Originally Posted by Neurochic

Hi Emily

If you weren't feeling constantly drowsy in the extreme, there would be something wrong with you!!!

Every single drug you are taking orally has drowsiness as a common side effect. The promethazine is used (amongst other things) as a pre-operative sedative because it causes such excessive drowsiness. It won't matter how much you sleep, you will still feel knackered and exhausted unless/until your body adjusts to the side effects of the medication. I'm not sure why you were prescribed the promethazine - it has many uses - but it may be one sedative too many!!

You need to push to get agreement as to which doctor is going to take the over-arching management of your medication. You need to force them to agree who is going to have the principal role in your prescriptions. It is not acceptable to tell you to go to the ER if you cant cope - thats just them dumping the problem elsewhere and not taking responsibility as they should. In addition, this is the start of a journey with a chronic pain condition. It's not manageable via regular visits to an ER department whencyou are atvthe point of being too distressed to cope. It requires a quite different form of long term management which they have to help you with - that is what they get paid to do.

Then you need to discuss and consideration your doctors:

1. revisiting the dosages of the medications and consider dropping the doses back down with a view to then increasing each one much more gradually to see if your body is able to cope better with the side effects via a much more gradual ramp-up;

2. Revisiting the total number of drugs and potentially stopping one or more of them, perhaps temporarily, until you can get a grip of the drowsiness and it subsides as your body gets used to the drugs. You could then add the meds you stopped back in one at a time with a very gradual ramp up to see if you get fewer side effects; or

3. Determining which of these drugs are actually having a sufficient effect on your symptoms to live with the levels of side effects and stopping anything that isn't working or anything where the awfulness of the side effects outweighs any benefit.

I think I mentioned that this is a long process and that goes for testing out the different drugs and giving them long enough in your system to see if your body adjusts. Sometimes no matter how slowly you increase the dosages, there are drugs that your body doesn't adjust to. Sometimes the relief you get is just not enough to make the side effects worthwhile. Only you can make those judgements because only you can determine how much relief you get from each one and what level of side effects you can cope with. Don't give up too quickly though - you could miss out on a really effective drug because you didn't persevere for a few weeks or months to let things settle.

It sounds as though you have been prescribed the Prilosec to protect your stomach and deal with the reflux issues - it is a proton pump inhibitor and its common practice to prescribe these drugs with anything that has a risk of irritating and damaging your stomach lining. It is a sensible precaution to take this to prevent ulcers or bleeding. It should kick in to settle the reflux type issues you are having.

I would have thought it very unlikely that the sympathetic nerve block had anything to do with the reflux issues. The fact is, you have started on a whole series of new medication just around the time of the block and it can take a few weeeks for a new drug to cause enough irritation for the reflux type symptoms to start presenting. If they go on for any length of time then it is also more likely to be the oral medication than anything to do with the sympathetic nerve block.

Have you told your doctor about the blood in your bowel movements?

Remember that drugs like tramadol are constipating and constipation is the one side effect that your body will not normally adjust to with opiods, no matter how long you take them. Many people have to take some kind of laxatives if they use opiods long term. It may be that the blood is being caused by constipation/straining especially if it is bright red. However, it could be related to one of your other drugs or it could be something totally unrelated, especially if you have a history of haemorrhoids, so it makes sense to just talk to your PCP about this.

It's not a surprise that the pain is increasing as time moves on after the sympathetic block. That is what happens for very many people. Increasingly there is a view emerging in the literature that they have limited pain management value for rather too many people and the value is more as a diagnostic tool. There is also the issue that if the block is not placed absolutely correctly it will be useless anyway. That is why it is bad practice not to do them under continuous fluoroscopy. You and the specialist who administered it will need to decide between you whether it is worth doing more of them. It's unusual to have a block with 2 anaesthetics but no steroid - that is usually included too.

Sorry this is long but read it and then come back to it to re-read and digest it. Your posts read as though you are in quite a state of anxiety - it's very hard but i promise, that will be making your pain considerably worse so you need to try and take a deep breath, digest all the advice from everyone, remember this journey is a marathon not a quick fix and try to be calm and not panic. If there is anything else just ask.