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Suggest treatment for severe anxiety and chronic body pain

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Posted on Tue, 19 Jul 2016
Question: I wanted to ask this question on my last inquiry but ran out of chances. Long story but trying to give history so, bear with me.
I suffer from anxiety which has drastically affected my life over the last 15 years.
I have chronic stomach issues, muscle twitches, bad sleep for a long time.
I seemed to get it better controlled until the last few years.
I am an ex-firefighter and i injured my back just over 10 years ago.
Ive had chronic pain since injury and have tried physical therapy, exercise, steroids but pain has remained. I stayed on NSAID's for first year but it damaged my stomach so i switched to tylenol. I have taken low dose of tylenol daily for last 10 years. I never exceed 2 pills daily which total is 1000 mg.
My doctors have told me this is well below acceptable daily allowance and is safe. Everything was fine until i saw a news report last year about tylenol risk.
I immediatly became concerned about kidneys and saw my doctors many times pertaining to this. They checked my labs and said nothing looked out of sorts and sent me on my way. Since injury Ive had bloodwork done yearly but in the last few years ive probably had it checked at least twice a year if not more. I even bothered my doctors for a CT scan of my organs(abdomen) which i finally recieved 6-7 months ago.
Doctors said liver, kidney, heart, pancreas all looks good on urine, blood and CT.
Dr told me that the stuff im concerned about is really rare plus, the good CT should give me much assurance as the kind of damage im worried about from long term use of meds would begin to be seen on CT as it progressed because it takes time and its slow.
Since then I have taken upon myself to analyze labs and the fluctuations i see worry me. The doctors say that fluctuations that are all still within normal limits are totally normal and that variation on labs are due to many factors like diet, hydration, stress, age, etc.... Its actually impossible not to have variation.
Im trying to stay on top of my health but feel im not really even taken serious anymore which i understand.
One thing that had driven me nuts is creatine clearence and GFR.
When creatine moves 3-4 tenths of a point i freak out because it alters GFR.
My doctors told me its normal because im still well in range and GFR is just an estimate and not the best tool for evaluating healthy individuals.
If all looks ok how would i be most prudent about being reasonable and catching something if it began to hurt me. I guess thats the dilema im in. I actually struggle with pain because i wont exceed 1000 mg of tylenol per day, which my doctors have said is uneccesary, but in my mind i guess since i was told early on that was a safe and low daily amount, thats where i stay.
Im worried, frustrated and tired.
Any advice?
doctor
Answered by Dr. Matt Wachsman (40 minutes later)
Brief Answer:
Well let us start with tylenol isnt txoic to kidneys

Detailed Answer:
even people who suceed in killing themselves w tylenol do not have kidney issues.

it is liver toxic.

the liver toxicity is simple. it kills it off. cirrhosis from it probably just never occurs because the tylenol toxicity to the liver is either terrible or zero so long term scarring just isn't an issue. the killing of liver is easily and accurately tested with simple liver functions.

also, the tylenol toxicity is based on acute overdose only

that is also true of water. if you take 5 gallons of water at one time it mightkill you but over the course of a week you probably require that much. i
likewise 1000 mg spread over a day every day forever is quite safe
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Matt Wachsman (25 minutes later)
Whats analgesic nephropathy? If i spelled it right?
That was what i saw the report on, been concerned every since. Also fact that i have back pain and get different aches pretty much every day depending on what ive done isnt the most assuring thing.
Tried gabapentin, cymbalta other pain modulators and i get mentally geeked out. I couldnt stand the side effects.
doctor
Answered by Dr. Matt Wachsman (2 hours later)
Brief Answer:
other anti-inflammatories.

Detailed Answer:
tylenol has effects on the brain perception of pain but does nothing for inflammation elsewhere. The way the inflammation is lowered (inhibition of one inflammatory hormone family called prostaglandins) is done the same way as control of fluid through the kidney. If the inflammation is stopped, flow through the kidney is lowered. This can cause short term reversible changes in flow and kidney function and long term harm to the kidney that does not necessarily get better.

