my chronic pain history

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WillyJ
New Member


Date Joined Apr 2009
Total Posts : 4
   Posted 4/5/2009 1:21 AM (GMT -7)   
Hi --
I am taking the following meds:
Aspirin – 324 mg at noon each day
Diazepam – 2.5 mg daily
Toprol XL – 100 mg 2x daily
Flomax – 0.4 mg 2x daily
Synthroid – 0.1 mg daily
Prednisone – 50 mg daily
Avapro – 0, 100, 150, or 300 mg daily as needed
Imitrex – as needed
Oxycontin ER
Codeine Sulphate - 60 mg 3x daily
Detrol LA – 4 mg daily
Tramadol – 50 mg tabs
5 mg Zolpidem tartrate - 1-2 per day
Lomotil – 2x daily
Loratidine – 10 mg daily
Metoclopramide – 5 mg daily
Prochlorperazine – 10mg tablets - 2.5 mg as needed
Testim 1% – 1 tube every day
Imuram – 50 mg per day
Fentanyl patches (25 ug / hr -> ?)
Red Yeast Rice – 2x 600 mg per day

The Imuram is for myasthenia gravis, the Testim and narcotics are for back injury, surgery & rehab.

My rehab schedule is:
* gluteus max & abdominal tension, 2 knee to chest, alternating single knee to chest, seated * lower back stretch - every other day 15 minutes
* angry cat, mid-back stretch, lower trunk rotation (9/23/2008: no more than 50% rotation)
* forward lean in half kneel - every other day 15 minutes
* 65 cm ball: anterior pelvic tilt, posterior pelvic tilt, pelvic circles, figure eight pelvic rotation, shoulder shrugs, ROM shoulder, arm, & neck - daily - 60 minutes
* bridge, ball-based flexion and extension, sitting forward bend with no flexion or extension, ball-based "swim" - every other day - 10 minutes
* 1/2 push-ups against table, knees on floor, feet crossed and up 15 min. every other day
* NMES PPR7 at 13/13 every 2-3 days - 5x30 minutes
* 15# rt. Arm, 8# lt. arm: press, curl, reverse curl - every other day 50 reps
* 4# / ankle: curl, reverse curl - every other day 50 reps
* 4 minutes @ 2 mph on treadmill - every other day 20 minutes

On the ten point pain system I monitor about 15 pain points and average them. I am between 5.3 and 5.6 on normal days. Some days I work out a bit harder and end up around 6.2 to 6.5.

What side effects or interactions do I need to watch out for? I have the following allergies: rifampin, tylenol, dust, dog hair, pollen

I have had the following surgeries:
* Oral, facial (numerous)
* Heel, thumb, hernia reductions
* Ulnar reduction, great toe-nail removals (lt. & rt.)
* Oral repair, partial laminectomy (C1-C2)
* Partial laminectomy (C2-C3)
* Full laminectomy (L5-S1), partial (L4-L5)
* Partial diskectomy (L3-L4)
* Sinus repair
* Diskectomy, fusion (C5-C6)
* Abdominal repair
* Left ulnar nerve re-location
* Partial diskectomy (L3-L4)
* Diskectomy, fusion (L2-S1)

I have had the following injuries:
* Shot (.22 rifle), upper lip, palate, sinus
* Simple fracture, left, right ulnae
* Achilles bruise; compound right thumb fracture; right inguinal hernia
* Compound fracture left elbow, ulna
* Non-displaced fractured patella, "turf toe" (lt. & rt.)
* Non-displaced fractured fibula
* Shot (.25 pistol, multiple shot-gun): mouth, cranium, thorax, abdomen, left elbow
* Aggravated ulnar injury
* Aggravated lumbar area

angel8
Regular Member


Date Joined Apr 2009
Total Posts : 109
   Posted 4/5/2009 3:52 AM (GMT -7)   

Hi Willy, I noticed that no ne had replied and thought I had a few alarms going off when reading your list of meds.

First I dont understand the combinations they have you on as it looks as if your on 2 longterm meds and 2 rescue meds even though the tramadol is nonarcotic in composition. I guess what I am trying to ask here is how much oxy are you on and trying to figure out what the purpose of oxy er and duragesic together and then the codeine and tramadol as rescue meds.

I would think they would have stuck with one longterm and one rescue and adjusted the doses of those before adding two completely new categories of either.

