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.

Pacing and Pain

I’ve been busy, again, hence no posts. Insanely busy, in fact, and I let something get away from me: Pain Management. I know, I’ve said plenty of times here and on my other blog that PM is a lifestyle, a way of living to allow you to live. But I had a whole host of mini-handbooks to write, some mini-supplements to write and edit, a players pack to finish, and some playtesting, an inquest and its rather stressy fallout…

You get the picture.  Basically I forgot two of the major tenets of PM: pacing and distraction. And probably exercise, too, if I’m honest, but that’s not been too bad.  As a result, extreme pain, opioids, sleepless nights, breakthrough pain, the bust scenario  – if you’re into PM, you’ll know it.

So I bought a book to remind me of it, to place on my desk in front of my eyes: The Pocket Book of Pacing by Hannah Ensor.

A path through unsullied snow

I know, it’s been a long time since the last post. That’s because of a whole range of real life issues, one of which was cutting open my hand due to this annoying nerve problem. It is an example of one of the hiccups that have to be factored into Pain Management: prioritisation. ‘I-want-to-write-a-post’ becomes ‘I-really-need-to’ and doesn’t quite make it into the ‘I-must’ category as it is pushed out by stories, essays and commentaries I am actually writing whilst in added pain.

Problematic Pacing: missing a plank

Breakthrough pain or unknown recurrence of serious pain is a problem sometimes. Recently, I’ve been having a lot of it and nothing I (thought I) did was managing the pain back down. Though things were complicated by a painful, but totally unrelated infection, I was back onto regular opioids, with all the problems they bring.

The Problem: Discovery

It was only a chance conversation with a neighbour that reminded me of what I’d been doing wrong. She is a Mindfulness teacher/practitioner and had just been on a Chronic Pain Mindfulness day (Mindfulness, meditation and similar structured relaxation/thinking techniques have been shown to really help in Pain Management: I use them all the time). Some of what she was talking about was standard Pain Management, effectively ‘slanted’ to Mindfulness, but a key comment was a discussion of how the trainer managed to write the books she had. Apparently the trainer used a timer set to 20 minutes, took a break/did something else (e.g. relax/distract), then came back and continued.

It was through pacing. Plain old, simple pacing.

Developmental Shorts: The Soul Destroyer

It’s been a difficult week, one in which progress on my MA has been slow. The Shipton Shorts Awards ceremony was at the weekend and, unfortunately, the very helpful lady who was organising the catering had an accident, ending up in hospital. She’s out now, with her arm in a sling, and we were lucky to have plenty of others step in to help (thanks, everyone!) but that, coupled with a number of other hiccups and over-commitment, meant the Pain Management suffered somewhat so pain returned with a vengeance. I am now working hard at recovery and I gave a choir a voice lesson last night – which is great fun – so things will be back on track soon.

More on Shipton Shorts, later, as the evening was good fun and we constructed the bare bones of a potentially quite complex story. And more on the problems associated with reworking a work, too.

My Little Book of Pain – moving on

I’ve been moving things round on this blog. The reason is because I am finally putting up a separate site/blog containing the extended chapters from My Little Book of Pain: A Practitioners Experience of Pain Management. Whenever more is to be done, it will be added there rather than here.

General comments and observations on Pain Management will still be placed here, of course, but any lessons from them will be carried forward into the relevant chapter in My Little Book of Pain. Some external links on pain still remain here, as does the general page on Pain Management as a lifestyle. Alternatively, an interested person can always search the ‘Pain Management’ category for relevant blog posts.

I hope those supporting or suffering from Chronic Pain will find it useful.