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medication prescribed by pain management doctors

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megsie84 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote megsie84 Quote  Post ReplyReply Direct Link To This Post Topic: medication prescribed by pain management doctors
    Posted: Jan/30/2013 at 5:09pm
Hi my physiotherapist rung me today to say that she has recomended that I get seen by a pain management doctor rather than be refered for steroid epidural injections to help slow down my muscle spasms, and I was wandering if anyone on here would be able to give me a rough idea of the type of medication the pain management doctor would prescribe? I have muscle spasms in legs down to knee and also in the groin area due to trapped nerve and muscle spasms in back and glutious are due to bulging disc . I have tried to goggle this and looked on uk nhs site patient.com, but all that came up was ketamine injections and steroid epidural injections. Many thanks,Megan.Confused
Mild bilateral forminal stenosis,Constant spasms , bilateral sciatica and osteo arthritis in knees.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Jan/30/2013 at 5:16pm
Hi Megan,

Well if you are having spasms, then a muscle relaxant would be first drug of choice.  Often times, a mix of medications are used----something for pain; something for nerve type pain and muscle relaxants. 

I wrote this up awhile ago and tried to put the different names of the same medications that are used in the countries most of our members are from.   Take a look through it and see if you can use it as a basic reference guide. http://chronicpainsite.com/mb/forum_posts.asp?TID=5128&title=medications-for-chronic-pain-patients  I hope this helps.  Stevie

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Spinal Fusions L5-S1 and L4-L5. Cervical DDD, stenosis, spondylosis, spondylolisthesis and facet arthropathy throughout cervical spine from C3-C7. Thoracic Spine: dextroconvex curvature of the thoracic spine, centered at approximately T8.(Scoliosis with 20 degree curve). At T7-8, a disc bulge. Degenerative disc disease T7-T9. Disc dessication from T3-T11.


NATIONAL SUICIDE HELPLINE 1-800-273-TALK (8255)
http://www.crisisclinic.org/
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Bailey Quote  Post ReplyReply Direct Link To This Post Posted: Jan/30/2013 at 6:14pm
Hi Megan,
 
I've tried two different muscle relaxants, flexeril and baclofen. Flexeril was more succesful for me in relieving or lessening the spasms. I did find it made me very tired to start, I couldn't drive until I got used to it.
 
The article Stevie gave you a link to, is very informative. I hope you get some relief soon.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Edie Quote  Post ReplyReply Direct Link To This Post Posted: Jan/30/2013 at 8:57pm
Hi Megan

The treatment you usually get from pain Management depends on the Dr there, (some are more conservative then others, when it comes to medications) the diagnosis provided by your physician, and the intensity of the pain. Since you mention you have nerve problems, along with muscle spasms, it is possible they may start you first with some PT, and then possibly some muscle relaxants and some type of medication for nerve pain, like Neurontin or Liryca. Depending on your pain level, they may also prescribe one of the opioid based pain medications.

At least that is how it is here in the States, but I think that it is pretty much the same in the UK.

When is your appointment? I hope it goes OK...Edie
Multilevel degenerative disc disease
C3-4, broad based disc bulge with small bone spurs
C4-5, dehydration of the disc with broad based disc bulge
C5-6 narrowing and dehydration of the disc, with small osteophytes. Mild effacement of the ventral subarachnoid space. Moderately severe bilateral foraminal narrowing due to disc and spur. Probable C6 nerve root impingement bilaterally.
C6-7 narrowing and dehydration of the disc with broad based disc bulge and postereolateral marginal spurs
C7-T1 narrowing and dehydration of the disc. Small posterolateral marginal spurs with fairly severe narrowing of both neural foramina. Probable bilateral C8 nerve root impingement.
T4 to T10: Moderate to advanced DDD with moderate to severe disc space narrowing
All non operable

Pain in both knees
Torn ACL and MCL in car accident, some years ago, no surgery
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Chronic depression, chronic insomnia, and anxiety manifested in constant hyperventilation (the constant need to take a deep breath) especially when I try to rest.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote megsie84 Quote  Post ReplyReply Direct Link To This Post Posted: Jan/31/2013 at 11:15am
Hi eddie my appointment is on march the fifth. My doctor has tried gabapentine with me which gave me pain of relief relief but not a lot of relief from the spasms so she prescribed me baclofen alongside tramadol hich kinda takes the edge of, but my muscles are still rock hard . more recentley I've been prescribed valium as well and she say's there is no more differnent types of medication that she could give me so i need to see a specialist dcotor . Fingers crossed I will be given a stronger muscle relaxant or one that suits me better. 
Mild bilateral forminal stenosis,Constant spasms , bilateral sciatica and osteo arthritis in knees.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote megsie84 Quote  Post ReplyReply Direct Link To This Post Posted: Jan/31/2013 at 11:17am
Thank you for that article stevie it's nice to know what type of medication to expectBig smile
Mild bilateral forminal stenosis,Constant spasms , bilateral sciatica and osteo arthritis in knees.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Jan/31/2013 at 11:58am
You are very welcomed Megsie. 

