Psycho-Babble Medication Thread 8605

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chronic pain: not always "just in your head"

Posted by Elizabeth on July 11, 1999, at 22:23:42

Hi everyone. A while back I posted about a problem with chronic back pain, and several people sent very thoughtful replies - my thanks to all of you.

Well, I've been to the pain clinic and had a couple x-rays, and it turns out that there is indeed something identifiable that is probably causing the problem. Specifically, a word came up that I hadn't heard in more than a decade: scoliosis. (I'm 23 years old.) That's right: somehow, my spine has been curved wrong all these years, and I never knew it, and nobody noticed before!

The doctor at the pain clinic said what I have is a "facet syndrome." He tried to explain what that is, but I didn't get it, as I don't know much anatomy. Basically I think it means that something is pressing against something else that it shouldn't be.

The treatments they are recommending are site injections (steroids and a local anaesthetic), biofeedback (to fix my posture), physical therapy, and muscle relaxants (baclofen, a direct GABA-B agonist which has the bonus effect of helping me sleep a little better). They also want me to fix my computer setup so it's a bit more ergonomic.

Anyway I was astonished by this, because I had been expecting to get an answer like the one that most people with back pain get, namely that there's no identifiable reason for the pain and that I just have to learn to cope (along with the implication that it is somehow "psychogenic").

I didn't realize how much it bothered me not to have an explanation for my pain until now. Mind you, dealing with it is still going to suck - there's no quick and easy answer for it - but at least they have to admit it's real. I hope that one day we will understand the brain and have easily used techniques to observe its functioning so that the source of so-called psychogenic pain can be identified as well. In the meantime I would like physicians to be reminded that there are still many things about medicine (not just the medicine of the brain) that aren't well understood, so that a problem is not always due to "anxiety" or somesuch just because you can't find any other cause. (I had been to doctors and physical therapists for this problem before, and none identified the cause until now.)

If anyone has experience with any of this stuff, I'd love to talk about it.

 

Re: chronic pain

Posted by JohnL on July 12, 1999, at 4:18:09

In reply to chronic pain: not always "just in your head", posted by Elizabeth on July 11, 1999, at 22:23:42

> Hi everyone. A while back I posted about a problem with chronic back pain, and several people sent very thoughtful replies - my thanks to all of you.


Hi Elizabeth. I really look forward to your posts. Thanks for being so helpful.

I just wanted to let you know you have company. I have scoliosis too, though rather mild. As a result, one shoulder is slightly lower than the other. My brother has it worse (it is genetic), and a few days a month he finds it so painful he downs a lot of Tylenol. Mine causes a constant mild pain, and I have to be careful of certain movements that make it worse. My father is an orthopaedic surgeon and says it can be corrected with surgery, but that is rather serious and reserved for crippling cases or acute gross deformity. It is known to worsen with age, but not always. (great news, huh?)

My brother has tried all the pain medications and says Percocet is the only one that works for him. He got it on the street once, but can't find it anymore. So far he hasn't been able to get a doctor to prescribe it because of its addiction potential. I wish doctors would more often consider the risk/benefit profile from a more empathetic angle. Clearly he wants the drug for serious pain, not for a high, and he's tried everything else. Reminds me of prescribing a psychostimulant like methamphetamine for depression. If it works, and all else has failed, then addiction might well be an acceptable risk to give the person a new lease on life.

Just realize you aren't alone. You have scoliosis company at this site. By the way, do you know anything about Percocet? Does it go by another name? My brother was considering an overseas pharmacy but we couldn't find it listed. I tried a search but found hardly any info on it. Like maybe the spelling is wrong, or goes by another name, or something. Thanks. Wishing you a smooth day. JohnL.

