Hi, I am going to go see my Dr. to ask about better pain management while I await surgery. Right now I take T3's 2 every 4 hours, Elavil 50mg 1xpd, and Effexor 225mg 1xpd. Can anyone suggest any meds besides nuerontin that I can suggest to my Dr.
With this Dr. I need to be very prepared, and very persuasive. So I am trying to get as much info together as possible. I get almost no pain relief at all right now. With the meds I am currently on I am still at a 7 or 8 most of the time. If I could just get to a 5 or a 6 for a couple of days I would be so grateful.
Thanks,
Tracy

I'll tell you what I take

I am on the fentanyl patch, 75 mcg/hr and I change it every 2 days rather than every 3; 10/325 percocet every 8 hrs for breakthru pain; I take effexor 300 mg daily (2 in the am and 2 in the afternoon after lunch cuz I can't stomach all of it at once); topamax 100 mg at bedtime; and magnesium 750 mg's at bedtime (for spasms and restless legs and cramping of the muscles in the hands and arms)

I don't thinkthe T3's work that well. Percocet worked better for me - the vicoprofen I originally took for breakthru pain "as needed" and "no more than two per day" was more like taking aspirin - so they changed me to the percocet every 8 hrs as a "maintenance" medication rather than an "as needed" med in addition to the fentanyl patch.

Keep in mind that these that you take evrey 4 hours are SHORT TERM med's, which means you take them every 4 hrs, so 6 times a day. You may want to ask for something that's longer lasting. If he will give you a duragesic, that's proabbly better. If you DON'T take the meds faithfully every 4 hours, then you "lose" the medication that is built up in your system cuz the "half life" is gone. You will have a lapse in the effectiveness if you miss or are late on a dose.

When is your surgery?

Hugs
LisaM

Hi trix,
you might check over on the Chronic Pain forum too.

I know some have mentioned they ran into problems when asking for specific meds by name. Unless your dr is very open to that sort of thing.

But a list would be good to have.

I've seen mentioned too that there is a difference - short term vs long term - as LisaM said.

And perhaps making sure to explain {with examples??} how you are limited by the pain and how constant it is. How it is affecting your day to day life & activites and sleep.

I hope your doctor will understand that you just need a better amount of pain control.

I have a question for you! Why not Neurontin? Have you already tried and had an adverse reactionto Norco or have you read things that have discouraged you to try it? I take 1500 mg.s a day 300 in the a.m., at lunch, and dinner, then 600 at bedtime. That dosage helps me more than anything esle I have tried.

Lyrica, Topamax, and most evertything else I tried didn't help at all.

I use Norco for break through pain and ms contin when that doesn't work.

I hope that helps you some!
G~

Tracy,

Some of the best meds for nerve pain are actually indicated for epilepsy, but have been found to be VERY effective for nerve pain - Neurontin and Lyrica, the newest, are among them. You might say you've been told that meds for seizures/epilepsy are being used for nerve pain, and ask him if any wd be appropriate for you - KEEP pressing him!

Vicoden MIGHT help, although it probably won't be much use when pain is that high - that's my experience, anyway. Oxycontin is the only thing even touches it.

I'd suggest asking for something to relieve tightness in your neck and shoulders - what you're really asking for is a muscle relaxer, Zanaflex is very effective and often RX'd. But in SMALL doses during the day, and you may need to titrate it slowly. Otherwise you'll be too relaxed for anything but a loooonng nap, just ask Victoria

Do you take the Effexor at bedtime? If so, you might ask if you can split it up, taking it 2 or even 3X a day, to keep it at a more even level in your bloodstream - the Effexor also helps with nerve pain as well.

Those are the 4 mainstays: nerve pain med (anti-seizure), pain med, anti-depressant and muscle relaxant. Some are RX'd a quick-acting break-through pain med for flare-ups between scheduled pain meds. And some have PRN (as needed) meds for when sleep is on vacation or a really bad flare comes on - you know, the 2-3 day or longer, kill-me-now headache variety. I have Valium 2mg RX'd for sleep problems, but use it only when I MUST, cause I'm out for hours when I take it. No way I would be able to get up to see my youngest daughter onto the bus!

All meds work differently for each person, Lyrica is working fine for me. Neurontin did too, til I had some really RARE side effects. The muscle relaxant I wd think will be no problem for him to agree to, and the nerve-pain med maybe as well. Most Drs don't like to start you on more than 1 or 2 meds at a time so if there are problems they know what is causing it. It's a fine line we walk, trying to get what we need without ticking off the Drs whose mercy we're at - takes a real diplomat!!

