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Doctors' Answers to "Frequently Asked Questions" - Pain

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 04/10/2000]
Question: I take MS Contin for control of CP. It is "very expensive", as U know.
Is Oramorph SR the same as MS Contin and would it work as well? Would it be cheaper to buy compared to MS Contin?
What other Rx could be used for severe chronic pain? (as compared to MS Contin)

Answer: Both are morphine sulfate in time release form. As to the price, check with your pharmacy. Oral morphine is cheap, but would require more frequent dosing.

[posted 04/6/2000]
Question: I have been taking percodan, percocet, and or vicodan for
over 5 years for pain relieve. I am not addicted - if i use
14 tablets a year i am lucky!!! My problem is that when i
take one of these tablets to get relief from my pain i get
a severe headache a few hours after i take it. I have damage
to the superior larygneal nerve from a car accident. Is
there any other drug that i can take as a pain reliever.
The pain that i get is severe and i cannot get any sleep
with this pain - it usually only lasts a day or so and is
generally brought on by stress or by jerking of my neck.
Please help, my current ENT physician does not appear to be
a good pharmacologist!

Answer: If it is due to narcotics as a class, then any of them will do it. I would try Ultram(a semisynthetic narcotic) and see if you get the headache. If that doesn't work large doses of Vioxx(like 50 mg)with acetaminophen would be my next bet.

[posted 02/14/2000]
Question: I had to seen an orthopedic specialist for my shoulder last year (3/99). I was given Percocet for abour 1 year (first 6 moths 40 tabs, then 20 tabs. I also went for physical therapy. The problem has not been that bad anymore, but I have a son who is Autistic. There are times that I have to restrain him when he gets violent with his episodes. When I have to restrain him, I always aggrivate my shoulder and also strain my back. The doctor gave me addtional refills for two months (40 tabs each month) for 12/99 and 1/2000

The doctor has now told me that he will no longer give me any medications, since he thinks that I am addicted. I am about to see my regular doctor but, he had me on Darvon for about 1 1/2 years before the Specialist.

Is there anyway to plead to a doctor that with a child with special need, who gets violent that I will need a narcotic pain reliver. I have taken 1500 Mg of Asprin, or 600 Mg of Motrin and I get absolutely no relief.

The most I have taken of the Percocet is 2 tabs per day, sometime 6 if it is really bad.

I have never taken more than 40tabs in one month

Any ideas or advise? Someone told me to visit a Pain Center here in North NJ where I live

LG in NJ

Answer: Doctors have different philosophies about narcotics. Specialists and surgeons hate to get into prescribing these medications chronically(as a group not any one individual physician). They almost always put you back to your primary physician once they cannot perform further surgery and it is a chronic problem. I'd see your primary and explain the situation and see what he/she says. Most likely to get your needs met here than a pain clinic. They generally are interested only in procedural ways to improve your pain.

[posted 11/18/1999]
Question: I have constant pain in my left occipital nerve. Experimental botox injections have been suggested. Is there any other alternatives that can be looked into. Also where would i find information about botox as it is being used for migraines?

Answer: I'd try a temporary nerve block before the Botox. If this achieves relief, Botox would be an accepted treatment option. I have not used Botox for migraines. I'd call the company for information Allergan 714-246-4500.

[posted 11/14/1999]
Question: I have had seven surgeries on my left knee between October 1996 and November 1998, as a result of a severe falling injury, and being kicked in the left knee. I completely tore my PCL and MCL, and partially tore both the ACL and LCL. I dislocated the entire knee and tore all remaining cartilege. In addition to six other surgeries, I underwent a total patellectomy last November. Since that surgery, I have been in severe pain and have experienced most of the symptoms associated with Reflex Sympathetic Dystrophy. I have been taking Demerol for pain off and on during this time, as I am allergic to both Codeine, Percocet and similar compounds.
My problem is this: It seems that Demerol makes me extremely irritable and short-tempered with the people around me. It is slowly put a serious strain on my relationships, but I don't know what else I can do. Most days I am stuck in bed, unable to get up because of the pain. Is this a normal adverse reaction of Demerol, and is there any thing I can do, or take, to help rectify this?
Any help you can provide will be greatly appreciated.

