Has anyone ever got complete pain relief from medication

[ramana]

A patient who has been on 30 mg methadone for a year for chronic pain (not pelvic pain) has encouraged me to find a way to bring complete pain relief. Her reasoning is that is what breaks the pain cycle and also the side effects do not scale linearly with the amount of drugs.

I have yet to see any post here that claims complete (or near complete) relief - at least for a few hours. Am wondering if this is possible for pelvic pain at all.
I got to try 5 mg methadone now :-(.

[webslave]

It can be achieved, but preferably with expert help, such as a pain management specialist clinic. More comments:
https://ucpps.men/pain-management-in-chronic-prostatitis-CPPS

I believe this option is worth trying in some cases, like yours Ramana, cases that are very difficult to treat and that have resisted all other efforts. Breaking the pain feedback cycle may be what you need.

[graeme]

surely enough morphine would stop the pain etc but its getting the right quality of life along with it, no use to anyone spaced out of your tree !

[scotsman]

My 100mg Tramadol (Ultram) in the morning takes away close to 100% of my pain - and it lasts well into the afternoon and perhaps longer depending on the sort of day I've had. Of course, if I'm going through a flare then it might only take 80% of the pain away.

[Jay]

Hi Ramana,

I do not believe that there's any shame in resorting to pain management, particularly in a case like yours. There is no excuse for you to be suffering the way that you are, regardless of what's causing your pain.

Pain management is a specialty all its own these days, and I'm sure there's a great deal that could be done for you at a specialized clinic. This is an option that I have researched pretty extensively, mostly for reassurance that I would always have a 'final' option. They will no doubt use oral narcotics for you, but also a multi-modal approach involving doctors, psychologists and physical therapists. A good clinic will want to not only take your pain away, but improve your overall condition on many fronts (body-mind connection).

If you are worried that oral pain medications are not sufficient, there are even alternatives for that, many of which are intended for chronic pain sufferers. One example is an intrathecal pain pump. This is where they implant a device just below the skin of the abdomen, and it delivers pre-programmed doses of pain medication directly to the spinal cord. It requires only a small fraction of the oral dose, and avoids a lot of the mental effects. There are some complications, however. For example, you do have to get it refilled every 3-6 months (depends on how much yours holds) and the battery has to be changed every 9 or so years. As well, there are the risks you would expect of surgery, and of being a bionic man. :laugh: I have read about these being very effective in the stories of some people with pelvic pain, though. One woman I recall with bowel movements of 10 on the pain scale went down to a 2. My own grandfather had a pain pump when he was dying of widespread cancer, and it kept him pain-free.

I don't mean to sound like a big proponent of pain management for everyone. It's definitely something you'd only consider after every other option had failed, because it does have consequences. That said, if you are suffering and have nowhere to go but up, I think it's a very important move to make. There comes a point where quality of life must be at the forefront. I'm on Ultram myself, because my pain was getting to such an uncontrolled level that I wept every day.

As my urologist says, there is always an answer to pain.

[graeme]

Totally agree Jay

[Clay]

I had a crash last October that lasted a couple months. I was on 8 vicodin (the max), 4-6 10mg morphines, 2 mg of Xanax. It wasn't enough to do more than keep me alive. I had extreme fatigue, depression and one long anxiety attack, and my colitis roared back.

One good thing about being older (60s) is that it is a lot easier to get pain meds from doctors. I have a cupboard full that a junkie would love. Speaking of junkies, I've never had any problem cutting back when needed and never gotten the slightest high from any of it.

So I can take whatever I want, and no, it doesn't take care of all the pain at any level of narcotics for me, even when I can barely walk from sedation. I don't think nerve pain reacts to narcotics the same way other pain does.

The Lyrica and Elavil, however, when combined with narcotics can really take the edge off. Unfortunately it took almost 2 years for anyone to give them to me.

[Jay]

One good thing about being older (60s) is that it is a lot easier to get pain meds from doctors. I have a cupboard full that a junkie would love. Speaking of junkies, I've never had any problem cutting back when needed and never gotten the slightest high from any of it.

I think that's an important point to take from your story, Clay. A lot of people suffer additional, unnecessary pain because they are afraid of narcotics. The reality is that only an extremely small percentage of chronic pain patients treated by responsible pain doctors become addicts. It just doesn't work like that on people in pain, because they are taking it for pain relief, rather than euphoria. You'll become dependent, of course, but that's different in that your body has simply adapted to having the medication at certain amounts every day. You're not craving it and taking more than prescribed for a mental high.

