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Suggest Remedies For Severe Chronic Pain
Question: Doctorwants to prescribe ribe lyrica for severe chronic pain. I have severe scoliosis in Lumbar with 3 areas no disc with bone on bone. XXXXXXX thoracic scolliosis. And sever did and DJD c6 to c7 with anterolisthesis of 6mm of c6 over c7 and several other areas in spine with modest anterolisthesis, multi level did and multilevel DJD as well as multi-level facet disease, etc. Was on morphine 5 years and tramadol total 10 yrs. Asking for oxycodone because less sedating for me (was on 70mg/day for 4 mos) and it helped pain level go from 8-10 to 4-6. Prev Pain Mgmt dr retired and new one trying stay away from oxycodone yet will not perform any pro eedure on Neck cause "too unstable". So will not help me with my debilitating pain. Wants to do nerve block on lumbar, however areas I have major pain are bone on bone and mylogram dr could not get needle into these areas because spaces to tigbt. Neurosurgeon who reviewed Lumbar mylogram said Nerve Block will NOT help.... no other pain Mgmt dr in my area accepting new patients. Have a 6th appt with this clinic mid-March to see the Dr again (last 2 appts have been with a NP who was delegated the task of setting up plan-she is one suggesting lyrica or cymbalta). I am on Baclofon, Pristiq, Lamictal, Depakote and other medications. What's is your opinion as far as if Lyrica or Gabapentin helping with my chronic/severy pain.? Tramadol only brings down pain level to 7-9.
Brief Answer:
They are a first choice alternative
Detailed Answer:
I read your question carefully and I understand your concern.
Chronic pain is one of the most difficult conditions to treat. Unfortunately there are no medications which guarantee efficacy and lack of side effects and have to walk a thin line in trying to maintain the balance.
There's no denying that opioids like oxycodone have their benefits in pain relief. On the other hand they are becoming a major source of addiction in the health care system due to their potential for tolerance and dependence. So recommendations from medical societies guidelines and health authority regulations are to use them only as a last resort when other alternatives have been exhausted.
So since pregabalin (Lyrica) and gabapentin are one of the main alternatives in chronic pain management, I find it reasonable that your new doctor wants you to try them, they are first choice medication. Of course as I said efficacy may be partial, they provide substantial relief in about 50% of patients, no chronic pain medication is a miracle drug. So maybe later on it will be deemed necessary to turn to oxycodone again, but a trial must be made first, I agree with the current recommendation. Actually I would consider them a more reasonable choice than Lamictal or Depakote (if pain is what you are taking them for).
As for Cymbalta that is another first choice option, belonging to different class, SNRI antidepressants. However since you say to be taking Pristiq I think it must be either one or the other as they belong to the same SNRI class.
I remain at your disposal for other questions.
They are a first choice alternative
Detailed Answer:
I read your question carefully and I understand your concern.
Chronic pain is one of the most difficult conditions to treat. Unfortunately there are no medications which guarantee efficacy and lack of side effects and have to walk a thin line in trying to maintain the balance.
There's no denying that opioids like oxycodone have their benefits in pain relief. On the other hand they are becoming a major source of addiction in the health care system due to their potential for tolerance and dependence. So recommendations from medical societies guidelines and health authority regulations are to use them only as a last resort when other alternatives have been exhausted.
So since pregabalin (Lyrica) and gabapentin are one of the main alternatives in chronic pain management, I find it reasonable that your new doctor wants you to try them, they are first choice medication. Of course as I said efficacy may be partial, they provide substantial relief in about 50% of patients, no chronic pain medication is a miracle drug. So maybe later on it will be deemed necessary to turn to oxycodone again, but a trial must be made first, I agree with the current recommendation. Actually I would consider them a more reasonable choice than Lamictal or Depakote (if pain is what you are taking them for).
As for Cymbalta that is another first choice option, belonging to different class, SNRI antidepressants. However since you say to be taking Pristiq I think it must be either one or the other as they belong to the same SNRI class.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am taking Lamictal and Depakote (anti seizure meds I believe) in conjunction with Pristiq for Bipolar I and ADHD. Looking for pain relief - not "self-medicating.... Concerned about adverse reactions from taking Lyrica along with Lamictal and Depakote. I own my own home and live by myself for over 20 yrs.. no family left and no friends. I can't afford to use the "wait and see" approach since have 2 acres to upkeep and house-keeping as well. Have been unable to do much of anything for 8 months now (morphine 5 yrs then to oxycodone for 4 months then Pain Dr retired) only on Tramadol which only brings my pain level down to 7-8 from 8-10. Morphine then oxycodone brought pain level down to average of about a 3. Few months ago recei "Notice of Non Renewel" from my H/O Insurance Comp due to condition of my property because unable to do anything. I am permeability disabled since 2005. I cannot afford Medicare part D premiums let alone the copays. I self-pay and also go through PAPs. I don't have the $ nor the time to "wait and see" what's going to work, if at all. I KNOWS that oxycodone works which helps my motivation. Morphine too sedating....I only take what I need daily. Some days take less and other days more according to pain level. So what options do I really have...?
