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inpain44 02-15-2011 04:11 AM

Long Term Pain Management??
Had chronic pain for 16+yrs from car accident. Currently taking 300mg to 600mg of Durotram XR + 100mg Tramadol + paracetamol/codeine/ibuprofen/buscopan with little relief some days. :(

Seen 2 pain specialists and both want to inject cortisone into my neck to determine which nerves causing pain and then kill off those nerves! :eek: Sounds very primative and risky to me, regardless of what they tell you. Got a sore arm? let's just cut it off!! Could end up with pins & needles, numbness or partial paralysis for the rest of my life. No thanks! :nono:

Tried just about everything - hot salt baths, massage, chiropractic, accupuncture etc etc... a lot of time and money!! :dizzy: Spend most of my time on managing pain instead of life!!

Research on Oxycontin and Oxycodone seems effective, but doctor is concerned about addiction. It seems from many posts I have read, Tramadol is more difficult to withdraw from anyway. I nor my doctor was aware of this obviously. Seems doctors automatically asssume you are an addict (or will be) because they can't see your pain or put a label on it to treat.

I would rather be dependant on a low dose of medication that actually works, than on a high dose of medication that doesn't really work or give relief.

Can anyone give any advice on long term pain management?
How to find a more informed doctor or specialist?

Please help??

Isotope 02-15-2011 02:02 PM

Re: Long Term Pain Management??
There are many ways to go as far as long term pain management. Probably best to start with Tylenol, Advil, and natural remedies.

Nucynta is related to Tramadol and some find good relief. The SNRI Cymbalta has some pain relieving claims.

As for Narcotics, look for a drug that is in a slow release or extended release form. This will be your best hedge against the ups and downs of short acting drugs, addiction, cravings, and euphoria seeking. Long acting meds tend to be slow onset, steady pain relief, low euphoria, and low drama.

There are a few character traits of the major opiate offerings such as [B]Morphine[/B] which has many uses, it's a pure Opiate, slightly sedating ([B][I]MS-Contin[/I][/B]). [B]Oxycodone[/B] some find energizing and a bit euphoric which can make it more abuse prone ([B][I]OxyContin[/I][/B]). [B]Hydrocodone[/B] is energizing for some, sedating for others but [U]not[/U] available in a long acting form ([B][I]Vicodin, Norco[/I][/B]). Hydromorphone and Oxymorphone are quite a bit stronger than the others. [B]Hydromorphone[/B] is a preferred BT med for many people ([B][I]Dilaudid[/I][/B]), the long acting version is called [B][I]Exalgo[/I][/B]. [B]Oxymorphone[/B] is long acting even in the immediate release forms, it has low euphoria, and some don't like that it is a low drama Narcotic ([B]Opana ER[/B]).

Many options, start low strength and low dose..... Follow the script.

Good luck~ :wave: ~

Isotope 02-15-2011 02:23 PM

Re: Long Term Pain Management??

[B]Addiction[/B] will depend on your intentions and your adherence to a good plan.

If your Doctor suggests Vicodin or Norco thinking that their relative low strength is the hedge against addiction, then your Doctor would be mistaken. Vicodin is the most popularly abused drug, partly because it is fairly weak and short acting, and that combination makes the user [I]need[/I] and [I]want[/I] more Vicodin over time.

OxyContin abuse is somewhat different. Prior versions of the drug were available in high doses that were easily crushed. Word of mouth turned it into a cultural phenomenon that far exceeded reason. Oxycodone has no super powers, though it does rate high in [I]likability[/I].

Regardless of your Narcotic selection, [B]dependence[/B] will develop fairly quickly, which means only that you will need to taper off the drug, as your body will rebel mightily if you stop taking the drug cold turkey.

inpain44 02-15-2011 06:16 PM

Re: Long Term Pain Management??
thanks Isotope - much appreciated. I have researched many of the medications you mentioned, but there are a couple I didn't know much about. My main problem is finding a good doctor where I live that understands and is willing to trial something that works for me.

i am hoping that alternating between different meds will keep the tolerance levels down on any particular med. Although dependence is inevitable, keeeping the tolerance down to low doses seems the best idea to me. Explaining this to doctor, who you would think should be more informed than you, but they really are not. Most information they get is either from the pharmaceutical companies directly (always misinformed/manipulated/selective information) or from governement departments only trying to restrict the use and abuse of meds.

It seems doctors just jump to the conclusion you are trying to abuse the medication, as some people do that of ocurse. My intention is to be pain free - that is a big enough high for me. On the rare occasions I have no pain I feel great, happy, energetic and get lots of work and other things done - although it has been rare - once every couple of months or so. Excited to not feel pain when suffering for 16+ years - that is the real "high" for me.

