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Dr. Andrew Rynne

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Suggest remedy for voluntary twitching and chronic back pain

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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 3228 Questions

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Posted on Sat, 17 Oct 2015 in Mental Health
Question: Hi, I am in Australia. Ian a 67 year old Ships Captain who has had chronic back pain since an accident on a ship in 1984. I have had periods of intense unbearable pain lasting from 6 days to 6 months & more. 6/7 years ago I was diagnosed Fentanyl which made life rather bearable. In this period I was made Marine superintendent of the largest Dutch dredging company in the world which gave me the ability to work as & when I could. In good periods 20+ hours a day. 3 years ago at 62 just short of my retirement I developed depression BAD diagnosed as bi polar though I did not agree with this as there was never any ups only times when I could cope fore short periods ( maximum 3/4 days. To finalise I had 2 suicide attempts, hospitalised for 4/5 times, 3 years of work and in my unconscious state ended up on Suboxone. For the past year I thought I was only going to councilling not realising they were testing me as an addicted person but I was getting better. They woul let me pick up 12 mg a day fro the chemist ( down from much higher ) To end I went on a trip back to sea for 5 weeks. I had enough melds for 3 weeks an d because of financial downturn losing $4mill dollars losing 4 homes I would have been on the street. I had one small 35 acre farm left which I needed otherwise I'd die. So I decided to detox myself, coming down from 12 ml to 2ml per day when I got home. On going to the clinic to explain what I'd done, I was treat ed as a Crazed junkie playing about with my mess & I should have come home from my ship 1200 mm out at sea when I realised I had to stay on( due to bad weather) I could not believe I was listening to a professional person ( as I deem myself to be ) also a clinical Physcologist . I to simplify, I felt I was in a den of bogans and had to just walk out.
I am now in the 5th day of detox ( 2 yrs Subooxone about 4 yrs constant Fenathyl ). I am very very sick and considered taking my life .....though that was a brief painful episode 2 nights ago. I am NOt going back to Suboxone. The in voluntary twitching has my back in extreme agony 20 hours of the day. This is my 6 th day will it soon be over or for my healthy sake should I give up ? Or can you suggest something ? Please help me
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Answered by Dr. Matt Wachsman 7 hours later
Brief Answer:
get help

Detailed Answer:
Wow, I could literally write over 10000 words on just the neurophysiology of the meso-limbic system alone and not necessarily cover XXXXXXX Blum
J Addict Res Ther. 2014 ; 5: . doi:10.4172/2155-6105.0000. (now there is one depressing paper! It says that everything in your brain is wired up for misery after the suboxone and you'll be better but it will take 2 weeks to be off of it).
Ok... I cannot comment directly on your particular situation, or diagnose, nor treat without directly being there.
and first, the article implies that brain chemistry is going to be very messed up by long term narcotics especially suboxone and this predisposes to severe depression. While anti-depressants work, they take longer than the time to reset the brain by being off suboxone and they do nothing for 2 weeks. Furthermore, the increased energy that some/most anti-depressants give are a known risk for suicide. In this context, inpatient supervision (brief) is best. Giving an anti-psychotic along with the anti-depressant is next best. And getting supervision by immediately going to an ER in the context of thought disorder and suicidality is really necessary. The thought processes of the depressed person are not normal, and are unreliable.

Next is about pain.
Yeah, there's way more than 10,000 words
http://dmm.biologists.org/content/6/4/889.full
(don't read it, it's really too hard for me and I'm an expert in the field; just realize there's a lot of reasons why the pain can be chronic).
Several signs can point to particular features of pain. There is the direct cause of pain both it's process and the underlying problem. Most people already know where the pain is coming from in a general sense (nerve injury, inflammation, infection, etc.). AND... there are particular reasons why the pain is worse on a given time frame. Often it is an inflammatory condition on top of a non-inflammatory injury. Steroids help ONLY in this narrow context. Then there's one I should care about,
http://www.ncbi.nlm.nih.gov/pubmed/0000 (he generally goes by WAXMAN), in which the spine is really upset and there's like an epileptic fit in the spine which doesn't feel good, and has a lot of LOCAL back pain.
There's particular neurophysiological ways to approach this.
now.
So, there is the overactivity of the spine itself and the muscles. They can theoretically ping-pong back and forth with activation. Interrupting the XXXXXXX is helpful. Any nerve pill will be quite good and quick. These include the anti-epileptics gabapentin and pregabalin (no relation), also carisoprodol. Maybe muscle relaxants like flexeril. But directly stimulating the nerves overwhelmingly can also be helpful.
(so, if I start with the neurophysiology, then saying "a warm shower with the water beating down on the area and mild movement, ideally massage by someone else during the shower", then that sounds more reasonable. If I started by saying that, people don't give it serious consideration). This can be done now.

Then, there is also the counter irritant effect
https://en.wikipedia.org/wiki/Counterirritant
this is broadly helpful on a lot of the mechanisms involved in that very hard article. Some of the mechanisms include over stimulation like above, stimulation induced killing specifically of pain nerves, modulation of the factors that wind down pain. Also changing the ionic surroundings of the nerves through sodium and pH can modulate their activity.

Now doesn't that sound better than "mustard plaster"?
but, today, one could freshly grind a LOT of mustard seed in vinegar, (warm, not hot) enough to cover gauze pad and apply to the area for 30-45 minutes.

So, in general, one would look at acute safety and often recommend emergency psych eval---short term stay.
Modulation of nerve activity through direct stimulation, anti-epileptics and counterirritants.
thats before even thinking narcotics.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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