 

Re: chronic pain: not always "just in your head"

Posted by leah on July 12, 1999, at 6:17:23

In reply to chronic pain: not always "just in your head", posted by Elizabeth on July 11, 1999, at 22:23:42

I got a very interesting web sit for a post here.
search on American Acadamy of Environmental Medicine they are
are having a meeting in October and their seems to
be quite a bit on chronic pain. Maybe you can find an
alternative to use along with you current M.D.
Best Wishes.
> Hi everyone. A while back I posted about a problem with chronic back pain, and several people sent very thoughtful replies - my thanks to all of you.
>
> Well, I've been to the pain clinic and had a couple x-rays, and it turns out that there is indeed something identifiable that is probably causing the problem. Specifically, a word came up that I hadn't heard in more than a decade: scoliosis. (I'm 23 years old.) That's right: somehow, my spine has been curved wrong all these years, and I never knew it, and nobody noticed before!
>
> The doctor at the pain clinic said what I have is a "facet syndrome." He tried to explain what that is, but I didn't get it, as I don't know much anatomy. Basically I think it means that something is pressing against something else that it shouldn't be.
>
> The treatments they are recommending are site injections (steroids and a local anaesthetic), biofeedback (to fix my posture), physical therapy, and muscle relaxants (baclofen, a direct GABA-B agonist which has the bonus effect of helping me sleep a little better). They also want me to fix my computer setup so it's a bit more ergonomic.
>
> Anyway I was astonished by this, because I had been expecting to get an answer like the one that most people with back pain get, namely that there's no identifiable reason for the pain and that I just have to learn to cope (along with the implication that it is somehow "psychogenic").
>
> I didn't realize how much it bothered me not to have an explanation for my pain until now. Mind you, dealing with it is still going to suck - there's no quick and easy answer for it - but at least they have to admit it's real. I hope that one day we will understand the brain and have easily used techniques to observe its functioning so that the source of so-called psychogenic pain can be identified as well. In the meantime I would like physicians to be reminded that there are still many things about medicine (not just the medicine of the brain) that aren't well understood, so that a problem is not always due to "anxiety" or somesuch just because you can't find any other cause. (I had been to doctors and physical therapists for this problem before, and none identified the cause until now.)
>
> If anyone has experience with any of this stuff, I'd love to talk about it.

 

Re: chronic pain/to John L.

Posted by Deb on July 12, 1999, at 10:17:19

In reply to Re: chronic pain, posted by JohnL on July 12, 1999, at 4:18:09

> > Hi everyone. A while back I posted about a problem with chronic back pain, and several people sent very thoughtful replies - my thanks to all of you.
>
>
> Hi Elizabeth. I really look forward to your posts. Thanks for being so helpful.
>
> I just wanted to let you know you have company. I have scoliosis too, though rather mild. As a result, one shoulder is slightly lower than the other. My brother has it worse (it is genetic), and a few days a month he finds it so painful he downs a lot of Tylenol. Mine causes a constant mild pain, and I have to be careful of certain movements that make it worse. My father is an orthopaedic surgeon and says it can be corrected with surgery, but that is rather serious and reserved for crippling cases or acute gross deformity. It is known to worsen with age, but not always. (great news, huh?)
>
> My brother has tried all the pain medications and says Percocet is the only one that works for him. He got it on the street once, but can't find it anymore. So far he hasn't been able to get a doctor to prescribe it because of its addiction potential. I wish doctors would more often consider the risk/benefit profile from a more empathetic angle. Clearly he wants the drug for serious pain, not for a high, and he's tried everything else. Reminds me of prescribing a psychostimulant like methamphetamine for depression. If it works, and all else has failed, then addiction might well be an acceptable risk to give the person a new lease on life.
>
> Just realize you aren't alone. You have scoliosis company at this site. By the way, do you know anything about Percocet? Does it go by another name? My brother was considering an overseas pharmacy but we couldn't find it listed. I tried a search but found hardly any info on it. Like maybe the spelling is wrong, or goes by another name, or something. Thanks. Wishing you a smooth day. JohnL.

John, I sympathize with your brother on his quest for pain relief. I've had surgery for a brain tumor (not successful) and have suffered excruciating headaches ever since. They last as long as two to three weeks at a stretch. I tried every avenue I could think of to alleviate this pain to a livable level: pain clinics, physical therapy, chiropracters, biofeedback, self-hypnosis, muscle relaxation, meditation, all to no avail. Now I have a doctor who prescribes Percocet for the moderately bad days and demerol tabs when it's totally out of control. These are powerful drugs and highly addictive, but he and I talked a long time and decided that living with an addiction couldn't be any worse than being in agony two-thirds of your life. He monitors my use carefully. I don't get any high from the meds, just blessed relief so that I can have some kind of life with my family. The generic for percocet is oxycodone/apap, but as it is a control 2 or 3 narcotic, it can only be obtained with a doc's scrip which has to be delivered in person to the pharmacist and is only good for 72 hours. That's how tightly these things are controlled. Wish I could be more helpful. I hope your brother can find a doc like mine who weighs the potential for addiction against a life in agony. Best to you, Deb.

