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-   -   A model pain relief program for you (http://www.healthboards.com/boards/chronic-pain/837962-model-pain-relief-program-you.html)

jonnstar 03-01-2011 12:27 AM

A model pain relief program for you
 
Nochange, after reading a lot of your posys and getting to know you over the last year or so, I've had a few thoughts that I think might be helpful to you, even if you dont use these ideas, they might be thought provoking.

I think that in the past, you have tended to change from one med to another a little to quickly, looking for one single pill that is going to solve all your problems, and that your doctor has been a bit too passive in allowing this.

What I think you probably need to do is settle down on a regular schedual of pain releivers and adjuvants tat you take every day, not intermitantly, and give them a month or so to bed in.

My ideal would consist of a narcotic (traladol er, Oxycontin), a long acting antiinflamatory (Celebrex, diclofenac er), a tricyclic antidepressant at bedtime (amitriptyline, doxepin) and probably the clonazepam at bedtime you already take.

You should take this regimen every day, twice a day or whatever is prescribed, to keep on top of your pain, not just gritting your trrth and taking an Oxycontin when its unbearable.

So... speak to your doc about a regimen such as this:

Oxycontin or ER Tramadol 200mg twice a day

SR Diclofenac 75mg twice a day

Amitriptyline or doxepin, 50mg at night

Your usual dose of clonazepam at night

There will be some side effects in the first few days, and you will probably still get some pain..... put up with it, and take the meds for a couple of week before making any changes, and if changes are made, make adjustments, dont throw the whole regimen away and start afresh with somthing new you've read about on the net.

I realy want you to get your pain under control, as do we all, so please give this some thought..... of course, its up to your doctor what drugs he prescribes, the examples i have used are just ideas as to what a model regimen might look like

Isotope 03-01-2011 11:19 AM

Re: Nochange - A model pain releif program for you
 
Sounds like a good plan though you may want to ditch the OxyContin if sleep is an issue. Maybe generic Morphine Sulfate with Hydroxyzine, q.i.d.

:wave:

jonnstar 03-01-2011 04:25 PM

Re: Nochange - A model pain releif program for you
 
Oh, the actualy meds are just there as examples, what nochane and her doctor end up using will probably be way different, its just the idea that I think she needs to think about, a structured, multimodal pain releif regimen that she takes every day, to keep her pain continualy under control. It might even stop me from being such a pain in the a**!

Print this out and take it into your doctor as a starting point for the discussion (and yes, given that tramadol and oxycintin releived the pain, but caused insomnia, it might be wise to switch the barcotic to Opana or MS Contin or the fentanyl patch, which ever your doc feels uncomfortable with)

Isotope 03-01-2011 04:30 PM

Re: Nochange - A model pain releif program for you
 
IMHO, and with all due respect to our friend -It's been difficult to discern where the problem lies; doctor or patient?

:wave:

nochange 03-06-2011 07:13 AM

Re: Nochange - A model pain releif program for you
 
Hello John. Hello isotope. it is not my fault. the problem is not me. My doctor refuses anything other than oxycontin or the fentanyl patch. He agrees both to be taken together(fentanyl patch + oxycontin) and also agrees for the percocet. That is all. Or you go to the pain clinic. There is no way I will ever go back there;;;;they told me it is all in my head.

By the way, as I said before, john, my doctor thinks morphine is dangerous.

Today I went back to my doctor and told him that in the forum I am in (he knows I am a member of a pain forum, no shame here) they recommended adding doxepin together with clonazepam. He always said no. Today he finally agreed. I guess I was really adamant. I asked him before and he said no.

He told me to start with a low dose doxepin 10mg and go up, next day 20mg. But here I see So, oh my, should I start with 50mg right away?. or do as he said 10mg doxepin and then the second day 20mg?.

Should I listen to my doctor cause my doctor never rx two sleeping pills together and never even knew doxepin is for sleep. I told him I read it in the forum.

So, 2mg clonazepam + 10mg doxepin or right away 50mg doxepin or gradually. HELP. want to sleep again 8 hours.

I wonder if I take fentanyl patch if that will cause insomnia?. anybody here takes that and not need to take sleeping pills?
cause my doctor has a patient who takes fentanyl patch and sleeping pills also. So I guess fentanyl patch keeps you awake also?.

nochange 03-06-2011 07:23 AM

Re: Nochange - A model pain releif program for you
 
Isotope, that is a good one. The problem is not me as you can tell. I am really suffering from this neck pain. It is something you cannot even IMAGINE. Today demonstrated my doctor my pain. He almost shout. You could not believe it. I pressed on his hand and he could not take it for one second. So imagine me, I have it 24/7 hours a day.

I know oxycontin is not good for sleep. but my doctor refuses to give me morphine. There is nothing I can do here other than look for another doctor but that can take time.

He thought today of sending me to a neurologist but I really do not think he thinks I really suffer that much. I would say 15 on a scale. But then what, if they decide to do a surgery, and in most cases neck surgery fails what is the point.

