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What to do when the meds are not effective??
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braumeisterbob posted:
Been having a major problem the pain has been getting to level 9 or 10 a few times a week. Have both blacked out & passed out from the pain. It is no fun waking up in the ER!! It takes 2 or 3 IV injections to bring me round. Then in CDU for 2 days or more!!
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cweinbl responded:
What pain? From what origin? Which treatments have been attempted? Which of them delivered some degree of efficacy?


We live in an age when the most physically devastated cancer, hospice and trauma patients can have their pain medically removed via powerful drugs. If you have legitimate pain from trauma or disease, then ask your doctor for a referral to a comprehensive pain management program. There are literally dozens of effective treatments.


What bothers me a bit here is that you have given us no reason for your pain, no indication if it is acute or chronic, no diagnosis or even an idiopathic statement about it. Why are you in chronic pain? What happened? What is your diagnosis? How has your pain been treated? By which medical specialists?


We can't help if we have no idea about your pain, its origin or the failed treatments. If you seek our assistance, please provide some information about etiology and efficacy. What happened? What worked? What didn't?
cweinbl
csw2@bex.net
 
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braumeisterbob replied to cweinbl's response:
Thanks, Sorry for the delay in getting back to you. I ended up in the hospitable and got out late yesterday. The pain is primarily the lower back I do not know the the location numbers. I had nerve root injections this past Monday. I have pain from the vertebra grinding against themselves. Nerve pain from from disk protrusions. I cannot take nerve meds or the antidepressants I am allergic to them.

My pain meds have been changed. I was taking MSCotin 30mg 3X, with nothing for break thru pain. Have been changed to Oxycontin 20mg 2X with 60 Oxycodone every 4 hrs if needed. With the meds for break thru pain I would take these when needed? These are not part of a daily routine as in must be taken daily?

All this pain management stuff is new to me. I started at the end of November last year. I apologize for the lack of clarity in my original post. I was not in the best state of mind for the last couple of months. Thanks
 
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cweinbl replied to braumeisterbob's response:
OK. This helps. I'm guessing that your breakthrough dosage (Oxycodone) is a typo. When you typed "60," was that the amount you receive in an Rx? 60 mgs per dose might produce dangerous respiratory depression. What is the strength of each Oxycodone tablet? Most patients start at 5mg and work up to 10mg (plus Acetaminophen or aspirin). How is it directed every four hours? One tablet? Two?


Have you tried other long-acting opioids? For example, one person can eat morphine like candy, yet Fentanyl is a wonder drug for him or her. We're all different. One person's wonder drug fails to help someone else at all. One of the primary purposes of comprehensive pain management is to try a wide variety of long and short-acting pain drugs in order to determine which combination works best for your unique body chemistry.


So... have you tried other combinations of long and short-acting opioids? If so, which ones? At which dosages?


Have you been through a comprehensive pain management program? I'm referring one that includes a variety of treatments, like
spinal decompression, a corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, rhyzotomy (radio frequency denervation), spinal cord stimulator, intrathecal infusion pump, off-label medications (anti-depressants, anti-convulsants), counseling, hypnosis, meditation, etc. For example, I can drop my pain by up to 20% with biofeedback alone. Some people rave about acupuncture. Others like hypnosis. Until you try most of these, you are cheating yourself. Of course, they don't replace medications. But they enhance medication pain management via alternative options. Ask your doctor for a referral.


One caveat about pain management programs. Today they so fear raising red flags with the DEA as a "pill mill," that PM physicians can be reluctant to provide powerful medications, or at least the one's you're using now. Starting from scratch again can be very painful.


If you've already tried a pain management clinic, then medication might be all that's left. Rotating and alternating medications can help you and your doctor discover the best combination. Also, some of us have a very high tolerance for opioids. Just like someone people can drink you under the table and look sober, some people can take high dosages of opioids and notice little pain relief. Under a physician's direction, you can gradually increase opioid dosages to fairly high levels without danger or risk of respiratory depression. The key is gradually and under a doctor's supervision.


When all of these fail, there are two options. One is the spinal cord stimulator, which can help patients who have referent pain (pain that travels from the spine into a neck, shoulder, arm, hip or leg). This is a mechanical device surgically implanted that exerts an electrical impulse upon the effected spinal nerve roots.


The other is called the intrathecal infusion pump, which is a mechanical pump surgically implanted with a catheter that drips an anesthetic fluid upon your effected spinal nerve roots.


These two items are last resort because surgery is required to implant and to remove. All surgery entails morbidity. So... it's a last resort for pain patients who cannot benefit from medications and other treatment milieu. If you decide to try either of these, know that there is a trial device worn outside the body with catheters and leads that go into your spine. If the trail effort does not help, then the surgical implantation is not worth the risk. The success rates vary from about 40% to about 60%, depending how much spinal damage, and especially spinal nerve root damage, has occurred.


If you're interested in such things, here is some very comprehensive research on all major forms of spinal intervention, including morbidity risks and efficacy. You can read it here: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf .
cweinbl
csw2@bex.net
 
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braumeisterbob replied to cweinbl's response:
Thanks for the info!! Yes it is a typo. I meant to say 60, 10mg tablets for a month I was taking morphine, MSContin 30mg 3X daily, and over the counter Tylenol, Aleve which was not helping very much. A lot to learn.
 
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braumeisterbob replied to braumeisterbob's response:
Sorry for not answering sooner been in the hospital. I had a bad reaction to a med I have been talking for 6 months. So now starts the process of getting everything all in balance again. The med I reacted to caused pain that felt like nerve pain but was not nerve pain. Once my head clears a bit and I feel stronger will post the name.
 
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braumeisterbob replied to braumeisterbob's response:
Sorry again for the delay work has been nuts. The meds are propranolol & nortriptyline these had caused my kidneys to shut down and actually increase the tremors & nerve pain. The 2 symptoms they were to help


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