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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for pain in neck,back and knees

I have osteoarthritis, osteoporosis, degenerative disk disease, sciatica nerve damage. I have terrible pain in my neck, lower back and knees. I have had four surgeries on both knees which included knee replacements in both knees as well as knee revisions in both. I have also recently had a radio frequency neurotomy on both sides of my back which has helped some. I m not diabetic but started experiencing signs of neuropathy in my feet my dr prescribed Duloxetine which seems to have helped. Last April my primary physician prescribed Gabapentin for back/nerve pain but I was told by pharmacist I shouldn t take these 2 meds together. He has recently given me Tramadol for pain and it doesn t seem to help at all. I suffer from insomnia and anxiety and take prescribed Temazepam and Lorazepam. I m on quite a lot of medicine as I have high blood pressure,COPD, asthma, bronchectisis, acid reflux w/hiatal hernia, sleep apnea, restless leg syndrome, congestive heart failure, and 3 liters oxygen at night. I also take meds for all of this which has caused lots of problems w/my stomach including ulcers several times. My dr says I shouldn t take any anti-inflammatory meds because of my stomach. I m 64 years old and have been sick for almost 10 years now. My question is this, what can I talk to my dr about that I can take for chronic joint pain especially in my knees. I have more and more difficulty walking and getting up and down. I have so much trouble sleeping even w/the sleeping med I take-can t get comfortable. Seriously, I have never gotten on-line before to ask questions but I m so tired of hurting and have tried so many different meds, I m confused on what to take. I currently have my primary dr., pulmonologist, oncologist (recently had iron infusions & blood for chronic anemia), neurologist, spine & pain mgmt. specialist, gynecologist, gastroenterologist, heart dr. and urologist (for recurring UTI s). I apologize for going into such graphic detail but felt it necessary for you to help me to find something I can take for the chronic joint, neck, and back pain I continue to have and was very concerned when I was told not to take Gabapentin and Duloxetine together and concerns about taking Tramadol (which doesn t seem to help), Lorazepam and Temazepam which I have taken for quite sometime now. I hope you can advise me what in your opinion would benefit me the most without being afraid about taking all these meds together, thank you......
Tue, 24 Feb 2015
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Orthopaedic Surgeon 's  Response
Thank you for your question.yes, it is bit difficult for you with so many treatments necessary- but if one may summarisethe main problem is of your pain in many areas and insomnia may be ensuing therefore.If duloxetine was prescribed for anxiety it may not be incorrect to take alonwith Gabapentine and you have to subjectively assess your pain/insomnia response to the meds.If it is still unbearable then consult your treating orthopedists who may assess the knees,back,neck for supportive measures like walker and some bracing to neck,back coupled with intermittent mild exercisesThis shall help you
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Orthopaedic Surgeon Dr. Sunil Kumar Srivastava's  Response
The combination suggested to you are often prescribed and does no harm. You can call on your doctor if you feel anything subjectively,however.You must seek help of a physiotherapist for palliative care of back and neck and use of cervical collar and lumbo-sacral brace for lower back will lend additional support.An ayurvedic oil called Kati Basti is an effective application oil massage done for 30minutes .The oil should be warmed beforeapplication and rubbed for about 30 minutes
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Geriatrics Specialist Dr. Prakash H Muddegowda's  Response
Hi,
Thanks for asking.
Based on your query, my opinion is as follows.
1. For neural damage, gabapentin is very helpful. However, along with duloxetine, increased risk of drowsiness and concentration difficulty is seen in few individuals.
2. These symptoms are rarely seen, and if found, you can try pregabalin.
3. Tramadol wont be helpful for neuropathic pain.
4. Also, good amount of hydration along with moderate exercises and physiotherapy is necessary. Transepidermal electric nerve stimulation therapy will be helpful.
5. You can stop tramadol and continue with other medication. Both Lorazepam and temazepam are not necessary, you can discuss and take one of them based on your doctor opinion.
Hope it helps.
Any further queries, happy to help again.
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Geriatrics Specialist Dr. Prakash H Muddegowda's  Response
Hi,
Thanks for asking.
Based on your query, my opinion is as follows.
1. You are on quite lots of medications and interactions between these is causing insomnia, acid reflux, etc.
2. With so many medications, I can advise only one extra medication - proton pump inhibitors like esmoprazole to reduce acidity.
3. For pain, as you cannot take NSAIDs, you need to go for transcutaneous electrical nerve stimulation, muscle strengthening physiotherapy and other alternate methods like accupuncture to reduce pain. Medications alone wont be sufficient and with the long list of medications, opioid analgesics wont be beneficial and could become addictive. Do meet a palliative care specialist for pain evaluation and further advisement.
Hope it helps.
Any further queries, happy to help again.
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