In addition to my reply few minutes ago... forgot to mention I tried the gabapentin and had a bad allergic reaction to it. Broke out in a rash from bottom of ears, down sides of neck, to all of neck under my chin that itched as bad as poison oak... no blisters and within couple days stopping gabapentin the rash started going away. Also nausea and eye movement made me very dizzy.
Pg 3 of 3 on my repliy--And was on Lyrica several years ago and pain dr took me off of it because of other meds I was taking. He was trying to reduce meds causing my daytime sleepiness/sedation
In addition to my reply few minutes ago... forgot to mention I tried the gabapentin and had a bad allergic reaction to it. Broke out in a rash from bottom of ears, down sides of neck, to all of neck under my chin that itched as bad as poison oak... no blisters and within couple days stopping gabapentin the rash started going away. Also nausea and eye movement made me very dizzy.
Pg 3 of 3 on my repliy--And was on Lyrica several years ago and pain dr took me off of it because of other meds I was taking. He was trying to reduce meds causing my daytime sleepiness/sedation
Brief Answer:
Read below.
Detailed Answer:
Thank you for the update.
It is ovious that you are frustrated which I can understand. I can only try to imagine what it's like to live with chronic pain for so long and the disability it causes.
Anyway I was only try to answer your question as to what I thought about the use of Lyrica or Gabapentin for chronic pain and I maintain that they are commonly used first choice drug. And we can't exclude them rightaway because of not being sure how well they will work.
As for the fact that oxycodone has worked for you, I am aware of that, but physicians are also aware about the tolerance and dependence it causes which so commonly leads to abuse and cases of overdose.
Generally speaking I would disagree with you about the "it works" point of view. Opioids are know to work, that has never been disputed, for almost all types of pain. If decisions were to be based on that alone we' would never use other painkillers and jump directly to opioids every time. It is the risks of their use which force us to employ other steps first, it is done thinking about the best for our patients, believe me there is no doctor good or bad who likes to see a patient in pain.
Anyway where you do have a point is the case of taking too many antiepileptics. Since Depakote and Lamictal are necessary for your bipolar disorder they can not be substituted with Lyrica which was what I was leaning towards. So adding a third antiepileptic does entail the possibility of added side effects. As for Gabapentine if you have had a reaction to it, it is to be excluded naturally.
So that would be a good argument to bring with your current doctor the risks of using 3 antiepileptics at the same time as well as the fact that you have used it in the past and it was interrupted for that purpose. That may be a possible argument to achieve his/her approval for oxycodone.
I hope things work out for the best.
Read below.
Detailed Answer:
Thank you for the update.
It is ovious that you are frustrated which I can understand. I can only try to imagine what it's like to live with chronic pain for so long and the disability it causes.
Anyway I was only try to answer your question as to what I thought about the use of Lyrica or Gabapentin for chronic pain and I maintain that they are commonly used first choice drug. And we can't exclude them rightaway because of not being sure how well they will work.
As for the fact that oxycodone has worked for you, I am aware of that, but physicians are also aware about the tolerance and dependence it causes which so commonly leads to abuse and cases of overdose.
Generally speaking I would disagree with you about the "it works" point of view. Opioids are know to work, that has never been disputed, for almost all types of pain. If decisions were to be based on that alone we' would never use other painkillers and jump directly to opioids every time. It is the risks of their use which force us to employ other steps first, it is done thinking about the best for our patients, believe me there is no doctor good or bad who likes to see a patient in pain.
Anyway where you do have a point is the case of taking too many antiepileptics. Since Depakote and Lamictal are necessary for your bipolar disorder they can not be substituted with Lyrica which was what I was leaning towards. So adding a third antiepileptic does entail the possibility of added side effects. As for Gabapentine if you have had a reaction to it, it is to be excluded naturally.
So that would be a good argument to bring with your current doctor the risks of using 3 antiepileptics at the same time as well as the fact that you have used it in the past and it was interrupted for that purpose. That may be a possible argument to achieve his/her approval for oxycodone.
I hope things work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your concern in my matter. I am planning to bring up the situation with my previous experiences with gabapentin and my concern using Lyrica along with my Lamictal and Depakote. Guess all I needed was an answer/opinion if I was heading in right direction in regards to my approach with the Dr on my next visit with him... and if I my "argument" was realistic.. Thank you again for your time, patience, and understanding in my quest to be able to have a life...
Brief Answer:
You're welcome.
Detailed Answer:
I hope you will feel better soon.
You're welcome.
Detailed Answer:
I hope you will feel better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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