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cweinbl

Joined: 02/05/2010

My Story:

Born with congenital central canal stenosis. Disc herniations began at age 17. Three disc herniations and four failed surgeries forced me into retirement at age 51. Osteophytes, osteoarthritis, advanced fibrosis, collapsed vertebra, bone damage, multiple areas of radiculopathy, nerve root impingement and nerve necrosis. Participated in two comprehensive pain management programs. Conduct research into alternative treatments, including molecular pharmacology and interventional techniques in the management of chronic spinal pain.

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Reply: refills

If you almost always run out of pain medication too early, then one of the following could...

cweinbl
csw2@bex.net

Posted by cweinbl

If you almost always run out of pain medication too early, then one of the following could be the reason:

1. You are undermedicated. Either your medication is insufficient, the dosage is too low, the pain level has increased or you have become tolerant to the medication (or a combination of the above).

2. You are deliberately using it other than as directed. You are taking it too often, using it too many times per day or taking too much at a time.

3. You are using it for reasons other than for pain.

I could add a #4 (you are giving or selling it to others), but I do not wish to accuse you. This happens far more often than anyone can imagine.

It is critical to match the right medication and the right dosage for each patient's pain, ability to tolerate the drug and to avoid potentially serious side effects. Each of us has our own unique ability to benefit from any medication. Some of us very tolerant to opioids and require much higher dosages to manage pain. Others are very intolerant and must use very small dosages. Finding the right pain medication for any person can take months or even years to determine. In essence, you and your doctor must agree to try a dozen or so different medications, often in combination, to determine the best option.

Chronic pain is best managed by adding an anti-depressant to your pain medication. They inhibit the reuptake of Seratonin in the bloodstream. Seratonin is one of the body's own pain-fighting chemicals. If you have neuropathic (referant) pain, adding an anti-convulsant can also help.

Finally, if you have chronic moderate to severe pain, the best results are often obtained by using a long-acting and a short-acting opioid (the short-acting drugs is for breakthrough pain).

P.S. Pharmacists are a critical part of this process. They are not simply pill counters. They monitor how much medication you are using. Pharmacists are also under obligation to make sure that you cannot obtain your next opioid Rx early. Doing so could cost them their job. Your insurance coverage only allows for a certain number of pills per day. They will not pay to have it filled too early.

Please determine why you are running out habitually early. If you require a stronger drug because your pain has increased or because you have become tolerant to the current medication, talk to your doctor about it.View Thread

cweinbl
csw2@bex.net

Posted bycweinbl

5 Replies | Reply | Watch This DiscussionReport This| Share this:refills If you almost always run out of pain medication too early, then one of the following could...

Reply: What do these symptoms mean

Going to a chiropractor with an undiagnosed spine injury can turn into a lifelong pain...

cweinbl
csw2@bex.net

Posted by cweinbl

1 Reply | Reply | Watch This DiscussionReport This| Share this:What do these symptoms mean Going to a chiropractor with an undiagnosed spine injury can turn into a lifelong pain...

Includes Expert Content

Reply: Prolong pain after ruptured disc surgery

The good news: damaged nerves take a long time to heal; sometimes a year or longer. So, at...

cweinbl
csw2@bex.net

Posted by cweinbl

7 Replies | Reply | Watch This DiscussionReport This| Share this:Prolong pain after ruptured disc surgery The good news: damaged nerves take a long time to heal; sometimes a year or longer. So, at...

Reply: St.Jude spinal cord stimulator failure after 2 mon...

The most critical aspects with a spinal implant (SCS & Intrathecal Infusion Pump) are...

cweinbl
csw2@bex.net

Posted by cweinbl

31 Replies | Reply | Watch This DiscussionReport This| Share this:St.Jude spinal cord stimulator failure after 2 months The most critical aspects with a spinal implant (SCS & Intrathecal Infusion Pump) are...

Reply: getting kicked out of pain clinic

Sorry to hear that you were booted out for THC. Millions of chronic pain patients have...

cweinbl
csw2@bex.net

Posted by cweinbl

Sorry to hear that you were booted out for THC. Millions of chronic pain patients have discovered that THC has an additive effect to long and short-acting pain medications. Some thoughts:

1. Go back to your family physician or internist and ask if she or he will prescribe your required opioids. Many of us use a family doctor to prescribe everything. It makes obtaining and maintaining prescriptions easy. Unfortunately, many family physicians today have drastically reduced their opioid prescriptions. However, they remain capable of prescribing it for any patient in desperate need. Explain the situation factually. You might wish to exclude the suicidal part, since that could slam shut the door to a Rx there. No physician in their right mind will prescribe powerful opioids to a suicidal patient. But you may find that a family doctor will be much more compassionate than a PM clinic, where broken rules mean expulsion without empathy. If your family doctor will not comply, try to find another one.

2. If you live in a medical marijuana state, request a Rx from your internist or family physician. If the physician is recalcitrant, find a new one. If you do not live in such a state, consider moving to one.