Isotope 02-15-2011 06:34 PM

Re: Long Term Pain Management??
Tolerance was a real problem for me when I took Vic, and Norco but not so much with Opana......

I'm not sure if there are stats regarding various Narcotics and which, if any, are more prone to tolerance effects? Some find tolerance and loss of effectiveness to be a problem with OxyContin. After a few weeks on Oxy I was ready to double up the dose because the pain just crept back in.....

Generally speaking -steady is what helps keep tolerance down. Finding a dose and sticking to it, keep the blood plasma level from having spikes and dips is what will help.

I'm in the camp that says [B][I]'take a low dose of a potent drug, rather than a high dose of a weak one.'[/I][/B] Others (J-Star) may have thoughts on this too.


nochange 02-16-2011 02:07 AM

Re: Long Term Pain Management??
Hello and welcome here inpain44. Again, so sorry to hear you suffer from chronic pain and have been in a car accident.

I have also been in a car accident, about 5 years ago. I have stopped counting the years. Well, anyway, I assume you are 44?. young enough to go through this painful life.
I know what you are going through.

So you still suffer from pain huh? have you tried the Fentanyl Patch already? perhaps that will help you. Oxycontin helps the pain but you will need to increase and increase.
It is not addiction. It is dependecy. Your doc was wrong. Why he told you it is an addiction. They just do not want to be responsible.

If you suffer from pain all over the body, did they check you for fibromyaliga. Car accident can cause fibromyaliga also. I would think so cause your profile says you suffer from pain all over your body.

I know how hard it is to find a doc who can understand what is chronic pain. Believe
me, I am going through this all the time.

Codeine is not enough for chronic pain especially you said you suffer from neck pain.
You probably had a whiplash. For severe neck pain caused by a car accident codeine
will not help. As with any car accident, you have soft tissue damage. sorry:(

Anyway with all this pain you have. I suggest the Fentanyl Patch. I do not know what else to tell you.

By the way, are you able to sleep at night??? with all this soft tissue damage, you are lucky if you are able to sleep at night.

Have you tried amitriptyline already? It did not help me, but perhaps will help you.

inpain44 02-16-2011 04:06 AM

Re: Long Term Pain Management??
Thanks nochange. no the 44 was random - i am 37.

Fentanyl patches have not ever been mentioned to me before, but I knpw my father was using them when fighting cancer. So i have heard of them. So using Fentanyl patches does not require continual increase of dosage?

I have mentioned Fibromyalgia to my doctor and he chuckled (like its a huge joke that I am in pain and I happen to care enough about myself and research possible causes of my own) without appearing to be a hypochondriac and assume I have anything I might read about over the internet. I am sure a lot of doctors just assume it is all in your head. I would love to see how they might react with the pain their patients go through. Its obvious some of these doctors don't really care and are more concerned with their status of being a doctor and how much they are paid, rather your health - doing their job! Sorry its very frustrating. I am a professional and would not have a job if I had the same attitude as some doctors do in their "profession".

But as far as I am aware there is no specific tests for Fibromyalgia and is just what they call your pain when they don't have a label for what is causing the pain.

Codeine is really the only thing available to me over the years and tried to keep off any analgesics but getting too hard to manage.

yes i do sleep at night most of the time. there is the occasional night I cannot but normally ok. but mainly because i am up all night waiting until pain subsides from heat packs and analgesics kick in, rubbing ointments into areas i can reach etc.

I think i have heard of amitriptyline in my research but not remember much about it. I will do some more research on this one and see if it may be effective. getting a doctor to prescribe something you suggest is pretty hard. they don't like you telling how to do their job that they are obviously not doing very well on their own...and i think they know it - hence the opposition to suggested treatments to trial...

thanks again and will see how i get on.

nochange 02-16-2011 06:47 AM

Re: Long Term Pain Management??
also, ask your doc for doing ANA testing. Your joints should not hurt you. When the doc ask why ANA testing. Say you just want to do it cause your joints hurt you. (that is how they check for anti-bodies).

As for muscle pain all over the body, I would suspect it could be fibromyaliga and car accident can cause it and/or trigger it. Car accidents can shake the body pretty good.

Have you ever done an MRI (neck and/or back)? Perhaps it is about time to do it. WHen was the last time they did an MRI? It may well be you NOW have bulging/herninated disks in your neck and/or back area. Things change as years go by.

I can tell you that 5 years ago one doc told me whiplash(car accidents)can cause arthritis and as I see it today it can cause other problems.

So honestly, I would check about the MRI and do the ANA testing(that is cause your joints hurt you).