 

Re: chronic pain: not always "just in your head"

Posted by Racer on July 12, 1999, at 10:49:55

In reply to chronic pain: not always "just in your head", posted by Elizabeth on July 11, 1999, at 22:23:42

Not scoliosis in my case, but chronic pain is an old acquaintance. I have a genetic condition that destroys my joints. It also leads to a body type that makes my joints even more unstable, and periodically some of my veins suddenly decide to commit hara kiri. Not a lot of fun. Depression makes the pain much much worse, right now it is at the point I find it very difficult to sleep. But since I've lived with it constantly since my teens, I can tell you some things I've found that help, too.

First of all, chronic pain is really bad for your mental state, since it erodes your resources as water erodes a rock. Be sure that you can find an outlet for that frustration, someone sympathetic to complain to, a doctor willing to try new treatments, whatever.

Secondly, exercise to strengthen the muscles surrounding the affected area is the best of all possible treatments. My lower back pain comes from having broken my tailbone twice. I do some stretching exercises for it, and abdominal exercises. It really does help, as does better posture. If you can find a class in your area, try Yoga. It's really fabulous for backs.

Finally, while they have their problems too, the best drugs I've found for my pain are NSAIDs. They're not addictive, and the best one of those I've found is Zorprin. You know what it is? Aspirin, in a different base. The base keeps it from getting toxic at the doses required to fix my troubles. It really works better than anything else, though. Miracle drug.

You're right about pain being ignored at times. Especially in women, and especially in depressed patients. It's a good start that you've found someone who took it seriously enough to diagnose it. Good luck on treatment.

 

Re: chronic pain

Posted by Elizabeth on July 12, 1999, at 15:13:34

In reply to Re: chronic pain, posted by JohnL on July 12, 1999, at 4:18:09

> Hi Elizabeth. I really look forward to your posts. Thanks for being so helpful.

Hi John. Thanks for being so flattering. :-)

> I just wanted to let you know you have company. I have scoliosis too, though rather mild.

Yeah, mine is mild too, that's why they missed it for so long presumably. But I saw the x-ray and sure enough, there it is.

>As a result, one shoulder is slightly lower than the other. My brother has it worse (it is genetic), and a few days a month he finds it so painful he downs a lot of Tylenol.

I think mine just keeps me from being able to establish a symmetrical posture. My back pain tends to be on one side or the other, and sometimes it shifts sides. For the most part, sitting still, not moving, is what exacerbates it. It's often worst first thing in the morning (along with my depression - sheesh). Walking with a shoulder bag or a really heavy backpack can also be a problem, though.

>Mine causes a constant mild pain, and I have to be careful of certain movements that make it worse. My father is an orthopaedic surgeon and says it can be corrected with surgery, but that is rather serious and reserved for crippling cases or acute gross deformity. It is known to worsen with age, but not always. (great news, huh?)

Fantastic, just what I wanted to hear. :-> Surgery does sort of seem like overkill.

> My brother has tried all the pain medications and says Percocet is the only one that works for him. He got it on the street once, but can't find it anymore. So far he hasn't been able to get a doctor to prescribe it because of its addiction potential. I wish doctors would more often consider the risk/benefit profile from a more empathetic angle. Clearly he wants the drug for serious pain, not for a high, and he's tried everything else. Reminds me of prescribing a psychostimulant like methamphetamine for depression. If it works, and all else has failed, then addiction might well be an acceptable risk to give the person a new lease on life.

If he doesn't have a history of addiction, I don't see a problem with it. Percocet is a combination of oxycodone and acetaminophen (i.e., Tylenol), and he should watch out for tolerance because, while there's no danger in upping the dose of a narcotic as you become tolerant to it
(other than increased pharmacologic dependence and annoying side effects), Tylenol can do yucky things to your liver if used in too-high doses. How much Percocet is he using, and has he needed to up the dose ever? (Some people using small amounts for chronic pain don't.) If he can find a doctor willing to prescribe narcotics, a better choice might be Oxycontin, which is a slow-release form of oxycodone *without* Tylenol or aspirin or anything like that added.

