it is some months since my last post. since then, my fractured hip has almost completely healed itself without any treatment other than enforced bed rest for three weeks a year ago. the fracture was such that i could bear weight on it, albeit painfully, held together by the sticky soft tissue.

strange thing is that i no longer fall down [well once in 10 months], whereas for years it was a weekly event. it makes me think that i had been "walking" on a fractured hip for years without knowing it!

anyway, the reason for this post is to talk about neuropathic pain and "tolerance". the latter is the phenomenon where drugs, specifically opioids [codeine, tramadol, morphine], loose their efficacy with prolonged use. i discovered this with a vengence while in hospital last year with the hip fracture: whilst Oramorph [5ml morphine] worked when i was first admitted, towards the end of my stay, 10ml oramorph had no effect on pain.

i have begun to think that "tolerance" is a more general phenomenon affecting other pain medications. for example, gabapentin [max dose 3600mg/day], which i take for neuropathic pain, is way less effective when i first took even small doses many years ago. there is a glimmer of hope in that i read of peoples experiences taking opioid "holidays" can lead to the medications recovering their effect. however, this whole area is vague, and i don't hold my breath. for now, i have gradually come off tramadol completely but..

my feet, mostly toes, are very painful, especially in the morning. sitting or better walking around [i use a 4-wheeled walker], gets rid of the worst of the pain, returning to a mild burning sensation.

nights are, these days, seldom times for sleep, even though i go through the motions. i have acquired "restless leg syndrome", something i remember from years ago when i was losing power in my right arm. i wanted to rip my arm from its socket! however, even now, i do not believe that my right side deficits [subject to spasticity [stiffness], muscle weekness], are due to "ALD/AMN" [the way they occurred is not consistent with those or a stroke]] . my left leg, whilst i have lost all sensation, nevertheless allows me to get around. my left arm allows me to use a walker and do most chores around the house.

i have been searching a way to combat the pain in my feet; any ideas? it is a bit like the neuropathic pain from diabetes [with its terrible end-points], but i am not diabetic [every time i am in hospital, it is the first thing they test]. the damaged nervous system leads to reduced peripheral circulation, and reduced ability to repair even the most minor skin damage.

sorry for writing so much, and possibly repeating what i have written in earlier posts.  i must not complain, as my hermit-like life is bearable, and i get much "work" on computers done [i have been forced to retire].

best wishes, jack 

11 Replies

  • Hello Jack.

    Pain, who needs it?  Gabapentin tolerence rises rapidly,  I can remember when 200 mg would space me out, 500mg would see me falling all over the place.  If I take it daily, I can do 3000mg in an hour, every hour.  I am not joking.

    A couple of day's abstinence and it resets everything to zero, though to be fair, a week is more like it.  And I don't even suffer from pain.

  • I take vicodin daily for pain. I break them in half and take it more often  because I don't like the high. I need my senses being a single dad. My feet pain has been unbearable lately. I literally can't stand it it has been so bad. I tried lyrica a few years ago but didn't like the way it made me feel so I stopped. I'm seriously thinking about trying it again to see if I can get any relief but I hate the idea of taking more chemicals. Right now I don't think I have a choice. 

  • Chemicals.  Don't get me started.

    Gabapentin/Lyrica, my neurologist never refuses me.  And like I said, I don't even suffer from pain.  But I'll be honest, it's not a bad high.  Does something for my spasticity, I take with 4APMEOH.  Going to bed without even the hint of a spasm is priceless.

    If I were in pain, the old Lyrica/Gabapenten wouldn't be such a bad option.  I can function OK on it, wouldn't like to operate heavy machinery on it though.

    My Mum takes Tramadol for her back pain.  Likely it's AMN related, she's nearly 80 years old.  She complains about the Tramadol messing up her head, I gave her some Gabapentin and it sorted her pain right out but she said the side effects were much worse.  

    i have so much wrong with me, I couldn't have pain on top.  That's non-negotiable.

    Vicodin is a properly recreational drug from what I've read.  All I know is Eminem was partial to it.

    Deengo, is your pain in your feet?  In your extremities, or in your legs?

    And you Jack3953?  How are you doing?  We should have this as the pain thread.