Good luck at your appointment, and please keep us posted on your progress.  There are several muscle relaxants in that list I sent you that may work for you.  As is with everything, what works for one person doesn't always work for another, so it's trial and error.  Stevie

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Spinal Fusions L5-S1 and L4-L5. Cervical DDD, stenosis, spondylosis, spondylolisthesis and facet arthropathy throughout cervical spine from C3-C7. Thoracic Spine: dextroconvex curvature of the thoracic spine, centered at approximately T8.(Scoliosis with 20 degree curve). At T7-8, a disc bulge. Degenerative disc disease T7-T9. Disc dessication from T3-T11.


NATIONAL SUICIDE HELPLINE 1-800-273-TALK (8255)
http://www.crisisclinic.org/
IN THE UK 0845790 90 90
http://www.samaritans.org/
For help for many things...
Canada: http://www.211Canada.ca/
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Merlin Quote  Post ReplyReply Direct Link To This Post Posted: Jan/31/2013 at 2:16pm
Hi Megsie
 
Welcome to our website - I don't think I have posted you a message yet
 
I hope all goes well with your appointment - and that you know that all of us here care very much for you and what you are going through - for although the symptoms might be different - we all have pain and we support each other - and we will support you
 
Best wishes
 
Merlin (Australia)
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Severe Inoperable Lumbar Spinal Problems - both shoulders damaged
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Edie Quote  Post ReplyReply Direct Link To This Post Posted: Jan/31/2013 at 2:54pm
Muscle spasms can be so painful. I do get them once in awhile. I hope the PM will find something better for you. You may want to try doing some stretches, rubbing the tight areas, and using some moist heating pads to help relax the muscles. Remember not to expect drugs to eliminate the pain and discomfort completely. The best thing to do is use just enough to cut the edge off, so we can be able to function. If we were to take enough medication to eliminate the pain, we would be so out of it, we would become useless, and that is not what we want to do.

Take care...Edie
Multilevel degenerative disc disease
C3-4, broad based disc bulge with small bone spurs
C4-5, dehydration of the disc with broad based disc bulge
C5-6 narrowing and dehydration of the disc, with small osteophytes. Mild effacement of the ventral subarachnoid space. Moderately severe bilateral foraminal narrowing due to disc and spur. Probable C6 nerve root impingement bilaterally.
C6-7 narrowing and dehydration of the disc with broad based disc bulge and postereolateral marginal spurs
C7-T1 narrowing and dehydration of the disc. Small posterolateral marginal spurs with fairly severe narrowing of both neural foramina. Probable bilateral C8 nerve root impingement.
T4 to T10: Moderate to advanced DDD with moderate to severe disc space narrowing
All non operable

Pain in both knees
Torn ACL and MCL in car accident, some years ago, no surgery
Migraine headaches
Very tender, painful spots all over scalp
Chronic depression, chronic insomnia, and anxiety manifested in constant hyperventilation (the constant need to take a deep breath) especially when I try to rest.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote up late Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 3:36am
Originally posted by Edie Edie wrote:

Hi Megan

The treatment you usually get from pain Management depends on the Dr there, (some are more conservative then others, when it comes to medications) the diagnosis provided by your physician, and the intensity of the pain. Since you mention you have nerve problems, along with muscle spasms, it is possible they may start you first with some PT, and then possibly some muscle relaxants and some type of medication for nerve pain, like Neurontin or Liryca. Depending on your pain level, they may also prescribe one of the opioid based pain medications.

At least that is how it is here in the States, but I think that it is pretty much the same in the UK.

 
That's how it is in here in Australia too, my pain doc is more interested in the nerve pain meds like gabapentin and lyrica to treat the pain, where his "nemesis" Wink across town prefers to do injections to treat the source of the pain.
Please do NOT raise the subject of mental health or therapy in reply to my posts.

