A CROSSOVER POST

[BenHall1]

This post straddles both Pain and AF …. so … if considered inappropriate please delete, I understand.

A few weeks ago I posted that during the night I had to make a comfort stop and in doing so I tripped over the cat … went flying through the air and smashed my osteoarthritis ridden left shoulder into a door jamb. Brill ! Thus started a learning curve …. about pain ! I know enough about AF ( after almost 14 years since diagnosis ) to not be too phased about it. About Pain I know/knew nothing…. Until now.

Damage report on shoulder nothing broken, referred to MSK Interface for Ultrasound. Meanwhiile on medication for pain relief. ( my personal feeling is some sort of rotator cuff damage ).

Although I tried to see my GP she referred me to our surgery Physio, she in turn gave me exercises to do but which I found too painful …. I mean, I couldn’t put a shirt or jacket on without assistance much less do painful exercises. Meanwhile I’m still waiting for an appointment for the Ultrasound, also, GP meanwhile starts me on ( for a second time ) Amitriptyline at 5 mg doses. This is the second time I’ve tried this for pain relief with diarrhea as a side effect. Soon abandoned that. Asked for an appointment with GP again … was told she would phone me. Waited a few days and GP phones … apart from asking how I was she launched into a previous tried enquiry …… would I come off Warfarin ( my preferred anticoagulant ). She then went onto explain that with the next level of pain relief ( two choices – Gabapentin and Pregabalin ) …. however this required me to come off Warfarin … would I do so ?

Of course I would because not only is the pain now impossible but I cannot sleep – maybe, 2 hours here, an hour there, sometimes 4 hours … its a QOL thing now. Waiting now for the prescription for new meds. So I am wondering if you wise guys and gals out there have any experience of side effects with any or all of the following : Edoxaban, Gabapentin, Pregabalin and/or coming off Warfarin onto Edoxaban or any other of these NOAC’s. GP claims Edoxaban has proven to have the least bleed rate of all A/c’s, including Warfarin yet still does a good job of protection.

So, there we are … I’ll post this on Pain Concern forum too in the hope that someone else will have endured rotator cuff damage.

Meanwhile the cat is absolutely fine, enjoying life and preparing for Christmas !

John

[Bevvy]

Sorry to hear your troubles but at least the cat is alright! I know one day I will fall over my boy because he’s always getting under my feet!

With regards pain control, I didn’t find gabapentin or pregapaline very helpful in treating nerve pain. What I do find helpful is taking duloxetine, which seems to help and if then things become very difficult I also take Tramadol.

Re Warfarin- my dad was on this for years with no issues. Following an unrelated spell in hospital he was persuaded to take a more up to date medication. It did cause some issues including gums bleeding and I know he felt he had less contact than when on Warfarin.

[kev60]

hi, I suffer with a lot of pain ( abdominal , chest and back) and have tried various medications including Gabapentin 14day course but after 5 days started swaying but didn’t realise then sent to hospital with suspected stroke. Three days later discharged no stroke but affected my walking, talking and thinking 19 months later diagnosed with FND had to learn to walk again back to 70% still walk into walls and door jams cannot go out on my own now. Turns out I had an adverse reaction to the meds, normally it’s ok just be wary my case was rare. Most of my pain is medically unexplained and after trial and error ended up being put on Bunov pain patches (30mcg) per week plus paracetamol daily and codeine for emergencies. Only dulls the pain so it sits at 7/10 with patches and 10/10 without. Good luck finding what works for you. Kevin

[cyberbarn]

Amitriptyline, duloxetine and Pregabalin and the others are for a specific type of pain. They are for neuropathic pain, chronic neuropathic pain, that is pain that has been in place for longer than 12 weeks, and past expected healing times. But if your fall happened only a few weeks ago it is likely that you are feeling acute pain still. And it is possible to have chronic and acute pain at the same time.

You say the damage report said nothing broken. Was that just an x-ray? X-rays only show bone damage, they don't show tissue damage and that takes a lot longer to heal, sometimes longer than bone.

Some of the physios that are attached to GP surgeries are not the advanced practice ones that can diagnose. They often just hand out exercises on the assumption that all healing has taken place, you just need to strengthen the muscles.

And for young active people that might be true, but it is not true for everyone. We have all sorts of other things going on that might slow healing.

Exercises shouldn't hurt. It isn't so much that they are doing more damage as it might prolong recovery if they are wrong for the type of injury you have.

As for the drugs for neuropathic chronic pain, not everyone metabolises drugs the same way so what works for one is a disaster for another. My son was started on amitriptyline, but they switched him to duloxetine. Disaster. He happily went back to amitriptyline. His neuropathic pain was in his feet. When he was in bed particularly he had a burning pain in his feet. No previous injury, so his feet weren't waiting to heal from tripping over a cat. Or in our case, a chicken!

I hope you figure out what is going on and find a medication that actually helps you.

[BenHall1 in reply to cyberbarn]

Hi cyberbarn,

Thanks for your comments. My fall happened on 15 November 2023. Yes, when I said that there was no damage I was referring to the XRays that the Minor Injuries Unit took. Nothing broken.

So, after that (long story short ) I went back to my Surgery Physio who referred me to our MSK Interface unit for Ultrasound. The problem is where I am in Cornwall there is a massive wait ( mind you there is everywhere in Britain nowadays ) so I have elected to have the Ultrasound and pay for it myself. Mind you I'm still waiting and some peoples experience is that it could be as long as 7 weeks, even private.