Anyway as such I think I myself would pick one of each and work those to get the best relief and try to not add the other two until which time you have to have them. Using them all at this point if you can get by with adequate relief with only two that is what I would do so you can save the others for another time. We get accomadated to meds some of alot faster then others and if we have used up all of the combo's we then find ourselves with no alternatives for good pain control.

Also alarming is that all narcotics have a tendancy to cause bradycardia or low heart rates and lowering blood pressure so the immitrex as known for rapidly dropping B/P and I would given the facts and early deaths related to the use of immitrex know what my B/P is prior to taking it.

I am NOT a Doc so please use this info as a guide to question your Doc and discuss your concerns.

There is also a website for interactions for meds at drugdigest.com and go to the dropdown box labeled interactions and enter all of the meds you listed here and it will list all of the combos of meds your on that can cause concern and the types of problems you can encounter.

 

Good luck to you!


Pamela Neckpain
Veteran Member


Date Joined May 2008
Total Posts : 1821
   Posted 4/5/2009 4:02 AM (GMT -7)   
Willy,

With all you've been through, we are lucky to have you here!

You sound like you're working very hard to make your situation better.
What brought about the change?

Not many people with CP could be so dedicated. Lots of times I just
collapse in my chair and think ... Who cares. My husband walks in,
ruffles my hair and then I KNOW.

If you have no one to ruffle your hair, we'll all get busy with our cyber
fingers. : - D.

Work hard. Come back.

Pamela
MEDICAL CONDITIONS

Osteoarthritis all levels of spine right down to Coccyx,Spondilytis,Myofascial Pain
Fibromyalgia,Bulging Discs,Spinal Stenosis,Scoliosis,Osteopenia,Chronic Constipation
Carpel Tunel Syndrome, Attention Deficit Disorder,
Depression & Anxiety

Methadone for Pain, Xanax for Anxiety, and more, of course.


Lindaloo
Veteran Member


Date Joined Sep 2006
Total Posts : 1713
   Posted 4/5/2009 5:39 AM (GMT -7)   
Welcome Willy,

We are glad you posted with us. Sounds like you are on a lot of medication. Hope your doctor is familiar with the fact that you take all of them. Please make sure.

Please keep posting and let us get to know you. This is a very caring and knowledgeable group. We are glad you are here

Gentle hugs,

Lindaloo
Moderator Chronic Pain
 
Believe in yourself.  Be kind to fellow humans and animals.  Take time to smell the flowers and the coffee.
And by all means, when you are down, ask me for help.  I will be there.
 
Linda


mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 4/5/2009 10:19 AM (GMT -7)   
Hi Willy,
Welcome from me as well. I am also a bit concerned with some of the medications that you are on....and the what appears as doubling of some of them for what might be a single condition. I see for example that you are on two different urinary problems, and as far as I know, they aren't usually prescribed that way. And the pain meds as well.
It might be prudent to discuss all of your meds with your doctors and make sure that they all know that you are on all of these meds.
I'm sorry that you found yourself needing to join us, but glad that you did and that you found us.
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2279
   Posted 4/5/2009 12:43 PM (GMT -7)   
Willy,
Welcome to HW! I don't have your condition & only a doc could say whether you really need to be on all those medications, but personally I wonder whether they are all helping b/c there is so much overlap. You can look up side effects & drug interactions at a site such as wedmd.com, but with so many drugs you can have additional side effects b/c 2 drugs can combine together & create a new interaction with a 3rd drug that would not have normally occurred. I would suggest working closely with your medical team which should include, at a minimum, a Primacy Care Physician, a Pain Medicine Specialist & a Neurologist. It may also be helpful to you, if you have more than one pharmacy in your area, to find a knowledgeable pharmacist who can clearly explain to you what all these drugs do & what benefits/risks occur when they are prescribed together.

Also, you are doing a ton of PT work every day. The meds you are on, assuming you do need to be on all of them to get down to a 6, carry significant side effects & potential for long-term damage to your body. Perhaps you might talk with your doctor about whether a slower PT schedule & fewer meds might better serve you over the long run. Maybe that's not practical for your condition but I just am wondering what it is doing to you to be taking so many meds to artificially strengthen GI & respiratory systems & then be on narcotics which weaken & retard GI & respiratory processes.

Finally, I would point out that there is the possibility of opioid-induced hyperalgesia. If you need to do the PT as scheduled every day, then perhaps there is no way to avoid the narcotics or their side effects, but hyperalgesia is a possibility & could mean needing more pain medicine down the road, which carries additional risk.

