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Thread: Long Acting Pain Meds; Lesser of the Evils

  1. #21

    Why can't it be easy?!?

    Alan - the medications and related issues have been harder for me to deal with than the injury. Did you ever find some relief?

    I'm back to square one. After looking up Amitrioptyline, I saw that it's an anti-depressant. I went through the gambit of these with my PCP at the time of the accident and could not tolerate any of them. I also noticed it has a brand name of, Alavil which I took in the late 70's. I have no idea why I would have been put on a, "nerve pill", (as it would have been called back then), but I clearly remember my blood pressure bottomed out, and there was an issue with my heart condition, Mitral Valve Prolapse. It was given to me at the same time I was diagnosed with Mitral Valve Prolapse so I want to think it was for that condition but the Pharmacist said, (in an nasty tone), it is NOT and never was used as a heart medication. I'm so confused!!!!

    In the meantime, I'm still short per day on PMs, and no return call from the Dr., regardless of explaining the situation, misery, and breathing trouble. The increased pain I understand but not the increased spasms and breathing trouble.

    Trying hard not to rant....
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  2. #22
    Do you experience AD? If so that could explain the breathing trouble with the increased pain. It is very important that you also allow the tension from the spasms to release. Perhaps some stretching, etc. If you continue to have breathing problems and/or low blood pressure use good judgement and contact a physician if you feel necessary.
    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  3. #23
    No AD, RRob. My blood pressure is good now - I never picked up or started the Alavil. I'm not even sure why or for what reason he choose this med. At first, I thought it was a long acting pain med that no one mentioned here...haha!

    Fatigue and stress are probably at the root of the spasms and breathing difficulties. I'm so disappointed, no make that angry, at my doctor for changing my meds when things were going well. I hate telling the kids that we won't be going on vacation AGAIN because of my medical problems.

    BUT, such is life....


    Quote Originally Posted by russianrob View Post
    Do you experience AD? If so that could explain the breathing trouble with the increased pain. It is very important that you also allow the tension from the spasms to release. Perhaps some stretching, etc. If you continue to have breathing problems and/or low blood pressure use good judgement and contact a physician if you feel necessary.
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  4. #24
    Just trying to make this mess make sense... more or less venting and bouncing this off the forum because I'm tired of the pain... Amitrioptyline, aside from an anti-depressant, can also be used for nerve pain. When I was diagnosed with Mitral Prolaspe of the heart, I also had the measles - the cause of MVP. Could it be possible that the Amitrioptyline was given to me because of pain from the measles? Any pharmacist here...LOL. I was a teenager at the time. I remember it well because I was laid out, and my Grandmother came to stay with me so my Mother could go back to work. Unfortunately, they're not around to ask. Sooooo, if you were in my shoes, would you try this medication again? I still haven't picked it up.

    I'm at a loss (as is my husband, who was sitting there too), for why my doc wanted to increase my Hydro dose, lower the acetaminophen or change me to a long acting pain med, but instead, lowered my current dose of PM's and Rx'ed Amitrioptyline when I take something for nerve pain at night and have Valium if needed. He's also aware to I don't react well to anti-depressants.

    Four years post and I'm still doing the pain dance... un-freakin-believable! OK, I'll stop with the cyber venting, (too much time on my hands, staying still so to not stir the pain monsters while I get through this dilemma de jour.)

    Thanks again for the help, everyone! I'm at least well versed on the long acting meds should my Dr. revisit the subject...
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  5. #25
    Please don't worry about ranting, Charlotte, it's an unavoidable side effect of trying to live with and manage central pain.
    Quote Originally Posted by Charlottes Web View Post
    Amitrioptyline, aside from an anti-depressant, can also be used for nerve pain. Sooooo, if you were in my shoes, would you try this medication again?
    I would definitely try it. Amitryptiline (brand name Elavil) ended up being a pretty lousy anti-depressant and is rarely prescribed for that purpose anymore; it's used almost exclusively to treat neurogenic pain. It does cause drowsiness, which is why it's taken at bedtime. For most people, the drowsiness wears off by the next morning, although it may take anywhere from a few days to a few weeks for your body to adjust to the medication.

    My belief is that if you're hurting really bad, *everything* is worth a try. Take it for a few weeks to a month. You can always discontinue it if the side effects are intolerable and/or you don't think it's helping.

    Quote Originally Posted by Charlottes Web View Post
    I'm at a loss (as is my husband, who was sitting there too), for why my doc wanted to increase my Hydro dose, lower the acetaminophen or change me to a long acting pain med, but instead, lowered my current dose of PM's and Rx'ed Amitrioptyline when I take something for nerve pain at night and have Valium if needed. He's also aware to I don't react well to anti-depressants.
    The doc wants to get you away from acetaminophen because it's very easy to damage your liver by taking more than the safe dosage (which was just lowered per dose and per day). He likely suggested increasing the hydro dose to compensate for the pain relief you'll lose when you're no longer taking the acetaminophen.

    Long acting pain meds are preferable for managing chronic pain to short acting meds. With short-acting meds, you're riding a pain roller coaster and always playing catch up after you're hurting. Taking long-acting medications levels out the track by keeping the pain levels low -- you get better pain control, and you can actually end up taking less medication.
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  6. #26
    Aww, thanks, Crip for reading my rant. I'm not one to whine but had a pretty rough time getting the pain under control yesterday. My meds have been in good shape since last visit to my Neuro, last (3 months), so I had my husband plant the garden, put out more flowers, and we've planned a vacation. We haven't been able to do this successfully since the accident. I am so excited about the gardens, and the beach but afraid I'm not going to be able to keep up the gardens or tolerate traveling on less medication. That makes me mad at the Dr. and in general, hence the rant.

