Some Pain Advice ... please

david65 · 08-25-2003, 11:00 AM

How do SCI people deal with hemorrhoids that hurt or a fissure that won't heal. The colostomies seem to be painful and cause more problems with gas and UTI's, which just adds to the not being able to sit up. Does Botox help to take away the pain in the anus. Also, does 4-AP seem to help anyone and would a good doctor prescribe this for me. Any th8ing else that works on stomach, intestional, and anus pains available please?

David65

P.S. - anyone know of a great pain doctor!

Wise Young · 08-25-2003, 12:14 PM

David65,

I can't judge from your description what is going on in your situation. As you know, the approach should not be to take a drug to get rid of pain in the stomach, intestinal, and anus. Rather, the approach should be to eliminate the causes of the pain. I am not sure that you need a "good pain doctor" as much as a good surgeon who can deal with your intestinal and anal problems.

Botox does not get rid of pain... it simply damages motor axons and reduces muscle strength. While 4-aminopyridine may reduce neuropathic pain, it may uncover real noxious pain that may be masked by spinal cord injury.

I gather that you have painful hemorrhoids with fissures that are not healing. Is your doctor considering a temporary colostomy to allow the area to rest and heal? I am not sure that I understand what you are referring to when you say that colostomies seem to be painful. To my knowledge, they should not be painful.

Wise.

david65 · 08-25-2003, 02:54 PM

Dr.

The ileostomy I now have is causing me problems with diversion colitis and gas trapping and more frequent uti's. For me, sitting on a commode chair was helping me to flush out my bladder.

It is the combination of all my problems that slows down the healing of my fissure. It will be 49 weeks this Friday since I have gotten the ileostomy. Also, this Friday, I am scheduled to have the ileostomy reversed and will try the suppositories.

If I should not heal the fissure again, then I will need a pain doctor to help me. That is why I have been so adament about a nice and effective way of irrigating the rectal bowel.

Sincerely,

David65

Wise Young · 08-31-2003, 03:34 AM

David,

Thanks. Your explanation really clarified a lot. 49 weeks is a long time, more than sufficient for the fissure to heal. I wonder why it is not healing.

One possibility is that you are not having pain from the fissure but the pain may be related to the diversion and perhaps irritable bowel syndrome. I understand that you are in hospital to get the ileostomy reversed and hope that this solves some of the problems.

What is your spinal cord injury level? The reason that I ask is that you must have a lot of sensation to feel so much. If so, one other possibility is that you may have a component of visceral central pain.

Wise.

david65 · 09-09-2003, 06:06 AM

Dr. Wise,

I cannot explain my pain except that spasms get worse if there is a uti or in my case, a non healing fissure. The reversal failed maybe because of two days of diarrhea in hosptial could have irritated it. Diet from the ileostomy was slim pickings but still wonder why it did not do better. Do get up rarely.

I had the choice of trying a colostmy. If I learn to irrigate - I hope to get my third chance this Oct. or Nov. Currently, the more gas I create the greater the pain, every where. A Catch-22, a problem causeS gas, therefore I cannot tolerate pressure on my fissure by sitting. If no gas forming, then no painful sensation - I can sit then!

I probably have neurpatic complete injury but I still am not too sure yet. C-5 for 15 yrs. is my injury. Do you think 4AP may help my perceptin with pain and if so who or how can I get a prescribed medical medication????

David65

[This message was edited by david65 on 09-09-03 at 09:19 AM.]

Wise Young · 09-09-2003, 03:42 PM

David, it sounds like you have a combination of pain stemming from fissures, gas, and surgery. Since it is positional, it is not as likely to be neuropathic pain. Let us hope that your gas problems resolve and you can get your colostomy reversal. I don't think 4-AP will help much in this situation. Note that 4-AP increases sensation and may aggravate pain. Wise.

whiterabbit11 · 09-10-2003, 08:08 PM

I tried 4AP and it seemed to help my coughing and could wiggle my fingers better but the pain down my right side became much worse and finally had to give it up, plus It gave me irritating heartburn. Be careful with 4AP if you have back and side pain it can make it unbearable.WR

08-25-2003, 11:00 AM	#1
david65 Senior Member Join Date: Apr 2003 Posts: 1,025	Some Pain Advice ... please How do SCI people deal with hemorrhoids that hurt or a fissure that won't heal. The colostomies seem to be painful and cause more problems with gas and UTI's, which just adds to the not being able to sit up. Does Botox help to take away the pain in the anus. Also, does 4-AP seem to help anyone and would a good doctor prescribe this for me. Any th8ing else that works on stomach, intestional, and anus pains available please? David65 P.S. - anyone know of a great pain doctor!