I really don't know what I would do if I were you. It sounds like you have a very difficult-to-manage & painful condition and I definitely would wish for you to be as healthy as possible. Please do be careful & make sure everyone on your medical team is communicating with each other regularly. You are the Project Manager of your medical team & need to take responsibility for making sure that everyone is contributing to your wellness & that all treatments are safe & effective. I know from my own experience that docs usually don't like talking to each other, but with as many meds as you are taking, communication is vital & could man the difference between life or death.

Keep us posted on how things go for you!

peace,
frances

WillyJ
New Member


Date Joined Apr 2009
Total Posts : 4
   Posted 4/5/2009 10:28 PM (GMT -7)   
Hi --
First, thanks to all of you for your posts. Quick update on what I take and why.
1) I am on the Fentanyl patches to give 24x7 relief. I use 50 ug/hr patches.
2) I am on the 12 hr. Oxycontin ER for the evening only, taking a 15 mg pill at midnight.
3) I am on tramadol when aspirin is inadequate.
4) I am on codeine sulfate when tramadol is inadequate.
5) I am on Testim as my testosterone level are about 50% of the minimum. After three
months it is up to about 75% of the minimum. My intent is to increase Testim until I
am 75% of the way between minimum and maximum, meaning the normal range for a
younger person. I am approaching 61.
6) I am on Toprol as my heart-rate without it tends to run up towards 110-125 bpm without
using it. At the rate I take it I maintain a pretty reliable 64 bpm.
7) I am on Imuram as myasthenia gravis is affecting my vision and the other meds have
proven ineffective. I also have swallowing issues, but I can manage that through patience
while eating, vision not so easy to manage.
8) I am on prednisone both for myasthenia as well as osteo-arthritis in my right hip. Besides
the gun-shot injuries I was pretty active in sports prior to being shot the second time.
9) I am on lomotol, Imetrix and Metoclopramide to manage the side-effects of Imuram. I
started Imuram in the latter third of March so I am a few months away from being able to
decide if it is actually helping preserve my vision.
10) I am on Detrol, Synthroid, and Flomax because I am 61 and have the normal issues of
anyone of my age and gender.
11) I am on zolpidem as that seems to be the only way to turn things of enough to get to
sleep. If 5mg works, fine, if not after an hour I take another.
12) I am on prochlorperazine if the Metoclopramide doesn't work, if I actually do throw up
the Imuram.
13) Only two doctors prescribe for me, a neurologist for myasthenia and pain issues, a GP
for the rest. Both communicate regularly and I provide a list of meds for them at each
appointment.
14) My PT schedule will increase in intensity as that is the only way I can see working out
of the hole I am in at present. My intent is to be off of disability within a year, pro-
viding the myasthenia is under control. That is my biggest concern as I see no way to
manage that without medication.

So, that is the rationale for my initial post. I cannot express how much I appreciate all of
your responses and am willing to try any suggestions that clear my physicians' approval. I
did not mention it but I take my BP and pulse twice a day and do use Avapro on the rare
occasions that my BP (low end) is above 90. I pretty much ignore the high number.

Thanks --
-- WillyJ (this site enforces anonymity - sorry!)

kttn251977
Veteran Member


Date Joined Jul 2007
Total Posts : 554
   Posted 4/5/2009 11:11 PM (GMT -7)   
willy, i complain about my 10 meds, how do you manage it? i hate to see your medical bill. you mentioned a gun shot wound, what happened- if you don't mind my asking. and how do you handle the constipation i can't imagine how much fiber you take, lol. my list clogs me for days. so bad a month ago i was admitted for appendix problems due to constipation, isn't that crazy? well, good luck- hang in there with all those meds and be careful.
RX's: Oxycontin 80mg 2x's daily; Oxycodone 30mg 5xs daily; Zanaflex 4mg 3x's daily; Restoril 15mg 1x; Soma 3x's daily; Lyrica 100mg 3x's daily (pain & fibro.); Phenergan 25mg (as needed); Amitriptyline 25mg 1x (chronic pain); Cymbalta 60mg 2x's daily (pain from fibro); Abilify 5mgs at bedtime (depression); Metoclopram (as needed) & Senokot (as needed).
"The most critical choice you'll ever make is the one you make about what you're going to do with this. The past is over. The future hasn't happened yet. The only time is now."
- Dr. Phil


WillyJ
New Member


Date Joined Apr 2009
Total Posts : 4
   Posted 4/6/2009 1:12 AM (GMT -7)   
kttn251977 --
First shooting occurred as I am of mixed race and the old rules had it that
one drop of "black" blood made you "non-white", i.e., fair-game for lynchings,
shootings, etc. The shot was fired from my cousin, no less. Second shooting
occurred while blocking a hold-up of the company I worked for. The crooks
had hostages so it was no possible to simply disengage, so I actively got
involved in rescue work. Developed a good piece of advice: don't get in a gun-
fight unless you have a gun on you.

