I learned something new today... - Pain Management Message Board

Moldova · 05-20-2008, 04:02 PM

Hi everybody! I hope you are able to enjoy beautiful spring in your areas... here, by me no end to rain and miserable weather...

I had my app today with my PM at HSS in NYC. He is also anesthesiologist (I just found out today) and has years and years of experience in this field. I am very happy with him that is why I am under his care for more than 2 years by now.

He wants to run more tests on me (MRI of the brain and Thorasic levels) and may take me off narco meds. Right now I am on LA every 8 hours of Oxy (20mg), BT Oxy 22 up to 6-8 times a day (he just increased it for me today from 3-4) or 20/650 Percocet as BT. He also increased Lurica for me.

The reason why he thinks to try taking me off narco meds because he has small % of patients who leave in severe pain without noticeable reason. He says that just pain may be caused by many reasons in my situation (I had 2 multi- level lumbar fusions and much more done during last 2 years) but severe pain i go through may be caused by something else.

I am almost fused by now (last surgery was 5 month ago), my hardware is in place so all this pain may be caused by taking opiates/opioids. He says that on some hyper sensetive individuals pain can be as bad as 10 on scale from 1-10. Can you imagine??

That is why he will try and see how will I do without it. If i still experience same pain and non-narco pain medication not helping, he will put me on them right back; for some reason he feels it may be the case. Too much muscle pain; some narco meds may cause severe muscle pain.

I learned today something new and I would like to hear from you what do you think and if anyone experienced something like this...

Best wishes and God Bless!!!!

forginon · 05-20-2008, 04:25 PM

Your doc is referring to hyperalgesia. The theory is that over time the opioid meds may actually cause one's system to become over-sensitized to pain signals. It's almost as if the opioids turn against you.

I don't know if I believe this theory or not - but many docs are using this as a reason to avoid prescribing narcotics, or to stop prescribing them to patients already on them.

One reason I find it hard to believe is that it seems awfully close to the definition of CP itself. The disease of CP is supposed to be the result of an original injury or condition remaining painful beyond the healing process - something that should have stopped hurting but has not - causing the body to become over-sensitized to pain - and then in need of strong pain killers, like opioids.

So here we have two causes for over-sensitivity to pain. One is from injury or surgery that never stops hurting, and the other is from taking opioids so long that they cause the same condition. In one case you start taking opioids for the over-sensitivity and in the other case you stop taking them (because they are causing the pain)?

Seems like a catch 22 to me. Especially since the full agonist opioids have no theoretical ceiling. One s/b able to continue taking increasing doses of opioids unless side effects become prohibitive - with no real limit. To me, that speaks against hyperalgesia.

I just have trouble buying it.

steve

slipperyslope · 05-20-2008, 05:41 PM

What is Narco medication. I have never heard of this. Do you mean Norco, a hydro medication as I am confused if not please fill me in on what Narco is, as I have seen other people mention it before and I always assumed they meant Norco but now I am thinking I have been wrong all this time.

I hope your new Dr can help you and is correct but it's really hard for me to understand this theory, especially when one has had the serious surgeries as you have had.... a fusion is big time surgery... Please keep us posted and let us know how you are doing and how your pain levels are w/o this med. it would wonderful if this Dr can help you as I know you have been suffering and really deserve to find a caring compasionate Dr that can do something for you. I will keep the faith coming for you.

SS

Moldova · 05-20-2008, 06:00 PM

Steve, thank you for your post.
I don't know much about this condition, never heard of it; that is why this new to me and scary as well. I don't know what to expect from be taking off narco meds. I know this is too early to talk about it : i have to go through tests and than who knows what he decides to do.
My dream is to be able to leave without any opiates/opioids, but if I still be in same pain -obviosly taking them is not the cause of my pain; it means I will have to go back on them.

I think he is puzzled (as well as my Neurologist) what causing so much pain for me. You know how they think? If you fused, your hardware is in place - you should be OK. Even though a lots of nerve damage all overy my body and Arachnoidities and RA on a top of all. Therefore he wants to try everything to help me without doing any harm first. He has no problem prescribing any meds for me, adjusting higher doses - all these years I have no complains about this matter.

His theory is to try to help me with less damage as possible; he says instead of increasing my meds higher and higher why not to try to go less dangerous way: to try and see if I am one of the small % of people who may benefit from going off meds all together except Lurica (nerve pain meds).

DR his caliber proved many times to me that his decisions were right; no wonder why Dr Camissa works with him only (as PM) and sends his patients to him only.
I think it's nice to have confidence in your DR and his decisions, but I value everybody's opinion on this board too and see, Steve, you brought something to my attention in your post that I have to give a thought about.

Sleepyslop and Livfreeordie - thank you all for your posts. I posted this thread because I want to learn more from people here since I don't much about it. I use this PM Dr for a little more than 2 years now. Like I said I trust him a lot, but I keep my eyes and heart open to other opinions too. More I think about it, less sence it makes to me. Narco meds are narcotics.

Thank you so much for your opinions, really appreciated!

aussiejono · 05-20-2008, 06:17 PM

This gem of an idea is very popular with neurologists when confronted with chronic headache patients... they now have decided that chronic headache is caused by daily use of aspirin, ibuprofen etc.... rather than daily use of aspirin being caused by chronic headache!

if ib doubt, blame the patient!