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08-25-2003, 12:14 PM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	David65, I can't judge from your description what is going on in your situation. As you know, the approach should not be to take a drug to get rid of pain in the stomach, intestinal, and anus. Rather, the approach should be to eliminate the causes of the pain. I am not sure that you need a "good pain doctor" as much as a good surgeon who can deal with your intestinal and anal problems. Botox does not get rid of pain... it simply damages motor axons and reduces muscle strength. While 4-aminopyridine may reduce neuropathic pain, it may uncover real noxious pain that may be masked by spinal cord injury. I gather that you have painful hemorrhoids with fissures that are not healing. Is your doctor considering a temporary colostomy to allow the area to rest and heal? I am not sure that I understand what you are referring to when you say that colostomies seem to be painful. To my knowledge, they should not be painful. Wise.

08-25-2003, 02:54 PM	#3
david65 Senior Member Join Date: Apr 2003 Posts: 1,025	Dr. The ileostomy I now have is causing me problems with diversion colitis and gas trapping and more frequent uti's. For me, sitting on a commode chair was helping me to flush out my bladder. It is the combination of all my problems that slows down the healing of my fissure. It will be 49 weeks this Friday since I have gotten the ileostomy. Also, this Friday, I am scheduled to have the ileostomy reversed and will try the suppositories. If I should not heal the fissure again, then I will need a pain doctor to help me. That is why I have been so adament about a nice and effective way of irrigating the rectal bowel. Sincerely, David65

08-31-2003, 03:34 AM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	David, Thanks. Your explanation really clarified a lot. 49 weeks is a long time, more than sufficient for the fissure to heal. I wonder why it is not healing. One possibility is that you are not having pain from the fissure but the pain may be related to the diversion and perhaps irritable bowel syndrome. I understand that you are in hospital to get the ileostomy reversed and hope that this solves some of the problems. What is your spinal cord injury level? The reason that I ask is that you must have a lot of sensation to feel so much. If so, one other possibility is that you may have a component of visceral central pain. Wise.

09-09-2003, 06:06 AM	#5
david65 Senior Member Join Date: Apr 2003 Posts: 1,025	Dr. Wise, I cannot explain my pain except that spasms get worse if there is a uti or in my case, a non healing fissure. The reversal failed maybe because of two days of diarrhea in hosptial could have irritated it. Diet from the ileostomy was slim pickings but still wonder why it did not do better. Do get up rarely. I had the choice of trying a colostmy. If I learn to irrigate - I hope to get my third chance this Oct. or Nov. Currently, the more gas I create the greater the pain, every where. A Catch-22, a problem causeS gas, therefore I cannot tolerate pressure on my fissure by sitting. If no gas forming, then no painful sensation - I can sit then! I probably have neurpatic complete injury but I still am not too sure yet. C-5 for 15 yrs. is my injury. Do you think 4AP may help my perceptin with pain and if so who or how can I get a prescribed medical medication???? David65 [This message was edited by david65 on 09-09-03 at 09:19 AM.]

09-09-2003, 03:42 PM	#6
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	David, it sounds like you have a combination of pain stemming from fissures, gas, and surgery. Since it is positional, it is not as likely to be neuropathic pain. Let us hope that your gas problems resolve and you can get your colostomy reversal. I don't think 4-AP will help much in this situation. Note that 4-AP increases sensation and may aggravate pain. Wise.

09-10-2003, 08:08 PM	#7
whiterabbit11 Senior Member Join Date: Feb 2002 Location: middle of nowhere Posts: 565	I tried 4AP and it seemed to help my coughing and could wiggle my fingers better but the pain down my right side became much worse and finally had to give it up, plus It gave me irritating heartburn. Be careful with 4AP if you have back and side pain it can make it unbearable.WR