Answer: Are you irritable due to the Demerol or the Pain? Often there is insufficient pain control leading to irritability. Adding Elavil or Doxepin to the narcotics will potentiate the meds and make you slightly drowsy, might help.

[posted 08/26/1999]
Question: I was searching the web to find out more on Elavil. My Doctor prescribed Elavil, 10 miligrams at bedtime. I've taken it for two days and so far the pain is almost nil. Needless to say, I'm very happy about the results. My question is: what can I do to reduce the prognosis about weight gain? Thank you for your response.

Answer: There's not a lot that can be done to reduce this problem, but at this dosage, I doubt you'll have much of a problem.

[posted 08/19/1999]
Question: I am a 55 yr. old male with a prior history of throat cancer, approximately 6 yrs. ago. I was treated with surgery and radiation. As a result of the radiation, I lost part of my lower jaw in the back of my mouth. Since then I have continued to suffer pain in my gums and jaw and have been treated now on several occasions with Augmentin. Treatment with a hyperbaric chamber has also been recommended. I am now on Augmentin again for mouth pain. I have continued to smoke and drink although I know these things worsen my problems and I know I should stop both these behaviors. I would still be interested in knowing if there are any other treatments or specific tests that I should consider to help determine the cause of my pain. I have not had any diagnostic tests other than mouth x-rays in several years due in part to the fact I have no health insurance. Thank you for any assistance you can provide.

Answer: This would be a strange treatment since Augmentin is an antibiotic. Sounds like you need a pain specialist, I certainly need more information to help.

[posted 08/13/1999]
Question: I suffer from reoccuring flare-ups resulting from a pinched nerve in my neck. Symtoms include numbness in the right hand index and middle fingers, pain(ache)in my right arn and pain (ache) behing my right shoulder blade. Seem to go in a cycle where minor pain felt first behind my shoulder blade, followed by pain in my arm and shoulder and numbness in my fingers (hard to sleep at this stage), followed by less and less pain, followed by long period of just numbness in my two fingers. I have been treating it with anti-inflamatories with little succes. Ice on the neck seemed to speed recovery last time and will start it again for this most recet episode. My father (a doctor) heard about a woman with similar problems being treated successfully with Neurontin. When I asked my HMO about it I was told it is for seizures only. What can you tell me about the use of this drug for my condition.

Answer: This drug is commonly used in both peripheral neuropathy as well as chronic pain. Some patients do get some relief. You would start at 300 mg a day and increase it to 1200 mg unless you experienced side effects. Most patients would have trouble getting above 900 mg.

Pain Treatment [posted 1/12/99]
Question: Is there a sublingual form of any narcotic analgesics? One of my patients has both chronic intermittent pain and severe gastroparesis. She has problems absorbing her po analgesics, so we're looking for a non-po route. Duragesic is out because her pain is intermittent.

Answer: Nothing obvious, have you tried s.l. clonipine? It's not an analgesic, but occasionally effective.

Pain Relief [posted 11/24/98]
Question:  Looking for effective pain relief in ankles for Charcot Marie Tooth (CMT)

Answer:  Try a TENS unit also topical capsaicin cream(available otc). 

Pain Medication After Surgery [posted 11/10/98]
Question: My girl friend had hemorroid surgery and was given demerol now they prescribed something else that isn't working what can she do now she is in serious pain.

Answer: Sounds like she needs a narcotic, she'll need to get that from her physician.

Pain Management [posted 8/7/98]
Question: I was told that a form of alcohol was used in an epidural. Is that true, and if so what kind? What long term effect would this have on a paralyzed person?

Answer: The alcohol is usually used to kill nerves, not anesthesize them. I'm not sure what purpose of the epidural you are asking about. There would be no effect on a patient with paraplegia if given below the level of damage.

Undiagnosed Pain Symptoms [posted 8/4/98]
Question: We have no insurance for another month so I can not go to my doctor, however, I have been experiencing these symptoms: very tired all the time, cold hands and feet, stiff neck, frequent urination, eyes puffy and hurting/itching, persistent and frequent headaches, back pain between my shoulder blades and also middle back extremely bad, increased irritability. In addition to these I just recently got over the flu or some bug and now have a persistent soar throat that flares up and I found two little lumps on the right hand side of my neck. I was really sick without the flu about two weeks ago. My sister in law is diabetic and so we took my blood sugar level one day and it read "in control". I don't know what to think and it just seems like there are too many different symptoms for it to be anything. Do you have any idea's and do you think it is serious that I should get in ASAP? It would be one thing if I just had to pay the $50 to see the doctor then the $20 or for the antibiotic, but I am worried if it is something else that we will not get insurance coverage.