Hysterectomy (adenomyosis and fibroids), osetoporosis, spine (disc/bone L4/L5/S1, milder arthritic trouble with C3/4/5/6) radiating pain into my pelvis, hips and legs. Chostochronditis, kidney stones, migraines. Unexplained vertigo, nausea, shaking sweats,orthostatic hypotension, blistering rashes and severe abdominal pain.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote up late Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 3:43am

opps double post

Please do NOT raise the subject of mental health or therapy in reply to my posts.

Hysterectomy (adenomyosis and fibroids), osetoporosis, spine (disc/bone L4/L5/S1, milder arthritic trouble with C3/4/5/6) radiating pain into my pelvis, hips and legs. Chostochronditis, kidney stones, migraines. Unexplained vertigo, nausea, shaking sweats,orthostatic hypotension, blistering rashes and severe abdominal pain.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote megsie84 Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 4:40am
That sounds a lot better to me as I'm a bit scared of the size of epidural needles having seen one before when I asked for one when I was in labour .
Mild bilateral forminal stenosis,Constant spasms , bilateral sciatica and osteo arthritis in knees.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Rocken Roni Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 5:26am
I don;t understand how they (the physician) can hit the right spot w/o an xray.

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1st injured Feb, 1997. Was told it was "Soft Tissue" and sent back to work - no X-rays
Late 1997 attended 1st Rehab Program to strengthen back. Mid 98 PCP took me off work. Tried going back to work over the next couple years, mostly off work due to pain.
June 2000, met with OS for first time. Did MRI , damage was L5-S1 totally blown out. Surgery done Jan, 2001.
Another Rehab program late 2001, attempted to go back to work early 2002. Slipped on water, fell flat on back screw fusion broke.
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No improvement. Attended 4th Rehab program in 2004, at time It was decided NO work.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Merlin Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 5:56am
Practice I guess Roni - but I never feel happy with Nurse RachedShotjabbing at me blindly
 
I have a bad memory from my youth - when my heavy periods had my mother taking me for a blood test
 
That nurse lost her head and I remember my mother getting frantic - and finally an older man came in and got the needle in and got the blood with one go
 
Roni - I think they do know it by heart if they are in the older brackets of ages - my GP did a fantastic job with the intra-articular right through all the arthritis
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Post Options Post Options   Thanks (0) Thanks(0)   Quote megsie84 Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 6:12am
Is there a risk of being paralaysed with a epidural done for pain relief? I know there was a risk with the one i was going to have (but wimped out of) when I was in labour,but then the doctor would have just stuck it in without a xray or me having had a mri scan and I have had a mri scan so they would know what nerve to stick it in and would be guided by a scan or xray.... Mum say's I'm just gonna have to go with whatever the rhematologist says and that my uncle peter copes well with injections and mri scans(he is claustrophobic) after having being given valium. I don't think valium would stop me from being scared though and I've been told I can refuse the injection,but mum will stop giving me so many lifts if I'm offerd a epidural and refuse it as she says thats making things worse for myself.. Sorry for the moaning
Mild bilateral forminal stenosis,Constant spasms , bilateral sciatica and osteo arthritis in knees.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Merlin Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 6:48am
You're not moaning MS - we all have a turn - you are having a bit of a practise run -
 
I had an epidural when I had knee surgery - I was aware that I was under an anaesethic but it was more like sedation - that was good - I had a fantastic trip
 
My daughter and one of my grand-daughters had epidurals during childbirth - you might hear some
horror  stories cause they have to warn you that this can happen. And they need to have you under
 
It all comes back into your Risk/reward ratio - how much pain relief would be worth have an injection - compared with the risk of paralysis - about which they legally must warn you even though the chances are slight
 
But realistically - I have not had an epidural for any other reason that the surgery - I was rattling my teeth together - yes - they let me keep my upper and lower partials in for the surgery
 
I would hate it if they took my teeth out for the surgery - think about what you would feel like if this funny things - and work out your thoughts their
 
All the best with that
 
 
Merlin
Severe Inoperable Lumbar Spinal Problems - both shoulders damaged
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Feb/02/2013 at 7:20am
Megsie,

There is always a risk of anything ----infection, etc anytime anything is injected into us---however the risks are small as long as you have someone who is expert at the procedure and uses fluoroscopic equipment to guide the needle into the proper space.

ESI's done for pain relief help about 1/3 of people. Generally they are more effective when done for acute pain rather than chronic, and often done in a series of three.  I would say that you should request sedation for this----it isn't always offered, but I have had them done both ways and wouldn't do it again without sedation.  It is probably worth the small risk of anything going wrong, as you may be one of those people who benefit from them. 

