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Old 10-10-2012, 02:46 PM   #1
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Narcotic Pain Relief without Tylenol or Ibuprophen

I am a chronic pain patient and have a P.M. doctor I see every month. They can't do any surgery for my neck due to the fact I just had 2 cardiac stents placed that requires blood thinners and aspirin therapy for the next year. I currently take Norco 10/325. The dose is not enough to overcome pain I experience now due to my neck (C-6&C-7 level) issues. They were going to try to get me a Neuro Spinal Stimulator for pain but the insurance company denied it and it's quite expensive. The current surgery for cardiac stents absolutely disallows me even a 5 day reprieve on taking the blood thinners. I am seeing the P.M. doctor Monday again, earlier than my normal 28-30 days, due to the new issues with my neck/arm and hand at night, which is so painful I am awake 2 to 3 times every night. I am going to ask for a different pain med something longer acting maybe? I also do not want to continue taking so my Tylenol or any Ibuprophen as I am on 81 mg. of Aspirin along with the Plavix. Does anyone here have any recommendation as to what I should ask for? I don't want to "ask" for a specific drug as I will feel as though I have researched too much regarding a specific medication. They tried to get me to take some kind of "anti-seizure" med, for the ridicuopathy? I refused as I was just put on the Plavix, etc. and didn't want to add another drug to my already growing necessary blood thinners, blood pressure, and Paxil. I am seeing the N.P. instead of the dr. (whom I dislike intensely as he does his dictations in front of me ("patient is non-compliant regarding the anti-seizure meds even though I gave her a free sample pack and a coupon, AND patient is now using the excuse not to try it because of her stents". How is that for a P.M. doctor?? Thanks to anyone who actually reads all my writing here! I just want to know what kind of meds would work best for my pain (neck, lower back and now arm/shoulder and thumb). Thanks! I hope I can educate myself as to how this website works in the meantime!

 
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Old 10-10-2012, 10:51 PM   #2
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Re: Narcotic Pain Relief without Tylenol or Ibuprophen

Hi Maggie Mia, I know it's very scarry to have a heart attack and to have to take plavix, The truth of the matter is you wiill probably have to take plavix forever. Ive had two Heart attacks and 2 sets of stents 5 years apart in the exact same place. The LAD. This was after 3 failed fusions and a decade of pain that was never treated with opiates other than a few weeks pre op and a few weeks post op. What they missed was treating my outragous BP.



I have a family member that worked on the clinical trials of plavix and the recomended time for use has grown from 6 months to indefintitely. His opinion is once you stop you are at much greater risks, particularly with the drug eluding stents. That's why I say it's likely for the rest of your life. I did have a short surgery and did stop plavix for 5 days prior and I managed to survive, so try not to put everything in the worst case scenario. Honestly I cant think of any meds in PM that are going to put you at risk by thickening your blood. I have polycycthemia now where I make too many red cells and the only treatment is to drain a pint every 2-4 weeks and keep my blood thinned that way. I'm still taking plavix 11 years after my first MI and stents. None of the neuroleptics, antiseizure or antidepressants are going to be valid reasons in a PM docs eyes, if he was concerned he would talk to your cardiologist and get his OK, which would be like I'm not giving the OK, your cardio said it was safe so if anything bad happens it's on the cardio for aproving the combo. But that isn't the situation. Your blood beeing to thin just isn't a legitamate reason to refuse treatment.

Nerve pain really doesn't respond that well to opiates. With the internet and the ability for anyone to read the full prescribing info on any drug, it's easy to become fearfull of every drug out there. I get the stents or MI if you had one, scared the crap out of you, I walked around for a year wondering if i had a hamburger was it going to kill me, serriously. The heart atack hurt like hell, its probobaly the most painful thing i have experienced and silly me thought they could give you a shot or something and stop it in it's tracks. That isn't the case at all with heart atacks, I had multiples on the wa and in the ER where they just pumped me with massive amounts of morphine and waited to see if I was going to survive the next one or if they would have to zap me to restart my heart. I'm sure the fear amplified my pain perception but I know what it's like to go through it, have the stents, and do the cardiac rehab while in intractable pain. They do make it sound like if you have a french fry you will drop dead. I didn't eat red meat for several years after the first one.

