My brother got married on Saturday. My job was to make sure the house was okay after they left, as well as help cat herd the flower girls (my daughter being one of them). I woke up on Sunday and was barely able to move. Of course I had drank the night before (1 hard cider, 4 small glasses of wine over the entire night). I was on my feet a lot (in flats) and was wearing a body shaper thing under my dress. My thighs were in so much pain when I woke up. I normally smoke pot to help with pain, but due to the party the night before, I didn't have a lot. My brother was given a bunch of joints for a wedding present, so he let me have one in the morning. It helped until it wore off. We went to lunch with my family as well as an old friend of mine. He's in a wheelchair and has some pain as well, and asked what I was taking, I told him I was trying to avoid opiates, he was as well.

So right now I'm only taking Oxcarbazepine, which is working for the buzzing. Pot for pain, when I'm not working (I'm in CA and this is medical MJ). I'm guessing I need a pain backup, for when it's really bad. I've been avoiding a lot of activities because I fear this kind of situation. I need something I can take at work that doesn't make me spacey, something I can take when I'm out of the house or when I'm out of pot. Not anything that makes me tired. The oxcarbazepine does that enough already. I'm on a generic only insurance plan, until probably November.

I meant to take an Epsom salt bath and just never got around to it as my daughter stayed up late and I just crashed right after she did. I'm at work today and completely drained, in pain but it's not as bad as yesterday.

I'm also very sensitive to meds. I'm not keen on Vicodin, it makes me hyper, nauseous, nor nothing at all. Tramodol had a horrible effect when I took it many years ago. Got physically addicted to Percocet when they gave it to me in the hospital, and I was taking a low dose. I'm currently taking Oxcarbazepine, Wellbutrin, Zoloft, Levothyroxine, a Nerve combo with B12 and other good things in it, Mirapex and MMJ.

I found this when I was looking up meds for breakthrough pain:
It should be noted that 7–10% of Caucasians are poor CYP450 2D6 metabolizers and are therefore unable to metabolize tramadol [Kroemer and Eichelbaum, 1995]. In addition, there are many commonly used medications (including bupropion, fluoxetine, paroxetine, and metoclopramide) that inhibit the CYP450 2D6 hepatic enzyme system [Armstrong et al. 2009; Laugesen et al. 2005]. These considerations should be taken into account when prescribing tramadol for breakthrough pain because patients may not achieve adequate analgesia when using tramadol despite dose escalations.
From: http://www.medscape.com/viewarticle/741754_7

This kind of explains why I'm not good at taking some of the drugs!
http://www.questdiagnostics.com/test...dc=TS_PainMgmt
It says to use alternate drugs for Codine (haven't taken since a teenager, I can't remember why but I think it didn't help enough), Oxycodone (see my Percocet reaction above), Hydrocodone (I've given up on Vicodin, makes me sick or nothing at all) and Tramodol (makes me sick).

Um, so kind of yay? Now I need to find something that works. I need to look this up more when I can focus on it. Science is so awesome, I love it when I can find info like this.

This explains it better I think:

http://en.wikipedia.org/wiki/CYP2D6

click on any blue fonted drug and it will explain in its own wiki article:

tramadol:
http://en.wikipedia.org/wiki/Tramadol

It is not as simple as your quote... since tramadol is metabolized by 3 different enzymes.

Thank you. I'll read up on it. Found some other info. I'll have to research this all before I go to the doc to get anything stronger. I've always known I react differently to a lot of drugs. Hopefully I can find an answer to what I need after looking through all of this, unless somebody else has already and has a really great answer.

I read this online:
Dr. Bratanow says research suggests people who have a problem with addiction may have altered receptors and drug binding. “And there may be a difference in the way people at risk for addiction metabolize opioids.” For example, she has heard patients with addiction issues say that doses of opioids give them a feeling of bliss that nonaddicted patients don’t report experiencing.
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2 Fportlets%2FcontentViewer%2Fshow&cntvwrPtlt{action Form.contentReference}=cap_today%2F0409%2F0409b_pa in_management.html&_pageLabel=cntvwr

I think this is me. I totally blissed out on that Percocet. It also mentions issues with tricyclic antidepressants. I tried one when I first got the PN and I hated the way it made me feel. The attached article and others have mentioned that fentanyl and methadone are two things that do work, but one doesn't usually need that strong of meds. I cringe at thinking I need them, but know that down the road I might.

Yesterday seriously sucked. Today is a bit better, but not good at all. I need something for pain, and it seems all I'm doing is being pointed back at pot! I just can't use it while working (I would never ever do that).

Does anybody have any other suggestions? I can't find anything online at all, except for the opiates that I'm trying to avoid. I really, really want to find something I can take at work or when I don't have access to MMJ.

Do I need to just go see my Neuro or go see a pain doc? And if so, which one is better? Or a different doc, like an integrative doc?

Neurologists generally do not prescribe pain medication, they may start you on something like Lyrica or an anti-depressant, but prefer that a PCP or pain management doctor handle it from there. In my experience they are uncomfortable with admitting that PN can cause severe pain. There really are, unfortunately, few alternatives to opiates for the type of pain you are describing.
Have you researched Butrans Patches? They are an opiate inhibitor and work for some PN'ers.

I'll call the pain doc here in town, hopefully I can get in without a referral.

The BuTrans patch is long term, I don't normally need something over many days (yet) but might work as it's not going through my gut. But I'm not sure if it's good for breakthrough pain (like what happened on Sunday). And it's still a dependent type drug. I'm very wary about opiates because when they gave me Percocet in the hospital my body became addicted really quickly on a low dose. But I will keep the BuTrans in mind when talking to the doc.