3. Ask your internist or family physician for a Rx for Marinol. Many of us have experienced improved pain management with this off-label drug. Keep in mind that it takes much longer to work than inhaling the THC. It can take up to an hour before the initially-digested drug reaches peak plasma level. Some people discount its efficacy because Marinol does not provide that brief "kick" that is achieved by inhaling the drug. But hours later, when the inhaled drug has worn off, the digested drug is still on the job.

4. Purchase it on your own. I am reticent to recommend that anyone break the law. However, when a chronic pain patient is considering suicide because the pain remains largely untreated or undertreated, direct measures must be taken.

5. Use whatever mind-body technique that worked from PM. For example, many of us have discovered that we can significantly reduce our pain with biofeedback. The same applies to meditation, systematic relaxation and Yoga. I know, at best it is a minor asset. But every little bit helps.

6. Use distraction therapy. You might believe that this is a lame suggestion. However, some of us find it powerful. For me, it's writing novels, creating book reviews, sports and movies. When I am deeply engrossed in watching a film or writing a book, my pain is pushed back a notch or two. Like biofeedback, it helps.

Good luck!
View Thread

cweinbl
csw2@bex.net

Posted bycweinbl

(FromChronic Pain Management: Member Discussion)

53 Replies | Reply | Watch This DiscussionReport This| Share this:getting kicked out of pain clinic Sorry to hear that you were booted out for THC. Millions of chronic pain patients have...

Reply: Microdiscectomy - recovery question

I am that "vegetable." After three wicked disc herniations and four failed spine surgeries,...

cweinbl
csw2@bex.net

Posted by cweinbl

62 Replies | Reply | Watch This DiscussionReport This| Share this:Microdiscectomy - recovery question I am that "vegetable." After three wicked disc herniations and four failed spine surgeries,...

Includes Expert Content

Reply: Pain pills need to know where to start

Why are you taking them? What are they, in addition to "Lortab?" How many different...

cweinbl
csw2@bex.net

Posted by cweinbl

2 Replies | Reply | Watch This DiscussionReport This| Share this:Pain pills need to know where to start Why are you taking them? What are they, in addition to "Lortab?" How many different...

Reply: St.Jude spinal cord stimulator failure after 2 mon...

The SCS has a success rate of 40-60%, depending upon the existence of prior surgery. This...

cweinbl
csw2@bex.net

Posted by cweinbl

31 Replies | Reply | Watch This DiscussionReport This| Share this:St.Jude spinal cord stimulator failure after 2 months The SCS has a success rate of 40-60%, depending upon the existence of prior surgery. This...

Includes Expert Content

Reply: Central Sensitization Syndrome

Get another opinion from a spine surgeon. A spine surgeon is an orthopedic surgeon or a...

cweinbl
csw2@bex.net

Posted by cweinbl

11 Replies | Reply | Watch This DiscussionReport This| Share this:Central Sensitization Syndrome Get another opinion from a spine surgeon. A spine surgeon is an orthopedic surgeon or a...

Includes Expert Content

Reply: Methadone and Pain Doctors/Clinics

If you are on constant severe pain, methadone might not be the best answer. I agree that...

cweinbl
csw2@bex.net

Posted by cweinbl

If you are on constant severe pain, methadone might not be the best answer. I agree that the doage you provided is dangerously high. I suggest that this may not be the best way to manage your pain. Have you asked about other long-acting opioids, such as Oxycontin, Kadian or Fentanyl Transdermal? Fentanyl is the most powerful pain medication (80 times more potent than morphine). The key to pain management is with trial and error, finding the combination of medications that work best for your body chemistry. Combination is the appropriate word. I would accept as an axiom that anyone with chronic moderate to severe pain should be on an anti-depressant. They inhibit the reuptake of Seratonin (one of the body's natural pain-fighting chemicals). If you have referent pain, yuu should consider an anti-convulsant (Lyrica, Neurontin, etc.).

BTW, opioids are not particularly effective with migraines. There are other medication that are more efficacious for that disorder.

Medications are only part of the answer for chronic pain. Mind-body treatments can be very effective. I use biofeedback for my pain. Others in this category include systematic relaxation, meditation and Yoga. Some people swear by acupuncture, PT, kinesiotherapy, TENS, spinal cord stimulator or the Intrathecal Infusion (IT) pump. There are a variety of injections that may help. You should also consider distraction therapy. What are you deeply interested in? When I'm writing, reviewing or editing a new book, the distraction from my pain is wonderful. The same goes for watching an engrossing film or sporting event. Distraction therapy is efficacious.

Some people with chronic pain have tremendous relief from THC (yes, the active ingredient in marijuana). If it's still illegal in your state, you can obtain it by Rx. The medication is called "Marinol" (Elan Phamaceuticals). Any physician can prescribe it off-label for pain.

Think out of the box. Try something new. Use combinations of medications (of course, only those approved and prescribed by your physician). The more you try the faster you'll discover the best combination for you. It took almost 15 years of trail and error before we found my best combination. I hope that you will find yours much faster. Good luck.View Thread

cweinbl
csw2@bex.net

Posted bycweinbl

26 Replies | Reply | Watch This DiscussionReport This| Share this:Methadone and Pain Doctors/Clinics If you are on constant severe pain, methadone might not be the best answer. I agree that...

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