Isotope 03-06-2011 05:01 PM

Re: A model pain relief program for you
 
NC-

I have no doubt you are suffering, and I am sorry for that. Your Doctor has some odd preferences.

katlin09 03-06-2011 05:48 PM

Re: A model pain relief program for you
 
NC,

Hi, I'm glad you got some change out of your doc finally. But let me caution you, yes everyone here on the boards gives advice of what we take and how our docs prescribe things, etc. But when it comes to taking our meds I'm pretty sure we take them according to our docs and not what board members suggest. You really should take your meds according to your doctors schedule and not go by the advice of anyone here on the boards. We are not doctors here, we're just a bunch of folks in pain who toss ideas around in order to try and help others.

I hope the new meds help some.

Kat

tommysp38 03-06-2011 08:41 PM

Re: Nochange - A model pain releif program for you
 
[QUOTE=nochange;4700087]Hello John. Hello isotope. it is not my fault. the problem is not me. My doctor refuses anything other than oxycontin or the fentanyl patch. He agrees both to be taken together(fentanyl patch + oxycontin) and also agrees for the percocet. That is all. Or you go to the pain clinic. There is no way I will ever go back there;;;;they told me it is all in my head.

By the way, as I said before, john, my doctor thinks morphine is dangerous.

Today I went back to my doctor and told him that in the forum I am in (he knows I am a member of a pain forum, no shame here) they recommended adding doxepin together with clonazepam. He always said no. Today he finally agreed. I guess I was really adamant. I asked him before and he said no.

He told me to start with a low dose doxepin 10mg and go up, next day 20mg. But here I see So, oh my, should I start with 50mg right away?. or do as he said 10mg doxepin and then the second day 20mg?.

Should I listen to my doctor cause my doctor never rx two sleeping pills together and never even knew doxepin is for sleep. I told him I read it in the forum.

So, 2mg clonazepam + 10mg doxepin or right away 50mg doxepin or gradually. HELP. want to sleep again 8 hours.

I wonder if I take fentanyl patch if that will cause insomnia?. anybody here takes that and not need to take sleeping pills?
cause my doctor has a patient who takes fentanyl patch and sleeping pills also. So I guess fentanyl patch keeps you awake also?.[/QUOTE]

Hello Nochange i use tizanidine at bed 2x 2mg strength. They work fast and when i wake i feel rested and not hungover like when i use meds from the pam family such as Clonazepam, Im currently on 50 mcg Fentanyl with vicodin es for breakthrough.

jonnstar 03-08-2011 01:23 AM

Re: A model pain relief program for you
 
Listen you your doc NC, and not us amaturs here on the board!

Start low, go slow is always a good rule. Start off with 10mg, then slowly increase until you get the desired result - might be 10mg, might be 50mg.

How are you getting on with the doxepin, is it helping your sleep any?

Are you now taking your oxycontin regularly twice a day, or just as needed? If you cant take the oxy twice a day, it might be worth asking if you can try the patch.

nochange 03-10-2011 07:35 AM

Re: A model pain relief program for you
 
Hello John. how are you? Yesterday night was taking 2mg clonazepam + 30mg doxepin. Was not sleeping good. Was sleeping only a few hours. Tonight will try 40mg-50mg plus 2mg clonazepam.

I cannot take this anymore. I have heard/read lowest dose like 1mg, 3mg, 6mg doxepin is better for sleep. That is how they made this new sleeping medication(silenor). but I am with doxepin. They found out low dose doxepin are more effective for sleep and now I am on 30mg doxepin.

HELP. Do I need to take the lowest dose(silenor way)or increasing the dose?.

Somebody help.


Completelly lost. WHY NOTHING HELP.

katlin09 03-10-2011 08:47 AM

Re: A model pain relief program for you
 
The thinking on many meds that make you sleepy is that lower dosages are more potent. This is true with Seroruel, Risperadol, Doxepin and many others. How did your Dr. tell you to take the med? What were his exact instructions?

Kat

Isotope 03-10-2011 11:37 AM

Re: A model pain relief program for you
 
I tend to agree with Kats' low dose theory. I've found it to be true with Benzo's in particular, and Antidepressants generally.

There is also that tipping point that we all face -when getting off everything and starting from scratch is the way to go.

I pulled a rib muscle really badly last week dragging a large patient around, still hurts today. A co-worker says I might want to take some Advil for the pain -little do they know--and I'm thinking to myself "...I'm taking 30mg of Oxymorphone a day, why do I feel any pain at all?" "Does any of this crap actually work?"

:wave:

jonnstar 03-11-2011 04:21 AM

Re: A model pain relief program for you
 
Nochange, i dont think there is evidence that lower doses are MORE effective, merely that ow doses have an effect.

Take the doxepin as your doctor prescribed it, wether that 10mg or 100mg (the dose range goes as high as 300mg per day for depression, so you are still on a low dose)

Do you take an analgesic at bedtime as well as the doxepin and clonazepam?

2 Aleave tablets would be worth trying, as they would give releif foroughout the period you want to sleep.

Are you taking your oxtcontin regularly now, or still just on bad days?

katlin09 03-11-2011 07:15 AM

Re: A model pain relief program for you
 
NC,

I'm just curious becuase you've asked various diff. questions on various diff types of meds. Could you tell us exactly what all your doc has you on and what dosses? It'd be easier to answer some of the questions that you're asking. Hope your doing better.

Kat


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