Best of luck,
beth

YES! That is VERY important! I found that going to the pain doctor. But if you are seeing an MD or neuro, etc, rather than a pain doc, sometimes it's harder to get thru to them. For instance, all the md's and specialists I've seen wanted to prescribe the shortterm drugs. But my pain was CONSTANT, so I'd have to take the medication ALL DAY LONG. I was taking so many pills a day, it was horrible. And what happens then is in the middle of the night, you wake up in pain cuz the medication wears off...and when you don't SLEEP WELL, the pain gets worse. And when you miss a dose (cuz you are sleeping perhaps when it's time) then the medication wears down in your system, and it takes a while for the levels to build back up again when you wake up and take another. So it's too many "ups and downs" or "peaks and valleys" with the short acting drugs.

So what helped ME was using the term "longer lasting medication." Try that, Trix. When you see the doctor, tell him/her that you get okay relief with the medication, but you find that it just doesn't LAST long enough. That you find you are in pain before it's time to take your next dose, so you get a couple of hours of good pain relief, then a couple of BAD hours, and you just wish there was something that LASTED longer. You don't like that you have to take so many pills a day, or that there are so many good and bad hours. It's like they're "even" - like you have 12 good hours and 12 bad hours, cuz you are in CONSTANT pain all day - and the T3's work good for 12 of those hours, but wear off way before it's time for another dose. Try that.

Then...you can also say that you were looking on the internet for different medications that help control pain and you read that there are some patches that last a couple days at a time....don't NAME it...tell her/him you can't remember the name. Maybe try that.

But if you word it that way, maybe you'll get him/her to listen better.

Hugs
LisaM

http://www.emedicine.com/pmr/topic136.htm


MEDICATION Section 7 of 11
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography



Muscle relaxants (eg, Flexeril, Soma, Robaxin, Parafon forte) are options to help decrease muscle tightness and restriction, thereby facilitating conservative treatment with exercise and manipulation. Tizanidine (Zanaflex) is being used for muscle tension cephalgia and may hold promise for TOS.

Anti-inflammatory medication can decrease irritability and pain and enhance conservative treatment results. Long-acting preparations often are most effective and are tolerated better (eg, Relafen, Daypro, Celebrex). Voltaren or Arthrotec and Celebrex are relatively long-acting alternatives that are less irritating to the GI tract than Naproxen or Clinoril.

Some internists or rheumatologists may recommend vasodilators and calcium-channel blockers, if significant vascular and vasoconstrictive involvement exists. These agents are not primary drugs of choice for TOS but should be considered ancillary or secondary options to be considered and integrated into treatment as clinically indicated.


Drug Category: Muscle relaxants -- Used to relax and loosen the tight musculature involved in TOS, facilitate stretching and manipulation treatments, relieve pain, and assist with sleep. Drug Name
Cyclobenzaprine (Flexeril) -- Muscle relaxer of moderate duration, centrally acting, related to TCAs chemically. This drug often produces a "hangover" effect, which can be minimized by taking the nighttime dose 2-3 h before going to sleep.
Adult Dose 10 mg tid PO; 20-30 mg before hs may be necessary, and taking only 5 mg (half a tab) bid/tid (in addition to hs dose) may be less sedating and better tolerated during daytime; not to exceed 60 mg/d
Pediatric Dose Not established

Contraindications Documented hypersensitivity; have taken MAO inhibitors within the last 14 d; cardiac conditions; hyperthyroidism
Interactions Coadministration with MAO inhibitors and TCAs may increase toxicity; cyclobenzaprine may have additive effect when used concurrently with anticholinergics; effects of alcohol, CNS depressants, and barbiturates may be enhanced with cyclobenzaprine; may block antihypertensive action of some medications, like guanethidine; may enhance seizure risk in patients taking tramadol (Ultram); atropinelike actions
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Caution in patients with angle-closure glaucoma and urinary hesitance; use of anticholinergic medications; avoid operating machinery
Drug Name

Carisoprodol (Soma) -- Short-acting medication that works at spinal cord level.
Adult Dose 350 mg PO tid/qid
Pediatric Dose Not established
Contraindications Documented hypersensitivity; acute intermittent porphyria
Interactions Increases toxicity of alcohol, CNS depressants, MAO inhibitors, clindamycin, phenothiazines
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Caution in renal and hepatic impairment; psychologic dependence, abuse, and possible withdrawal symptoms may occur

Drug Name
Methocarbamol (Robaxin) -- Short-acting muscle relaxer that probably works through CNS mechanisms.
Adult Dose 750-1500 mg PO tid/qid; not to exceed 8 g/d
Pediatric Dose Not established
Contraindications Documented hypersensitivity; renal impairment
Interactions May cause color interference with screening tests for 5-HIAA and VMA
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Caution in patients with history of seizures

