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Old 08-03-2004, 10:14 AM   #1
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Question Xanax for chronic pain?

Does anyone know if a Xanax helps with chronic pain? I have ongoing neck/disk problems, but don't want to go the surgery route at this time (would need a 3-level fusion). I'm a 37 y.o. female and am currently taking Buspar (for approx. 6 months) for anxiety, but it doesn't seem to do "anything" for me (I don't feel anything from it). If Xanax would be helpful, what is a good starting dose? My thinking is that less anxiety/stress, would result in less pain building up in my neck/shoudler area.

I have an appt with my Primary Dr. next Tuesday and would like to discuss the subject of Xanax with him. He is aware of my ongoing neck problems and has tried me on numerous pain medications. The best meds I have found for my type of pain are Ultram, Darvocet and Advil Liquigels (taken as needed). I never take more than 2 Ultram/day and only take a Darvocet when it gets real bad in the evening. Also, I have been to a Pain Mgmt Dr for a series of 3 ESI's (last injection was on 6/21/04). But occasionally the pain gets severe and I can't seem to relax, which only makes it worse.

Thank you in advance for your feedback!

 
Old 08-03-2004, 11:12 AM   #2
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Re: Xanax for chronic pain?

Hi Heather, First off, All PM docs are not the same. If this doc simply gave you the max dose of cortozone "nobody"" should recieve and then referred you back to the GP saying this is all he's cabale of. I would say his ability to manage pain is very limited if he only has one "unsafe" trick up his sleeve.

The reason I say unsafe is because a report called the Burton report that explains how the Depomedrol can cause arachnoiditis from the cortozone and from the polyethelene glycol "AntiFreeze" used as a preservative. A study was done comparing Depomedrol ESI's and Saline injections into the epidural space, and the depo group had no better results than the saline group.

If it wasn't an anesthesiologist practicing pain management then you also take great risks of scarring, spinal fluid leaks, the need for blood patches etc. I wouldn't let anyone but a anesthesiologist near my spinal cord with a needle. An Anesthesa guy does thousands through out his carrer, where a doc like a physiatrist takes a seminar and refines his skills on his patients desperate for anything to relieve pain.

But if this PM doc can't offer more than ESI's you haven't even scratched the surface of what a true multi facected PM docs or clinics can do for you. Robaxin infusion, Occipital and other nerve blocks, TENS or TINS, acupuncture, Botox, Trigger point injections. Learning Biofeedback, self hypnosis, guided imagry or yoga might be benficial before deciding to become dependent on a med to relieve anxiety and stress

Doesn't sound like the doc even tried using medications and there are meds like antidepressants that reduce anxiety, meds in the antiseizure class like Neurontin,. toppamax, Lamictyl, Tegretol, Dilantin and a half a dozen others that relieve nerve pain.

Your GP is not a PM doc, he can prescribe a pill that may relieve your pain but is it the best way to deal with the problem? Would you benefit from some modality a true PM doc can offer and if the doc can only offer one type of treatment for every single patient, he isn't much a PM doc or Pain interventionalist.

The same treatment doesn't work for everyone and a doc that tries the same treatment on everyone is simply milking your insurance and likely causing all kinds of harm doing ESI's. Arachnoiditis, scar tissue that wraps and squeezes the arachnoid layer of the spinal cord. Demyalization of nerve tissue, where the outer coating of the nerve tissue is destroyed or steroid induced osteo perrosis are all risks of ESI's.

I saw a dozen PM docs through out 11 years and 3 failed surgeries and it wasn't untill I was actually bedridden did they get serious about trying to improve the quality of my life. The same doc that got me moving again had always been there, He's been pracicing PM for 20 years in this area and not one doc wanted to refer me to him, because they didn't believe in his use of opiates when opropriate for patients that all these other modalities had not helped. Every method I had tried and that failed and the ones that helped some are documented to protect the doc from prosecution and to justify the use of the meds he prescribes.

There are dozens of modalities including a half a dozen PT techniques to help you. You may benefit from traction, you may benefit from anyone of the things I mentoned or didn't mention. But what you are getting at, is yes anxiety and tension do cause additional pain and muscles to tighten. The problem with all Benzodiazapines is that in higher doses they cause the inability to create new memories, and cause significant cognative problems.

If you have no other option than to turn to the benzo, Xanax is short acting, has a short half life and rebound problems are definitely possible. Klonopin is a Benzo, that also prevents seizures so you may get relief from nerve pain. Klonopoin also has a 30 hour half life making it much easier to susatin a constant serum level without the rebound problems.

But asking your GP to trade hats from GP to PM doc and now to psychiatrist by prescribing psycho interactive meds isn't a safe way for your doc to practice medecine. Have you seen a shrink and counselor, a Psychiatrist that specializes in these meds that effect your brain chemistry or cognative abilities. What other specialties does your GP practice? Get the idea.

He's out of his leage playing PM doc, He's out of his league playing psychiatrist when all he simply needs to do is refer you to the right doc. It may take months to find the right doc or years in some cases.

