Pain Concern
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Help !! Thoughts or/and advice needed 😟

Hi all

I am due a medication review (my last 3 yrs ago) on Wednesday this week. I get breakthrough pain all the time more bad days than OK days. I am on tramadol x6 daily. I also take paracetamol x8 daily. I know better pain meds exist other than morphine but unsure how/ what to ask for?? My pain is caused by scar tissue fusion and can be overwhelming I want a better quality of life I am 41 and my pain limits me too much any advice please?? What can I expect from my GP ? I also take 40 mg Paroxetine 40mg daily and 30mg Amitripyline at night.

Please share your own experiences good or not any thoughts are welcome x

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I'm so sorry those meds are not helping. I have tried them all and found Oxycodone for short breakthrough pain to be a Godsend and Oxycontin extended release that lasts 12 hours to be just as good. These are stronger than what you take but my Dr started me on weaker meds as well. Here in the States tramadol may still be telephoned in to pharmacy, my husband had a tooth pulled & Dr called in forty-five 50 mg. Hubby said Ibuprofen worked better. Also I was able to cut way back off of the Oxy's. I never took more than prescribed, so it wasn't so hard (although I thought it would be). My pain Dr is open to suggestions but many are not. Just tell your Dr what you have is not working and he will probably keep going up until what works for you. Good luck & be better soon. Although it's so cold, Spring is just around the corner and I hope you feel like enjoying it.

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My thought would be not to look for stronger meds or larger doses...more is not better.

Ask for a referral to Pain Clinic where they can teach you how best to manage your pain with some meds and alternative therapies.

x

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Thank you for your reply Banana5 I have a tens machine I use after my first visit to pain clinic 5 years ago. I guess I would just like something to rely on when my pains gets too much. I am so tired off having to start each day shattered after a bad night with little or no sleep. Been unable to do a quarter of what I used to. Then having to push through my pain and access how bad it is to dictate what I can do. I will go back to the clinic if only to talk to people who get it.

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I’d suggest Pain Management Course would be a great step. Things change all the time and 5yrs is a good time to go try another course. I’d suggest as well that the pain meds that you are on are one of the big reasons for your sleep problems. I wouldn’t be looking for stronger meds either and if anything I’d be wanting to get off the morphine completely. Maybe asking to try MR Tramadol might be an idea, stop the peaks and troughs. Learning techniques to manage and take control of the pain is definitely the best thing I’ve ever done.....it wasn’t easy and it took an awful long time to see the benefits but I feel like I’m getting my life back again.

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Is there any reason you can't take Ibuprofen?

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Hi Winnie, As stated in previous answers, I am no doctor but have had many years experience of pain, since 1979. I have had several operations on my back at the L3,L4,L5,S1 vertebrae. I have nerve root damage caused by a herniated disk and the amount of damage caused to the nerve root cannot be assessed because of surgery. I have rods and screws and plates that obscure the X-rays, CT scan and MRI scan.

My pain is low back and down both legs. The left leg mildly affected and the right leg affected all the way down to the right two toes. This is coupled with Type II diabetes which has caused Neuropathy pain in the foot. I have tried many pain killers from paracetamol all the way through to Morphine and Hydro-Morphine, given by tablets, injections and patches. Nerve blocks, Massage Therapy, Accupuncture. I’ve tried the lot. To cut a long story short get off Paracetamol, Tramedol and anything else.

Get in touch with a good Pain Specialist and discuss the effectiveness of having Electric Stimulaters placed or a drug pump implanted. Depending on your pain a few tests will discover which would be the right one for you. In my case I would have needed several Stims and the more you use the less effective they become. I was advised to have a drug pump inserted under the skin and a catheter to take the painkiller right to the pain producing site.

My pump is filled with Hydro-Morphone, (stronger than Morphine) and is refilled about every three weeks. It does not stop the pain but anything less than 10/10 is great. My pain is now about a 3-5/10. Now that all sounds easy and, really it is. You would have to have a psychiatric evaluation and several questionnaires about pain. Morphine is addictive, yes. However if used properly you will never be addicted to it as the addictive ness is used up stopping the pain and is carefully determined and measured before you are let loose on it in a pump.

Learn to relax, deep breathing exercises, physical exercise. Try controlling your pain with your mind. I have attended two Pain Management Courses, one in Canada and One in UK at The Walton Centre, Liverpool. Both were excellent and some excellent advice, teaching and learning were obtained.

Digest the above and speak with your doctor and good luck.

Clive.

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Thank you for your reply. I am going to go back to pain clinic I should try it again anything to have a break from nine or ten days is worth a go. I have been on morphine tablets before my last surgery but after my operation to cut away scar tissue I was put on tramodol. I do mindfulness and body mapping I use heat patches also. I would really like a day that I could go shopping or for a long walk.