I know that they prescribe narcotics at the pain clinic where I go (I've talked to other patients in the waiting room), so it is possible to find a doctor who will do it.

 

Re: chronic pain

Posted by Cass on July 12, 1999, at 16:25:02

In reply to Re: chronic pain, posted by Elizabeth on July 12, 1999, at 15:13:34

Hi Elizabeth and everyone,

I have also had many negative experiences with doctors regarding pain. To this day they don't know the cause of my chronic foot pain, and, therefore, do not treat it. The best any doctor has ever done is to grudgingly admit that the pain may somehow be associated with my autoimmune disorder (which is a Mixed Connective Tissue Disorder with Lupus variants and other associated illnesses). But the cause of the pain has never really been diagnosed. Many doctors have been very skeptical of my claims of pain. Since a lot of medical tests have been negative, the issue of Deppression always seems to give doctors a way out. It seems like most doctors do not want to go out of their way to diagnose something that is unusual. Once, many years ago, when I was pursuing treatment for my undiagnosed autoimmune disorder, I saw a GP who simply refused to beleive anything was wrong. He kept on saying, "You're young." In his mind, my being young seemed to preclude the possibility of having any serious illness. His generalization rendered him incapable of helping me. I ran into him years later and told him the diagnosis, he brushed it off irritably, saying, "Well, that's not fatal." What's more, the disease is fatal for some.

Over time, chronic pain erodes one's capacity for joy. It has greatly contributed to my suicidal urges. I find it disheartening that many doctors, and people in general, will not believe that something exists unless it is visible or conspicuous. It makes me feel alienated. I was lucky that my autoimmune disease was diagnosed. (It took a long time.) These days when I see a medical specialist of some kind, I do not always include the diagnosis of Depression, because I feel that it subjects me to discrimination, i.e., jeopordizes my chance of receiving quality health care.

My sympathy goes out to everyone who lives with pain and Depression, especially when the pain is undiagnosed. Thank-you for sharing your experiences.

Cass

 

Re: chronic pain

Posted by JohnL on July 12, 1999, at 18:22:49

In reply to Re: chronic pain, posted by Elizabeth on July 12, 1999, at 15:13:34

> Elizabeth, your description of scoliosis, especially the backpack part, the shifting pain, and, well, all of it actually is so eerie to read because it is EXACTLY my situation. Almost like you've been spying on me. Thanks for info on Percocet. Have a smooth day. JohnL.

 

Re: chronic pain - Racer

Posted by Elizabet on July 13, 1999, at 17:15:07

In reply to Re: chronic pain: not always "just in your head", posted by Racer on July 12, 1999, at 10:49:55

Hi Racer. You're sounding a little better/less down these days; that's good. I hope it continues.

> Not scoliosis in my case, but chronic pain is an old acquaintance. I have a genetic condition that destroys my joints.

:-( That's got to suck, especially with the depression too (they probably feed off each other, huh?). What is the name of the condition, if I may ask?

>Depression makes the pain much much worse, right now it is at the point I find it very difficult to sleep.

Sleep loss is one of my main complaints resullting from the pain, yeah.

>But since I've lived with it constantly since my teens, I can tell you some things I've found that help, too.

Goody. :-)

> First of all, chronic pain is really bad for your mental state, since it erodes your resources as water erodes a rock. Be sure that you can find an outlet for that frustration, someone sympathetic to complain to, a doctor willing to try new treatments, whatever.

My friends have been really sympathetic and understanding. And, thank goodness, the pain clinic I've been going to seems pretty progressive.

> Secondly, exercise to strengthen the muscles surrounding the affected area is the best of all possible treatments. My lower back pain comes from having broken my tailbone twice. I do some stretching exercises for it, and abdominal exercises. It really does help, as does better posture. If you can find a class in your area, try Yoga. It's really fabulous for backs.

Physical therapy was one of the recommendations the pain doc made, and even though I've already had it and it didn't help, I'm going to give it another try and see if it will work now that they have more of a clue what's going on (like, a real diagnosis for example).

