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There are numerous opinions as to how one can manage chronic pain. No one person seems to have exactly the same experience when receiving identical treatments. Pain management is an immensley personal journey. It's imperative that we track our pain and document results for our selves and our Doctors.
In dealing with chronic pain for several years now, I have found that there is a simple approach that works well for me. The goal for a chronic pain patient should NOT be to attain a completely pain free life. It must be to MANAGE the pain, or to keep the pain at an acceptable level. What is an acceptable level of pain? For me this means that I am able to continue to be a productive member of society. I am not always able to do all the things that I would like to. There may still be some really bad days. I have to accept that fact and take it day by day. I am able to be employed, and do some things with my family. I am able to have some enjoyment in life despite the pain.
How is this goal of acceptable pain levels achieved? I achieve this result by having a strong and steady flow of base pain medication in my system throughout the 24 hour period. When pain raises above that "base," I can find relief in a hot bath, massage therapy, acupressure or an over the counter pain med such as Ibuprofen or Tylenol. If this does not work, the last defense is a lesser narcotic pain medication such as Hydrocodone, Darvocet, or one of it's relatives. In my theory, there are two types of pain medications: 1) The BASE pain medication.
The "Base" pain medication covers the daily pain that a chronic pain patient suffers. This medication is NOT meant to completely take care of the peaks in pain. It's sole purpose is to relieve the total body pain that is consistent in the patient and make that pain be at an acceptable level.
2) The PUNCH THROUGH pain medication.
Punch through meds are taken only as a last result to assist in making it through the peaks in pain. FMS sufferers have what we call "Flare-ups." When a FMS patient goes into a flare, this causes the pain levels to increase dramatically and "Punch Through" the base pain medication. When message, hot baths, or some over the counter med cannot deal with the flare, the FMS patient has this "Punch Though" med to fall back on. These punch though meds keeps us from having to lie in bed and cry like a baby until dawn. Again, punch through pain medications should NOT be utilized daily and should only be used as a LAST RESORT. Their purpose is not for the patient to achieve complete pain relief, but only to reduce the pain back to an acceptable level.
What are some of the name brands of the medications that fall in these two major groups?
1) Base Pain Medications: · Kadian; is a time released Morphine capsule that is taken once daily. This medication had very few side effects in my personal experience. It causes no “loopy” feelings and is extremely effective in treating long-term pain. You may have some of the tired and groggy feelings for the first week at the most until the body adjusts to the medication being on board. After the initial adjustment period, you should not be limited in driving or operating dangerous machinery, etc. · Avinza; is another type of time released Morphine capsule. I have had the same success with this medication as with the Kadian. I switch periodically between Kadian and Avinza to prevent my body from becoming to resistant to the medication. · Oxycontin; is a time released Morphine tablet that is taken daily. I have had more side effects and less pain relief with this medication.
2) Punch Through Medications: · Hydrocodone/APAP; this pain medication is a narcotic mixed with Tylenol. This medication is taken as needed for punch through pain and should not be taken daily. It does contain Tylenol which can be harmful to the body if ingested in large amounts or over extended periods of time. · Darvocet; this medication is another decent punch through med that has few side effects. It also works quite well for managing the punch through pain. · Butalbital; this medication is the only medication that I have found effective in relieving migraine headaches. This med is a mixture of a narcotic, Tylenol and caffeine.
I have found that there are ways to prevent the pain cycles from becoming over bearing. We must pay close attention to what our bodies are telling us to ensure that we do not stay in a pain cycle causing daily flare-ups. The following is a list of items to watch in your life, as I must in mine to prevent punch through pain:
· Sleep patterns. Your sleep patterns can cause pain cycles to increase. We need the appropriate quantity and quality of sleep. · Stress: When stress gets into your life, it can and most likely will cause a flare up. There are many ways to manage the stressors in your life. FMS sufferers must try to eliminate the stressors if at all possible. · Nutrition. Taking daily vitamin supplements and eating healthy can do wonders for the FMS afflicted. · Weather patterns. There is much controversy over whether or not the weather has anything to do with flare-ups in FMS patients. I say that it has everything to do with it. There are many FMS patients that have this experience. Cold wet weather can be our worst enemy! There is not much that we can do about Mother Nature, but limiting our exposure to the outside elements can assist a little.
Other helpful medications for FMS sufferers.
1) Elavil: This medication is an anti-depressant. Your physician to assist you in pain management and sleep patterns may also have you use it. 2) Ambien: This medication can assist you in getting a good nights rest. I have found this one to be the most useful. You cannot take it everyday without a break. It is commonly prescribed 7 days on and 3 days off. I have found that this medication helps me to sleep more soundly and I do not awaken feeling groggy. 3) Sonata: This medication can assist you in getting a good nights rest. I have found this one to be the most useful. You cannot take it everyday without a break. It is commonly prescribed 7 days on and 3 days off. This medication caused me to have hallucinations. That does not mean that you will not have success in utilizing it though. 4) Flexaril: This medication is utilized to prevent muscle spasms. I take it once at night and it helps to relieve the restless leg syndrome a little. It also helps with the general pain level. 5) Soma: This medication is utilized to prevent muscle spasms. If taken once at night, it helps to relieve the restless leg syndrome a little. It also helps with the general pain level and spasms. 6) Lexapro: Many FMS patients tend to have panick attacks. This medication works wonders for me in this area. In speaking with other patients, it seems to have rave reviews. 7) Lyrica: This is the new "wonder durg" approved by the FDA for FM treatment. I have heared many that say it's been helpful and many that say the opposite. Try it and decide for yourself.
OTHER FORMS OF PAIN MANAGEMENT: 1) Rhizotomoy or Risotomy is the severing of a nerve to control pain. This proceedure can be done during day surgery and can be quite effective in specific troubled areas. Occipital Rhizotomy's can be performed to lessen or stop severe migraine headaches. The nerve can and will grow back eventually and the proceedure will need to be repeated. The average time of relief is between a year and two years. I have personally had great success with this proceedure.
2) Trigger Point Injections are injections that are performed to loosen painfully, knotted areas known as trigger points. The injection will likely consist of a pain relieving med mixed with a steroid. I have had excellent results with this proceedure as well. This could be done during an office visit but can be painful enough that I would suggest sedation first!
I hope that this information is helpful to my friends that suffer with chronic pain. If you would like to have further information or want to ask a specific question, please feel free to wite by clicking on the e-mail link.
