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Doctors' Answers to "Frequently Asked Questions" - Chronic Pain
Treatment of Chronic Pain with
Narcotics [posted 1/14/99]
Answer: Well, they're all narcotics. If he isn't sedated, he isn't receiving too much. That does not mean that he will not become dependent, he will. However, there are few other options for treatment for chronic pain.
Compression Fracture [posted
Answer: You have had trauma and damage to the back and lower nerves of the body. This is probably permanent and treatment is limited at best.
Chronic pain - hip, waist, knees
Answer: Chronic pain following pancreatitis is fairly common. See a pain specialist for consideration of a nerve block
Neuropathy - Chronic Pain [posted
Answer: Well, someone has started you on the usual treatments. Others that are of occasional help are acupuncture, TENS electrical stimulators, steroid injections, and last but not least Morphine - addicting, but effective. If you are going to suffer chronic pain, I would try all of these to see what is effective. A pain specialist will need to administer the steroid injection.
Debilitating Pain [posted
Answer: Unfortunately, I'm not familiar with Doxyfene or Molipaxin. These are either not available in the US or go by different names, which is unfortunately a common practice with drug companies. However, sounds like either pain from depression or fibromyalgia or both. I assume a work up has been done to exclude Addison's Disease and Thyroid Disease. Next, I would work with massage therapy and/or acupuncture. Sometimes very helpful if the patient can afford it. Also, if he is not on an antidepressant I would try several different ones for both pain relief and possible treatment of depression.
Medications for Chronic Inflammation
Answer: Acetaminophen, Ultram, Duract, will help with the pain, but not the inflammation. There is no patch currently. If your problem is due to gastritis (hence the patch, but not the oral) have you tried using Cytotec with the NSAIDS? It is protective in most patients.
Chronic Pain Treatment
Answer: Are you taking any non-steroidal anti-inflammatories? This is the usual treatment. Yes Talwin is addictive-Tylenol much less so, but somewhat. There are several new potential drugs to try. Ultram and Duract are the newest and so far don't seem addicting. Failing this, a pain clinic might be the next place to try.
Chronic back pain
Answer: Sorry, no data about this nor any guesses about who to contact other than the FDA.
When I was first returning to work in 1993, most of the work I was able to get was temporary, with no medical benefits. The most economical way to control pain was Tylenol 3 and Feldine. Depending on the type of work I found, I am a Computer Specialist by trade. When I had to sit for long periods of time, I required more medication. If mobile less medication, and in one position no medication. I have been subjected to all "Managed Care" has to offer in their arsenal for readily available drugs. I have been with my current doctor, for almost 2 years now. I was able to convince him to have more testing done via a Neurosurgeon. The prognoses after all these tests was not to operate, although degeneration in the original injury area is very evident. I agreed to have another epidermal steroid injection, and Ive had this done this several times before. I had a epidermal steroid injection last month that caused problems, including more pain.
Last year I went in to get a Cortisone injection because I had to work out of town for a couple of weeks. My doctor said that he did not want to do the injection, but prescribed 60 Tylenol #3 x 4. I have never had more than 90 in a month prescribed to me before, but I quickly got used to taking this amount. About 3 months later I saw my doctor and he said this was too many, and suggested I had a problem. I told my doctor I was aware of the problem and was willing to do what ever was needed to decrease the amount of medication. His attitude towards me, the patient is now obvious contempt, disgust and dislike. I am still trying to figure out what do because I know the doctor - patient relationship is gone. I just had this injection in my spine by another doctor who claims to be autonomous in the whole matter. I have to fly out to Salt Lake City Tuesday and drive 200 miles to a town called Box Springs, Wyoming and smile at the customer while I install his entire computer system. I have a doctor who claims Im now a dope addict and he will only prescribed 90 Tylenol #3 per month. What am I suppose to do about leg cramps, moving and sleeping?
Answer: You have a common problem. This problem is common to patients with chronic pain who experience the social paranoia caused by the anti-drug campaigns of the last thirty years. Patients who experience chronic pain will need pain medications. Usually, some type of non-steroidal anti-inflammatory and/or narcotics. Unfortunately, many physicians do not understand chronic pain and the appropriate treatment. I would ask for a opinion from a pain specialist. Also, have you tried a TENS unit? Sometimes this is very helpful.
Answer: Pain and its management comprise an entire subspecialty of medicine, and
is a very complex problem from which a great many individuals suffer. It would be
difficult to even summarize appropriately all the many facts we now know about the bodily
production of pain, how it is perceived, and how it is treated. To answer the definition
questions, pain perception is that ability of our nervous system, to detect pain, and
hopefully act to remove its cause. An example of this would be stepping on a nail; most of
us would know about the nail in an instant, drop to the floor and proceed to inspect the
area where the pain is perceived. This is due to the pain perception ability
of the nerves in our foot communicating to the spinal cord, and in turn to our brain, to
notify it of a problem. The brain in turn, sends a command for action- to do something to
remove the problem causing the pain. Pain threshold is that level or intensity of pain
required for our nerves to be able to detect it. You may not be aware that a mosquito is
biting you, for example, until the pain reaches your pain threshold. Pain tolerance is as
the term describes, our ability to endure pain. This tolerance increases for example, with
chronic pain. Also, at the level of the individual nerve, for example in the skin of our
foot, tolerance to chronic pain occurs, allowing persistent painful signals to impart less
of a conscious effect on the brain and thus diminish our awareness of it.
There are many modalities, or ways that pain is managed. In the acute setting, the health
care provider will often provide medication to ease pain until whatever problem caused the
pain is corrected, such as a fracture, kidney stone, or gallbladder stone. Since the
injury, and therefore its pain are temporary, there is less (but not none) concern for
dependency on pain medication, or for lasting effects of the pain medication. Chronic pain
conditions however, have been the subject of an entire discipline of the medical field.
Regardless of cause, chronic pain can become a disease unto itself, with all of the
physical, emotional, and psychological problems that arise from its presence. Effective
pain management on a chronic basis requires a team effort from the patient, his or her
health care provider, as well as the patients friends, family, and if necessary, a
physician specializing m pain management. From medications and physical therapy, to nerve
and spinal devices, the health care provider can do more for the patient with chronic pain
than ever before, and hopefully in the not-to-distant future, no one will have to live
with chronic pain.
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