Journal - need some support with pain management

[Ilsa]

so swim managed to finally quit using opiates intravenously about a year ago, and quit altogether last october. the last two months, though, she has been in physical therapy for an old back injury that's flared up and is causing chronic pain. the doc has written her a couple prescriptions for 5mg hydrocodone/500 mgs apap (acetamenophin). these don't get her high by any stretch of the imagination and they don't really help with the pain unless swim does a cold water extraction(CWE) and pulls out the codeine. she's done this once or twice on really bad days (pain was 8 or 9 on a scale of 1 - 10). this helped, but again, didn't get her high or anything, almost as if the pain 'used up' the codeine.

she doesn't want to be on meds long-term, and pt is helping, but swim wants to know of other, non-narcotic, methods of pain management. it's gotten bad enough a couple of times that she considered making a phone call for some oxycodone (she knows plenty of people), but she's been down that road, and although she thinks she could control her use and not shoot up, she doesn't want to play with fire. she went to see her doc today, as it was really bad, and they gave her a shot of toradol intramuscularly(ketorolac, a steriodal anti-inflammatory, which did help, but she can't be on that long-term, as it's very hard on the liver and kidneys).

some words of support and some ideas for managing the pain until pt starts working are much needed. swim is considering getting back on clonazepam for anxiety, as her doc thinks (and swim agrees) that someof this pain is psychosomatic and stress-related. swim has noticed that on days when she can take the muscle relaxer she was prescribed, whe doesn't have nearly as much pain, and she suspects that the reasons for this effect are two-fold: first, if the mucles in her back don't get tense, she doesn't have pain and second, she thinks the sedative effects of the muscle relaxer keep her anxiety levels down. keeping in mind that benzodiazepines like clonazepam are the best muscle relaxers (as well as the best anxiolytics), she thinks that perhaps it's time for her to admit she needs help with controlling her anxiety and get back on meds, maybe even back on antidepressants.

thoughts please!!

thanks in advance everyone, and namaste

she is prefixing this as a journal because she wants to chronicle what she tries, what works, and because she thinks talking about this may be helpful psychologically.

[rokman nash]

My friend is sorta in the same boat.He has been getting deep tissue massage therapy for the last month or so,and though it hurts like a motherf....r it really helps for several days after.His massage therapist also has him on a painful stretching regimen,which has also been very helpful.

Of course its pretty painful in and of itself,but really helps his mobility and quality of life.Unfortunately for him he was addicted long term to every pain med legal and illegal so opiates are not a viable option for him.His doctor has mentioned some other alternatives,and he will see her tomorrow and find out what she has in mind,and ill share it with swim.

good thoughts

[Ilsa]

sweet, thanks!! i've been doing yoga again, albeit a very gentle, restorative routine. let me know about the price ranges for massage--i'm curious!

[pinksox]

Have you tried Lyrica at all? What about Lidocaine patches?

They have these awesome little things called "PainMaster" MCT patches now that I swear are a freakin' godsend. I was plenty skeptical, but they actually work. My pain doc hands them out like candy at Halloween. So, nowadays I usually have about 5 stuck all over various places on my back.

Does your pain doc do nerve blocks or trigger point injections? I'd recommend buprivicaone over lidocaine injections because bupivicaine last longer and only a small amt. needs to be injected in each spot...plus it just doesn't feel as "weird" as lidocaine TPI's or blocks.

Acupuncture works wonders too; although it's not covered by many insurance plans unfortunately.

If you're already going to PT, ask them about starting the session with "myofascial release" therapy each time. That should loosen things up considerably.

Those are some of the things that help me. From your description it sounds like we have some of the same type of pain. So, perhaps they'll help you as well

[Ilsa]

cool, it sounds like you have some experience with this, so i'd definitely like to hear more....it's all new to me, well except the anxiety part. i have tried gabapentin, but not pregabalin...i have some other options before i move back to something like that. i've been dealing with ptsd for some time now, and am finding that the anxiety will manifest itself in odd ways...this exacerbation of pain is a new one, but i'm convinced it's a component of the pain, since anxiolytics/sedatives do help. gabapentin helped, but minimally and i didn't care for the dosages (up to 900mg in a day?! no thanks). benzodiazepines have always worked best, which makes sense. between a rather tumultuous childhood sleep routine and a stint in boarding school that triggered that ptsd and the nightmares that come with it, i've had a few go rounds with anxiety.

