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There has been an ongoing barrage of news media attention focusing on overdose deaths due to prescription opioids, suggesting that the issue has reached "dangerous" or "alarming" levels of epidemic proportions. In response to these statistics we've seen an almost mob-like crusade to track down and punish incompetent, unethical, "pill mill" physicians and their practices. At the same time, there also seems to be a push to punish and/or eliminate the pain physician who by some mysterious standard is considered to be over-prescribing pain medications, and/or prescribing medications in "extraordinary" or inconceivable combinations.
These assertions fly in the face of science, and the experiences of the untold myriad of patients who literally have new, functional lives, less troubled by the specter of chronic debilitating pain. These patients still have pain and they always will suffer from it; however, with the right combination of medications — including and especially opioid medications — they once more can experience lives that contain a modicum of tranquility.
Great medical benefits are bestowed upon the vast majority of these patients with chronic pain who are prescribed opioid analgesics. They and their families attest that this is so, and with an objective eye, doctors see the benefits as well.
What will follow in this series are Dr. Sachy's personal experiences and opinions regarding the anti-opioid medication hysteria that is gripping this nation, and a rational defense of long-term opioids which, if not diverted or abused, are an absolute medical necessity, if not a medical miracle, in an inflexible world that predisposes humans to chronic pain disorders and other related neuropsychiatric diseases.
Read this article and future articles in Dr. Sachy's series here: http://updates.pain-topics.org/2011/12/tales-from-trenches-in-war-on-pain.html .
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NEED HELP PLEASE......View Thread
Chris.View Thread
Now my Dr. that is prescribing me this dosage has only a small handful of pts. that he sees for pain management and he is almost 70 so you can see my concern I have been searching for another Dr that would be willing to take over when the time comes the reactions I have received because I am a long term pain patient and the dosage. Most Drs. have signed contracts with heavy emphasis on the mg per day that is to not exceed 200 or they will not take me at all due to narcotics and I have too many problems that exceed their time limits. I am now looking for Drs. 75 mi. from home and my husband and I have talked that there is a possibility that we might have leave our home and move if I have to go to far for medication. I have also done the injections but one of the medical works have told me also once you have to go over the 200 you automatically have to go to a pain clinic the UP clinics do not do narcotics and I can no longer have any more injections the pain clinic on the other state side want you off all narcotics and basically start you all over again but they still have a dosage they prefer not to go over.
I think of this and the pain in my back neck and shoulders that is into my legs that is a deep knawing pain to touch me is sending out currents of pain I start crying just the thought of that constant pain. I am not pain free I know this is the best I will be I can handle this but to go back to the way I was I sincerely do not think I could get thru it.
I have tried to talk to my congressman/woman who tried to find some thing in my area no luck part of this pain management is political and this is not going to change unless our state reps help what they are paid for find out in there healthcare views.View Thread
If you don't know what it is read about it as I can't explain it.
If you can help me deal please reach out!View Thread
I have polyarthritis and five artificial joints. I have two large dogs and two teenagers. I do not get much support from my ex-husband and he still makes very rude and humiliating cracks about my being on disability.
I use a wheelchair and walk with a cane. My former mother-in-law is forever blaming me for her son's problems. She makes conintual remarks to my children. So the psychological barriers to me are the most difficult to break. When people around me sound petty, I try to educate them about assumptions. I had to go to a food bank when I could not work and had no income.
It is unfortunate that have a disability or a handicapping condition in our culture is still considered a stigma. I have a doctorate and feel very guilty about not working and it is still most significant loss for me.