I handle the side-effect you describe by taking lots of Senokot. drinking lots of
water, and eating whatever else has lots of fiber in it. Also, the main side-
effect of the myasthenia meds is diarrhea.

I was on Cymbalta which put me in the hospital with high (106F) fevers so I
intend to stay away from that. It may have been an interaction with tramadol,
but since it stopped when the Cymbalta stopped the course of action seemed
pretty easy to call.

Sorry to hear about your fight with depression. If it helps, go to PT then look
around. You'll probably find a lot of people with similar issues so it makes you
realize that God didn't pick you to be Her / His personal outhouse. No matter how
bad things get, there is always somebody in worse condition, so you can make
it back to where-ever you want to get to. It might not be fast and certainly
won't be fun, but the bigger the challenge the better the reward feels when
you get there, and you will.

Take care --
-- WillyJ

Pamela Neckpain
Veteran Member


Date Joined May 2008
Total Posts : 1821
   Posted 4/6/2009 1:57 AM (GMT -7)   
WillyJ --

You wrote "Sorry this site enforces anonymity" This makes me want to know,
Would we recognzie your name?

We should all be so knowledgeable about our various ailments. We should
all have your philosophy that you discuss in you post right above this.

I had just posted something about hyper-induced Analgesia. I guess I
don't have to explain that one to you. Ha.

Frances, what a excellent post. Maybe it doesn't apply here but never the
less ...

Pamela
MEDICAL CONDITIONS

Osteoarthritis all levels of spine right down to Coccyx,Spondilytis,Myofascial Pain
Fibromyalgia,Bulging Discs,Spinal Stenosis,Scoliosis,Osteopenia,Chronic Constipation
Carpel Tunel Syndrome, Attention Deficit Disorder,
Depression & Anxiety

Methadone for Pain, Xanax for Anxiety, and more, of course.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 4/6/2009 5:36 AM (GMT -7)   

Hi Willy,

I looked at your list of meds again and might have a tip or two for you. The condition you are taking Imuran for I have no clue what it is. I think you said that you started the Imuran in March. I have crohn's disease and have been on 225mg of Imuran for nearly 7 yrs. Usually people are started on 50mg. My gi dr has his patients take the Imuran at bedtime to avoid the nausea that can be associated with the drug. Most people do have lots of nausea if they take it during the day. It should also help with some of your joint pain. Do you have regular blood draws to check your liver, if not you should.  Some drs do it every 3 months, my rheumy orders labs every 30 days. The down side to Imuran is it takes about 3 months to get in your system before you can notice any difference. So, don't throw the towel in yet, its too soon.

I don't know how long you have been on Prednison, but taken long term it can cause necrosis of the hip joint. Its an old standard crohns medication and the people that became steroid dependent, many had to have hip replacement surgery. A good drug with nasty side effects.

Lomotil I see you take I think 2 a day, I am assuming  for diarhea. If the two does not help, you can have up to 8 a day, not to exceed 8 in 24 hrs. My 1st gi tried the 2 a day crap, of course it did nothing for my chronic diarhea, gi number 3 is the one that changed my doseage for the max doseage. He could not belive what that other one did on the Lomotil.  Made a huge difference.

Wow thats alot of aspirin. Watch out for stomach issues, including a stomach bleed. Why such a high dose may I ask?  

