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notloki

Visit with Pain Doctor

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Posted (edited)

I went to see my pain doctor for the first time. He is also an anesthesiologist. I had met with his APN a while back but today's meeting is to come up with a treatment plan because I am having breakthrough pain, 8 on the pain scale and general pain at 4 on the pain scale.

They offered Cannabis but I already have a license for that (Seizures). I get facet joint steroid injections in my spine but I was still having breakthrough pain. What I wanted was 200 mg Celebrex,  2 gram Diclofenac Gel 1%, and 10 mg hydrocodone. The doctor offered that exact combination (I led him there). I said I used it in the past (I did) and it worked well. Everything is PRN.

At least now I have a stable source for hydrocodone (Norco) 10/325. They did not bat an eye at the Klonopin or Ativan nor adding Norco, an opioid. We went over an inventory of my meds so they knew what I take.

Edited by notloki

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That sounds like a pretty much perfect appointment. I’m glad it worked out so well for you.

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sounds like appointment went really well, hope it helps! @notloki Do you know what is causing the pain or how it started?

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I have cervicalgia, which is neck pain. Neck pain is very common and often they cannot pin down the cause. Same with dad and it ruinned his life. The whole neck and head system holds a lot of weight. I get regular injections into the first 4 joints, C-1, C-2,C-3 and C-4.- with steroids and local anesthetics to kill the pain.

My honest opinion is I have a big head, hat size 7 3/4 and holding it up and positioning it has worn out the upper spine and neck.

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My chiropractor idly remarked to me one day that it seemed to him that there are a lot of women with my build (very, very fine-boned) who have neck problems. I said oh, interesting, why is that? And he stopped, and just stood there, holding my (small) head in his (large) hands, and said “Well, I haven’t read any research behind this...but I think your necks are just too small to support your heads.”

And it was so funny; it could have been really insulting, but he way he said it, so simply, sort of wonderingly, it was very endearing. I wish to god he hadn’t left practice. His replacement sucks.

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NSAID's work well for me but I resist taking them all the time as overall NSAID's have a stroke or heart attack potential of about 4%. NSAID's work best if taken all the time. Celebrex is the least likely to cause stroke/heart attack, so says my pdoc. I  take Celebrex prn just like the gel. The gel is Voltaren (Diclofenac) a strong NSAID. So I start with the gel because I can place it right where the pain is coming from. If that does not do it I add Celebrex. It is better for situations where I have pain coming from several places. I try and avoid taking 2 NSAID's together so when it is that bad I add/switch to hydrocodone, which honestly works the best. If it were not 2020 with opioid mania going on I would just take hydrocodone. It is cheap, I have been on runs as long as 4 months contiguous with no problems stopping it. I still want an anti inflammatory as my condition is an inflammatory process. It requires treatment to slow or stop the damage done by inflammation.

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1 hour ago, notloki said:

Celebrex is the least likely to cause stroke/heart attack, so says my pdoc.

I had no idea, I thought it had more of a chance than standard NSAIDs. Interesting.

Plus there's the whole ACE2 upregulation and COVID-19 thing going on with NSAIDs, especially ibuprofen...

1 hour ago, notloki said:

The gel is Voltaren (Diclofenac) a strong NSAID.

Good, good, good, good stuff. I've used it before, and my mom uses it quite regularly for all her pain that she has (like everywhere... she is held together by surgery...)

1 hour ago, notloki said:

I still want an anti inflammatory as my condition is an inflammatory process. It requires treatment to slow or stop the damage done by inflammation.

I am almost certain you have tried like everything, but have you tried oral steroids or injections of steroids (either in the joint or epidural injections, not even sure if the latter would help you in your case)? Muscle relaxants?

