urgent pain relief advice needed please help..

[Megan H.]

Hi Everyone,

Had L4/5 discectomy about a year ago...taking a fair bit of disc out the left side. About a month ago it's gone again. Saw surgeon and having scan next week, he reckons some has come out the right side. I am so lent over to the left and can't straighten up. The pain is different this time though with night time/early morning being the abosolute unbearable worst..

I really can't cope anymore about 1 or 2 hours sleep per night for the last few weeks, waking in agony and writhing around not getting close to finding a comfortable position.

On tramadol, but the more i take makes no difference to the pain, just feel really high. Few Diclofenac and paracetamol too.

What painkillers are you lot on?
i am desperate to get to sleep, I don't want to feel my right leg anymore, I just don't know what to do.

Any help or advice on pain relief much appreciated, feel like i'm losing it a bit..

Cheers,

j

 

[Dick Bender]

So, so sorry to hear what you're going through. After just going through one L4/L5 I can't imagine having to go through that pain all over again.
when I was at my worst I ended up A&E screaming with pain, begging them for help. They put me onto diazepam, voltarol and co-codemol (apologies for spelling). That helped a lot and after my op I was on Tramadol too. Its worth a go, but you won't get much else done. I just slept a lot. I had the sciatic scoliosis too, I tried deep breathing exercises, meditation, all sorts but it just defied me time and again. My OH told me I often made it worse by panicking, which he totally understood due to the agony I was in, but he could see me totally tensing up. Try to deep breathe through the worst of it, if nothing else it gives you something to concentrate on.
good luck and keep going

x

 

[GenesisAnswers]

Unfortunately, if you've already had surgery in the area there's little anyone can do to you, so it rules out things like chiropractic and osteopathy.

The after-care physio you were given, and McKenzie exercises that you were probably given before the surgery are your best bets for treating this without resorting to surgery again.

Beyond that TENS machines should be able to help with pain relief, but won't make any difference to your actual problem. Again, this is discussed in detail in other threads; here's a good one
You may find some symptomatic relief from acupuncture, but really, you'd need to speak to an acupuncturist about that.

 

[momokins]

Sorry to hear things aren't going well. Hope you find some resolution soon.

The following may be of use. If Tramadol isn't working you could try another opiate/opioid e.g. codeine phosphate or dihydrocodeine. If you have dihydrocodeine (DF118) you are best taking 30mg every four hours even though it will say 30-60mg four times a day on the box. 60mg doesn't give you extra pain relief but it will constipate you more. Or you could ask your GP about fentanyl or buprenorphine patches. Also ask your GP about amitriptyline if you haven't tried it before. You start with a low dose, usually 10mg and build up by 10mg weekly to about 50mg stopping if side effects start to outweigh benefits.

Take your diclofenac regularly regardless (150mg in 24 hours) and also paracetamol regularly (max 8 per day).

I agree with BIA that a TENS may be helpful for the pain relief.

If you can get to an aromatherapist you could ask about Plai, Cinnamon and/or Clove for local massage.

Best wishes
EBx

 

[PRELUDE]

I was prescribed Ibroferon. (spelling) but don't know whether it would be good for you. It takes 2 or 3 days before it starts working but the pain clears like magic.

 

[Deke]

Hi- this type of pain often responds to homeopathic medicine (this is not the same as herbal supplements and can be taken safely in conjunction with any of your other medicines).
Hypericum is one homeopathic remedy that might help -this isn't the same as hypericum in herbal form- it is a homeopathic preparation and shops like holland and barrett or Boots sell it. If you need further advice about that, you could always phone a Homeopath. HTH Hom

 

[shallow hal]

Depends on what you are on and how much. One of the Consultants I used to work for would tell her patients that with the more sedative drugs (notable amitriptyline or the anti-convulsants or opiate/opioids) it was up to them but to be aware that the alcohol will affect them more rapidly. She never told them not to as she knew that some people found it helpful. In excess or with a higher regular intake (e.g. 3-4 glasses of wine + per night every night) it can cause problems with drug interactions. Alcohol can potentiate some drugs and increase the risk of side effects in the longer term especially the non-steroidals (diclofenac, ibuprofen etc.) and paracetamol.

If you are thinking one or two glasses some nights and perhaps none on others then there is no problem at all. Some of our patients have found it help with their sleep when things are particularly bad. Remember also that alcohol is a depressant and therefore mood altering.

Best wishes
EBx

 

[Prime96]

Thanks.

Actually doc gave me some amitriptyline yesterday, he said it will help me sleep but don't take at the same time as tramadol. Leave a few hours in between tramadol and amitriptyline.

I have been on so much tramadol and really high on it... so would like to cut it down or maybe take more co-dydromol instead, what do you think?

