Medication vs. Pain Management

Rejoice! Why? Because the drugs seems to be working.

For anyone who’s undertaking a Pain Management regimen, medication is merely part of the answer. In the UK, it is common to be referred to a hospital-run Pain Clinic for analgesia/medication advice.  The problem is that the drugs that work with neuropathic pain or fibromyalgia tend to be somewhat narcotic (tramadol, morphine or even codeine derivatives) or used for other things such as depression and insomnia (amitriptyline) or epilepsy (gabapentin, pregabalin). Often a mix of medication is required: paracetamol can potentiate the effect of tramadol or, in the experience of some, actually enable it.

Why is it only part of the answer? Because there can be adverse side-effects or other problems. My mind is blown by tramadol, gabapentin and morphine, for example; addiction is a known problem with morphine; and effectiveness can deteriorate with these sort of analgesics. Likewise, distressing weight gain is a common problem with some pain control medication, such as gabapentin and pregabalin.  Sometimes it can a while for the side-effects to settle down, so you don’t know if the drugs are going to be useful or not.

Further, sometimes a combination of drugs is used. NSAIDs such as Diclofenac or Ibuprofen can be prescribed to cope with tension, another side-effect of pain. It may be that in some situations NSAIDs are required in conjunction with the rest.

There is an important caveat about the detail, here: as I’ve mentioned, I am practitioner, not an expert, so the combinations are a mystery; what I do know are the combinations with which I have experimented. I was – and remain –  lucky in that my GP had once been an anaesthetist and had also run his own Pain Clinics.

For me, the only combination that worked was 1000mg paracetamol-plus-150mg tramadol, often in combination with 600mg ibuprofen (don’t try this at home – all of this was under Pain Clinic and GP supervision). The tramadol puts me in lala-land, taking me away from the pain, but it works providing I don’t use it too much.  This has to be boosted with Pain Management techniques, rest, distraction, relaxation… If that doesn’t work, the oramorph has to be broken out.

You may wonder why codeine hasn’t had much of a mention. The reason is simple: some people lack the ability to metabolise codeine so it has either limited, or nil, effect. I’m one of them – I’d always wondered why people raved about it or swore by butrans patches and it was only during the past few years I found out why. It’s a key illustration as to why pain medication and Pain Management is a highly individual affair.

So all that’s the background as to my last post and why I’m excited (I’m British: excitement comes in careful doses).  Gabapentin was a disaster, so we held off pregabalin.  Sure, the uptake of pregabalin over the past few weeks has meant severe dizziness but now I’m on the intended dose we (Pain Management is a family affair) can begin to take stock. And it is promising.  I had a few hours of total freedom from pain this week: moreover, I’ve been able to type for longer without having to resort to the dictation software.

That’s brilliant.  Sure, accuracy is an issue, but my typing speed was pretty good (60-80 rated wpm) so it helped my writing immensely.  If I can get back to any speed close to that, I have a chance at really getting going.  At the moment, I have to break off, still, as pain starts to grow but the fact is it ain’t the searing pain I’m used to. That means I can manage time more effectively, pace better.

In between dizzy spells, that is.  But that’s  the reason for rejoicing: the dizzy spells are getting fewer; life is returning to normal. I can write in the way I prefer writing and at a speed that approximates to the way my mind works.

Rejoice with me! 🙂

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