I miss been OK I know I will always get some pain all I want is a reasonable quality off life. I am going to also ask for a pain specialist and stay positive thanks again.

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Hi there,

Not having a medication review for 3 yrs is unusual as you are meant to get one a year,looking at what you are on Paroxetine and Amitriptyline are both used mainly to treat depression although Amitriptyline is used to help with sleep disorders the dose you are taking is the lowest dose which is normally where you start out and then build it up to 100mg per day or the maximum is 150mg but doctors try not to give you that much for any prolonged period, it sounds like tramadol along with paracetamol are your main painkillers paracetamol help increase the effect of most other painkillers.

It looks like you have been prescribed the normal starting does of each medication but not increased any of them you are like most people who go to the doctors for something but once you have been prescribed something you do not return later to say whether it is working ok or not when you go for your review tell your doctor that they are not giving you enough pain killing effect he/she will not be bothered that you tell him/her that it is not working correctly they want you to tell them if it is working or you are just the same as before you started taking them.

For me I take :-

Dihydrocodein 120mg twice a day.

Nefopam 30mg 2 X 3 times a day.

Pregabalin 50mg twice a day.

Paracetamol 500mg 2 x 4 times a day.

Amitriptyline 50mg 2 once a day at night.

Morphine sulphate as and when required.

Naproxen 500 mg one twice a day.

Omeprazole 20 mg one per day

I take several other items but they are not for pain control the one I consider my main one is Dihydrocodein which I cannot do without and that is not due to the withdrawal effects I go through if I have not taken them correctly if I miss one tablet then around 3 hours after I have missed it I end up with extremely bad pain plus I end up sweating all over along with the shakes just the same as any other person going through withdrawal (ie drug addicts).

Good luck finding something that works for you.

Regards Poppy Ann.

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Thank you for your reply the paroxetine I have been on 40 mg for postnatal depression initially then I had a really bad couple of years so stayed on them. I do get a low mood still and feel depressed a lot I am having trauma therapy weekly. The Amitripyline I started on 20mg but asked for it to be increased as I was waking constantly with pain. I get sweats when my pain is bad but my skin feels cold and clammy. I sweat more if I attempt to do anything I look like I am running a marathon. You are on a lot of medication I do not know anything about most of what you take. I was going to ask for Lidocaine patches but will wait until the Dr rings. You are right I should have gone back years ago but my fight had gone I had so much else to deal with my mum passing, daughter having a eating disorder, and my partner been made redundant. I also do not have a good GP relationship I struggle to be assertive and get my point across, always feeling like I am making a fuss and that other people are worse than me kinda thing.

Hope your having your best day x

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"Amitriptyline are both used mainly to treat depression although Amitriptyline is used to help with sleep disorders "

That is no longer strictly true, Amitriptyline is rarely used to treat depression, because they found it doesn't work well and there are many other drugs that work much better. It works much better at a low dose to treat neuropathic pain than it ever did as an anti-depressant.

The pharmacist or GP that is doing the review is in a much better position than any of us here to know what is best, so I wouldn't ask them for anything, I would just be honest with them about what you think is or isn't working, and be open to other options if they suggest them. There are different drugs that work better for different types of pain, and new information about this may have come in since your last review.

Good luck!

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Thank you for your reply cyberbarn I was told by my Dr that Amitripyline was for my pain before it I had a nightmare most night. I find the dose I take makes my sleepy and takes the edge of a little so I can wear my heat patch and manage some sleep. I will keep a open mind for anything new to try the Tramodol just do not seem to help anymore !?

I am going to concentrate on taking time to get sorted so I hopefully get OK days

Hope your having your best day x

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It has been proven that opiates do not work for long term pain, just for acute pain. I've got degenerative spine disease and had two hips replaced. I now have arthritis in most other joints and I am in agony. However I came off the morphine because I think it was too blame for a stroke like event. I have also come off amitriptyline and pregabelin. I can't promise I'll stay of them, but at the moment I'm enjoying a much better quality of life in that I'm awake! I'm still in a lot of pain but have a spinal implant and am looking at other strategies to manage my pain. Personally I'd keep off the opiates and get referred to a pain management clinic. Good luck

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Thank you I think I am going to need all the luck I can get. So happy that your quality of life has improved. Good luck staying of them and finding new coping strategy for a better life.

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i have spondylitis and it started getting worse just before Christmas and like you i have had most terrible pain in my neck head i thought i would go mad,well i have been back to the doctors and they put me on morphine sulfate i was frighted i would get addicted the chemist said no only take it if pain is bad. it a week now have only taking 4 times and it only 10mg, as i have learnt of the computer excersie that have help me very much my back not been bad at all and my head as been good i know you have some thing different from me but if you ask about excersises might help i hope so i do pain

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Glad you have found something that works for you I find my pain gets a lot worse walking and climbing stairs.

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