Susie                                                                                                                                                                                                                                                                                                                      



kttn251977
Veteran Member


Date Joined Jul 2007
Total Posts : 554
   Posted 4/6/2009 8:01 AM (GMT -7)   
thats really sad to hear. but i used to live in rural ga and unfortunately racism is strong there. i am white and my hubby is black, so i know what you mean. we met in atlanta, which there was never a problem about a mixed couple. when we moved to tampa, when we go out- to eat, etc i get a lot of nasty looks sometimes. but he is a good man and treats me like a princess. i stay at home due to my back, i can't do much without severe pain, and he is very understanding. he had a severe muscle strain once in his back and kept saying "how do you deal with this?" lots of medication. its sad that racism still exists today. we should be way beyond that in our country. i was so excited when the elections were happening, history would have been made either way on the democratic side. i personally would have voted for hillary due to her want for a organized medical system. i think its sorry of the us to bail out this companies and yet people have to chose between eating and medication. i have been there and its awful. cancer is strong in my family, everyone has died from it. i had cancer when i was about 21 (stage 1, no big deal) but you don't really grasp it at that age. i'm 32 now and it seems like a lifetime ago when i could run and ride roller coasters. i think i miss that the most, lol. and i wish i would have had the chance to have a baby. but sometimes there is a curveball in life. i felt so bad when i read what you have gone through. i'm such a wimp if someone shot me i would be over the top freaking out. let alone shot twice. i'm sorry for everything you are going through and i hope you find some relief- golly all those meds, i couldn't keep up. i seriously don't know how you do it. good luck and just hang in there.... your friend, shannon.
RX's: Oxycontin 80mg 2x's daily; Oxycodone 30mg 5xs daily; Zanaflex 4mg 3x's daily; Restoril 15mg 1x; Soma 3x's daily; Lyrica 100mg 3x's daily (pain & fibro.); Phenergan 25mg (as needed); Amitriptyline 25mg 1x (chronic pain); Cymbalta 60mg 2x's daily (pain from fibro); Abilify 5mgs at bedtime (depression); Metoclopram (as needed) & Senokot (as needed).
"The most critical choice you'll ever make is the one you make about what you're going to do with this. The past is over. The future hasn't happened yet. The only time is now."
- Dr. Phil


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2279
   Posted 4/6/2009 7:21 PM (GMT -7)   
Willy,
It is possible that the Cymbalta reaction was from combining with the narcotics, the Ambien or the Imitrex. Not sure whether it was actually
Serotonin Syndrome or not, but regardless of an actual dx, the combination of those drugs is likely to really mess with your serotonin levels
which can cause spikes in temperature, high BP and high HR, among other problems. Serotonin Syndrome is very rare, but still there are less
dangerous complications that can result from combining so many meds that alter serotonin & other chemicals in the brain. Just something to
consider in the future as too much serotonin can be fatal.

It sounds like you are pretty happy with your neurologist, but having a trained pain medicine specialist (often certified in anesthesia) does
have its advantages -- chief of which is that they can choose medications to safely & effectively treat symptoms. In addition, from my experience
at least, my neurologists would only see me every couple of months, even when I was really in bad shape. They did get me in right away when I
developed the SS, but other than that I was on my own between appointments. My PM's have much more proactive about seeing me as
often as needed -- sometimes a couple times a week when I would be in especially bad shape or when I would have a lot of problems with
my meds. good luck with everything!

blessings,
frances

WillyJ
New Member


Date Joined Apr 2009
Total Posts : 4
   Posted 4/6/2009 9:39 PM (GMT -7)   
Frances --
Interesting enough, I had low BP and HR with the temp spike problem. Being an obsolete chemist, I
tried three times to replicate the problem by going on the Cymbalta, having the issue recur after 72 to
96 hours, then of course stopping the Cymbalta as soon as my temp exceeded 100F. Each time it got as
high as 105. Thermometers are cheap, and last pretty long, so we got three of them just to be sure that
one little tube wasn't the problem. The first incident had me in ICU getting blood draws every two hours
with no trace of any source of infection, and actually a slightly below normal WBC. The doctors actually
just gave up and took me off the Cymbalta as it was the only new med I was on and they had no other
tests to run. I also found out that I am probably allergic to rifampin, which I did not try to replicate.

I do have an anesthesiologist who occasionally give me injections in the L2-L3 area which calm down
a really bad "hot spot" in the mid-thigh area. I don't see him but 2-3 times a year but he gets copied
on everything the GP and neurologist do, and also manages me for the occasional surgery. Fortunately
I am older than any of these three doctors and with everybody's 401k taking a big hit I don't expect any
of them to retire early. That was half a joke and half serious as good physicians are hard to find. My
neurologist is pretty busy but he can squeeze me in with just 2-3 days notice. I have had my anes-
thesiologist put a surgery off for two hours to help when the neurologist thought it was necessary. Its
funny but the hardest appointment for me to make is with my GP - she never seems to have an opening
for 7-10 days when I need to see her.

Thank you tons for taking the time to respond to my posts. It sounds like your pain managers are working
out well for you so hopefully your life is under your control.

Take care,
WillyJ
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