It's not just your PM doc or NP that will see refusal to try a non narcotic med as a red flag. The potential isn't severe enough for your doctor to be concerned and you simply have to trust that your doc knows what he is doing, just like you weren't giving your cardiologist drug choices or refusing what he says or making recomendations on the cath table. A good PM can have just as much education and training as your cardiologist. If anything the heart is much simpler to deal with allthough the outcome can be catastrophic in cardiology. A good PM is going to be Board cert in not only his specialty, Neurology, anesthesiology or physical medicine and then be board certified in PM within that specialty. To be blunt, who are you to question and suggest treatment plans based on access to the internet.

Before I found treatment with pain meds without apap, I tried anything and everything ever offered and this was in the 90's when the LA meds didn't exist and we took 4000 mgs of apap a day on top of 2400 mgs of IBU which was the doctor, FDA and manufactured aproved max dosages for a decade when I took them. They also used antidepressants and antiseizure meds back then. In a PM docs mind , if your not willing to try something as proven as antiseizure meds for the nerve pain, then it must not be that bad. If it's not that bad, then you dont need oxy or dilaudid or mophine. I can see this doc dropping you if your next request is for apap free opiates or LA opiates.

If your not willing to go through the step therapy your going to be hard pressed to find treatment. The stents dont excuse it nor do the meds you have to take because you have stents. I know people are looking for support and that's what I am trying to do. Unfortunately agreeing with you that the doc or NP is a jerk for making those notes isn't going to help you find any relief. I remember the fear factor after a cardiac event. The bottom line is that your wrong to refuse proven protocol and it will get in your way when that med could provide relief.

I know poor pain treatment leads to high BP and that's what caused my MI. My cholesterol levels were fine, triglycerides were fine, no family history of anyone half my age having a MI, I was 36. I didn't have polycythemia back then, wasn't overweight, I just had to live with BP in the combined 300 plus range for almost a decade. It's really what made my docs take treating my pain seriously. I now have an implanted pump and it keeps me moving and the side efects aren't as severe as orals, But I would never have gotten to this point refusing therapies because of unrealistic fears. If your in enough pain and the doc says duck walk with an orange under your chin, you need to at least try it.

I had a tremendous amount of rediculopiothy prior to the surgeries and the pain meds used prior to surgery would help the back pain but wouldn't touch the leg pain "radiculopothy". So I know from experience that nerve pain is an entirely different animal. I have so much nerve damage now from being fused from L1-S1, all the places that were once on fire are now numb. I'm just trying to let you know that I get the fear but the docs will only see your refusal of non opiate treatments as a red flag. If your that worried consult your cardiologist and have him call your PM and work out something safer. If they both say it's safe, drop the excuse. There is no such thing as a drug without side efects and some people will have extremely adverse effects, The FDA requires they report them in the trials and honestly any drug can seem dangerous if you only focus on the 3 in 10000 that had an issue that might conflict with a heart patient. Your fear is having too thin blood? If it happens it's a plus given your stents.

I do wish you luck but I think your going about it the wrong way. Take care, Dave

Last edited by Shoreline; 10-10-2012 at 11:05 PM. Reason: speling

 
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Old 10-19-2012, 07:17 PM   #3
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Re: Narcotic Pain Relief without Tylenol or Ibuprophen

Maggie-welcome to the boards. I hope that you will come back here often and join in. Please listen to Shoreline. He has lived through things that no one should endure. his wisdom is hard won and he has a depth that few of us do.
As far as the seizures meds go. I would give them a chance. The secondary use for them is for nerve pain control, which is sounds like you have. Give your PM (and the PA) a change-even if the bedside manner lacks some manners.. good luck and keep us posted!

 
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