Discussions that mention morphine

Pain Management board


Hey BITS, Yry and rememebr that each doc you see is only giving you there opinion. There are theories that back what the surgeon is saying but he's not a PM doc that does interventional procedures and deals with chronic pain on a daily basis. Even among PM docs there is a huge difference in the opinion you may get from one doc and the opinion you may get from another. It's virtually impopossible to be uop to date and use every single method of pain management available. Anti seizure meds are really the first line in treating nerve pain, There are many other things that can be done for nerve pain butevery PM doc doesn't know of or use every procedure available. Some PM docs are trained to implant and manage implanted pumps and spinal cord stims, some don't use these devices, simply because they haven't bothered to learn or in their opinion, their methods will work. Some PM docs do nothing more than prescribe meds, some PM docs have the ability to do medication infusions like Lidocaine or baclofen. A multi faceted clinic made up of several sp[ecialist will likely be able to offfer the most help, an anesthesiologist on staff, a neurologist on staff, a phsyciacal med and rehab doc or DO on staff. Nerve blocks may be very effective, you may be a candidate for an implanted spinal cord stim which could dull the signal.

The idea of breaking the pain cycle is nothing new either. ketamine comas have been used succesfully to break the cycle of pain, They basically knock you out and keep you out for several days, the ketamine blocks virtually all pain by way of blocking the NMDA receptor. PCP blocks this same receptor and explains why people under the influence of this drug can be very difficult to bring down even with extreme force and multiple gunshots, they simply don't feel the pain so they can't be brought down.

Other meds also have this same property, Nemanda is one of the newest and has the least side effects. If your doc isn't familiar with the use of ketamine or Nemanda and the potential benefits of blocking the NMDA receptor, it won't be offered. If his methods can't manage your pain, rather than tell you to find someone more knowledgeable, they tend to tell you this is as good as it will get and you have to learn to live with it.

Any procedure or med is trial and error, it's good they are startng Lyrica, but you may respond better to any of the dozen or so other anti seizure meds. There is no absolute rule of success with medication. Meaning if Lyrica doesn't work, you need to try all the other anti seizure meds to be able to say this class of meds has no effect, not just one med from a large class. It would be like saying if codeine doesn't relieve your pain their is no point in trying methadone or morphine.

Antidepressants have a completely different role in PM, they supress the produiction of substance P which is a potent neuro inflamatory agent produced when acute pain turns chronic. Clonodine is another drug from the calcium channel blocking class of BP meds, however it closes a particluar channel used to carry GABA, another neuro transmitter only seen in chronic pain patients.

Botox paralyzes muscles, it's normally uised on muscle in severe spasm or with severe spacticity, It's more geared towards muscle pain, but if nerve pain is being caused by passing through a muscle that's con*****tly in spasm or a stsate of spasticty, this can also cause nerve pain. Often sciatica is caused by thspasms in the glutes or periformis, not bu trama to the nerve at the root near the spine.Trigger point injections and trigger point pressure can break up muscle spasm whether the pain is musclualr or the muscles are clamping down on a nerve that passes through the muscle group.

Even something as simple as trigger point injections can produce a wide variety of response depending on the guy holding the needle. Any PM doc can learn to do a trigger point injection, but there are several techniques and then the human factor where one doc just has "the touch" and these bring great relief and some docs aren't able to give any relief doing the exact same procedure.

Finding a good PM doc is like finding a good barber "hair stylist" you like, they all learn the same things in school, they all learn the same or similar technique, so why can't you expect a good hair cut from any barber? Some have a passion for what they do, some have a gift and some merely repeat the same technical method they learned in school and get good results sometimes and do a hack job others.

When a doc tells you this is as good as it gets, you don't have to accept his opinion as absolute fact, it's just his opinion. More than likely there are dozens of techniques he simply can't offer or doesn't believe in the benefit of. You are talking about your life so don't be afraid to speak up and say thanks for trying but I have read about to many other methods of pain management you have never mentioned and want to try these for myself before I decide this is as good as it gets.

It's your life and up to you when or if you want to accept a poor prognosis or keep looking for an answer. The docs are trained to detatch their feelings from your prognosis so they don't go home at night and think about the poor guy they have condemned to a life of chronic pain. You have the right to the same detachment when listening to a particluar docs opinion.

Just as an example, when my cousin was 21 he went to 42 different docs and ER's complaining of testiclular pain, he was told everythng from it's a simple infection to he was a drug seeker. Had he given up and accepted some docs opinion that it was chronic infection of the epiditimitis before the 42nd doc did the right tests. He would have died from a verry treatable condition simply because the docs didn't test or consider the possibility he had cancer because of his age.

You still have lots of options and don't have to accept this is as good as it will get.
Take care, Dave