thanks for your input, i look foreward to hearing more of what you have to say

[rokman nash]

ilsa , will PM tomorrow

[Ilsa]

newest development: doc and i discussed my history and i mentioned that i have been diagnosed with ptsd (post-traumatic stress disorder) and had been on clonazepam for several years, but had gone off it when i left florida and haven't found a doc willing to prescribe here. she asked if i needed a referral and i told her i had found someone, recommended by a friend, who might be helpful. so she wrote for some clonazepam to get me by until the psych appointment. well, the cat took a couple last night, slept well (duh) and has had significantly less pain today, she took a 0.5 mg tab mid-morning and, while still a little sore by the end of the day, was much better than she normally is by that time. so part of this is def anxiety-related. i won't get into the specifics, but it's safe to say that she's been hyper-vigilant, with good reason, since a young child. this is a relief, to say the least.

there is still some pain, but it's not making me crazy at least. now i'm dealing with cravings, but just managed to turn down an offer (that was tough, seriously), so that's one small victory.

[Dickon]

Ilsa,

I think you're lovely, and frankly I'm really concerned. Anxiety caused by something such as PTSD should not be treated with benzos. Think about it! Benzos will work fine for a couple of weeks or even months, but all they are doing is masking what lies beneath. My cat found that getting off things like clonazepam and alprazolam was unpleasant, and either previous experience with benzo addiction or the fact these newer ones were inherently more addictive made him display w.d.s after fairly short-term use, far shorter than his experience with say diazepam and temazepam. You of all people know about rebound anxiety.

Secondly, the back pain is chronic. Again benzos will provide short term relief, but being dosed up on them will soon become the default state. I'm not sure what the official stance is on long-term effectiveness of benzos on muscle relaxation, but hazarding a guess from my cat's experiences, I'd say it likely that tolerance develops.

Keterolac (a NON-steroidal anti-inflammatory) seems fairly heavy-duty from what I've gleaned from wiki. I hope its effects merit the side-effects profile. Also you are talking about hydrocodone, not codeine right? Hydrocodone is considerably stronger.

I'd really urge you to reconsider the path you are going down. I don't doubt that for some time at least you'll be able to control things, but the longer term prospects concern me. You're a real sweetie, and I'd hate to lose you to the dark side. You know me well enough to know I'm not trying to be self-righteous or blinkered. I'm just concerned.

I recently bought a book called the Back Sufferers' Bible - You CAN treat your own book, that got very good reviews on amazon (uk). I've not looked at it yet, but maybe it's worth a go. I'd so advise you to try non pharmacological methods, or stick with NSAIs. Certainly avoid the benzos, and avoid the opiates unless you are absolutely exploding with pain. TENS machines: I'm not up on them, but some swear by them, other seem to find them useless. Accupuncture? Massage? Meditation, if the thing is more mental. There was some recent research into beta-blockers that was ostensibly about memories, but about reducing the impact of over-stressy responses to stimuli. It might tie in with PTSD.

If I think of anything else I'll let you know. I'm really sorry to hear about your problems. You're in my thoughts.

Lots of fluffies and all good wishes

Dickon

[Ilsa]

^^thanks Dr D, your input is always welcome

my cat has been pretty good about avoiding the prescribed hydrocodone, except on very bad days, and she doesn't feel high from it....she has been adamant over the years about trying to stay off of long-term psych meds, but there have definitely been periods in her life that have necessitated the use of antidepressants and benzodiazepines. she tends to use the latter because she doesn't have to take it every day, just when anxiety levels shoot up. she has been in therapy and doing yoga for about five years, and both have hlped significantly. there are still times, though, when she experiences a prolonged period of anxiety that is particularly intractable and that in turn causes feelings of depression from being so worried all the time and feeling helpless and overwhelmed. she has learned to ,deal with situations that elicit such feelings down into smaller, more manageable steps, and yoga helps her feel like she's taking care of herself. sometimes, though, those measures are not sufficient...


gotta run at the moment. will finish this line of thought later....

[Ilsa]

well, swim managed to slip up the last couple days and needless to say, is feeling the effects. last night was a friend's birthday and someone offered swim a couple of 60 mg morphine sulfate tabs, which, unfortunately, she accepted. having been on hydrocodone already for pain was playing with fire. now that the pain is manageable without though, she's got no excuse to do any opiates.

she's trying not to beat herself up for the slip, but this HAS to stop. it's just too easy to slip into daily use again. hopefully she won't feel any wd's (doubtful, since she wasn't using heavily), but she is definitely feeling the depression that always seems to kick in after indulging, and the anxiety that goes along with having used and feeling guilty and having let the use affect her performance with teaching and lab work somewhat.

on the brighter side, this time last year she was using more heavily and getting NOTHING done in the lab, so losing a day this week isn't so bad in comparison. at least feeling guilty is a good motivator to run some samples tonight and tomorrow though.

rrrrrrrrgh, she still wishes she hadn't even gotten into it

[Dickon]

And there I was after reading the post before this last one, saying to myself as I lay in bed, that Ilsa needs a bollocking, her thinking has "relapse" written all over it. So, although I'd mellowed somewhat, and was more coming here to check up on you, maybe I should have shown my stern side and got my stick out.