Feel free to ask your doc for Fentanyl Patch. Why should you be afraid from him?. They give it for Chronic Pain. I, personally, have not tried it yet. But that will be my next step.

I do not know how to comfort you, whatever those results(blood tests and MRI)would be, at least you can sleep at night.
Most chronic pain patient cannot sleep at night and need sleeping pills.

Hope you get better soon:)

P.S the main deal for you is to do another MRI of your neck area. Do not be afraid of any radiation. MRI does not have radiation. Once you do an MRI doctors will agree to rx Fentanyl Patch. and also, you can try gabapentin, it is a mild pain killer but it is not strong enough for car accidents.

inpain44 02-16-2011 05:36 PM

Re: Long Term Pain Management??
not sure if it is called ANA testing but have many blood tests including for Lupus, arthritis, viruses etc. Have also had many x-rays and MRI scans. recent MRI scan does not show anything significant, but i think after such a long time it has caused what might be termed as fibromyalgia.

not afraid of the doctor and have asked about treatment with something other than Tramadol because i am on the highest allowed dosage and most days not helping much and always taking extra meds.

but because the current doctor i am seeing can't put a label on what is causing the pain, hence conducting many extra tests (probably just to see if I was willing to do the tests and assuming I am an addict looking for meds), he doesn't believe I should be on anything else. Tramadol is no more potent than codeine.

So thats when i asked to see a pain specialist and then another for second opinion. but i believe they are not so "special" in their field. one of them did not even check me over at all - and the other was just talking the whole time about everythng else he knows and how smart he is (apparently) and didn't even listen to what has been happening from the source of the actual person in

I have been through it all before after the accident seeing many doctors, physio, chiro etc etc. and just put up with the pain and took codeine to help a little i guess. but after 16 years and trying everything i have had enough and just want the pain gone.

so new doctors and new tests and little help. need to find a doctor that actually cares about their patients and not a "sausage factory". well thinking the pain specialists might be that person, but obviously i was wrong. surely i am just making up the whole experience of the car accident and imaginary pain...

apparently because i still have pratically full range of movement i can't be in pain and their is nothing wrong with me. have covered over and put up with the pain for so long - you get a tolerance for it and just take it as normal.

i try to keep fairly active which makes the pain worse of course but i can't just sit around and do nothing all day and on meds - thats not a life.

I work as a professional structural engineer, and want to have meds that actually work and just get on with life and stay fairly active.

jonnstar 02-16-2011 06:14 PM

Re: Long Term Pain Management??
Thats not true, medical journals are a source of peer reviewed unbiased infomation that most doctors read and trust much more than the crap the drug reps tell them - atleast here in Australia. I think most doctors treat the drug reps with a degree of suspicion, and as a pain in the you know where that they have to bare

inpain44 02-16-2011 07:08 PM

Re: Long Term Pain Management??
maybe its just my experience with the particular doctors i have seen. don't mean to be biassed against all doctors. i am sure there are some out there that are good and care about their patients.

he seemed to laugh at the comment i made about peoples experiences with particular meds and the real effects they term "side effects" of particular meds. experience either first hand, second hand from my own family members or forums such as this one.

some of these so called "side effects" can be very damaging and permanent and of course i am going to be sceptical about what the drug reps or literature state about their drug and how good it is and how they outright lie and falsify tests etc etc. it is very common because there is too much money in it.

if there was not so much money in the industry and were truely tested by independent companies with nothing to lose or gain, i am sure we would get very different medications and hear more about the real effects of some of these drugs, before people actually use them, cause bigger problems than the illness they took the meds for and potentially die from them and then take them off the market.

there are many examples i am sure, but the one i had in mind is Lyrica a pain specialist provided a sample to me. i did do some research on it prior to taking it, but thought i would try it anyway so i could at least tell him i tried it. It gave me some undesired side effects after only one tablet and did not take anymore. i did some more research on it and other peoples experiences with it were pretty scary.

i really don't think it is worth the risk with some of these meds as there are so many. they really have no idea of the long term effects of some of them; everyone is different and may have different reactions to them; and the combination of them with other meds or vitamens or foods etc. there are literally infinite possibilities.

i am a bit of a vitamen junkie also and would prefer to take a med/drug that is natural or semi-synthetic, rather than fully synthetic. maybe i am wrong and is just a personal opinion but they seem like they might be safer to take being based on a natural substance.

although too much of anything is never healthy regardless of what it is. but under controlled conditions/moderation and not being abused i think they might not be too harmful even from long term use.

