Met w/ Pain Management yesterday

[Cindylou]

Covered alot of bases yesterday at my pain management appt. I was so discouraged going in to it. Had some initial challenging conversation with the Nurse Practitioner.

We agreed to spread the Gabapentin out throughout the day, instead of the original instructions of taking it at bedtime. We also agreed to try taking the muscle relaxer, one of them, at bedtime, and the other during the day, as necessary.

Where we disagreed, was on the pain pill, Oxycodone. She wanted to cut it back even further (I have been taking it only 2x day) to 1x day. I said I was in no shape or form ready for that. She said I couldn't rely on it to get me going for the day. I countered I hardly think 2x a day is relying on it. But she thought I was showing dependence by needing it to get moving. I cited an example of taking one before I went for a fairly long walk w/ my neighbor a few weeks back. I said, isn't it the idea that a pain pill should be used to get me moving again? I expounded that, on the walk, thanks to the pain pill, I #1: got exercise #2: got fresh air #3: got distraction from pain #4: and laughed w/ my neighbor, which likely increased my endorphins. Isn't that a good strategy for usage of a narcotic? She had to admit it was.

But earlier, she compared me to a parapalegic, suffering endless pain who was doing really well, and how come they could be doing so well and I am not. I said, hmmmmm, because we are all different? And everyone processes pain differently. And just because she can't see my pain, doesn't mean I am in any less pain than the parapalegic. I couldn't believe I was having to explain this to a professional in the pain management field. Of course, she agreed with my explanation because that is what she has been taught is true, but she clearly sees it differently, or else there would have been no comparison. She ultimately agreed to fill the pain script for 10 less than last month. Fair enough. I guess alot of (even) pain professionals really don't believe that we want to be off all narcotics way more than they want us to.

Right before I walked out the door, I asked about trigger point injections in my spazzed out lumbar muscles. She was quite open to that, and left to discuss w/ doc. Came back in saying he could do it right now. I have never had any before, and admit, I was reaching, in desperation, for some immediate relief. I couldn't believe it was a thumbs up. :thumpup: So I got 4 trigger point injections bilaterally, in thoracic area, and way low in trochanter areas. After a few minutes waiting for the numbing meds to kick in, I was like, wow. My back feels good and loose. I enjoyed the whole rest of the day like that. We got the tree up, decorated it, and the whole house trimmed out in Christmas yesterday. I was on cloud 9. And the best news: I also woke up on cloud 9 still.

I don't know how long trigger point injections can last, or even how often you can get them, but I am relishing my relative pain-free status, and definitely want to use it to move more. I also had p.t. yesterday afternoon, and she used the tens unit. That is to be ordered for me as well, per pain management. If I can keep these muscles from locking up on me, and continue to increase core strength, I may be onto something. Still have some right hip issues, but hopefully they can resolve with this treatment plan.

Sorry this is so long. I figure there may be a few folks who have been following me from the get go, so I am trying to be thorough in my journey back to health. Thanks for listening.

[Justin]

Hi CL,

It's great to see your detailed update. I'm glad that the trigger point injections helped and that you are still feeling good.

In regard to the oxycodone, I understand that it is helping you get through your days. I was the same way a couple of months ago. However, the quicker you can cut out the narcotics, the quicker you will start to feel true relief of your symptoms. Narcotics can be very helpful in the short-term; in the long-term (6+ months) is where patients really start to build a tolerance and dependence on them. When narcotics are used long-term, they can actually cause patients to become hypersensitive to pain and actually make their pain worse (this is called opioid-induced hyperalgesia).

This might be a helpful read for you:

Clin J Pain. 2008 Jul-Aug;24(6):479-96.

Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations.

Chu LF, Angst MS, Clark D. Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.

Opioid-induced hyperalgesia (OIH) is most broadly defined as a state of nociceptive sensitization caused by exposure to opioids. The state is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain may actually become more sensitive to certain painful stimuli. The type of pain experienced may or may not be different from the original underlying painful condition. Although the precise molecular mechanism is not yet understood, it is generally thought to result from neuroplastic changes in the peripheral and central nervous systems that lead to sensitization of pronociceptive pathways. OIH seems to be a distinct, definable, and characteristic phenomenon that may explain loss of opioid efficacy in some cases. Clinicians should suspect expression of OIH when opioid treatment effect seems to wane in the absence of disease progression, particularly if found in the context of unexplained pain reports or diffuse allodynia unassociated with the pain as previously observed. This review highlights the important mechanistic underpinnings and clinical ramifications of OIH and discusses future research directions and the latest clinical evidence for modulation of this potentially troublesome clinical phenomenon.

PMID: 18574358 [PubMed - indexed for MEDLINE]

[ajj1001]

Sorry this is so long. I figure there may be a few folks who have been following me from the get go, so I am trying to be thorough in my journey back to health. Thanks for listening.

No problem at all and its not long, I want to hear all the details. It really helps to think that we are all in this together trying to get through living with chronic pain.

Its good to hear about the injections helped.

[Phylly]

Cl,
I am glad the injections helped! When I used to get them for my back they lasted months depending on the steroids used. I hope that this will help you get through the holidays and last a long time.
Phylly

[Cindylou]

Yes, I am aware of this phenomenon, Justin, of opioid induced hyperalgesia, and it does make total sense. Thank-you for posting the article as a reminder too. I did go off all pain meds a few months back....you may not recall my continuing saga. Unfortunately, my pain levels skyrocketed and I felt compelled to go back on. But this time, I believe, as soon as the injection juice kicks back in, I can slowly ramp up my exercise and physical therapy routine, and go from the 2 a day, to 0 a day. Always my goal. I don't think it helps that I have osteoporosis, osteoarthritis, and scoliosis. Throw in an extra vertebra and an extra rib, and now my body, at age 57, is going woa, I better learn how to walk tall again!

[Justin]

But this time, I believe, as soon as the injection juice kicks back in, I can slowly ramp up my exercise and physical therapy routine, and go from the 2 a day, to 0 a day. Always my goal. I don't think it helps that I have osteoporosis, osteoarthritis, and scoliosis. Throw in an extra vertebra and an extra rib, and now my body, at age 57, is going woa, I better learn how to walk tall again!

Make sure to adjust your medications so that you can help minimize withdrawal associated with coming off of them (just a friendly reminder here...not medical advice ).

Let's hope that you can get to your goal. BTW, have you looked into naproxen (Aleve) to help with your symptoms? As always, consult with a physician regarding changes to your medications.

[Cindylou]

I haven't tried Aleve. I will do that. Also, can Neurotin make my joints hurt? My hands are just aching tonight, my knees too, and my back is really hurting. I believe I read it can cause swelling of joints, so maybe that is why my hands and other joints are aching so much. I have major heat on my back.

I will definitely get a scheduled "reduction tx plan" for the Neurontin when I go off it.

Thank-you for the suggestions Justin. :thumpup: