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Old 02-16-2011, 02:47 PM   #1
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Seeking Advice for Neck Pain

I'm asking for some advice for my chronic neck pain. I was referred to a pain clinic after going to a family doctor and seeing a specialist. I've had an MRI from C1 to C7.

The pain runs down the back and sides of my neck, and sometimes runs into my shoulders and shoulder blades. It constantly hurts, but it's somewhat bearable. It does become much, much worse at times; quite often I can't even move my head.

I've tried Ultram, Ultram ER, Zipsor, Lyrica, Lortab, Percocet, Oxycodone 15's, and many other medications. The only medications that helped were the narcotics, which seems to be the problem. My doctor at the pain clinic said that there's nothing showing in the MRI that constitutes prescribing any pain medication.

My question is this: What can I possibly do after this? Nothing that she is prescribing is helping, and the pain level isn't decreasing.

Looking forward to all responses! Thanks!

 
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Old 02-16-2011, 04:27 PM   #2
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Re: Seeking Advice for Neck Pain

Did the ER Tramadol help?

I found ER Tramadol 200mg twice a day, and Celebrex 200mg twice a day provided reasonably good relief for me.

If tramadol + antiinflamatory has failed, then you are looking at the long acting narcotic meds, Oxycontin etc.

Before taking that step, i would try a course of physical therapy to see if that reduces your pain

Another one worth trying is amitriptyline or nortriptyline, starting at 25mg at night, and working up to 75mg at night. This sometimes gives miraculous results.

You can take this with your tramadol.

It might be worth trying tramadol 200mg twice a day, an antiinflamatory (say Celebrex 200mg twice a day) and nortriptyline 75mg at night.

This might just do the trick, and if it doesnt, its another peice of supporting evidence that you need a stronger med.

But seriously, give physical therapy a chance, it might help reduce your pain to a point where milder drugs work, long term use of narcotics isnt somthing to be undertaken lightly.

A TENS machine can be brought online for about 100 dollars, and also would be well worth trying before going down the potent narcotic road.
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Old 02-16-2011, 06:16 PM   #3
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Re: Seeking Advice for Neck Pain

I'll give that a try. Thanks for your help!

I've already been to a few sessions of physical therapy, and the Tramadol and Zipsor did not help.

My doctor seems quite reluctant to prescribe pain medication, which scares me. If none of this works, I don't know how I'm going to get through daily activities.

Again, thanks for your response.

Last edited by subter1; 02-16-2011 at 06:31 PM.

 
Old 02-16-2011, 08:32 PM   #4
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Re: Seeking Advice for Neck Pain

Unfortunately, if your doc doesn't think that there is evidence to warrant pain medication, you may have the same problem even if you were to switch docs. Like Jonnstar said, try to give PT a real shot, because if your doc is this adamant about not RX'ing meds....it's not likely that you'll be able to talk him into it. heat therapy is also good for the neck, a rice buddy works great. It's a simple little pillow case about 12 inches long and about 6 - 8 inches wide that you feel with rice, then it's sewed shut at the end. It's great because you can just pop it into the microwave, heat it up and then drape it over whatever part that hurts, in your case your neck. There's a prescription topical gel that work well also, you might ask your doc about that, it's called Voltaren Gel.

Good luck,

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Old 02-17-2011, 02:08 AM   #5
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Re: Seeking Advice for Neck Pain

Thanks for the information. I'll give the rice pillow a try, and I'll ask about the topical gel. I've already got another PT appointment made, hopefully it helps more than it has in the past.

 
Old 02-19-2011, 12:06 AM   #6
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Re: Seeking Advice for Neck Pain

What dose of Ultram were you on?

Although neither ultram or an antiinflamatory worked when used alone, they might well work if taken together at maximul doses (eg Ultram ER 200mg twice a day, and Celebrex 200mg twice a day)

A tricyclic antidepressant at bedtime (amitriptyline or nortriptyline, 50 to 75mg) helps some people, and would certainly be worth a shot in combination with the Ultram and Celebrex.... nortriptyline usualy causes fewer side effects thasn amitriptyline.

Also, please open your wallet and spend 100 bucks on a TENS machine, they can be amazingly effective for many people.

Sadly, most doctors are going to be wary of prescribing Oxycontin or somthing similar for chronic functional neck pain, so you realy do need to explore every possabiluty for relief

I would ask your doc for a 4 week trial of

Ultram ER 200mg twice a day

Celebrex 200mg twice a day

Nortriptyline - start off at 25mg at night for 3 mights, then 50mg at night

If at the end of that month, things are good, keep taking the pills, if not, you have added to your case for the stromger stuff.

Also, try an agressive regimen of physical therapy (not just massage, also ask for excersises to do at home to help build up the muscles) - that can totaly eliminate the pain in some people, or reduce it so that milder analgesics will surfice
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Last edited by jonnstar; 02-19-2011 at 04:59 PM.

 
Old 02-22-2011, 06:51 AM   #7
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Re: Seeking Advice for Neck Pain

Quote:
Originally Posted by subter1 View Post
The pain runs down the back and sides of my neck, and sometimes runs into my shoulders and shoulder blades. It constantly hurts, but it's somewhat bearable. It does become much, much worse at times; quite often I can't even move my head.

