e chronic back pain related to a number of surgeries with more planned. my pain relief is failing miserably, any suggestions ?

[unisonlady7]

my dosage is 30mg twice a day of targinact, with oxynorm as as when required, paracetamol and an anti inflammatory with oramorph when needed .

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Hello Bob here

You are on one hell of a script there, have you seen the pain clinic, they may be able to help with this, your Consultant may be able too help with more distractions or further forms of control such as TENS and relaxation techniques

BOB

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Well, you are not yet on the max dosage of Targinact, (that's 40mg x2) [although I am well surprised in these days of restrictions in prescribing you are getting it, as it's not cheap and more specifically it is not widely seen as any more effective than opiates with a laxative, and some areas it's not "allowed!"]

The usual approach (as laid out in BNF) is to add more modified release Oxycodone if extra pain relief is needed, which is pretty much what you are getting (although Oxynorm is not a slow release type) I personally find Oxynorm leads to a very up and down roller coaster ride as it wears off so darned quickly!

Non steroidal anti inflammatory drugs in such cases are usually prescribed daily rather than on an "as-needed" basis... certainly I can barely walk at all if I stop my NSAIDs for more than one dose! I often wondered why I was taking them, but when I tried to wean off (as they are hard on my kidneys and on blood pressure) I realised just how much worse I was without.

What I would say is you are getting a pretty mixed up deal with drugs... sounds like one has been added on after another, without any real thought given - why both Oxynorm AND Oramorph for example!?

Often the trick is to prevent pain "taking over" and keeping it at a lower level all the time, and this reduces the need for large doses of Opiates for "breakthrough" pain... I get the feeling you are not at that point

Who is overlooking your pain meds... a pain clinic, a consultant or just one (or several!) GPs?

Have you discussed the option of muscle relaxant type drugs, and drugs for neuropathic pain such as Amitriptyline and Pregabalin and whether or not they might be beneficial?

I must ask the obvious question too... why the surgeries, what were they supposed to do, and why the need for more?