The thing that you need to do, is to ask the Dr when you see him/her about any and all concerns you have prior to going through with the injection.  Stevie

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Spinal Fusions L5-S1 and L4-L5. Cervical DDD, stenosis, spondylosis, spondylolisthesis and facet arthropathy throughout cervical spine from C3-C7. Thoracic Spine: dextroconvex curvature of the thoracic spine, centered at approximately T8.(Scoliosis with 20 degree curve). At T7-8, a disc bulge. Degenerative disc disease T7-T9. Disc dessication from T3-T11.


NATIONAL SUICIDE HELPLINE 1-800-273-TALK (8255)
http://www.crisisclinic.org/
IN THE UK 0845790 90 90
http://www.samaritans.org/
For help for many things...
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Tas Quote  Post ReplyReply Direct Link To This Post Posted: Feb/03/2013 at 12:00am
Big smile  Hi,

I have had and am still having facet blocks (epidurals) put in about every three to six months. The pain management dr. who performs the operation gives me anaesthetic in the lower back.  I usually watch the the needle go in on the big screen.

Hasn't been working the last two times, therefore had an MRI scan done yesterday.  Will be getting some results this week.

Facet blocks - nothing to be scared of.

Good luck with your treatment, do try and stay off the drugs, though.

Ken (Tas)

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L1/2 Mild bilateral facet astropathy. L2/3 same as L1/2. L3/4 ditto. L4/5 Disc bulge indenting anterior thecal sac. Bilateral facet astropathy. Mild canal and left foraminal stenosis. L5/S1 Severe disc narrowing with extensive osteophytes. Broad based disc osteophyte protusion indenting anterior thecal sac and resulting in a right foraminal stenosis. Exiting L5 nerves intact. Osteophytic contact with descending right S1 nerve root. Conclusion_ Severe degenerative disc changes L5/S1 with disc-osteophyte protusion. Moderate disc bulge L4/L5 Moderate central spinal stenosis with obileration of the epidural fat and distortion of the thecal sac. L5/1 Decreased disc height and signal. Super Ventricular Tachacardia. (SVT) Type 2 Diabetes, Arthritis knees and hips.
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Bailey Quote  Post ReplyReply Direct Link To This Post Posted: Feb/03/2013 at 10:22am
Hi Megsie,
 
I've had numerous injections for my cervical problems, without any problems whatsoever. I've had both ESI's and Radio Frequency Ablation or Rhizotomy, where they burn the nerves around the facet joints for pain relief.
 
These were all done using floroscopy, a real time x-ray machine. I've never been given sedation, they do use local anesthetic. It's uncomfortable, but not too bad for me.
 
Only you can make the decision, it's your body. Some people have great success, others not so much. The ESI's tend to be one of the first things they try to relieve swelling and reduce pain. If you go ahead, I hope they bring long lasting relief.
 
Good luck.
 
Bailey
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Post Options Post Options   Thanks (0) Thanks(0)   Quote megsie84 Quote  Post ReplyReply Direct Link To This Post Posted: Feb/04/2013 at 6:34am
Hi my dcotor today has prescribed me 15mg of mirtazapine to be taken at night for pain and to help me sleep,.I've been told it's a antidepresant that works well for nerve pain my dosage will be increased every few weeks. Iwas wandering if anyone on here has ever been prescribed it and how long it takes to kick in as there is nothing in my instructions leaflet about it being used for pain(only it's uses for deppression), thanks.Confused
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Stevie Quote  Post ReplyReply Direct Link To This Post Posted: Feb/04/2013 at 6:49am
mirtazapine (Remeron) is a sedating antidepressant which should help with sleep.  Many antidepressants seem to help with management of chronic pain-----it is unknown often how they work---possibly by increasing mood which in turn helps with pain, or by increasing the efficacy of other medications.

I haven't heard of other members using this particular antidepressant for nerve pain, but possibly your Dr knows of studies done using this for pain management.  How about calling your pharmacist and discussing this with him/her?  Stevie

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The information and articles provided on our website are designed to support, not replace the relationship between patients and physicians.

Spinal Fusions L5-S1 and L4-L5. Cervical DDD, stenosis, spondylosis, spondylolisthesis and facet arthropathy throughout cervical spine from C3-C7. Thoracic Spine: dextroconvex curvature of the thoracic spine, centered at approximately T8.(Scoliosis with 20 degree curve). At T7-8, a disc bulge. Degenerative disc disease T7-T9. Disc dessication from T3-T11.


NATIONAL SUICIDE HELPLINE 1-800-273-TALK (8255)
http://www.crisisclinic.org/
IN THE UK 0845790 90 90
http://www.samaritans.org/
For help for many things...
Canada: http://www.211Canada.ca/
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