As for your specific case, Clay, I am sorry that you have had such difficulty getting relief. You seem to have some other circumstances, such as the colitis, which my aunt also suffers from. I know that it's really painful! Is the Elavil+Lyrica combo giving you satisfactory relief? If not, have you discussed other options with your pain doctor, like a pump? Have you tried an extended release pain medication intended to keep meds in your system throughout the day?

There are some types of narcotics which will work on nerve pain. As with other types of medication, it could be a matter of switching around to different pills (with your doctor's guidance, of course) until you find a better one. Vicodin is just a drop in the bucket compared to the number of pain meds available, and it's not nearly the most potent. Really, if they're having you take that many a day, I would think they'd want you on something else anyhow. Vicodin is hydrocodone mixed with paracetamol, the latter of which is toxic in high doses.

I'd hate to think that you are taking that much medication (max Vicodin, morphine, etc) every day and barely getting anywhere. If it's not helping, and physical therapy isn't either, it seems like some alternative methods should be attempted to help you!

[Clay]

Thanks for your concern, Jay. I should have added that my flare was last year and I came out of it and have steadily improved to where I'm taking a fraction of the meds. The Elavil and Lyrica both help a lot.

I've avoided taking longer lasting narcotics because I don't get much pain at night. I like the idea of giving my body a rest from the drugs for a few hours. I do worry about the tylenol (as we call it here) in vicodin, but since I'm down to about 3 a day my doc doesn't seem concerned. Eight a day is the max.

My uro has suggested an implanted electronic devices, but I'm willing to wait at this point and see if time will heal it just as well.

[Jay]

Thanks for your concern, Jay. I should have added that my flare was last year and I came out of it and have steadily improved to where I'm taking a fraction of the meds. The Elavil and Lyrica both help a lot.

Hi Clay,

I'm glad to hear that you've improved since that time. Interesting to hear about the Elavil and Lyrica combo. I seem to have some neuropathic issues myself, so that might be something I'll want to explore.

[Explorer]

Naproxen works for me very well and keeps me almost 100% pain free.

[gmccormack]

The pain clinic I'm going to is VERY against opiates. The Dr. said in this day an age there are many possibilities, frankly after seeing this thread it makes me nervous.

So far doc has doubled my dosage of gabapentin and that has done nothing and the next thing she said she would try after I kept bombarding her with neuropathic pain is Ketamin injections. I have read the risk, I know it presents some danger. Has anyone had one of theses before? How long did it last for?

The fellowship doc there said that this is a really "new age pain clinic where we rarely dole out opiates, the medical community is drastically moving away from them. " Are there relatively new non opiate pain meds that have not been used already on CPPS?

I would love to know how the Tanezumab trial is going, I know Shoskes is in trial with it now for CPPS. It should be out for things like knee pain etc in the near future. If I'm not mistaken and maybe someone with more pharmacology knowledge can correct me, in the past trials for new anti nerve growth factor meds they overshot it and it actually irritated the nerves even more causing pain to be worse.

Human nerve growth factor (NGF) is involved in the transmission and sensation of inflammatory and neuropathic pain, and anti-NGF therapy has been shown to alleviate these symptoms (Sevcik et al. 2005). Personally, I have eliminated the pulled muscle feelings in my body and it has positively affected frequency and urgency but I am left now with itchiness in my inner thighs and testicles along with pins and needles in my pelvis. That is neuropathic pain and if this drug works it could help a lot of men.

Tanezumab - a molecule designed to target nerve growth factor, a key pain mediator; CP-690, 550, a JAK-inhibitor that suppresses immune-related inflammatory response; and esreboxetine, a highly-selective norepinephrine reuptake inhibitor which plays a role in controlling the activity of this important neurotransmitter.

Any thoughts?

[Jay]

My experience in reading has not been that the medical community is "drastically" moving away from opiates. For some people, they mean the difference between leading a normal life and being crippled with pain. It would be more accurate to say that some are distancing themselves because of the DEA, which watches pain clinics like a hawk. Any slips and they get shut down, with the doctors possibly winding up in court. I can only speak for the US on that, of course.

That said, it's true that there are many pain clinics which do not prescribe opiates. They prefer other drugs and/or procedures. This doesn't necessarily make them bad, but it's a different approach. If you aren't comfortable with it, I think you should be open about that and find someone else. I was very clear with my PM doctor that I felt all options should be on the table, and though he disagreed, the fact that I was able to say that indicates a trusting relationship.