Brief Answer:
management of chronic pain

Detailed Answer:
Good evening

Thanks for your query.

Well, to manage pain we need to understand the source of origin.

The pain which we see due to arthritis or muscles or nerves are mostly localized to that area. for the joints, it will get aggravated on touch or activity and there is limitation of restriction of movement. I understand the osteoarthritis of knees is a very troublesome problem and can hamper the quality of life , to such an extent that the patient gets bed bound. Considering your co-morbid status, the surgeons will be very reluctant to perform a surgery as ILD and pulmonary hypertension are big risk factors. But never the less, if it has to be done it should be.

Since we are not able to perform surgery, we need to manage it differently. Synvisc hasn't been useful in our settings. We have tried it many times but there is no much benefit. So in these conditions, where surgery cant be done and pain is intense, we give a small dose of steroids intra articular into the knees. That has shown significant benefit. This is one option you can discuss with your rheumatologist or orthopedic.

With the back pain and spasm, i would recommend you to try some yoga exercises. It is known to help as it helps stretch the muscles and relieve the spasm. Your medication list is already so long plus there is little benefit from Celecoxib and morphine you are taking. So i am recommending some different therapy.

Lastly, the generalized pain does develop when you have been experiencing pain in lot of other sites. It develops like a vicious cycle from knees to the brain to the spinal cord and back to the knee and then it spreads all over the body. Pregalin is also used for its management, but it is not the first line. So that is why i wanted you to switch to Dulane or tryptomer. I would also suggest some sessions with psychoanalyst to help you with pain coping strategies.

I understand the tough spot you are in and the lot of medications from different doctors haven't helped you. So i am trying to help you in a bit different way..

Do let me know for more queries. Would be happy to help you out

Regards
Dr Naval

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Brief Answer:
Chronic Pain Syndrome

Detailed Answer:
Good evening

Well, i never tell my patients to give up. You need to keep fighting till you are alive. Moment you give up, the life is not worth living at.

Yes, you should carry out the plans you have mentioned. As for yoga, if you can get a personal teacher or attend some classes for a while that would be more helpful as you dont wanna bend in the wrong posture and sprain your muscles. Once you get hold of the exercises, you can do it on your own. I am sure there are plenty of Yoga classes going on at the place you stay.

As for Oxycodone, it is a narcotic analgesic. For time being you can increase it but just remember, one tends to get dependent on it and on tapering it you tend to experience withdrawal symptoms. But if it gives you relief, you can increase it as we need to break your pain cycle.

hope the information has been useful

Do let me know for more queries

Regards
Dr Naval

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