Drug Name
Chlorzoxazone (Flexaphen, Paraflex, Parafon Forte) -- Short-acting muscle relaxer, working via central pathways (spinal cord and subcortical).
Adult Dose 250-500 mg tid/qid up to 750 mg tid/qid
Pediatric Dose 20 mg/kg/d or 600 mg/m 2 /d tid/qid
Contraindications Documented hypersensitivity; hepatic impairment
Interactions Increases toxicity of CNS depressants
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Rare idiosyncratic and unpredictable hepatocellular damage, possibly fatal; may cause tachycardia and tightness in chest
Drug Category: Nonsteroidal anti-inflammatory drugs -- Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Drug Name
Nabumetone (Relafen) -- Nonacidic NSAID rapidly metabolized after absorption to a major active metabolite that inhibits cyclo-oxygenase enzyme, which in turn inhibits pain and inflammation.
Adult Dose 1-2 g PO qd
Pediatric Dose Not established
Contraindications Documented hypersensitivity; active peptic ulceration, hepatic impairment
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Category D in third trimester of pregnancy; elderly patients may require lower doses; caution in hepatic and renal impairment

Drug Name
Oxaprozin (Daypro) -- For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.
Adult Dose 600-1200 mg PO qd; not to exceed 1800 mg/d
Pediatric Dose Not established
Contraindications Documented hypersensitivity, history of GI disease, cardiac failure, renal or hepatic dysfunction, bleeding disorders
Interactions Increases toxicity of anticoagulants, aspirin, and diuretics
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions May cause dizziness, indigestion, nausea, and abdominal cramps

Drug Name
Celecoxib (Celebrex) -- Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.
Adult Dose 200 mg/d PO qd; alternatively, 100 mg PO bid
Pediatric Dose Not established
Contraindications Documented hypersensitivity
Interactions Coadministration with fluconazole may cause increase in celecoxib plasma concentrations because of inhibition of celecoxib metabolism; coadministration of celecoxib with rifampin may decrease celecoxib plasma concentrations
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Category D in third trimester of pregnancy; may cause fluid retention and peripheral edema; caution in compromised cardiac function, hypertension, conditions predisposing to fluid retention; severe heart failure and hyponatremia, because may deteriorate circulatory hemodynamics; NSAIDs may mask usual signs of infection; caution in the presence of existing controlled infections; evaluate symptoms and signs suggesting liver dysfunction, or in abnormal liver lab results

Drug Name
Rofecoxib (Vioxx) -- On September 30, 2004, Merck & Co, Inc, announced a voluntary withdrawal of rofecoxib (Vioxx) from the US and worldwide market because of its association with an increased rate of cardiovascular events (including heart attacks and strokes) compared to that of placebo.
Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited thus GI toxicity may be decreased. Seek lowest dose of rofecoxib for each patient.
The suspension dose, 12.5 mg/5 mL or 25 mg/5 mL, may be substituted for 12.5- or 25-mg tabs, respectively.
Adult Dose 50 mg PO qd; subsequent doses are 50 mg qd prn; use for >5 days in management of pain not established; tablets may be taken with or without food
Pediatric Dose Not established
Contraindications Documented hypersensitivity
Interactions Coadministration with fluconazole may cause increase in rofecoxib plasma concentrations because of inhibition of rofecoxib metabolism; coadministration of rofecoxib with rifampin may decrease rofecoxib plasma concentrations
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions May cause fluid retention and peripheral edema; caution in compromised cardiac function, hypertension, conditions predisposing to fluid retention; severe heart failure and hyponatremia, because may deteriorate circulatory hemodynamics; NSAIDs may mask usual signs of infection; caution in the presence of existing controlled infections; evaluate symptoms and signs suggesting liver dysfunction, or in abnormal liver lab results
Alert: On September 30, 2004, Merck & Co, Inc, announced a voluntary withdrawal of rofecoxib (Vioxx) from the US and worldwide market because of its association with an increased rate of cardiovascular events (including heart attacks and strokes) compared to that of placebo.

A major FDA study of rofecoxib found an apparent 3-fold increase in the risk of sudden cardiac death or heart attack among patients who had taken higher doses of the drug compared to the risk of patients who had not recently received similar medication. The report showed that even patients taking the standard starting dose of 12.5 mg or 25 mg of rofecoxib had a 50% greater chance of heart attack or sudden cardiac death than patients on any dose of celecoxib (Celebrex). The large-scale study was conducted after analyzing the medical records of 1.4 million people insured by Kaiser Permanente in Oakland, Calif, between 1999-2001.Note: The study has inherent limitations in that it is observational, rather than randomized and
controlled.

