Brief Answer:
Your PCP may be responding to tougher narcotic regulations.

Detailed Answer:
Hello XXXXXXX

I am so sorry for the difficulty you are having getting the meds that have helped control your pain.

I am trained as a family practice physician (in U.S.) and I know that there are much stiffer regulations on primary care physicians prescribing narcotics now than there were when I first finished residency 20 years ago. If PCPs are seen prescribing a patient narcotics on a regular basis, they may be called before a board to investigate why they are doing this and may be reprimanded. I have witnessed this happening. So PCPs have grown cautious in prescribing narcotics to anyone on an ongoing basis. It probably isn't anything personal.

You mention that you can't go to a Pain Management clinic because of the cost. I don't know what your insurance situation is but perhaps insurance would cover you seeing either an orthopedic doctor or neurologist (or both) for them to address the pain management? Since you have known diagnoses (OA, chronic neuropathy, fibromyalgia) perhaps the insurance will pay for being seen for those things rather than for pain management.

Since there is more regulation of medically prescribed narcotics now, other medications are being used more often for pain management. A new medication that is now being prescribed for fibromyalgia pain is Lyrica (pregabalin). Perhaps your PCP may consider a trial of this if it is otherwise medically appropriate for you.

I hope this helped answer your question. And I am sorry about the situation you are in. Please let me know if I can answer anything else on this subject.

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Brief Answer:
acupuncture may be helpful, supplements, and some medication alternatives

Detailed Answer:
Ok, I will start with alternative treatments. For most of these there is less data compared with medications, but that there are newer studies that show some of these things are helpful.

#1 Acupuncture is particularly helpful for nerve, back, muscle, and headache pains.
If you choose to try this, I would encourage you find a practitioner that was trained in China, not here in the US. I think the Chinese training is better. If it is going to work for you, you should notice some effects after 3 treatments. If no benefit by then, probably try something else.

Some studies show acupuncture may help by changing the release of neurotransmitters.

#2 Mindfulness training and meditation.
These techniques help the mind to help the body. There are classes in these offered at local hospitals, community colleges, or if you can't find one, you can purchase a CD to play at home. Or you may find one on Youtube.

#3 Biofeedback training can also help you with control over the pain.
For this you need to find a practitioner - some psychologists offer this, and they will monitor your breathing and heart rate. The idea is that people can use this information to learn to control your body's response to pain.

#4 Some people find benefit from chiropractic manipulation.

Of the therapies listed above, I would personally recommend trying acupuncture and mindfulness/meditation.

Regarding Homeopathy, I personally am not a fan of Classical Homeopathy. In this form of Homeopathy, the practitioner conducts a lengthy interview to get the basic essence of who you are and fix the "miasma" that may even date back to your ancestors. They the practitioner prescribes a "potentized" preparation for you to take that is meant to fix the underlying problem of your whole being, not just your current symptoms. In theory and philosophically this sounds wonderful, but I have not seen it fix anything other than a particular symptom if that. And I've seen side effects from it too.

If, however, you want to go to a place like Whole Foods and just get something to relieve symptoms, such as Arnica, in a less potentized homeopathic form for OCCASIONAL temporary relief, that would be safer and more likely to help.

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Supplements for pain, and fibromyalgia:

This can get a little tricky in that some supplements can effect how prescription meds are handled in the body (increase or decrease their breakdown). You can ask a pharmacist to check meds your on with these supplements as there are some data bases that do this.

1. The spice Turmeric as an anti-inflammatory
The active anti-inflammatory in turmeric is curcumin (not the same as cumin).
It isn't absorbed very well, but there is some evidence that a little black pepper with it increases it's absorption.

Other anti-inflam. herbs are green tea, ginger, XXXXXXX cat's claw, devil's claw, and willow bark.

If you are on blood thinners, or have a sensitive stomach, use these with caution as they are a bit like NSAIDS (ibuprofen, etc)

2. Fish oil (like Cod Liver Oil) or Omega 3 fatty acid supplements. Or eat fatty fish like salmon, sardines, etc a couple of times a week.

3. Vitamin D: A study showed people who needed opiates for chronic pain had lower levels of Vitamin D. If you haven't had your's tested in the past 6 months, ask your doctor to check a level before starting supplementation.

4. Capsaicin cream can be helpful for osteoarthritis pain.

5. Bromelain, an enzyme from pineapple stems has been shown to help knee pain.
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Other thoughts:

I don't know what medications your primary doctor has tried already. I do know that when a patient tells me they cannot afford a referral to a specialist, I often then call the specialist myself for them to help guide me in treating the patient myself. Most specialists will do this as they know the PCP will refer other patients to them. I don't know if a Pain Management specialist would be willing to work with your primary or not.

If you just ran out of the opiate medications you've been on, in addition to the pain you already would have, you may be feeling the effects of withdrawal if you were on the opiates for several weeks.

A class of medications your PCP can try with you (if he/she hasn't already and it isn't contraindicated for medication or medical reasons) is a tricyclic antidepressant such as Elavil, Norpramin, or Pamelor. Elavil is used for prolonged pain following shingles and other neuropathic pain. Also good for fibromyalgia pain. Also good for getting a good night's sleep! If you choose to try this, start with the lowest dose and gradually increase.

Another med a PCP can try with you is Cymbalta. Cymbalta is FDA-approved for the treatment of diabetic neuropathy, fibromyalgia, and musculoskeletal pain like that of osteoporosis.

There are other medications for pain which include:
Lidocaine patches - lidocaine numbs pain like what your dentist uses
Ultram ER, which is not a narcotic but works like a narcotic
Duragesic patches - this IS a narcotic, but slowly releases across the skin.

These last 3 medications should probably be reserved for if nothing else works and on the advice of a pain specialist.


I hope some of this information helps you. If you have no further questions you can close the transaction and rate it.

Best wishes to you,
Bonnie Berger-Durnbaugh, MD

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