I have a herniated disk at C5C/6. At first my pain was only after sleeping and woke me up at 3am. But since these brilliant pain Dr.'s messed with me I have a constant pain running down my arm to my thumb (feels like my arm is in a trunicate).

I have tried Celebrex and a muscle relaxer (robaxin). Celebrex had a very very very mild effect (maybe same as a tylenol), muscle relaxer did absolutely nothing (but give me a headache).

Toradol has a mild effect but you can't take that everyday as it really messes up my stomach and does nothing for the morning pain.

I'm going into the ridiculous pain Dr. tomorrow and requesting a fentayl patch. Can anyone make recommendations for what might be the best thing to try? as they might not agree with my recommendation

I am also doing traction and apply heat to my neck and arm at night (seems to be the only thing that feels good while its on there the second i take it off it hurts). I also have an appt to do accupuncture Sat. But I have been in this constant pain for 2 weeks now and if I have one more minute of the pain i feel like i might shoot myself in the freaking head... argh... very flustrating...

I also have a tens unit that does absolutely nothing, seriously on my last nerve (haha get it nerve.. argh)

thanks for any suggestions..

J.

Hi ~ I'm sorry you're experiencing such pain. I can empathize! I have most of my problems in the lumbar region, but I also have a herniation in the cervical spine.

First, do NOT use alot of heat. Heat causes more swelling & pain. It draws blood to the heated area, and that makes it swell more. YOu should use ICE, which will reduce the swelling, and lessen the pain. I know it sounds awful, but it DOES work. At first it feels terrible - LOL - but after you've had it on there for a few seconds, it does feel better. Wrap the ice in a towel so it's not directly on the skin.

I've been on several medications -- MS Contin, Lyrica, Oxycontin, and now I'm on Methadone and the Fentanyl patch. The MS Contin, Methadone and Fentanyl Patch have worked the best. I've had steroid injections, and they did NOTHING at all. I've talked to literally HUNDREDS of people, and they too got NO results from injections. I really don't know why they still use them. The muscle relaxer that worked best for me was Soma -- but be careful with it because it can be habit forming -- and it's hard to get off of. I had a hard time tapering off of it. I never took more than was prescribed, but it seemed that I felt withdrawal effects for several weeks! It's unfortunate, cause the medication DID work well.

I also had a tens unit that did nothing for me. You might ask your doctor about having a Spinal Cord Stimulator implanted -- those have helped MANY people get their lives back! I had one implanted for 6 months, but due to other problems I had to have it removed.

I wish you the very best. Please take care & God bless. Hugs, Lee

Ok, I went back through and read most of your previous posts regarding your history.

While the results of pain management have not been successful for you yet, everything that I see that has been tried appears to be appropriate.

I don't understand why you would request a fentanyl patch at this point. Fentanyl is an extremely powerful opioid with a high rate of side effects, and usually prescribed only for opioid-tolerant patients (and I see no mention of your being prescribed any other opioid/narcotic pain medications). For these reasons (and more) I think it highly unlikely any knowledgable doctor would prescribe them for you.

There are many other (types of) pain medications that your doctor may want you to try before moving on to an opioid/narcotic medication. These include some tricyclic antidepressants (like amitriptyline), some antisiezure meds (like gabapentin), and possibly some others.

While narcotic/opioid medications are very effective for patients who do not respond to these other kinds of medications, they are usually not a firstline choice for chronic pain (whether right or wrong) because of their potential for dependence (not the same as addiction) and other risks/considerations:
http://www.jpain.org/article/PIIS152...08316/fulltext

Generally, the decision of what to try is left to the physician's knowledge and experience.

What's more important: which drug you're prescribed/taking - or - controlling your pain?

All that said, rather than typing for the next few hours, you can find out more easily by googling: chronic pain medications list

In preparing for discussions with your doctors, google: talk doctor pain

There's nothing wrong with asking for recommendations, but they may not be relevant for you. All of the meds used today are very effective for the treatment of chronic pain, but as each person is different, what works for one may not work for (or be well-tolerated by) another. This is another reason your doctor's knowledge and experience are important; s/he knows what has worked well/best for the greatest number of patients with conditions/histories similar to yours. Once that decision has been made, there will still be the matter of titration - finding the right dosage to control your pain with the least side effects.

Good Luck & Best Wishes,

Doc

The Dr. gave me a Flector patch and Norco first, she said insurance likes you to try these first and then move to the Fentanyl patch if needed.

I think this patch isn’t doing much.. lol.. crap.

Anyway thanks for advice. I can’t have antidepressants because #1 they give me migraines after 2 days even on low dose #2 they make me a very very angry person.. lol.. I have not tried Gabapentin but I doubt I can take it because of the migraine issue but more important is the risk of suicide seems really really big with that medication? since I am at extreme high risk that medication scares me somewhat but I may have to give it a try at sometime in the future and how long does it take to work would be another question?

Mainly the reason for the Fentanyl patch was because the pain is at 3am after sleeping and medications like my Norco are not going to last that long if I take them before I go to sleep at 10pm and I am hoping that this nerve pain is temporary, which brings me to my next question I might ask the group.

The pain Dr. hit the nerve during the tranforminal injection, Will the pain go away? and should I contact the medical bar about this?

They of course didn’t discuss this will me but I know now it’s not my neck pain its his mistake that caused this pain and I am kinda mad about it, since it’s the second time he did this. The other time was a different nerve during the MBB and it did go away quickly.

Thanks again

J.