katlin09 02-16-2011 09:54 PM

Re: Long Term Pain Management??
sorry that you're having such a hard time with this and finding the relief you need. A couple things're probably going to have a hard time getting any doc to sign off on a "medication rotation" plan. Dependence to these drugs is just a fact of life for a Chronic Pain patient. You can't really avoid that by switching up meds frequently. The idea is to get on a solid regimin that is consistent and works. This regimin should consist of whatever it takes to work, including non-medicinal therapies, such as PT, injections, etc. Once you and your doc find the combination of LA and SA meds that work well together, you should plan to stay on that as long as it works, not be looking for something else to change too, in order to avoid dependence. Another very important point to realize is that this is called "Pain Management" for a reason. The odds of you being pain free are very small. The goal should be to get your pain down to a level that you can live with on a daily basis, like a 3. Once again this should be part of the plan that you work up with your doctor, so that you're both on the same page and have the same goal.


inpain44 02-16-2011 10:16 PM

Re: Long Term Pain Management??
thanks Kat - well said, that makes sense.

nochange 02-22-2011 06:57 AM

Re: Long Term Pain Management??
Sorry inpain44, it took me a while to get back to you.

1) Please do the ANA testing (blood test). It will tell you if you have a negative ANA or a positive ANA. (very important test to do when you have pain, they can rull out fibromyalgia and check for auto-immune diseases. Sometimes the ANA can be positive and sometimes negative - since you have done the test probably once, I suggest you do it again. Please let me know if it is positive or negative.

Sometimes just being stress, casued by pain, can cause an auto-immune diseases. It triggers it. I suspect you do not have an auto-immune disease but it worth to check this out. Just ask to do the ANA testing again. I really suspect what you have is fibromyalgia. Otherwise, why you suffer from pain all over your body?

2) I did not understand. What your neck MRI showed?. Did you have any bulging disks?
If you suffer till today...gosh I can so much relate to your suffering cause I have been in a car accident also, but that happened 5 years ago...pain never goes away for me.

What I am trying to say is that. Sounds like you had a SEVERE whiplash. (Were you sitting in the back of your friend's car?)You have been so young, 20 years old and usually when you have a whiplash in your 20's the pain goes away. I suspect there is something going on in your neck, otherwise you would not suffer till this day. I would be AMAZED if you do not have any bulging disks in your neck after such a SEVERE whiplash. That would be a MIRACLE.

So, please check when you had your last neck MRI and let me know if it showed any bulging disks. Again, consider yourself as a very lucky guy if you do have any bulging disks in your neck area. By the way, you are already a lucky guy, you are able to sleep. Severe whiplash can cause you not to be able to fall asleep. (me for example). and the pain can cause you discomfort so you will not be able to fall asleep.

3) Do not go again to any chiropractors they can damage your neck and can also cause a stroke when they manipulate or whatever they do to the neck area. Just do not go again. They are also not for the back. Thanks god, I do have back pain.

4) Have you ever tried Gabapentin(neurontin). It does not have the side effects Lyrica has, depends on the person, but it is milder than Lyrica. Anyways, Gabapentin is a very mild pain killer, non-addictive and helps body pain, like you have (unfortunatelly).

5) What hurts you the most??? Is it your neck or back?

You need to understand, when you take narcotic pain meds you will need to increase and increase. You will not be able to take a low dose for the rest of your life and you are young and have many years ahead of you. So please, do not "plan" on taking a low dose for the rest of your life. I do not want to dissapoint you just to tell you the truth.
I can also tell you that narcotic pain meds help the most but plan on going to your doc forever.

So to sum it all up, I would say, do the ANA testing and let me know what your neck MRI showed. Have you done the neck MRI with contrast?

Hope to hear from you again and I hope you will find a new doctor. I have had the same experience with doctors. They would rather not giving you pain meds I know been there, still more or less there etc. They prefer to rx tramadol extended release than narcotics. I undertand them. It is better to keep your job than to help a patient.
I once had a doctor telling me she does not want to "lose" my license because of you!!!. That was nice to hear. she also told me I imagine the pain and that there is no way I suffer so much cause of a car accident and that people who have cancer are those who suffer. Knock on wood, I do not have cancer but the pain I have in the neck, I cannot even describe you how much I suffer, cannot rest my neck on the pillow without meds. It hurts so badly.

BrisNeck 09-20-2011 09:35 PM

Re: Long Term Pain Management??
I've been on the Tramadol Durotram highway for 3 years.
My big breakthrough was doing a 2 week pain management course at Wesley hospital at Auchenflower Brisbane.
I have reduced Durotram from 300mg down to 200mg and stopped taking Gabapentin.
They helped in all aspects of life from understanding the injury through to exercise, work proceedures, mentality of recovery.
It really made my life worth living again, I still have pain (way Decreased), but I am now getting back to doing a lot of what I did before the collision.

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