Drug Name
Naproxen (Anaprox, Naprelan, Naprosyn) -- For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Adult Dose 500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric Dose <2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Contraindications Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Category D in third trimester of pregnancy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug


Drug Name
Sulindac (Clinoril) -- Decreases activity of cyclo-oxygenase and in turn inhibits prostaglandin synthesis. Results in a decreased formation of inflammatory mediators.
Adult Dose 150-200 mg PO bid or 300-400 qd; not to exceed 400 mg/d
Pediatric Dose Not established
Contraindications Documented hypersensitivity; patients whom aspirin, iodides or other NSAIDs induce hypersensitivity; gastrointestinal (GI) bleed, and renal insufficiency
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Category D in third trimester of pregnancy; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in preexisting renal disease or compromised renal perfusion; low white blood cell counts occur rarely, and usually return to normal in ongoing therapy; discontinuation of therapy may be necessary if there is persistent leukopenia, granulocytopenia, or thrombocytopenia; caution in anticoagulation defects or are receiving anticoagulant therapy

Drug Name
Diclofenac (Voltaren, Cataflam) -- Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclo-oxygenase which in turn decreases formation of prostaglandin precursors.
Adult Dose 25 mg PO bid/tid
If well tolerated, increase by 25 or 50 mg at weekly intervals until satisfactory response is obtained or total daily dose of 150-200 mg is reached
Higher doses generally do not increase effectiveness
Pediatric Dose <12 years: Not established
>12 years: Administer as in adults
Contraindications Documented hypersensitivity; do not administer into CNS or give to patients with peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, and those at high risk of bleeding
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding) may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Category D in third trimester of pregnancy; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; low white blood cell counts occur rarely, and usually return to normal in ongoing therapy; discontinuation of therapy may be necessary if there is persistent leukopenia, granulocytopenia, or thrombocytopenia

Drug Name
Diclofenac and misoprostol (Arthrotec) -- Diclofenac inhibits prostaglandin synthesis by decreasing activity of enzyme cyclo-oxygenase which in turn decreases formation of prostaglandin precursors.
Misoprostol is prostaglandin analog that protects lining of GI tract by replacing depleted prostaglandin E1 in prostaglandin-inhibiting therapies.
Adult Dose 1 tab PO bid/tid
Pediatric Dose Not established
Contraindications Documented hypersensitivity
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding) may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy X - Contraindicated in pregnancy
Precautions Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; low white blood cell counts occur rarely, and usually return to normal in ongoing therapy; discontinuation of therapy may be necessary if there is persistent leukopenia, granulocytopenia, or thrombocytopenia


Hi my experience is that of much narcotics as prior to surgery I was on over 200mg of morphine. I then had surgery to remove my 1st rib and am blessed with a cervical rib........hence it to say I have again become symptomatic.......so I use zanaflex.( is used for MS)..depends on the pain.....if it is nerve go with the lyrica....if muscle go with the others.......was prescribed 8mg three times a day and am actually taking 1mg-2 mg ever three hours as well as lyrica. I am not sure why u choose not to use neurontin, but lyrica is a better new drug ....despite weight gain....however I am on 150mg of it and have gained no weight....little tummy but always been an issue still a size 6 and was a 12 while on narcs.....not sure what will work best but the ONLY thing that takes the muscle pain away is Diazepam.....Vallium.....it works!!!!!!!!!!!!!!

I am not sure if this helps you, but checkout the article I posted the link and info for as this is what I took to my doctor. I must say I am a nurse and ask my doctor for the meds I need.
Any questions please feel free to PM me!

take care and good luck
Sincerely,
Victoria

ps for the constipation eat lots of prunes dates and colace helps as well as sennokot but I am sure u are aware of this by now.
Victoria

sorry it has taken so long to reply. I still do not have a date for my surgery. In BC it is considered an elective procedure, and it can take up to one year (sometimes less sometimes more) to get scheduled.
My Dr. at my last visit prescribed to me 200 T3s, and told me he expected that that should last me six weeks. If I took them the way I need to I would only get 16 1/2 days from 200 tab.
I can break the effexor dosage up anyway I want to, as long as I get the 225mg every day. I can also do the same with the amytriptyline.
I have previosly tried the neurontin, and I did not like the side effects. So that is why I would prefer something else.
I hope I answered all the questions in everyone's posts. I am seeing my Dr. this am, so hopefully I can get him to understand.
Thanks,
Tracy

Well, I saw my Dr. today, and he finally heard me about the pain levels. I am now taking codeine contin 150mg twice a day. He renewed my prescription for T3's to use every 4 hours as needed. He doesn't want me to take the amitriptyline or effexor in the morning because of drowsiness. It will take a couple of days for me to get things under control. So, I will let you know what happens.
Tracy