Hi everyone, I had a question I was wondering if I could get some input/answers to.

I'm on 50mg of Tramadol right now for chronic back/leg pain due to several issues including a herniated disk. The tramadol was prescribed by my pain management doctor, but for now I am just under the care of my primary. Anyhow, I am allowed to take 2 tablets at a time for 100mg, as long as I don't go over 6 tablets in 24 hours.

I get some help from this medication, but it mainly only helps with what I call my 'normal' aches and pains. Basically, it helps with all of the chronic pain I have had for years, but not the severe pain I have that just recently started last December. I was on a lowish dose of Hydrocodone before this, and it actually helped LESS. It made me loopy, but I still felt awful physically!

My question is basically, what would be other options to discuss with my doctor? I have an appointment, but I like to have an idea of what I want to say before I go. Right now I am just feel like I can't take the pain, even with the Tramadol. I've also tried anti-inflammatories like Naproxen, but it has about the same effect...though I had awful side effects with the Naproxen. (Acid reflux/stomach stuff.)

So what would be the next step or alternative? A different narcotic? A higher dose of what I am currently on? Or is there a different type/class of medication that may help? Any info is appreciated!

I wonder if different modalities mixed together might work?

Lidoderm patches, on the back... give them a chance to work, for a week, 12 hrs on and 12 hrs off.

Ice treatments? Both of these help me with nerve pain and may in combination with the Tramadol, be better for you?

Heat can sometimes stir pain up, so avoid heating pads and hot tubs and see if that helps.

I take hydrocodone 10/500 with xanax and it helps. Does not remove all pain but loosens me up

Hi misterkatamari,

First, google: talk doctor pain. There's a lot of good information & advice in those articles.

Any of the options you mentioned (and some others as well) are possible, but your objective is controlling the pain - not necessarily how that objective is accomplished - so I'd ask the doctor about options/opinions.

Also, you could ask about being referred to a Pain Management (PM)specialist/clinic, who should be more knowledgable/experienced about the different options than most PCPs. Once a treatment plan has been established, depending on what it is, your PCP may be able to continue maintenance.

Doc

Thanks everyone.

I have actually tried Lidoderm patches, but it sorta just numbed the top of my skin. I don't really know if it is supposed to do that or not, but that is the only real noticeable change I felt.

I have actually found heat to be more helpful than ice for whatever reason. I have a heating pack that helps. It actually helps way more than say, the Hydrocodone did.

Also, the whole 'hydrocodone and xanax' thing sounds strange. Maybe I should talk to my doctor about it, because I'm actually already taking xanax. lol! (Never took it with the hydrocodone, though.)

But yeah, so far my best way to reduce pain has been basically this: Take tramadol, recline on my chair, and stick the heating pad on. I'd say it helps more than anything else I have tried. Obviously, I don't expect any of the pain to go away really..but that combination above is the only thing I found so far that I would even say 'takes the edge off'. Course, the downside is that I am stuck lying on a couch with a heating pad on.

But yeah, I intend to ask my primary doctor about all this. He's been really helpful, but also forthcoming on what he can--or feels comfortable--prescribing. My clinic has a no-narcotic approach, officially, but they make exceptions in certain cases. He made it for me when I took the hydrocodone, but he could only go so high in dosage. So, if he does think I would benefit from something like that or a combination--I am thinking he is going to suggest I go back to the pain management doctor and update him about what's going on and my current situation/pain levels.

Thanks again!

If you can seek the advise of a pain specialist, I think that would help you. I started to go to one after my first spinal fusion, and he was the one who helped me thought my lastest spinal fusion C3-7. It is all about the quality of life you have. I am on a low dose of narcotic and it does allow me to have somewhat of a normal life. These specialists have ideas sometimes that a PCP may not consider. Fight to get the relief you need, so that your life has good in it and not just pain. ginnie

See a pain specialist or clinic there are many options for controlling real pain. One of course is the fentanyl patch methadone for pain is another and delauded the list goes on. An expert will evaluate your tolerance for medications too.

Hydrocodone can be funny that way (well, anything can, but it seems I hear/read more about this one); it works great for some, and pfft for others.
Would this be a general purpose clinic or pain management? There are different reasons for their going that way (that I won't go into again right now.)

The goal is to control your pain so you can function:
1. To reduce the sense of suffering, and
2. To improve the quality of life.

Being chair/couch/bed/house-bound are not acceptable options.

By all means try everything else first, but if everything else doesn't get you out of that chair, ask for a referral to a different pain specialist.

Doc

I also have disc problems, 3 of them in my neck are herniated. the best thing you can do is describe the symptoms of your severe pain to your doctor. With a herniated disc in your spine and the radiating pain to your leg, it stands to reason that there is a good chance you are suffering from neuralgia, and nerve pain is a whole other ball-game. I had a severe allergic reaction when I took tramadol and like you I was put on a low dose of vicodin along with 800mg ibuprofen 3 times a day and it didn't work. Eventually my doctor gave in and tried me on neurontin, for the most part my pain is tolerable now. Good luck to you.

I've been dealing with a work injury low back/leg pain for three plus years now, and your body will eventually need something more than the Tramadol for the pain.

I had been taking 50mg 3x a day for trigeminal neuralgia before my back injury, and they added it at 100mg 3x a day to my pain regimen after the injury. Now I'm trying methadone, building up very, very verrrrrrry slowly, to avoid fatal side effects and percocet 2x day for breakthrough.

Although my pain is nerve pain shooting down the leg, I also found that ice did nothing and that reclining on heating pads helped more than anything. However, after 3 yrs of sitting on heating pads for 16+ hours a day, I now have 2nd and 3rd degree burns and skin changes on my back and buttocks as a result, and you can see purple outlines of my veins all over, which may never go away even if I stopped the heating pads now. (They are STILL the main relief I get!)

Do NOT try Xanax and Hydrocodone on your own without discussing it with a doctor, as many fatal overdoses you hear about on the news are from a combo of Lortab and a benzodiazapene. It sounds like your pain management doc is one of those that are afraid to prescribe opioids, and I can speak from experience, it is unlikely you will find too much relief for too long without them. Flexeril, a skeletal muscle relaxant, can help some, for relaxing the muscle spasms in the back that likely trigger nerve issues down the leg, so that may be an option.

I found in my experience, and many others hear also recommend it- one of the best things you can do is to keep a pain journal of your pain levels, when and where, and any triggers you discover, as well as the medications you take when, so a doctor can keep track of your flares and determine the best course of action for relieving your pain. It also, as one person put it to me, lets your doctor know that you are a patient in pain, willing to work with the doctor- rather than just a drug seeker. The pain journal I used I found and printed from here:

http://www.painfoundation.org/learn/...etNotebook.pdf

Good luck!