I would say that my Surgery Physio falls into your description .... "not advanced practice" thus the referral to the MSK unit where they keep all the specilaist Physios. And yes, that's what I got exercises and exercises. Great for maintaining mobility, not good for much else. I said to the young Physio ...... what good is that ? I can't put and shirt on and jacket on either because of pain.... why are you thinking Physio pain is going to do any good ? The reply was you have to keep mobile and break through the pain. Grrrrr !

Anyway, onward and upward, time will tell. Thanks again for your comments.

John

[mutterley1]

Hello Ben,

Suffice to say you have my heartfelt sympathy as, like you, I have been nowhere getting the surgery I needed at the time I needed. After my 1st Spine op in 1990 I was given 10 years free of pain (as the Consultant said). After that from 2001 to present day, 2 new knees caused by my spine not being straight and me waling like Quassimodo, 11 further surgical interventions + 4 more from 2017. The only 'constant' throughout all of this has been my bucket of tablets. Even back to 2008 I was on a regime that did very little and like you said, its a downhill place to try and live in if that can even be called 'living'.

The, about 15 years ago my original Consultant from 1990 was in the area and I still had the same landline. We had a great get together in a local hotel during which he mentioned my current tablets were - remember this is about 5 years ago. I told him and he was at first sorry for me, then annoyed with the tablets themselves and kept repeating 'what about GABAPENTIN ? He was 100% adamant that my GP was not prescribing properly and that amongst other things such as Morphine I should be taking GABAPENTIN + paracetamol as they are good together. He spoke to my GP who sent a script to my local pharmacy and I started - I know too many people who have many issues with Pregabalin & its ben round since the time of Queen Victoria-more or less.

The GABA tablets I got were orange in colour, each being 400mg and an initial dose of 1 tab morning, one tab teatime & 2 tabs at bedtime. Long story condensed the doseage did nothing to help BUT I found no side effects. Over a period of 6 months untilmy typing this reply I have run on the stated 'maximum daily dose of THREE (3) TABS MORNING, THREE (3) TABS MID AFTERNOON and THREE (3) TABS BEDTIME = 1200 mg each of the 3 periods of time. I cannot lie and said 'eureka' but if the Consultant gave it a nod I was willing to stick it out AND on this maximum recommended dose I have been in a whole better place than I had ever been. Obviously some GP's will NOT go to maximum from day 1 but you now know that at some point between NIl & 3600mg you will hit the levels suited to you. It is also much less addictive than most of the usual offerings and has never put me to sleep, caused wonky bowels......nothing but EXCELLENT to say about it. My dear MUM, in the great A&E in the sky for 6 years had been an A&E Doctor for 43 years but kept up with all the new things until they got too many & her job was stressful enough BUT she always said to fight for new things whether tablets, natural remedies or surgical procedures. I also take morphine 40mg/day, Diazapam 15mg/day, Paracetamol 3 g/day (6 x std 500mg tabs) AND 3,6g of Gabapentin and since starting 15 years ago & building it up in my system after which I have stayed in a much reduced level of pain from my spine to my toes albeit a cack handed surgeon severed nerves rendering my left leg below my knee + my left foot totally without feeling not to mention the increased pain from the live end of the nerve. GABAPENTIN stopped it within 14 days and it never came back. Fro my arsenal, various, over the years GABAPENTIN is the one I believe most in and it has enabled me to be as pain free as I have ever been and even at max daily usage for so many years it has never failed to deliver and as such it is my all time recommended medicine and absolutely I would ONLY have tried Pre-goblins if the GABA had not worked. I have also heard nothing but positive about it when I have my reviews, when I have another operation or just personally in thanking my Consultant to catch up with me and get me onto it. AS a measurement, before I started on GABA I spent most of the day lying on the floor & even that still dished out agonising bursts of pain. I should also mention that I do not drink alcohol- not for 30 years as I became a Food & Beverage factory manager in the Middle East and liked my head too much to risk it for 'fermented potato & spinach leaf 'moonshine' so that is something I cannot comment upon buti believe normal drinkers, whatever they might be, are OK but just a thought. Soz if this is long but background and honesty are paramount in replying to someone else who is suffering so I hope this does it for you and DONT take no for an answer ! Message me & let me know how you get on but I cross my fingers that it really goes a long way to helping you as pain, no sleep....bad mix so GP's and surgical offerings should be given to you without question - GOOD LUCK

Kind Regards

David

[BenHall1 in reply to mutterley1]

Hi David,

Thanks for your wide ranging comments. Well, I collected my new round of meds today - Edoxaban & Gabapentin. Not worried about the Edoxaban.

My Gabapentin is only in doses of 100 mg. I have to say I have never seen such a convoluted set of instructions for taking this stuff ... sadly I’m not a Rhodes Scholar. These tablets are coloured white and are oval. My GP did discuss the dose with me and we finally agreed on the dose ... I elected to start low first and see how I go. Have been put off by the fact that Amitriptyline just gave me diahorrea and thus I discontinued it. These are my instructions ..... “TAKE ONE AT NIGHT INCREASED BY ONE TABLET EVERY 3 DAYS UNTIL TAKING TWO TABLETS THREE TIMES A DAY. ONCE STABLE ON THIS DOSE FOR A WEEK PLEASE ARRANGE REVIEW WITH GP”.

Of course the point is with me this dose of Gabapentin only puts me in a “holding pattern” until I have my Ultrasound ( with the state of the NHS, who knows when that will be and I have elected to pay for this myself ) and it is determined exactly what the problem is .... some people have said that even going private this has taken some 7 weeks. I hope I have as much joy with Gabapentin as you have had.

Thanks again for your comments. Wishing you well in the future.

John