I will tell you that I have never worked harder in my life to have a life and make the most out of this wacky body. I have to look at it like I am driving a tank and that I can only go where my tank will go and use it to my best defense. My brother a retired veteran, taught me that!View Thread

About a month later I was experiencing numbness, tingling and pin and needles thru-out my upper extremities plus headaches (progressive neurological symptoms)
. My ortho ordered an MRI with showed 3 cervical herniations with stenosis
. I f/u with the ortho when the results were ready. He recommended an EMG, neuro consult for the headaches and to f/u with the spine specialist. The latter freaked me out b/c I feared the spinal surgeon would automatically recommend surgery. My ortho doc also said to continue PT. In the end of July I felt pins and needles at my lower extremities. In early August, I finally got an appt to see the neurologist who ordered an MRI of the lumbar spine which showed disc herniation in two locations with impingement. He performed the EMG and NCV both were positive and indicative of carpal tunnel syndrome and pinch nerves in the upper and lower extremeties. The ENG confirmed vestibular neuronitis and BPPV. The neuro said to continue to PT.
In third week of august the headaches which I thought were improving with traction and PT, were becoming chronic and all day with no breaks and no relief from the NSAIDs. And I was experiencing shoulder and upper arm flares (burning pain and pins and needles)which lasted longer than a few minutes
. The neuro gave me a stronger oral NSAIDs to take daily and an NSAID cream which has helped tremendously. I still feel heaviness and pressure in my head. Pins and needles do come and go but I have not experienced a flare. The neuro guy said to continue PT.
The following week I saw the spine specialist, who said 80% of patients improve with conservative treatment but are not necessarily 100% better or back to "normal" He said 20% of patient get progressively worse. He said to continue PT and to f/u in two weeks. Practically the following day I experience lip numbness.
I believe PT has helped with my neck ROM. I am not as stiff. Since I've been going I wonder if PT has maintained neck ROM or have I already recovered. However, depending on my neck positioning, I feel discomfort, pin and needles. Regarding my lower back I feel pins and needles and a constant dulling and heaviness. The pins and needles concern me more than the lower back dulling ache.
So thats my history up until now. My question is based on my history is PT futile or is it worth it to continue. The spine specialist said that NSAIDs and PT will only provide temporary relief. And only time will tell whether how significant is my recovery.
What is your personal experience? I may consider ESI so I don't have to take NSAIDs on a daily basis, but I am freaked out . I look forward to all comments and or advice.
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My surgeon placed a Brace in my back and then fusion's grow into
BRACE..............
The brace has 2 bars on each side ( left & right ) anf then a top bar.
They used screws - painful because I feel it, and they did 4 fusions.
I know it was L4 - L5, but the other's I can not recall.
They pulled my spinal cord back into place due to my disc's rubbing on spial cord for yrs. Also some degererited all disc where bone on bone.
So much more was done in the 10 1/2 hour's of surgery.
Currently, my P.A. who works w/ surgeron is starting to tapper me off one of my pain meds ( not doing well w/ that ) then I insitied for a pain med, and he gives my low dose of OXY/325 tylenol.
I see my P.A. at the spine clinic next week, due to having to do a cat-scan because they are worried about something.
When I go next week I honestly feel like I amgoing to blow too much steam at him.
Still cannot wash my laundy, dish's, vacume, bathing ( even though I have a shower chair, and take off shower hose) I have days that I am in bed for 7-9 dyas do to pain.
Two mo's ago my X moved in to help ( we were not married, but togeather for many yrs ) he helps, but also has a F.T. job M-F,
After all that venting, is anyone experincing what I am going though?
Is anyone using differnt kinds of pain mgnt.?
I'm bad have not been doing my re-hab, P.T. due to sleeping too much, and my painView Thread
Researchers at Stanford University, California, conducted a longitudinal, MRI study examining 10 individuals with chronic, moderate-to-severe, nonradicular low back pain who were administered long-acting oral morphine (MS-Contin) daily for 1 month [Younger et al. 2011>.[a name="more"> Brain imaging was conducted immediately before and after the morphine administration period, and a third time at an average follow-up of 4.7 months. Similar imaging was conducted on a separate group of 9 subjects with chronic low back pain, receiving a blinded placebo substance for the same time period, to serve as a control group for determining if any brain changes might occur that were not specific to opioid administration.