You're too damn clever! It's not always a blessing being able to reason your way out of any situation. I won't repeat what I posted earlier, but I stand by it. So, the question is, what are we going to do now?

It is maybe a platitude to say this slip doesn't need to become a relapse, and you can learn from it. I picked up on a fair bit of justification of your use of hydro and benzos. I'd know, speaking for myself (or my cat) at least, that such things really must be avoided. I'm not saying don't have a shot of morphine if you need your leg amputated.

I have suffered somewhat with back pain, and I know how unpleasant it can be, but it's not something that responds well to pharmaceuticals, not in the long term. Sure you might have to use opiates if you get a real flair up of excruciating pain but this should be a last resort.

This might be somewhat controversial, but I think a lot of "somatic" pain is the result of underlying unaddressed issues. At the very least purely somatic pain can be rendered less severe by the mind. As you have mentioned anxiety and depression I am guessing (and may be wrong) that your main problems are psychological in nature (I don't really hold with the physical/psychological distinction, but let's not go there now).

Right now, I think it would be a really good idea to talk more about what's going on in your head. If it would be of any help, and you'd rather talk in private, feel free to PM me. If there's anything, within reason, I can do to help, just let me know. I know there's not a lot or anything I can do on a practical level but I can listen or make suggestions if you want.

For many of us, it's easier to see quitting drugs in a black-and-white way, even if we don't hold with the 12-step view ideologically. My cat finds it avoids confusion, and makes decisions easier. I think the US medication-driven attitude to health is so wrong. It makes sense from an economical market-driven point of view but not from a human one. My wife takes antidepressants, and I really don't think she benefits from them. I know that if I can't change the way she thinks, I'm unlikely to change the way you think, but I am, to say the least, sceptical.

As I've been spending a lot of time sitting Zazen recently, let me remind you of the first two Noble Truths. Life is suffering. Suffering is caused by desire (or attachment). Heck that's too depressing! Let's go with three and four too and remember that the cessation of suffering is attainable, and there's a way to do it! [But I don't think old Buddaha Siddy was talking about Prozac!!]

Ilsa, sweetie, my thoughts and best wishes are with you. I'm sending you lots of warm fluffies to keep you safe

Dickon

[Ilsa]

serendipity is the greatest reinforcer.

you are dead-on, D, and i appreciate your honesty and gentleness. i have been struggling with this, which is why i made it a journal---i know i'm good at explaining, rationalizing and justifying, and i know i need others who are willing and able to keep up with it all and be honest.

i was just talking to another friend of ours an hour ago about this. i've decided (adn not just today, the decision has been weeks in the making) to just stop the use of any opiates (my cat will keep prescribed benzodiazepines on hand, as they are necessary when physiological response exceeds her ability to mentally handle intense anxiety). my pain is manageable (even if it weren't, i'd say i need to seek alternatives) and makes it that much more sensible to get, and stay, far away. i've been sitting and doing some gentle yoga, which is helping in and of itself in the sense of being compassionate with myself--something i find very hard to do. which brings us to what's going on in my head. *deep breath* it's almost too much too explain and too little at the same time. basically, i survived my childhood and early teens by being hypervigilant: there could be an episode of annihilating rage directed at me by my care-taker (mother in most instances, another person in a few other instances), as well as certain other circumstances that were rather dire. years of counseling and cognitive behavioral therapy have helped me work my way to a place where i can have functional relationships and trust ppl (for the most part) in those relationships. those years in therapy, coupled with yoga and sitting are helping me understand that the world is not always such a scary, painful place. and my situation could have been far worse. it takes a long time to counter-act patterns formed in such early years, and even longer to internalize the counteractions. i am getting there, but there is still a formidable amount of anxiety in daily life. swim's benzos are nothing but a band-aid in the worst of such times, and she knows this.