I cannot imagine a more biased reference than this, but all the other ones say the same.
https://www.yyyyyyyyyy.com/safety-yyyyyyyyy/health-yyyyyyyyyyy/kidney-disease

Here is what the kidney foundation says.
What analgesics are safe for people who have kidney disease?
Acetaminophen remains the drug of choice for occasional use in patients with kidney disease because of bleeding complications that may occur when these patients use aspirin. However, kidney patients who need to use acetaminophen habitually should be supervised by their doctors and be sure to avoid drinking alcohol while on this medicine.
https://www.yyyyyyyyy.org/atoz/content/yyyyyyyy_yyyyyyyy
The reason they say that is that alcohol may use up the liver's protection against acetaminophen toxicity and lower the dose of acetaminophen that might damage the LIVER. It is a controversial point. The alcohol ALSO inhibits the liver from making acetaminophen toxic in the first place and people who od on both may have lower risk of liver problems than those who just od on acetaminophen.

But that is liver.

Kidney is fine with acetaminophen.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Matt Wachsman (4 hours later)
I quit drinking years ago when i first hurt my back.
I know chronic pain just plain stinks. You have few options if gaba or cymbalta dont work. if your fairly young and in pain but functional, surgeons actually discourage you from surgery because you can very easily be worse off. Steroids can work but for me have been hit and miss plus, you can only have 3 shots per year. If you have chronic pain your labeled a drug seeker, even if you dont even take narcotics and have years of diagnostics & history to back up your pain.
My advice to my familyis to be very careful with your back because if you hurt it you may have life altering hurdles. Blame always goes to patient.
Look at what kind of doctor this site directed a kidney/ med interaction concern. The frustration continues i guess.
Thanks for your response
doctor
Answered by Dr. Matt Wachsman (3 hours later)
Brief Answer:
a few thoughts. But I totally agree.

Detailed Answer:
An MD with a PhD in pharmacology who worked with the developer of the protocol for acute acetaminophen overdose. He's retired, and never much got into computers so, I'm not certain who you would be looking for instead of me. But don't take my word for things, I included links to the most authoritative sites (kidney association. FDA approved advertisement/information from the drug manufacturer). If you really want I can see about controlled trials and statistical studies but frankly I don't find them generally very good.
Oh, I also have a board certification in addiction. People think funny. Not only do you not have much/anything for addiction, your viewpoints on pain are quite correct/reasonable/grounded in reality:
"chronic pain just plain stinks".
"You have few options if gaba or cymbalta dont work"
"if your fairly young and in pain but functional, surgeons actually discourage you from surgery because you can very easily be worse off."
see, those would be correct.

The labeling issue, that's correct too.

Oh, speaking of labeling,
"Look at what kind of doctor this site directed a kidney/ med interaction concern."
See, that wasn't actually either correct nor useful to anyone. Why would one say it ?
"The frustration continues i guess."

Ok, here's the problem, the frustration changes the perception of pain. various therapies on the frustration, psychological, anti-depressant, but mainly mobility training like physical therapy could be directed to this.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Matt Wachsman (6 hours later)
Its not a jab at you at all, youve given good info and could work wonders for addicts.
My point was, i mentioned pain and a med and to the addiction counselor was sent. im not addicted to tylenol nor have i ever heard of anyone that was.
Sorry if you took that the wrong way.
I should have worded that different.
Thanks for your help.
doctor
Answered by Dr. Matt Wachsman (9 minutes later)
Brief Answer:
No problem

Detailed Answer:
except with the person sending you to addiction counseling for tylenol. I agree that is just silly.
it illustrates how very much of medical. beliefs are merely fads.
we are past the ones where aspirin like drugs were bad and narcotics are good. we are almost past the tylenol hysteria and about to hit the peak of fear of narcotics.

just wanted to put a word in for coping skills instead of medication
physical therapy...except they dont do it right.
the building up of back supporting muscles is good but moving with grace and balance masters more but isn't emphasized
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

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Suggest treatment for severe anxiety and chronic body pain

Brief Answer: Well let us start with tylenol isnt txoic to kidneys Detailed Answer: even people who suceed in killing themselves w tylenol do not have kidney issues. it is liver toxic. the liver toxicity is simple. it kills it off. cirrhosis from it probably just never occurs because the tylenol toxicity to the liver is either terrible or zero so long term scarring just isn't an issue. the killing of liver is easily and accurately tested with simple liver functions. also, the tylenol toxicity is based on acute overdose only that is also true of water. if you take 5 gallons of water at one time it mightkill you but over the course of a week you probably require that much. i likewise 1000 mg spread over a day every day forever is quite safe