I also found an article (link) with a list of a bunch of "biologicals in the therapy of chronic autoimmune and inflammatory diseases." I don't know if this will help you out any, but it may... Just thought I'd include what I found... Some of these are for Crohn's disease, RA, MS, etc., but may help you with your condition(s). I'm actually going to leave out the medicines that have been withdrawn, aren't out yet, etc., and only leave the ones that have come out/are still on the market (along with their brand names), so I am modifying this list a little. Also, some of the "generics" were misspelled (quite badly), so those I'm going to edit too.

  • Anti-CD20 (rituximab: Rituxan, Ruxience, Truxima, Rituxan Hycela; ocrelizumab: Ocrevus; ofatumumab: Arzerra); anti-Blys MoAb IgG1 (belimumab: Benlysta)
    Targeting B cells
  • Anti-TNFα MoA (infliximab: Remicade, Inflectra, Renflectris; adalimumab (Humira); golimuma: Simponi, Somponia Aria); anti-TNFα pegylated Fab' (certolizumab pegol: Cimzia); soluble TNF p75 receptor Fc fusion (etanercept: Enbrel)
    Reducing TNFα activities
  • Anti-Il-6 receptor (tocilizumab: Actemra)
    Reducing Il-6 activities
  • Anti-Il-12/23 (ustekinumab: Stelara)
    Neutralization of Il-12 and IL-23
  • Il-1 receptor antagonist (anakinra: Kineret); anti-Il-1β (IgG1) (canakinumab: Ilaris)
    Reducing Il-1β activities
  • Anti-α4 integrins MoAb (natalizumab: Tysabri)
    Blocking cell adhesion and migration
  • CTLA-4 Ig fusion protein (abatacept: Orencia)
    Blocking T cell coreceptors

There is a lot more information about potential anti-inflammatory agents in that link, but I just kinda copied everything and did a tiny bit of research on each agent just to verify that they existed in the US (left out the ones that didn't anymore or yet).

I hope this helps (if needed), and that you get to feeling better. :) 

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1 hour ago, mikl_pls said:

I am almost certain you have tried like everything, but have you tried oral steroids or injections of steroids (either in the joint or epidural injections, not even sure if the latter would help you in your case)? Muscle relaxants?

Yes. I get spinal injections of methylprednisolone and Marcaine into the facet joints (C-2,C-3,C-4) when I needed them but no more than 4 a year. They last 1-2 months. I had bad bad allergies as a kid so I am aware of Kenalog and prednisone. We need to be careful as steroids increase glucose dramatically, that is in only time I went above 300. I have a friend with major back problems who they pumped methylprednisolone into several joints and the nerve roots going into the spine and put her into adrenal insufficiency. She is bipolar so the steroids really set her off into manic land.

They are doing or offered to do all of this, offered cannabis which I was already licensed for and end the end to do ablations if all does not work.

.

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11 hours ago, notloki said:

They are doing or offered to do all of this, offered cannabis which I was already licensed for and end the end to do ablations if all does not work.

Getting ahead of ourselves, but if you end up going with ablations, make sure they sedate you for the procedure. A friend of mine had that done to try to treat her ruined knee, and the procedure itself was so painful, she injured herself trying to endure it. She ended up worse off, for a very long time.

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Ablation is where they sever the nerve that carries the pain. They use high frequency waves to essentially cut the nerve as HF waves self cauterize without damaging (to badly) the nervous system on either side of the site of the ablation. Things like lasers and electro-cauterization  or just a scalpel will not make an acceptable ablation.

But. BUT BUT BUT there is a catch. They have to first connect to the nervous system and send pain impulses throughout your body so they can map out the nervous system. This is very very  painful but it is essential to figure out which nerves carry your pain from your specific condition. You have the be AWAKE during this so you can scream "That hurts" over and over again. There is a limit to how sedated you can be, any amount that dulls the pain makes the test less valid. One such test is the EMG, a/k/a Electromylogram.i am not looking forward to this. It, by default, has to be painful.

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My friend got hers done through the VA. If there’s a way to skip the niceties, the VA will find it.

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