The only medications that helped were the narcotics, which seems to be the problem. My doctor at the pain clinic said that there's nothing showing in the MRI that constitutes prescribing any pain medication.

My question is this: What can I possibly do after this? Nothing that she is prescribing is helping, and the pain level isn't decreasing.
You have pain in your neck and shoulders?

I have pain in the neck and not the shoulders. Severe neck pain so I can relate to your pain.

1)Did you do a neck MRI with contrast?. If so, what were the results? any BULGING disks??? If you have any bulging disks in your neck and that what I think then doctors HAVE to rx you narcotic pain meds. It is against the law to REFUSE rx narcotics when there is a reason to rx it. Reason: Bulging disks press on your neck's nerves. I would be soooo surprised if you do not have any bulging disks. Then why the neck pain???. Why the shoulder pain. So if they did a neck mri without contrsast and it showed NOTHING then do it again with contrast.

2) How long has this been going on. more than 6 months than it is considered chronic pain and I would suspect bulging disks in your neck.
What happened to you, was it a car accident?

Do neck MRI with contrast and go from there.

Last edited by nochange; 02-22-2011 at 06:52 AM.

 
Old 02-22-2011, 08:55 AM   #8
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Re: Seeking Advice for Neck Pain

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Originally Posted by nochange View Post


1)Did you do a neck MRI with contrast?. If so, what were the results? any BULGING disks??? If you have any bulging disks in your neck and that what I think then doctors HAVE to rx you narcotic pain meds. It is against the law to REFUSE rx narcotics when there is a reason to rx it.
I'm sorry, but this is JUST NOT TRUE. While there are some very mild restrictions on doctors "requiring" that they "treat" pain in the US, they are NOT legally required to prescribe narcotics if you have bulging disks in your neck or even if you have terminal cancer. Telling a person to take Tylenol or advil and use a heating pad or ice pack is considered treating pain, no prescription is required. A good proportion of the adult population has bulging disks in their necks and never has any pain at all from them, and wouldn't even know they existed if they didn't have an MRI for another reason.

 
Old 02-24-2011, 10:23 AM   #9
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Re: Seeking Advice for Neck Pain

tigger is right here. while there IS a law that now states that a patients complaints of pain 'must be appropriately treated", it does NOT have to always include any form of narcotics. its that word "appropriately" that kind of IS the law part. and THAT unfortunetly, for esp people with in some cases, very severe pain of "unknown etiology", simply sucks. all any doc realistically has to do is try using the more 'standard modalities' that most docs will use BEFORE going to the narcotics. but on the other hand, there are many different types of pain a person can have that will NOT actually really respond to narcotics but will respond to other things too.

but part of the problem here when ANY doc chooses to go the narcotic route is that the doc HAS to document the actual reason FOR even writting that script. if there IS NOTHING that is showing, esp upon an in depth scan like MRI(tho not everything even wrong will ALWAYS show itself on any given scan), that is not helping your current situation at all, despite your complaints of pain? that part simply can get any doc into trouble down the road should anyone else look at your records. so its not 'only' just the doc himself that makes the determination. it is also 'documenting the need" for use of narcotics that plays a big part too.

i am wondering if you have actually even seen a copy of your own MRI results? do you have your own copy to look at? if not, DO get one just for your own files. and of course so you personally can read thru it too.

what you are describing here really sounds alot like some pretty impactful myofascial/muscle pain. believe me, it CAN be pretty painful when those muscles simply overly tighten from the outter fascia thinning then clamping down upon them. is there ANY areas that when you just run your hands around where the main pain generators feel like that are somewhat 'wadded up' or feel like a knot under the skin? these would be the main trigger points where the over tightened muscle radiates out pain to the rest of the "group'.

what you described and the areas esp where you are feeling this pain just truely sounds to me like all pretty much the deeper thicker muscles we just have in those areas are too tightened up and need some release(this just CAN cause some very intense pain levels). women esp feel/take in their stress mainly in the more back of the neck muscles/upper back area? and if there ever was any type of neck injury in your past somewhere, trust me, those can come back to bite you as you just get older too.

there IS an amazing therepy called 'myofascial release' that you can at least give a minimum of like six sessions a good solid try just to see how that area actually would respond to it? i was referred to this therepy three years ago only becasue i have some permanent myofascial damage in my upper back and areas within my c spine that are kinda falling apart. i was amazed at how MUCH of the crap this therepist was able to totally get rid of in five sessions, including trigger points i had under one shoulder blade for over a decade. that one area and what he did is what truely convinced me that this therepy was very needed for 'my' partial pain process there. i have been seeing him now for three years just for 'tune ups" since my deteriorating c spine crap will regenerate,anmd becasue this therepy just does work. it has just become a big part of my overall pain management now.

but if yours is from other factors NOT having to do with your C spine, the therepy should work to actually get rid of the overly tightened fascia that surrounds every muscle up there. the fascia we have inside our bodies actually covers and surrounds every single muscle, organ and blood vessels with what is one huge interconnected spiderweb like covering, literally from head to toes.

this just DOES sound to me like you are suffering from more 'muscle/fascia" issues up there given the no show findings on your MRI? it would be worth your time here to really try this form of therepy just to see/feel what happens. it could actually take it all away if this is myofascial. just something that if this IS all muscle related, i KNOW could work for you if it actually worked on MY myofascial mess i have here. marcia
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