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02-03-2011, 10:54 AM | #11 | |||
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Senior Member (**Dr Smith is named after a character from Lost in Space, not a medical doctor)
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1. I have a number of chronic pain issues going on. 2. Any one of them can flare and override others at any time. Headaches generally override/rule, because they're where I live - in my head. 3. My "6" may be (and often is) someone else's "9" or "10" because when it comes to "10" being the "worst pain imaginable" I have a VERY vivid imagination (think "R" rated Vietnam war/graphic Horror movie scenes). On a really good day (rare), I may record a 4. On an average day, a 6. On a bad/flare day (much more frequent than a good day), 7 or 8. I have only recorded higher than that once, while in an ER. So PN doesn't really enter into my way of thinking about it; it's just another symptom/source of pain. When I need to take a gabapentin is when I cannot sleep/function without. Even at the low dose I take, the side effects are intolerable to me; it knocks me out for 2-3 days, and I cannot function normally. Like I said, everyone is different. Doc
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Dr. Zachary Smith Oh, the pain... THE PAIN... Dr. Smith is NOT a medical doctor. He was a character from LOST IN SPACE. All opinions expressed are my own. For medical advice/opinion, consult your doctor. |
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02-03-2011, 03:15 PM | #12 | |||
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Senior Member
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This has been posted before, but it never hurts to 'freshen' memories:
Mankoski Pain Scale Copyright © 1995, 1996, 1997 Andrea Mankoski. All rights reserved. Right to copy with attribution freely granted. 0-- Pain Free No medication needed. 1-- Very minor annoyance - occasional minor twinges. No medication needed. 2-- Minor annoyance - occasional strong twinges. No medication needed. 3-- Annoying enough to be distracting. Mild painkillers are effective. (Aspirin, Ibuprofen.) 4 --Can be ignored if you are really involved in your work, but still distracting. Mild painkillers relieve pain for 3-4 hours. 5-- Can't be ignored for more than 30 minutes. Mild painkillers reduce pain for 3-4 hours. 6-- Can't be ignored for any length of time, but you can still go to work and participate in social activities. Stronger painkillers (Codeine, Vicodin) reduce pain for 3-4 hours. 7-- Makes it difficult to concentrate, interferes with sleep You can still function with effort. Stronger painkillers are only partially effective. Strongest painkillers relieve pain (Oxycontin, Morphine) 8-- Physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain. Stronger painkillers are minimally effective. Strongest painkillers reduce pain for 3-4 hours. 9-- Unable to speak. Crying out or moaning uncontrollably - near delirium. Strongest painkillers are only partially effective. 10-- Unconscious. Pain makes you pass out. Strongest painkillers are only partially effective.
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Bob B |
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"Thanks for this!" says: | dahlek (02-03-2011) |
02-03-2011, 04:39 PM | #13 | |||
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Senior Member (**Dr Smith is named after a character from Lost in Space, not a medical doctor)
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Yes, and I've responded with the even better known Hochman Scale, created by an actual PM doctor, rather than a lay person.
http://www.algosresearch.org/Practic...PainScale.html Our docs - all of them, from all disciplines including PM - don't like either of them (or any of the others I've dug up). I've been having this discussion with them for years, and they've been quite candid about it. They don't want an objective scale nor one with benchmarks; they want a subjective scale compared against each patient over time, because each patient's pain threshhold, tolerance, and perception is unique. If anyone's docs accept them, great. Personally I haven't met any yet (other than a brief exchange with Dr. Hochman). None of the docs around here do.
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Dr. Zachary Smith Oh, the pain... THE PAIN... Dr. Smith is NOT a medical doctor. He was a character from LOST IN SPACE. All opinions expressed are my own. For medical advice/opinion, consult your doctor. Last edited by Dr. Smith; 02-03-2011 at 04:41 PM. Reason: spelling |
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03-01-2011, 11:55 PM | #14 | |||
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I always have such a hard time knowing which is the most accurate answers with those scales. A lot of the time, my pain feels like first degree burns...some would say that's unimaginably horrible, yet others would say it's not bad at all. Like someone said earlier "I can imagine some pretty horrible things" and none of mine is in that category, but it still doesn't mean I don't want it to stop or that it isn't having a profound negative effect on my life.
Let me ask this: what number will get a doctor to believe that your pain should be treated?
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PPMS Rx 2013, symptoms since 2000 |
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03-02-2011, 08:30 AM | #15 | |||
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I have headaches all the time, never gone. I go to work with head pain that many would stay in bed with. Movements make me dizzy when the pain is bad and people do not understand this. We have a delivery man that has a clipboard we must sign when he drops off items...he will wiggle it back and forth for my reaction, I just can not convince him it's not funny. If he truly understood what he was doing to me, he wouldn't do it, yet some people just can't fathom what you are going through. We all have different levels we can handle and these levels can change according to the day. I wish everyone could be painfree, would be so wonderful.
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Deb We urge all doctors to take time to listen to your patients.. don't "isolate" symptoms but look at the whole spectrum. If a patient tells you s/he feels as if s/he's falling apart and "nothing seems to be working properly", chances are s/he's right! |
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"Thanks for this!" says: | dahlek (03-03-2011) |
03-04-2011, 04:29 PM | #16 | ||
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Junior Member
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The pain scores are relative for each person. Ideally the scores are used as one tool to measure a response to treatment. Regardless of the number, if you are debilitated from the pain you should be treated. The response to treatment is measured by, among other things, your change in pain score coupled with your functional improvement. If your doc isn't doing it this way, try to find another.
Neurontin is titrated in 100 mg increments. Ideally start at 100 mg/day and increase the dosage by 100 mg increments every 2-3 days. You do this until you either get the desired improvements in symptoms or until you experience side effects from the medications. Many people experience sedation, but this can improve over time. Again, not easy to find a doc who will do it this way or knows how to do it this way. Hope that helps |
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