Pain and Mirtazapine

I know, I’ve not blogged for a while but I’m hoping to be a little freed up from now on. So, I’ll start with a major change in my pain management.

I’ve mentioned a few times about the disasters that I’ve had with medication for pain management. I ended up settling on paracetamol (acetaminophen in the USA) for taking on and just managing the rest of the pain, using lidocaine patches (it’s an anaesthetic) placed on two points on the problematic pain sites. Due to the various issues with opioids and opiod-derived drugs, I hated taking them but have to admit the pair helped considerably, especially in allowing me to get out an exercise (walking and hiking, mostly).

But though useful, use of either – or both – still meant constant, careful pacing and a rigid adherence to a pain management routine, which meant a part-time job. And regular breakthrough instances were common, especially when the routine broke down. As anyone with Chronic Pain will tell you, breakthrough pain is highly distressing, deadening and agonising, frequently reaching a nine on the pain scale (10 being unconscious through pain, which isn’t much use).

But, for a year or more, I’ve had some new medication that has meant managing my pain is sooo much easier. Sure, I still occasionally have to use patches and paracetamol more than a non-PM person, but the frequency of use is much less and breakthrough events are far less common. It’s even got to a state where I can regularly run through a full day’s work with – which has meant I have applied for and been offered a full-time job (hopefully a start date will come through soon).

Sure, the job spec had to be carefully analysed as I still can’t do overly physical work with my arm/shoulders (lifting, even shelf stacking) or be involved in constant shaking that arises from driving or travel. But it’s a job, and one I’m pretty sure I can do day-in and day-out. It helps, of course, that it’s in an area of work I find fascinating and absorbing, so distraction is already built-in!

I’ve mentioned about depression and pain management, before, and probably also that I suffer from SAD, no doubt exacerbated by the pain. Just over a year ago I was put on a new drug, mirtazapine, one which I was informed was also used for pain management in the USA. In the UK we use amitriptyline for pain control, amongst other anti-depressants, but none worked for me. In constrast, on a high dose of mirtazapine I found no negative intellectual or emotional impact, though they make me drowsy about 4-6 hours after taking them (so I take them in the afternoon), BUT I did find that the day-to-day pain levels were significantly reduced.

I really do mean significantly. The difference in my quality of life is fantastic.

The pain is still there ā€“ I have some now, as I type ā€“ but the general levels are so much reduced that I can manage the pain much easier, sometimes even ignoring the pain and forgetting pain management strictures completely. For a while, that is, as forgetting a PM routine always leads to increased pain and eventually breakthrough and a lack of ability to do anything… it does mean that I have to be more mindful of following my routine even when the pain is low.

Is it a cure? No. Am I still in pain? Yes. Do I have to take the maximum dose? Yes. Do I still have to be mindful of my pain management routine? Yes. Has it made a positive difference? Emphatically YES. Cure or not, it has become a major plank of my PM routine and one I am relieved has made so much difference.

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