  • The only things I take are zma and vitamin d3 and I get hardly any pain now! but my left arm is starting to worry me now though pain and weakness?

    All the best

  • Here is the original link...


    Gabapentin and pregabalin are anticonvulsants with antihyperalgesic effects in animal models of neuropathic and inflammatory nociception. This study characterized the manner in which gabapentin or pregabalin interacts with naproxen to suppress thermal hyperalgesia and inflammation in the carrageenan model of peripheral inflammation.


    Gabapentin, pregabalin, naproxen, or a fixed-dose ratio of gabapentin + naproxen or pregabalin + naproxen was administered orally to rats after the induction of inflammation by intraplantar injection of lambda-carrageenan in one hind paw. Nociceptive thresholds were determined by the radiant heat paw-withdrawal test. Paw edema was measured by plethysmometry. Drug plasma concentrations were determined by a liquid chromatography-mass spectroscopy-mass spectroscopy method.


    Gabapentin, pregabalin, and naproxen alone reversed thermal hyperalgesia with ED50 values of 19.2, 6.0, and 0.5 mg/kg, respectively. Mixtures of gabapentin + naproxen in fixed-dose ratios of 50:1, 10:1, or 1:1 interacted synergistically to reverse carrageenan-induced thermal hyperalgesia. However, 1:50 gabapentin + naproxen produced only additive effects. No combination of gabapentin + naproxen decreased paw edema in a manner greater than additive. Plasma concentrations of gabapentin and naproxen were unaltered by the addition of the other drug. The mixture of 10:1 of pregabalin + naproxen interacted synergistically to reverse thermal hyperalgesia on the inflamed hind paw, whereas mixtures of 1:1 or 1:10 produced additive effects.


    These data suggest that gabapentin + naproxen and pregabalin + naproxen can interact synergistically or additively to reverse thermal hyperalgesia associated with peripheral inflammation. Therefore, the use of gabapentin or pregabalin in low-dose combinations with naproxen may afford therapeutic advantages for clinical treatment of persistent inflammatory pain.

    I'm back now.  The above states that low dose combinations of gabapentin + naproxen and pregabalin + naproxen can reduce inflammatory pain.  Has to be worth a shot.


  • Monkeybus,

    I like all the good information you post. 

    I've been doing K-Laser treatment on my feet again and the pain I was having is about 80% gone. Much mire bearable.

  • Hello deengo, I thought I'd replied to you, must be in my phone.

    I hadn't heard of laser therapy until you mentioned it.  I was sceptical at first but there are good reports on it.

    This one has a good conclusion,,

    The day may not be far off when most homes will have a light source (most likely a LED device) to be used for aches, pains, cuts, bruises, joints, and which can also be applied to the hair and even transcranially to the brain.

    That one was published in 2011, I think that day is here...

    Deengo, do you have to pay for your treatment, or is it covered by your insurance?

  • Immediate effects of low-intensity laser (808 nm) on fatigue and strength of spastic muscle.

    This is really interesting stuff,  I am tempted to get one off of Ebay.  I probably will.

    You've really put me onto something here, deengo.

    Low-level laser therapy alleviates neuropathic pain and promotes function recovery in rats with chronic constriction injury

    Interesting bit about lasers promoting nerve regeneration.

  • Monkeybus. Sorry for the late reply. My insurance won't pay for it. I found a chiropractor here that offers it at half the price I paid a couple years ago.  I'm having great results. I pretty much have no pain in my feet now. As I stated in my previous post the pain was unbearable. I was going twice a week and now am going once every 2 weeks 

  • thanks for all your replies.  i have since been given butrans-5 patches, as my gp thought the different delivery mechanism might get around the loss of efficacy, but so far i am not impressed.  

  • update:  butrans-20 trans-dermal patches had little effect on pain, and i became aware of the  "buprenorphine blockade", which is where very much stronger opiate-based analgesics up to fentanyl fail.  i don't plan on needing emergency surgery any time soon, but if i did it would be scary if none of the available pain killers work.  i have decided to come off ALL opiate based pain killers for 3-6 months, perhaps longer, put up with the pain, and see if my pain receptors start behaving normally.

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