[Seaglass1972]

I have a follow up tomorrow with my NP. I have tried and failed, gabapentin,
tramadol, Cymbalta, and amitriptalynie. I take flexural and Ativan as needed to help the spasms, and for sleep. They are not perfect, but I have no side effects from those 2.
My NP wants me to take Oxycodone. I just cannot take this medication. I have not filled the script. The way I respond to the lower forms of meds, has me petrified to even take the oxycodone.
Because I am a work comp patient, I still have not been approved to see a neurologist and at this point I think I will have to go to the ER. What can they do for me??
Have any of you had side effects from all of the above and oxy??
My CRPS is in my right arm to right hand. Today though, the bottom of my feet are burning and I am getting really worried. I don't know what to do. I had a gastric bypass 5 years ago and I do not absorb the meds the way someone with a normal stomach does, I think this is part of the issue. My CRPS happened this past December from a work accident. This is just terrible.

[Littlepaw]

Dear Seaglass,

I am sorry you are having such a difficult time with medications. That sounds very frustrating and I'm sure you're worried. Please don't give up yet though, you are not yet out of possibilities. If you didn't try nortriptyline it may be an option. Amitriptyline is the first generation of the tricyclic antidepressants and is known for its side effects. Nortriptyline is a metabolite of amitriptyline and so has far fewer. Desipramine is another options in the same family with fewer side effects. Compounded topical creams with gabapentin and ketamine could help. There are medications that come in patch. And ketamine infusions would get around the whole problem.

Start low! I am little and don't always tolerate meds well. I usually have to start at a half dose of anything. I found 25 mg of nortriptyline too much and so went to 10mg. Try the lowest dose possible and go up from there.

I know that bypass complicates absorption issues. A knowledgeable pharmacist may have recommendations on what may help depending on the type of procedure you had. You may also consider contacting the doctor who did your bypass or see a gastroenterologist for advice. I'm sure they are aware of the repercussions and may know more about viable options.

Here is an article on oxycodone extended release use in gastric resection patients for what it's worth.... It may be worth trying just to see. Getting your pain down is important and will help you heal.
http://www.ncbi.nlm.nih.gov/pubmed/25392115

The ER may be able to help if your pain is absolutely out of control, but their options are very limited and this would be a stop gap measure for short relief. Are you thinking of going for pain or to get a neuro consult? Neurology doesn't get into the ER too terribly often... That said, I would never discourage anyone from going to the ER if they felt they should go. I would just be prepared that they may not be able to help as much you'd like or need.

Hang in there Seaglass. I hope things get better soon!
Sending hugs and healing thoughts,

[-Spike-]

Originally Posted by Seaglass1972

I have a follow up tomorrow with my NP. I have tried and failed, gabapentin,
tramadol, Cymbalta, and amitriptalynie. I take flexural and Ativan as needed to help the spasms, and for sleep. They are not perfect, but I have no side effects from those 2.
My NP wants me to take Oxycodone. I just cannot take this medication. I have not filled the script. The way I respond to the lower forms of meds, has me petrified to even take the oxycodone.
Because I am a work comp patient, I still have not been approved to see a neurologist and at this point I think I will have to go to the ER. What can they do for me??
Have any of you had side effects from all of the above and oxy??
My CRPS is in my right arm to right hand. Today though, the bottom of my feet are burning and I am getting really worried. I don't know what to do. I had a gastric bypass 5 years ago and I do not absorb the meds the way someone with a normal stomach does, I think this is part of the issue. My CRPS happened this past December from a work accident. This is just terrible.

Oxy is the one med that provides me with the greatest relief. I'm on other medications, but that one is my must have med. I do not know what the harsher effects of Oxy are, since I don't notice them, since the drug helps me so much. In my case many of the other drugs that you mentioned also provided help help for me but gave me such nasty side effects that I could not take them. I see you have some of those same hardships in relation to some of those drugs too. What is your doc saying about the side effects in relation to your "trying" Oxycodone?

[Seaglass1972]

Thanks for the info.
I have been asking to see a neurologist, a pain management specialist, and a neurosurgeon. In my accident I also have a bulging C6-C7 in my neck.
I will give the oxy a try and I will ask for the norotryptiline.
Something has to give.

