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QUESTION:
I have a severe lower back injury sustained in 1998. Despite X Rays, bone
and MRI scans, a cause cannot be found (permanent nerve damage is suspected)
so I am being treated with anaelgesics. Latterly I have been on a continuous
dose of:
Paracetamol - 500mg - 2, 4 times daily
Dihydrocodeine - 30mg - 2, 4 times daily
Diazepam - 2mg - 1, 4 times daily
Naproxen - 500mg - 2 times daily
I was still experiencing breakthrough pain so came off the Dihydrocodeine on
to Duragesic patches but these made me feel extremely drowsy.
I have now been prescribed Oxycodone Hydrochloride (2 varieties, 10mg slow
acting twice daily and 5mg 4 times daily) along with the others above (apart
from Dihydrocodeine). I have only just taken the first tablet so its too
early to say whether this is the correct regime but my question is how high
up the scale is my pain relief heading? Having become essentially immune (if
thats the right word) to Dihydrocodeine over 6 years I wonder how much
further I have up the pain relief ladder.
If it helps I'm 45 years old, live in the UK and was a fit and well police
officer before the accident.
ANSWER:
I am sure someone will be along to help you. I wish I could. I can relate and
am sorry you are having such pain. I have damage to the lower back, cervical,
and FMS.
I don't think anyone can predict that with any degree of certainty. Pain
is a subjective thing and tolerance builds at different rates for
different individuals. Then there's your doctor and how willing he may
be to provide adequate relief and where (if ever) does he start feeling
uncomfortable with the amount you're taking.
Everyone reacts differently to medications. What may work for you, may be too
much for someone else or vice versa.
If nerve damage is present, you can expect your pain levels to stay about the
same as you are experiencing now. If nerve fibers do not regenerate or repair
themselves within about 12 months from the time of injury, the medical
profession concedes they will probably never regenerate or repair. Analgesia
will be needed for the rest of your life, as nerve pain from this type of
injury cannot be tolerated for any length of time.
You didn't say how long it had been since you had any previous increase or
change in your medications. I assume it has been a while since you didn't
mention it. Most people, according to my pain specialist, will reach a plateau
where they won't need an increase for quite a while. Using me as an example, I
haven't needed an increase for over 2 years. I have nerve damage in the
cervical region of my neck and back.
You will probaby always experience break through pain and require a short
acting medication for it. The more active you are, the more these damaged
nerve fibers are irritated and your long acting medication may not cover the
pain experienced with the added activity.
If you are experiencing continuous pain, you may need to talk with your doctor
about increasing your slow acting medication. The dose of 10mg twice daily is
not a very adequate dose for intractable pain.
Remember we can only give you information in relationship to our own personal
experiences. My experience with my nerve damage requires a high dose of long
acting medication, with the use of short acting meds for any type of activity
beyond sitting or laying down.
Hope this information helps you Ted. Let us know how you progress with your
med changes. Having been a very fit and active person before your accident,
dealing with the emotional side of the many changes required when something
like this happens, is extremely difficult. You seem to have handled this loss
very well.
I'm going to suggest two other areas you have that could potentially benefit
you and one area that is a huge potential worry.
Potential benefits:
1. Opiates. You are taking hardly any, and you can go up tons. You have
huge potential for short term pain relief through opiate therapy.
2. Other nerve drugs. (For lack of a better name.) The human body handles
pain in two ways. We create endorphins to block pain immediately (when
someone hits you in a fight, you keep fighting, you may not even notice you
got hit, because the endorphins block the pain -- but only for a short
time). Then, over a long period of time, serotonin and noradrenaline (all
over, in your brain and your spine and the location of your injury and we
don't even know where else) get involved to somehow keep the injured area
signaling you to avoid reinjuring it but not enough to disrupt your life.
Unless something goes wrong and you become chronically painful. Opiates
work by fooling the body into thinking they're endorphins. They're a
short-term solution. The "other nerve drugs" (and there are literally
hundreds of them), seem mostly to affect serotonin or noradrenaline (or
both) either directly or indirectly. Unfortunately, they also seem all to
be in the category of "the mechanism of causation is unknown". And it may
be that you really need to see a neurologist, but I don't know enough about
patterns of practice in the UK to know for sure.
Now, for the word of warning. I would be concerned about the 4000 mg/day
level of paracetamol (acetaminophen for you US-based readers) and the
ongoing use of naproxen. You're looking at potential kidney and liver
problems here, plus intestinal problems. Also, make sure your doctor knows
about any other painkillers you take, even over-the-counter painkillers.
That includes alcohol (even if you don't take if for pain -- or even as a
medicine).
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