I also try to stay active whenever I can, though I don't do any specific exercises at the moment. Apparently posture, and not so much muscle weakness, is the difficulty here.

A friend and I had talked about taking a yoga class together at this place in Harvard Square. I'll have to give her a call and find out if she's still up for it.

> Finally, while they have their problems too, the best drugs I've found for my pain are NSAIDs. They're not addictive, and the best one of those I've found is Zorprin. You know what it is? Aspirin, in a different base. The base keeps it from getting toxic at the doses required to fix my troubles. It really works better than anything else, though. Miracle drug.

I've tried many, many NSAIDs, none helped even a little bit. The two things that helped me were Nardil (hydrazide MAOI) and Fioricet (barbiturate with APAP and caffeine added). Jury's still out on the baclofen that I'm trying now. I'm considering switching from Parnate (nonhydrazide, doesn't help) to Marplan (hydrazide, might help???).

> You're right about pain being ignored at times. Especially in women, and especially in depressed patients. It's a good start that you've found someone who took it seriously enough to diagnose it. Good luck on treatment.

Thank you, and thanks for your thoughtful advice.

 

Elizabeth, another thought for you

Posted by Racer on July 14, 1999, at 0:04:30

In reply to Re: chronic pain - Racer, posted by Elizabet on July 13, 1999, at 17:15:07

I take another supplement that you might consider. This is another "well, it helps the horses..." discovery I've made! Chondroitin Sulfate, and Glucosamine Sulfate. Together they work much better than alone. I know that the club stores out here, Cosco and Price club, sell the combination under the name Pain Free. It's not like a painkiller, which just kills pain, but more like an anti-depressant: you have to give them time. In this case, you'll have to take them religiously for about 30 days before they work, and you won't suddenly feel better. You may not even notice any improvement, but I can swear that when I stopped taking them for a while, because I didn't notice a change, I could tell there was a difference as soon as it got really bad again. The results are pretty subtle, and it's one of those gradual things that you really may not notice.

The theory behind these drugs, as I understand it, is that the Chondroitin Sulfate improves the viscosity of the synovial fluid while the Glucosamine improves the health of the cartilidge. Something like that, anyway. Since your spine is made up of joints, even if you don't think of them that way, it may very well help your discomfort.

And may all those doctors who say it's 'all in our heads' experience gout every Monday morning for the rest of their lives! (Seems only fair, after all...)

 

Racer, Thinking along the same line

Posted by Deb on July 14, 1999, at 10:12:58

In reply to Elizabeth, another thought for you, posted by Racer on July 14, 1999, at 0:04:30

> I take another supplement that you might consider. This is another "well, it helps the horses..." discovery I've made! Chondroitin Sulfate, and Glucosamine Sulfate. Together they work much better than alone. I know that the club stores out here, Cosco and Price club, sell the combination under the name Pain Free. It's not like a painkiller, which just kills pain, but more like an anti-depressant: you have to give them time. In this case, you'll have to take them religiously for about 30 days before they work, and you won't suddenly feel better. You may not even notice any improvement, but I can swear that when I stopped taking them for a while, because I didn't notice a change, I could tell there was a difference as soon as it got really bad again. The results are pretty subtle, and it's one of those gradual things that you really may not notice.
>
> The theory behind these drugs, as I understand it, is that the Chondroitin Sulfate improves the viscosity of the synovial fluid while the Glucosamine improves the health of the cartilidge. Something like that, anyway. Since your spine is made up of joints, even if you don't think of them that way, it may very well help your discomfort.
>
> And may all those doctors who say it's 'all in our heads' experience gout every Monday morning for the rest of their lives! (Seems only fair, after all...)

My husband was diagnosed with gout a little over a year ago. This is not a man who complains, but did he ever carry on. The pain must be excruciating. Anyway, I did my research, went to the vitamin section of my pharmacy and got him a bottle of Glucosamine Chondroitin. I checked with his pharmacist for posssible interractions since he does take the regular gout meds. Before the gout he had frequent back pain and stiff joints. Now after a year on this supplement, plus his meds, his attacks are fewer are farther apart and I don't remember the last time he complained with his back! Could be there's something to this. Maybe we all should look a little more into "horse medicine" .


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