Answer: If your sugar is normal, then there is no clear answer that I can give you over the net. A low thyroid could be causing this or even a low grade urinary infection. Both would require testing. Neither would affect future insurance since they are both treatable and cheap.

Question: What can I do if I have sciatica pain?

Answer: Heat, non-steroidal antiinflammatories, and physical therapy.

Question: What could a pain in my lower right hand side (near intestines) that burns and then feels like a popping, be?

Answer: There are lots of things on the lower right side. These include appendix, colon, and several possible hernias. You'll need to be examined or provide more information (onset, character, radiation, inciting factors, duration, etc.).

Magnets and Pain Relief
Question: Do magnets really work as alleviators of pain?

Answer: These were used extensively in the middle ages for all types of problems and did not appear then nor now to have any appreciable medical uses.

Chronic Pain
Question: I was a victim of a violent crime, I suffered massive skull fractures and also neck and spine damage. I have had a MRI that shows protrusions at C-4-5-6-7 in the cervical area and in the lumbar area T 121-13. I have had pain in for over 7 years and for this I started out with T-3 and went to Darvon and always in and out of the hospital for pain shots. The pain is centered like a diamond at the back of my head that connects to the spine to about the bra level. Some times the pain gets so bad all I can do is cry. I have been taking for over the past four years high doses of pain medication from Vicodin to Lorcet to Narco now at 10/325mg 2 tabs every four hours witch goes over what I have read as being safe for my liver. Some times I vomit with the pills in my hand; I don’t want to take them I hate to take them but when I do not take them the pain gets so bad I end up in the hospital. I have a question about Percodan, is this safer for my liver then the narco made by Watson I know it is a triplicate but I don’t know what to do I have tried therapy both mental and physical. I am only 28 years old is there anything I can do to help cope with the pain. I have taken this drug for so long I know my body must be dependent and yet there are some days that the pain is minimal and I don’t take the pain pills. I take over the counter medication and I don’t seem to have withdrawals. Can you help me? Please tell me why this pain has never gone away.

Answer: Chronic pain is one of the harder things to treat or to have. The only advice I would have is to see a specialist in a pain clinic if you have not already. Occasionally, they can find ways to minimize the pain. The liver risk of percocet is the acetaminophen. If you would take narcotics without acetaminophen-long acting morphine or methadone-this risk would go away.

Tooth Ache
Question: What is best pain reliever until I can get to a dentist?

Answer: Two regular aspirin, two regular or extra-strength Tylenol and an antihistamine(benadryl or the like 25 or 50 mg.). Topical benedryl and topical ice is also of help.

Emergency Tooth Treatment
Question: What is the best emergency treatment for a tooth ache?

Answer: Try heat or cold to see which helps the most. The analgesics that I have previously mentioned.

Question: Is it harmful to take Advil or something similar with alcohol? Is Advil addictive? Is it harmful to take more than 2 Advil at a time?

Answer: Advil is not addictive. It does increase the risk of GI bleeding to take it with alcohol since both are risk factors for bleeding. Minor amounts of alcohol with no history of GI problems is probably not a big deal. The prescription dose for most patients of Advil is 400mg 4X a day or 800mg 2X a day. Advil is 1/2 the prescription dose so in general not a problem-depending on how many you take a day 1600 mg is the usual highest you should take.

New Pain Control Meds
Question: I heard that there is a new medication out which is used for pain control without causing addiction like other controlled substances can. Can you tell me the name of it?

Answer: Ultram is one.

Question: My husband is recovering from hip surgery and has been taking Codeine for almost 3 months now. He says he needs it for his pain and extra-strength Tylenol doesn’t help. I know Codeine can be addicting. Should he stop taking this drug or stay with it until he can function without it?

Answer: Usually, the hip pain should be bearable by three months if it is going to improve. Codeine is definitely addicting-discuss other options with his physician.

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