Results reported in the August 2011 edition of the journal PAIN indicate that 13 brain regions in morphine-administered subjects evidenced significant volumetric change, and the degree of change in several regions correlated with morphine dosage. Dosage-correlated volumetric, gray matter decreases were observed in limbic areas, primarily in the right amygdale. On the other hand, dosage-correlated volumetric increases were seen in select limbic and cortical structures: the right hypothalamus, left inferior frontal gyrus, right ventral posterior cingulate, and right caudal pons.
Prior evidence has demonstrated that chronic pain itself influences important changes in brain structure and function. In this current study, significant changes were observed in brain structure attributable to morphine administration. But here is the most important question for further research: Were these morphine-induced brain structure alterations potentially harmful or, equally likely, of benefit in helping to reverse the neurobiological damage of chronic pain and returning the brains of suffering patients to a more normal state?
While the authors imply that these neuroplastic changes might be detrimental, it seems equally likely that long-term opioid administration restores the pain-altered brain to a more normal, healthy state. Thus the increases in limbic matter in select limbic and cortical structures: (the right hypothalamus, left inferior frontal gyrus, right ventral posterior cingulate, and right caudal pons) might be the brain's way of compensating for the decreases in other limbic areas.
Much more research, using much larger groups, is in order. At this point (and we can only guess), the brain changes from chronic pain appear detrimental; but the changes from opioid administration may be both detrimental and beneficial. The body has miraculous recuperative capacity, perhaps expressed with the greatest complexity within brain structures. Thus a decrease in one part of the brain that correlates with opiate administration may well be compensated for by the brain's new increase in another structure.
Read the entire article and commentary here: http://updates.pain-topics.org/2011/07/brain-changes-wrought-by-opioid.html .
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The authors conclude that, despite important advances in understandings of the mechanisms underlying pain and a growing range of treatment options, overall effectiveness remains inconsistent and poor. "Of all treatment modalities reviewed, the best evidence for pain reduction averages roughly 30% in about half of treated patients, and these pain reductions do not always occur with concurrent improvement in function."
Because current treatments by themselves provide only modest improvements in pain and physical and emotional functioning, future research should focus on the effectiveness of combining various treatments; such as, combinations of several drugs, combining drugs with physical treatments, and pharmacological combined with psychological treatments.
For the foreseeable future, they note, "people with chronic pain will continue to live with some level of pain irrespective of the treatment or treatments they receive." Therefore, chronic pain management should include a "dialogue with the patient about realistic expectations of pain relief, and bring focus to improvement of function."
A companion editorial to The Lancet series on pain reminds healthcare providers of their ongoing obligation to manage pain more effectively and states the following…
[blockquote>In 1931, physician and philosopher Albert Schweitzer said: "We must all die. But if I can save [patients> from days of torture, that is what I feel is my great and ever new privilege. Pain is a more terrible lord of mankind than even death itself." To help eliminate or mitigate an individual's pain is a privilege that clinicians must neither forget nor neglect.
http://updates.pain-topics.org/2011/06/common-treatments-fail-to-relieve.html
[/blockquote>View Thread
I want to take dilaudid for my extreme pain, I have an enormous tolerance for drugs so I have to have a good drug. I hate oxycodone,, vicodin does not work - I have had dilaudid with an IV and it was the first drug that not only took the pain away, it really calmed me down but I have no idea if doctors prescribe it ? Does anyone know ?