I'm sorry you are dealing with this pain, especially during the night, hindering your sleep.
Regarding the fentanyl patch - Like Dr Smith said, it's way up there with the most powerful of opioids. Your Dr might think you are coming on too strong by asking for this right away. Sometimes doctors get a bit leary if patients start asking for meds by name, especially narcotics.

I've been using the Fentanyl patch for a few years now. At one point I was up to the strongest dose (100mcg), without adding additional patches to the dose. Keep in mind, once your body does get used to this med, it can be pretty tough getting off of it. I had to slowly be tapered down and (thank God) I can get by with the 50mcg dose now. The withdrawal effects are pretty nasty. You might want to keep this in mind before you commit to the idea of being on this med.

Hopefully when you wake up in pain, taking the Norco might be effective. If not, your Dr will probably work you up the ladder in pain meds, but I certainly wouldn't ask for something that strong up front.

Hope I'm not being a bummer, I'm just concerned - that's all

Rae

Ok... Flector is an NSAID (non-steroid anti-inflammatory), which is the same category of medication as ibuprofen. Norco is another name for Vicodin, which is one of the firstline opioids. Many opioids are not very effective in treating neuropathic pain (the kind you have), but Norco is a little different in this respect; it interacts pretty well with other medications used for treating neuropathic pain.

Gabapentin is an anti-seizure drug that has proven quite effective in treating neuropathic pain. It shouldn't be a problem for migraines, as it's sometimes used to treat them. It does carry a warning about increased suicide risk, so extreme care would be in order, but it is very effective in treating that kind of pain for a lot of people. Lyrica is similar to gabapentin, but more expensive (still under patent). Both gabapentin and Lyrica work fairly quickly for neuropathic pain; you should get relief with the first dose.

Anyway, your focus should still be on controlling the pain - not necessarily how (specific drugs). There are still many other options of long-lasting pain medications (up to 12 hours) before getting to fentanyl. Rrae is correct; once you start with the more powerful opioids, it becomes progressively more difficult to get off of them; they are usually used for people who will have chronic pain indefinitely. You don't want that at this point. Hopefully, yours will resolve.

Are you in a MMJ state?

There's no way to guarantee the pain will go away, but it should get better, though it may take some time. That's too bad about the anti-depressants - one of the reasons I mentioned amitriptyline is that in addition to helping chronic pain (particularly at night) it's also helpful in migraine prophylaxis, and has recently been found to help in neurogenesis (helping damaged nerves heal/regrow). Have you actually tried amitriptyline? (I'm not trying to be argumentative; it just seemed like a really good possibility/fit.)

Doc

Just a note regarding gabapentin....I've been taking now for 6 weeks. Had to take 1 at bedtime for 3 days in the beginning (gives somewhat of a whirling feeling in the beginning) then 1 in the a.m. and 1 at night. At that time, it was 400 mg. am and pm. Am now taking same 1 at breakfast, 1 at lunch, 2 at bedtime = 1600 mg. with no ill effects. It slows - does not eliminate - the nerve spasms in lower half of body, with no ill effects mentally.

My brother has been taking 2400 mg. for several years now. Complications of Pemphigoid and Pemphigus (now in remission, Thank you God) and a ruptured esophaegus times 2. When he was hospitalized for 57 days he had tubes and incisions everywhere, and as a result he has nerve damage now controlled with the gabapentin. No ill effects.

Well, the Norco/Flector patch idea didn’t work, instead got a migraine and was two steps away from ending up in the hospital as so many of my migraines end me up there.

Crap, this nerve pain is not going away. I tried acupuncture and it helps but it just comes back when the effects of the treatment wear off.

I am sitting here crying I'm just getting tired of the constant pain.

I have taken amitriptyline in the past that’s how I know after 2 days I will get a headache. It only helps those with migraines if they get migraines are because of stress. I have a serotonin sensitivity issue, any change in serotonin causes a headache. However, I am going to take as much amitriptyline as I can, I started taking it last night.

I do not live in a MMJ State however I have also proceed with that idea.

Thank you to everyone here.. thank you sooo much... I'm very lucky for this site

J.

As others have mentioned, the three main firstline treatments for nerve pain are gabapentin, Lyrica, and topiramate. Each has their good and bad points (risks). On rare occasion two of those may be prescribed together. More often, one may be prescribed in conjunction with an anti-depresant, anti-psychotic, or anti-seizure medication (in very small doses) and/or sometimes in conjunction with an opioid pain medication. Methadone is one because it's different than other opioids in that it binds to all 3 (4?) kinds of receptors, making it better suited for neuropathic pain, but methadone has it's own risks associated with it, which can be found in the link I posted in Post #3.

That's pretty much the entire pharmocopia for nerve pain. It's possible I've forgotten something, but I can't think of anything at the moment. You can always ask your PM doctor.

Please understand that there are certain things your PM doctor is obliged to try in certain orders before progressing to the next level. It may seem stupid, and that we're being forced to jump through hoops (and perhaps that's true, right or wrong) but that's how they do things. You might try a different PM doctor/clinic but there's no guarantee they wouldn't put you through the same/similar. Eventually, they may get to very expensive treatments not covered by insurance, pain pump & spinal cord stimulator implants, and finally, surgery.

I truly wish I had more to offer/suggest; it's something I believe we've all gone through - part of the journey/ordeal in the quest for pain relief.

Best wishes,

Doc

I wonder if I should do the RFA on the left side, since the left side is giving me so much pain? It's scary though because they cause the pain with the trasforminal injection, but I am thinking the RFA might help?

I had the RFA on the right side and my right side doesnt have the nerve pain but then again he didnt hit the nerve on that side.

thoughts?

thanks. J.