There is a trade you have to make when manageing pain with meds that cause physical dependnence lke Benzo's or opiates. Having not tried anyother method to manage anxiety or not having learned any stress relieving modalities what your doing is looking for the quick fix with a doc willing to write scripts for meds he knows very little about. Although most GP's feel qualified to play shrink and prescribe antidepressant after having a patient answer a a basic questionare scares the crap out of me. If you were having a baby, you wouldn't go to your GP to deliver it or a urologist. You would go yo an OB/GYN. Why people allow GP's to play guinea pig with meds they know nothing more about than what a rep told them is scarry and GP's playing shrink and altering someones brain chemistry is asking for problems., Just like I wouldn't want a GP to do an epidural or nerve abalation just because he took a 4 hour course on it.

Keep hunting for an answer in the mean time if you think an anti anxiety med may help, your doc may be willing to cooperate but it doesn't mean that's the right treatment for your problem just because it does relieve stress and relieve tension chemically.

Ideally you can find a clinic or group of docs in practice that have multiple specialties that don't have to slam every single patient through the same hole and then send you back to your GP. My relationship with my PM group is now a lifetimne relationship do to the Intrathecal morphine pump installed 8 weeks ago.

A Pm doc that only has one modality to offer someone in pain is no different than a GP that is stumped by anything other than strep throat. If that's all he can recognize and the only group of meds he's familiar with are antibiotics, He's no different than the very limited PM doc you saw.

Good luck, Dave

 
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Old 08-03-2004, 11:47 AM   #3
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Re: Xanax for chronic pain?

I was fused from C4 - C7, I can tell you it was the best decision I ever made, not only did I wake up with all the primary pain and numbness gone but I am doing overall fairly well. It's probably one of the few surgeries I'd ever recommend having, it is very effective in correcting the problem. The thing is if you don't have surgery your problems will only get worse over time and you run a high risk of herniations completely compressing your spinal cord shut. This happened to me in a matter of about 4 weeks. I had large herniations show during an MRI 4 weeks before my surgery was scheduled, from the time I had the MRI to the time they did the ACDF the herniations grew so large so quickly it compressed my spinal cord. Lord only knows what would of happened if I waited longer. I am sure permanent deadening of the nerves would of been a result.

I read something interesting today on the Back board, someone went to the Pfizer web site and looked at the actual med sheet for SI injections, guess what, it says specifically there that they are not intended for sacrial (sp) joint usage, particularly in the spine! Apparently doctors do not read this and do it anyhow. The description of the damage that could occur as a result is mind boggling. It is even far more descriptive than the Burton Report.
It specifically also says they are only inteneded for the knee, wrist, hip and shoulders, nothing else should be considered, ever. Go check it out, you will be pretty surprised to at what it says.

As for the Xanax, no it isn't a good pain option. I agree with Shore completely your PM should not be administring anything for your pain, it isn't his job. Go back to the PM who did the injections, refuse to have any more injections and explain the pain situation and get assistance that way. They may not be willing to assist you because there is a fix for your problem unlike most of the individuals here who have no fix for their chronic pain, it is something we are doomed with for the rest of our lives.

Try having someone massage your neck, it does wonders. Stress doesn't play a huge factor when you have problems or herniations, it plays part of a factor but not all. Ice helps alot and sometimes heat, everyone is different. Though heat can cause undue swelling. You should also be on anti-imflamatories should flare ups arise.

I'll be totally honest, if you want the pain to stop your best option is surgery and with a qualified surgeon you will be very glad you went that route.

 
Old 08-03-2004, 05:10 PM   #4
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Re: Xanax for chronic pain?

First thing, generally you shouldn't feel 'anything' from a RX drug - 'feeling' something can be a bad side effect. (except 'feeling' relief from pain, or 'feeling' relief of anxiety.) BuSpar is not a benzodiazepine and usually is not sedating in the manner of anxiolytics. It would do nothing to relieve immediate anxiety symptoms. (i've tried it. 120mg a day! nothing.) If you are waiting for a doctors appointment, and you are having anxiety attacks or panic attacks, you might want to try taking a antihistimine drug such as benadryl. I know it sounds dumb, but it can be very sedating and really ease your anxiety. I have seen a lot of doctors try using vistiril to treat anxiety before resorting to a tranquilizer or benzo.

As far as a benzodiazepine for pain... I do not think that it is a good choice. If you are considering the xanax to treat nerve pain, you should consider a few other drugs first (tricyclics, for example - elavil (amitryptiline) is a good one) - just a suggestion. Benzos can be bad news.

The only benzo I have heard of ever being used to treat pain (and not even pain, but muscle spasm/tension) is Valium, as it is a stronger muscle relaxant than it is an anxiolytic.....

and you might not heed that advice to have surgery...---
I know a few people who are way worse off after the surgery than they were before! I refuse to look at surgery as an option unless it comes down to that or a cane and wheelchair. It just messes people up bad. I could stand a fusion myself -- at 26 years old I say NO WAY!!!!!
good luck!!!!!!!!!!!!!!!

 
Old 08-03-2004, 06:15 PM   #5
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Re: Xanax for chronic pain?

I can't agree that surgery is necessarily the right answer unless the neck is unstable. Some people are helped greatly, others are not. No one surgery is right for everyone and it should be the very last resort, in my opinion.

Carol
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bone spur removal
cerv. fusion, 1 level
morphine pump

 
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