AllisonView Thread
please let me know because hes suffering and doesnt want to get his tooth pulled and hes in dire pain. i hate to see someone suffer, and hes afraid to tell them that he's on methadone because they won't give him anything to take the pain away, or that they'll look at him differently.View Thread
These are not your ordinary cramps. My feet cramp so bad I an unable to do anything besides sqwat and put pressure on the balls of my feet or bend my toes back toward my calves to get relief. They are so bad sometimes I can't even walk. I try and try to stand up and move around the room but it's nearly impossible. Every time I try to stand up they cramp and I find myself swatting in the floor bawling my eyes out. Lately the cramps have been accompanied with numbness and pain up my legs, not to mention a strange crawling feeling on my feet. I had a bad spell last night and my feet cramped most of the night. My husband had to carry me to where I needed to go because I could not walk . It's embarassing to be temporarily crippled by something as small as a muscle cramp. Today my feet hurt and keep trying to cramp, my legs ache and as I sit here I am on the verge of tears. When I walk it feels as if my feet have no tissue and I am walking on bare bones. I've also had numbness in my hands and they quite frequently feel as if they are dislocated, but this is not nearly as big an issue as my feet. I have no idea what doctor to go to. I have other minor health issues such as migraines, chronic dizziness, low blood sugar and low back pain. I am in fear that there is a underlying cause for all of these issues, but I don't even know what doctor to start with!! Any any any advice would be much appreciated.
Thanks, Misty
PS...I've researched foot cramps. I've tried magnisum, calcium, potassium, natural tonics, warm baths, muscle rubs and etc etc... nothing helps.View Thread
New research from McGill University reveals that this cortical thickness is reversible when the pain is relieved. Read the research here: http://updates.pain-topics.org/2011/06/treating-back-pain-reverses-brain.html
After successful pain treatment, patients exhibited increased cortical thickness in the left dorsolateral prefrontal cortex (DLPFC), which had been thinner before treatment compared with controls. The DLPFC plays an important role in pain perception and its increased thickening correlated with reductions of both pain and physical disability. Additionally, increased thickness in the primary motor cortex was associated specifically with reduced physical disability. In terms of cognitive performance, left DLPFC activity during an attention-demanding task was abnormal before treatment in patients with CLBP but normalized following treatment.
It should be noted that all of the chronic pain patients whose pain was not successfully treated in this group failed show an increase in brain mass at the conclusion of the study. This validates the fact that only successfully treated brains produced reversed (improved) cognitive functioning.View Thread
I was discharged from the army due to tearing my acl in my right knee. A buddy of mine says the pain in my ankle is probably from compensating and leaning on the left side.
I dont have insurance and the veterans dept tells me i have to wait about 4 months for paperwork before they will see me. I am debating on going into the er to see someone but I really cant afford it. My question is if I wait for the 4 months to pass will I have significant damage to my ankle? And what could this be thats causing my pain?
thanks in advanceView Thread
I started losing weight last year, I admit that I probably lost it much faster then is healthy. Since around the fall of last year I have had a couple of episodes of really intense pain (on a scale of 1-10 I'd put it at a 8-9 the kind of pain that you'd rather just die) and would last a couple of hours each time. Since these episodes occurred late at night and I didn't want to wake up my parents to go to the hospital at first I didn't say anything. Now that I've been maintaining my weight for awhile these episodes actually seem MORE frequent (and they aren't just in the evening and very late at night) but they last far less time (maybe... 30 minutes to an hour?) and aren't nearly as painful (maybe a 3 or 4?)
The pain itself is muscle pain. It feels as if every muscle in my upper body from my shoulder blades, the muscles under my breasts, my abdominal muscles, the muscles in both my upper AND lower back are all cramping up at once. At one time it had gotten to the point where it was difficult to move around and getting hard to breathe because all of the muscles were so tight. While the pain itself has a gradual onset of the muscles tightening: often when it ends it's just a release of the tension all at once with the pain just melting away with the relief.
Nobody knows what it is.
Other then these episodes I'm a perfectly healthy young woman. My neurological functioning is fine, my blood pressure is normal, I've had blood tests done and the only issue was that I had slightly elevated liver enzymes, but not enough to warrant any actual concern. I do have anxiety and depression (which I'm not on any treatment for) but I know for a fact that this isn't psychological pain since it's pretty clear it's not just pain and has an identifiable physical cause. The only problem is I don't know what is triggering my muscles to just... spasm.
While I'm not overly concerned that this is a serious medical issue: I really wish I knew what it was so that I wouldn't have to worry about being in that kind of pain anymore. Even now while I can function during these episodes they are still on the painful side and are nauseating.View Thread
Thanks!View Thread
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