    When I realized this SCI is for keeps, I was concerned about the acetaminophen, and the docs have tried to decrease the dose. But they give up on the 325 combination because of my yellow dye allergy. It usually turns out the Dr. gets frustrated with the Pharmacy or vise versa, and I end up back to point A (500 Acetaminophen), with everyone frustrated at me.

    If my Dr. doesn't return my call today, I'll set up an appointment to go over his math again. My husband feels bad because he agreed with the the math at my last visit. They're both getting pocket calculators for Christmas! LOL

    Thank you for your post. I agree, the long acting medication will probably keep my pain under control better than my current semi PRN program and end the acetaminophen battle for good.

    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  7. #27
    If I read your first post correctly, you were doing ok with 30 mg of hydrocodone/day but the tylenol made you sick. Here's some info on different opiods and their strength. You'd likely get the same pain relief from 15-20 mgs of short-acting oxycodone in 5 mg tablets. Methadone is tough to discontinue and it builds up in your system. Morphine tends to be 'itchier' and cause more nausea.
    http://en.wikipedia.org/wiki/Opioid_comparison

    I'm guessing you have muscular/joint pain...small doses of short-acting opiates work well for that, in my experiences after shoulder surgery. Or long-acting formulations like extended release oxycodone. An extended release form of hydrocodone is supposed to become available. Buprenorphine is also being used for pain.


    When I get nervous and upset I seem to have trouble breathing... mini -panic attacks about pain!


    It's my opinion that some docs will try every non-pain medication such as Elavil, gabapentin, etc, etc in an effort to avoid opiates. (My apologies to those for whom these medications work). You might end up with no pain relief but the joys of the side effects.


    Google search all the medications they're considering; the Wiki articles have enough medical oversight/review to be very accurate. Google search side effects too.


    I really hope you get some relief and can enjoy your summer and your vacation.

  8. #28
    Avictoria, no side effect issues with Tylenol, the Dr. has issue with my liver and long term use of Tylenol (acetaminophen). Although my liver is in good standing now, I have concern also. BUT, isn't all of it toxic in some form?!

    Yes, I have plenty of muscular pain from my shoulders. I've dealt with that and the surgeries without pain medicine since 1987. My fear of the stronger drugs, even in small doses, comes from having them Rx'ed post-op shoulder surgery and the meds making me too high and not in control of myself. Comical for others! I'm breaking the 10 Hydro's in half now, too strong!

    How is your shoulder(s)? How far out are you post-op? Did you injure your shoulder(s) post SCI?

    You're spot on, most of the Dr.'s in this State avoid Opiates - they're scared the DEA will barge into their offices. IMO, SCI patients should be exempt from the "war on drugs" as Cancer patients are. There is no cure OR treatment for us! I just can't get used to gov having so much control over my quality of life but I can only tolerate so much pain before I say Uncle to the pills and the screwed up system that comes with them.

    I'm scheduled with the doc next week. After all the research I've done, and all of you with your helpful replies, he'll probably never mention long acting PM's again!!! LOL

    Regardless, thanks for the information and good wishes! I'll post back with an update after my appointment. In the meantime, enjoy your summer too!

    T


    Quote Originally Posted by avictoria View Post
    If I read your first post correctly, you were doing ok with 30 mg of hydrocodone/day but the tylenol made you sick. Here's some info on different opiods and their strength. You'd likely get the same pain relief from 15-20 mgs of short-acting oxycodone in 5 mg tablets. Methadone is tough to discontinue and it builds up in your system. Morphine tends to be 'itchier' and cause more nausea.
    http://en.wikipedia.org/wiki/Opioid_comparison

    I'm guessing you have muscular/joint pain...small doses of short-acting opiates work well for that, in my experiences after shoulder surgery. Or long-acting formulations like extended release oxycodone. An extended release form of hydrocodone is supposed to become available. Buprenorphine is also being used for pain.


    When I get nervous and upset I seem to have trouble breathing... mini -panic attacks about pain!


    It's my opinion that some docs will try every non-pain medication such as Elavil, gabapentin, etc, etc in an effort to avoid opiates. (My apologies to those for whom these medications work). You might end up with no pain relief but the joys of the side effects.


    Google search all the medications they're considering; the Wiki articles have enough medical oversight/review to be very accurate. Google search side effects too.


    I really hope you get some relief and can enjoy your summer and your vacation.
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  9. #29
    Senior Member alan's Avatar
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    I've never found any relief. I just get worse. I hope you find some.
    Alan

    Proofread carefully to see if you any words out.

  10. #30
    Hey Tina

    My shoulder injury and surgery was post-SCI. Surgery (acromioplasty) was 7 years ago. It took months to heal and the bone pain was awful. I still have flare-ups of pain but have found that doing a lot of swimming and range-of-motion really protects the joint and prevents strain and pain. I take 2.5-5 mg oxycodone when the pain is particularly bad and that works well. I try and take it intermittently and at very low doses to prevent any physical dependence and keep the side effects to a minimum. The swimming really helps a lot. Hope this info is useful!!

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