[NurseKris]

Originally Posted by Seaglass1972

I have a follow up tomorrow with my NP. I have tried and failed, gabapentin,
tramadol, Cymbalta, and amitriptalynie. I take flexural and Ativan as needed to help the spasms, and for sleep. They are not perfect, but I have no side effects from those 2.
My NP wants me to take Oxycodone. I just cannot take this medication. I have not filled the script. The way I respond to the lower forms of meds, has me petrified to even take the oxycodone.
Because I am a work comp patient, I still have not been approved to see a neurologist and at this point I think I will have to go to the ER. What can they do for me??
Have any of you had side effects from all of the above and oxy??
My CRPS is in my right arm to right hand. Today though, the bottom of my feet are burning and I am getting really worried. I don't know what to do. I had a gastric bypass 5 years ago and I do not absorb the meds the way someone with a normal stomach does, I think this is part of the issue. My CRPS happened this past December from a work accident. This is just terrible.

Have they tried a stellate ganglion block? Some people find relief from these and it may be worth looking into because its not an oral medication.

I understand the frustrations of being a WC patient and sometimes it helps to be really on them about getting the care you need. One thing I have found helpful is instead of making an appointment through a central scheduling service try calling the office directly. Often times I am able to get in sooner when I explain very polity that I am in a considerable amount of pain and is there anyway I can get a sooner appointment.

Good luck and I hope you find some relief.

[Seaglass1972]

Yesterday, after my visit with the NP, I was sent up to MGH in Boston.
Blood clot in my arm was ruled out, and they are sending me for urgent visits to Neuro and rheumatology. I cannot tell you how happy I was, to have the ER doctor walk in the room, take one look at arm/hand and say "How long have you had CRPS?"-- He new all about it, his best friend has suffered with it for 15 years. He was great, the entire staff was great, and I feel like someone finally understood my worries.
Now just waiting for the neuro visit.
For a laughable moment, that all of you will understand. Other patients in the ER waiting room were asking me if my arm was broken, because it is so swollen and shinny, along with discolored. So cute.....

[Littlepaw]

Seaglass,

I am so glad to hear you had such a positive ER visit. I didn't realize you had not had workup for a clot, etc. or I would've said something different about going!

Having your NP send you in was probably very helpful. It's great that your consults got bumped up too. Great news!

[carolf]

Originally Posted by Seaglass1972

Yesterday, after my visit with the NP, I was sent up to MGH in Boston.
Blood clot in my arm was ruled out, and they are sending me for urgent visits to Neuro and rheumatology. I cannot tell you how happy I was, to have the ER doctor walk in the room, take one look at arm/hand and say "How long have you had CRPS?"-- He new all about it, his best friend has suffered with it for 15 years. He was great, the entire staff was great, and I feel like someone finally understood my worries.
Now just waiting for the neuro visit.
For a laughable moment, that all of you will understand. Other patients in the ER waiting room were asking me if my arm was broken, because it is so swollen and shinny, along with discolored. So cute.....

I'm glad you finally have a good team. What neurologist at MGH were you referred to? I'm in the Boston area and looking for a good neurologist with CRPS experience.
Thanks.
Carol

[Seaglass1972]

Originally Posted by carolf

I'm glad you finally have a good team. What neurologist at MGH were you referred to? I'm in the Boston area and looking for a good neurologist with CRPS experience.
Thanks.
Carol

Hi Carol,
I am still waiting for a call back from them. I have left 2 messages, and they have my referral, yet, they are not calling me..... Not very happy here.

[maygin]

I hope you find relief. I tend to react badly to medication as well, but I've tolerated noritytripline very well. It's worth a shot. When I was switched from gabapentin to Lyrica, I was told Lyrica was the new, more concentrated form of gabapentin, so it had less side effects. It may be something to consider. I didn't find it helped and I gained a ton of weight rapidly.

I also reacted badly to tramodol and was really nervous when I was put on Norco. I had side effects, but the trade-off was worth it at the time. I was also put on perocet and I did not tolerate it well. I eventually went off opiods because I didn't find much pain relief on them.

I second the suggestion to start on the smallest dose. Once, a doctor told me that technically the starting dose of a med was 50 mg, but she always started patients at 100 mg because it never works at 50. I instead started a 50 and it worked, too well. We all metabolize meds differently and you know your body best, so ask the doctor to start on the lowest dosr, even if they don't think it will work that low. It's there for a reason.

I hope you find relief soon and I'm so glad the ER visit went well!