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 – I have some now, as I type – 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.

A series of unfortunate events…

I think most of the blog posts on here are when my Pain Management fails. It’s not through self-pity, but because at those instances you really have to focus on management and run through the techniques you know to apply them. Right now I’m on the tail end of a couple of weeks of unfortuante events and I’m, well, ouch and trying to sort out how to deal with it without resorting to myriads of opioids.

When running through the techniques and applying them, it brings to mind some odd, quick-fix things that can help. There’s a few here coming from my experience. Of course, as ever, the are always limited by what the pain sufferer can physically do, but it is worth making the effort.

Messing up: a cascade

I’ve just come back from a few days away which involved a couple of key meetings and a games day. I’d have to stay over either side, of course, but the meeting and day seemed to be worth it. Further, I thought I could manage it properly from a pain viewpoint but, frankly, I was wrong.

I am now in shed loads of pain.

Added the Pain, Medication and Constipation chapter

I’ve been heavily at work putting up what I can and have reached as far as the main chapter on medication – analgesia, and the like. It is a long chapter, not just due to the history but due to the subject matter, so has been split into multiple sections.

See Pain, Medication and Constipation

Breakthrough Pain

I missed the Creative Non-Fiction seminar yesterday due to breakthrough pain. This is pain that somehow gets through all the training, all the routines, all the distraction and all the painkillers. For anyone suffering Chronic Pain it is a frustrating phenomenon that has to be accepted and dealt with to make sure it is kept to the minimum. If the breakthrough pain is not brought under control you find yourself falling back into permanent, uncontrolled pain.

That control is not easy to reassert.

In my case it means swallowing my pride, reaching for the more powerful opioids and making sure that all the relaxation, meditation and transference exercises are brought to the fore. Whilst some rest is really useful to let the worst of the pain die down and the analgesics take effect, over the course of the day resting becomes both exhausting and ineffective: exhausting because I have to focus on the exercises all the time; ineffective because that focus is impossible to keep up for very long.

So what to do?

Little bits at a time…

I was struck recently at how slow progress on First Drop was, but then realised that I’d been thrown by a number of other, smaller projects, restarting the MA (which takes me a lot of time) and playing about with Pregabalin.

On the upside, the projects have been useful and fun, ranging from writing (lots – and various), attending the local Marlborough Literary Festival (whilst the content of which was excellent, it was a show I found disability-hostile in the extreme, even being shouted at by one organiser who obviously didn’t give a monkeys about disabled people and stability on stairs), attending the monthly Hampshire Writer’s Society meetings at Winchester University (they have some really interesting guest speakers) and a Writing Group at Salisbury Library (Mondays, 10:15), and reading (also a fair bit, including attending a local reading group at Salisbury Library).