagnosis, although I don't. I do understand what you are saying when you do not have a definitive diagnosis. It has just been so long I don't worry so much anymore.

I can't say that I decreased my opioids at the time I started gabapentin, but it did make me feel better, and perhaps I did not increase my dose as often since then. I keep a written log of all my opioids along with comments and dates, etc. It helps me identify flare ups and why they happen. That helps me accept that they happen, and they do go away.

Take care of yourself.

Annette

Hi Annette,

I'm close to having another MRI on my lower back at the request of my pain doc. I'm more inclined to purse that one cause I know my L5, S1 disc is protruding even more. Since my round of prolotherapy, I have been committed to lying on my back. I do, on heat pads, almost the entire day because I cannot sit.

It's interesting that my ischial, left hamstring tendon, pain have let up since the prolo; however my left SI joint (untreated area) is so fragile that if I squat to dress my boy, or kneel, it feels like a hot pick is stabbing me. Most recently I have had pinching pain in my low back, along w/ sacral nerve root irritation.

Over the years I have sciatic nerve irritation (not "true" sciatica) that spreads down my leg. It doesn't matter which area flares up (SI joint, hamstring tendon, low back) they all mimic the effects of disc compression/bulging. I think this is why I haven't received an official diagnosis.

Since my low back/SI have not received imaging in a couple of years, I'm thinking it's called for.

The strange thing, my pm doc just mentioned an MRI my last 2 appt's but he is not ordering one yet (he wasn't even aware of my insurance issue); he said let's just wait to see how "this all works out". I'm assuming he meant the prolo, but not sure.

The prolo could have caused things to shift, resulting in this pain increase-I hate it, but it has helped my hip, IT band, and ischium.

Since starting Gabapenten, I've not been able to reduce opioids. Disappointing. But if I don't take it, horrible nerve pain (stinging). Isn't it true that if one relies too heavily on BT med's that long acting should be increased? My BT med's require a double dose (30 mgs roxicodone) to put a dent in the pain. But I could use that dose 4 hrs later. Sorry to ramble, just having some rough days her & cannot function, much less decrease my opioids-wish I could.

Hope you are well and thanks for your continued support! -B

Hi, Bren-bren

Be careful about laying on top of heating pads, it is very easy to burn your skin. Most of them tell you in the directions not to do that.

I am curious as to the difference between sciatic nerve irritation and true sciatica? What is the difference?

I would avoid any kind of imaging tests until the doctor feels it is needed enough to order it. If he thinks it is right to wait and see, then do that. I think MRIs are grossly over-ordered, just my opinion.

So the gabapentin is helping the nerve pain, that is a good thing.

What I have read about BT meds is that if you are taking more than 2-3 doses a day, you might discuss with your doctor increasing your long acting meds. There is a formula somewhere out there for you to estimate what your dose should be. A PM doc figured mine out prior to me having surgery 18 months ago. I recently got to where I was having pain at a 6-8 score all the time and taking my BT meds every four hours while awake. I talked to my doctor about it and increased my methadone 2 of 3 doses per day from 5 to 10 mg., now all three doses I take are 10 mg. each. I am taking my BT meds only once or twice a day most days. I think this is a good thing.

Hang in there, you will do fine, this will pass. You will feel better after it is all straightened out.

Take care, Annette

Yeah, I've laid on heating pads before & not realizing it until days later, burned myself. Scars to prove it. I'm more careful now-more embarrassed by it than anything.

In my experience a true sciatica pain is like an electric jolt that runs through the buttock, down the entire leg. It's so painful that one can't even bare to speak. I had a doc hit my one of my nerves in my back with a needle while administering an epideral (at l-5, S1 nerve root)for pain management and it felt very similar to that-minus the leg flying off the table. I had what I call true sciatica while I was pregnant and it caused my to topple over. It was brief, but would occur over & over. One cannot walk while it's happening, and I'm sure sitting is impossible.

The sciatica-like pain I have is similar, in that the afflicted muscles tense up, burn, legs burn down the back side, there are certain nerve paths that sting (like the outside of the calf, a specific spot on the bottom of the foot.

Maye I'm confusing the latter with nerve root irritation. I just had a doc tell me once that VERY few patients have sciatica-its overly diagnosed. Most of them have a "faux sciatica"; so that's where I got my crazy interperatation.

About the BT med's, I'm in a sticky situation. Committed to showing one doc I want to get better (by reducing opioids) but can't stand the aggravation/pain I get from reduction I've already made. The other doc has never mentioned a formula, but insists that my BT med dose (15 mgs Roxicodone up to 4xday) is the limit. I think he has forgotten that he recommended taking 2 every 12 hours (even though he still writes the script the other way to "avoid red flags" to the powers that be), because recently he told me to try breaking pills in half & taking them more often. Tried it. It works best as a BT med at 30 mgs. but some mornings I can get away at 15 mg doses. My Fentanyl is too low for the amount I have to rely on the BT med's. I know that, but trying to please doc B I guess.

Question: I have some pills in my bottle that do NOTHING for the pain, then others that work fine. Is this possible? I had a script for 120 so I'm sure there are two batches in there. I thought that maybe I was responding better on days that fentanyl levels were at its peak & that's why they were sufficient. But seriously. I have had zero relief from some. It's frustrating & just thought maybe you could offer insight.

Thanks so much, B

I personally think sciatica is sciatica, as long as a doctor diagnoses it. You know how I feel about self diagnosis, lol. Sometimes sciatica may feel worse, but to me it is a matter of degree that you are talking about.

I would assume that your pain or your response to the pain is different, before I would assume the pills are different. My pharmacy always tells me if they have two batches of drugs in to fill a RX, and they put them in different bottles, with the different lot numbers on them. Ask your pharmacist if your store mixes two different batches in one bottle. I don't think the FDA allows that. Tell them what you have said here and ask what they think? I think most people under-rate their pharmacist as a member of their health care team, I have found them to be VERY helpful. They seem to like not being thought of as just pill counters.

I think your theory that your fentanyl levels were higher is a good one, keep records of the times of the fentanyl, and the BT med and how much you take each time. Score your pain and the times also. This way you can see trends that you might miss otherwise.

Take care, Annette

PS-Do not try and please the doctors, just tell them the truth about how you are feeling.