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Old 01-16-2011, 05:50 PM   #1
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Nochange, its time for change!

Nochange, I've watched yous struggle with chronic pain for quite a while, have have formed a few conclusions, and also some oppinions about what I'd do if I was in your shoes, hopefuly they might be of some small help.

- I think you have been looking for one single pill which is going to make everything like it was before your accident. I think this is unrealistic, that you are probably going to need several pills to get adequate releif.

- I think that your doctor might have been a bit too passive in letting you try a variety of drugs with no overall plan

So, here is what I would aim to do if I was in your shoes

1. Get only a regular regimen of LA Pain meds I could take every day, day and night.

I'd start with an antiinflamatory (say Celebrex, 200mg twice a day) and a narcotic. Given that tramadol and oxycontin kept you awake, MS Contin would likely be a good one to try next. The combo of Celebrex and say MS Contin 30mg - 60mg twice a day should give you excelent teleif of the pain most of the time

2. Get your sleep meds sorted out. Even 4mg of clonazepam isnt giving you adequate sleep, thats probably becuase your pain isnt controlled (sleeping pills arnt good at making us sleep through pain)

Once you are on an anti inflamatory and a narcotic, its likely that a lower dose will work for you. It might be worth taking 2 different sleep meds in lower doses, say your clonazepam 2mg plus either Amitriptyline or Seroquel, or Doexpin or Phenergan, which ever your doctor feels comfortable prescribing (all of these prpduce sleep because of their antihistamine effects, so the results should be similar). Taking 2 Tylenol at bedtime would also help, by maximising releif of pain at that critical time

3. Get a breakthrough med you can take when pain spikes - Vicodin, Norco, Lortab, Percacet. most chronic pain patients need an LA med plus a breakthrough med, to cope with differing levels of pain.

4. Lastly, add an adjuvant if the above doesnt provide adequate releif, amitriptyline, tomamax, lyrica, cymbalta - the list goes on.

5. Stick with it, be prepared to take time to work out a plan. if a drug gives some, but not total releif, dont abandon it, take the bit of releif it gives you, and build on that with a second, comp;ementary drug. The idea is to end up on several drugs, all working in different ways, giving you multiple layers of pain releif, without having to be on massive doses of any of them


So - if i was you, i'd see my doctor this week, and ask if I could change from Oxycontin to MS Contin, and also if i could try Celebrex 200mg twice a day, and take them regularly - even if there are side effects, take them regularly for 2 weeks to see how they work for you, give them a chance to settle in.


The rest should follow from there
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Last edited by jonnstar; 01-16-2011 at 07:31 PM.

 
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Old 01-16-2011, 09:10 PM   #2
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Re: Nochange, its time for change!

I agree John. I'm hoping for good things for NC.

NC, definitely get a stable, repeatable plan together that includes an LA and a BT Med. You may need to trickle out of some of your meds to get on a better footing and lower your tolerance a bit, then start fresh with a new plan.

I'm confused by the Benzo intake though, which should be producing lots of drowsiness at your dosage. 4mg is not a massive amount but it is a significant amount due to its long half-life. That long half-life keeps building and building on previous doses etc.... There may be a negative feedback loop happening, a form of Hyper-agitation?

I can't help but wonder if tapering out of the clonazepam might be helpful. Benzo's are strange creatures, fiercely addictive and stealth. Not to mention how they may be interacting with everything else.

NC, you are a good person, and always ready to help others with their pain. My best thoughts go out to you.

~

 
Old 01-18-2011, 05:13 PM   #3
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Re: Nochange, its time for change!

Nochange, i know you've been on several times, and havent replied to this, so I hope i havent up set you or offended you in any way, it was meant to help you.

If I have upset you, please accept my appologies

Jon
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