i have a rough plan to continue from here: i have learned (and am developing the self-discipline to employ this all the time, not just at my convenience) to sit with uncomfortable, painful, anxious and just generally difficult feelings, to acknowledge them, sit with them, let them run their course. this is my first step toward the cessation of suffering: recognizing that emotions are a great survival mechanism, but not necessarily revealing of truth at all times. the second is the practice of compassion, which is currently my main focus. i'm not great at it, but i like to think it's coming along. it has been and will be a mainstay in the days to come. i think we all saw that last slip coming, but it provides motivation for NOT slipping up again. it also provides humility, which begets compassion.

i'm not sure what exactly is next, but i've been down the much rougher version of this road before....all i can say at the moment is thank you to everyone and Dr D in particular. your thoughts and suggestions are welcome and helpful to me in determining which steps to take next.

namaste




and i do agree with what you have to say about addressing underlying issues--we here in the states have been raised to treat symptoms and not the fundamental problems. it's been a long-term goal of mine to be off all psych meds, but there are times when they are necessary. the key is not relying on them. i do not intend to go back on antidepressants, and as i said the cat keeps a supply of benzos on hand just in case, but not for regular use. aside from being in grad school (which is inherently insane ), i've been addressing the aforementioned issues over the years with various approaches, and they are working. it just takes time, and i do have the occasional freak-out and fall off the edge episode. i don't think i'm too close to anything like that, but it's time to move past the last over-the-edge episode and actively re-structure my life and daily routines

[electrolingus]

Electroacupuncture has been unbelievably helpful to the hamster for pain management. Electroacupuncture can also reduce drug cravings and PAWS in early recovery.

Here is an article from Medscape.
AAPM 2009: New Data Point to Analgesic Effects of Acupuncture / Conference Coverage based on selected sessions at the: American Academy of Pain Medicine (AAPM) 25th Annual Meeting.
http://www.medscape.com/viewarticle/588015

Here is a link to further Medscape conference news from AAPM 2009 that you may find useful.
http://www.medscape.com/viewcollection/18921

[ex-junkie]

swims old opiate specialist used to use low dose buprenorphine for some of his chronic pain patients because there is no high associated with it. it was helping some of his cancer patients, they were on next to fuck all.

[G_nome]

Has swiIlsa heard of corydalis yanhusuo? Mother monkey used it quite successfully to treat the pain caused by diverticular disease, before it was diagnosed, instead of using the 30/500 co-codamol that the doctor had prescribed her.
Why the doc gave her co-codamol when she's on prozac i'll never know.
But aye, it could help. Corydalis has been used in Chinese medicine for thousands of years as an alternative to opiates. It's not addictive, and may also help swiy sleep.

Though if the pain stems from anxiety then my monkey doesn't know what to suggest. He wishes he did, having suffered from anxiety and PTSD for quite some time.

Anyway, good luck with whichever path swiy chooses

[Spucky]

My Cat thinks that Opioids are not always the Way to go,
particulary if it`s a chronic form!
Many Times Opiods are kind of a booster for Pain-Sensitivity.

There are better Articles than this on but my HDD is still not working:

Physical impact of pain killers
Doctor Clifford Bernstein, a pain management physician and author on Spine-health.com clearly outlines how these pain medications physically affect the body:

• The brain responds to the pain medicine by increasing the number of receptors for the drug, and the nerve cells in the brain stop functioning
• The body stops producing endorphins (the body's natural painkillers) because it is receiving opiates instead
• The degeneration of the nerve cells in the brain causes a physical dependency on an external supply of opiates, and reducing or not taking the pain killers causes a painful series of physical changes, known as withdrawal.

At this point many people (an estimated 7% who are prescribed narcotic analgesics) continue taking the pain medication to avoid the withdrawal symptoms rather than to treat the original pain. When this occurs the person is dependent on or addicted to the prescription pain medicine.
Pain killers may actually increase pain
Most people do not know that taking painkillers over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long term use of opiate painkillers causes a decrease in your ability to tolerate pain, and an increased sensitivity to pain. When the pain increases, people are often led to believe they need to take higher doses of pain medication than they were on initially.
For those who are addicted to narcotic pain medications, a detoxification program is often needed. Pain killer addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.

I have also many Time hard Pain, so that i cant move
but a few Years ago i found a Oil, called "Yellow Oil", the Recipe is coming afair. from Wat Pho in Krung Thep/ Bangkok
(The birthplace of Thai Massage and Herbal Treatment in new Time Thailand)
it is like a Miracle because it help so much.

And don`t forget the Vitamin D. Effect, the File must be already inside somewhere here,
if u cant find give me a Note!

Reputation Comments on this post:

good point re: hyperalgesia