So I took one amitriptyline before bed last night and it definately made me very drowsy and i did sleep for an hour or two more than normal. Problem is after 1 or 2 hours lying still, i seem to freeze and lock up and it is very painful when i wake. Think my back likes to move about a bit.
I certainly would only take it at night and don't think i could drive so drowsy.

When pain eases in the day due to painkillers kicking in or moving about more, I make a real effort to do some stretches and move around a bit, leaning the other way to how i have to lean when i am totally locked up and lent to the left....

Am staying positive, definately not depressed. But yes a few drinks also seems to loosen me up a bit.

Scan on thursday will be good to see what the hell has happened now. My big worry is that the degeneration of my discs will mean i have to go through this every year or two.

I remember my first MRI in 2003 the doc said i have the back of a 40 or 50 year old and several of my discs are degenerating. Which is quite scary for a 25 year old to hear!

Anyway feeling slightly more upbeat today, couple more hours sleep, pain slightly more manageable, sun is shining - don't really know why but great to have all your advice...

J

 

[lil_bit_spoiled]

I went through a huge number of medications before I found something that worked for me - or at least helped. Very simply I was taking a combination of 2 x Nurofen Plus (Ibuprofen and Codeine) with 2 x Anadin Extra (Paracetamol, Asprin & Caffeine) but up to 3 times per day.

I tried Cocodamol, Tramadol etc from the doctor but nothing worked for me as well as the combination above. A big warning though - I have been taking huge amounts of over-the-counter painkillers for 20 years because of severe migraine - so my liver is either ruined or immune. Long term high doses of painkillers are dangerous.

At least try the combo, but stop if you feel dizzy, sick or get any stomach pains.

 

[MYRTEL]

Hi jcee

In my experience in Chronic Pain we never said avoid Tramadol and Amitriptyline together, however for advice on Amitriptyline we always suggested taking it a couple of hours before you would go to bed and roughly twelve hours before you would normally aim to get up. Amitriptyline has a long half life and can leave you feeling very muzzy in the morning if taken too late. It can also take a couple of hours to "kick in". When I was taking it I found it a great boon for sleep. It can help with early morning stiffness/muscle spasm but you may need to find the right dose for you. You may notice an slight increase in muzziness/drowsiness for the first couple of days when increasing the dose.

Out of interest what dose did the doctor start you on? They sometimes start at 25mg which can be a little too high to start for many and you may want to try cutting the tablets in half for the first week.

 

[Aamir Zaka Buttar]

Hi Earthbabe,

I only have the 10mg Amitriptyline. Had a couple of beers at about 7 pm with dinner - standing up! After dinner had 1 diclofenac, 2 co-dydramol.

Then had one amitriptyline last night about 10pm - felt drowsy but pain still meant i couldn't get comfortable so couldn't sleep. At about 2 am i took another but didn't work well and i probably only got 1 or 2 hours sleep last night.

At 5 am i took 2 co-dydramol, 1 diclofenac and tried again to sleep!
At 7 am i took 1 tramadol.

Lose track sometimes of all the pills i take, I'm just desperate for a good nights sleep.

You seem pretty clued up about these drugs,what do you do? So it sounds like you think it's ok to mix them all up...

Nico, cheers for telling me what worked for you, you'd think the prescription only stuff would be more effective than the otc, but maybe i'll give some other stuff a try sometime.

I get really hot but my feet are like blocks of ice!

Thanks for support and advice, will be pleased to have my mri on thursday and get the ball rolling to get me fixed...

notice your in southampton, i went to uni there and lived in shirley for 2 years! Which was interesting..

Cheers,

J - very tired and a bit down today...

 

[Tjhsan]

You should try massage therapy, one that works in Med or Chiro. It sounds like your in severe pain and pain firing paterns react to inflammatory reponse so massage can help to offset the pattern plus there is an endorphin and enkalphin release to help you relax!

 

[tamsie]

Ther is absolutely no reason why you cannot take Amitriptyline and Tramadol togther.
If you are going with OTC medicines, you will find that the vast majority of them are weaker than the prescription drugs you are on. Which will mean, if you have been on them for a while, that the OTC drugs may not help at all.
You are obviously staggering your analgesia.
Looking at maximum doses: 150 mg a day of diclofenac (either as three 50mg a day, or two 75mg slow release tablets a day), Tramadol - 50 - 100mgs four times a day, Co-Dydramol - one or two tablets every four to six hours (no more than 8 a day), Amitriptyline is usualy given at a 10-25mg dose for neuropathic pain, but the dose can be up to 75mg.
Make sure that your are staggering properly to get the maximum relief you can from your analgesics. Also, don't wait until you are in agony before you take a painkiller. Take one as soon as you start to feel sore.
I definately agree with the fact that either Fentanyl or Buprenorphine patches may well hlep your pain. A TENS is a must to help relieve it too. I would also go back and politely but firmly () request that your GP refers you to a chronic pain clinic at your local hospital.
Huge (((hugs))). Healing thoughts coming your way.

 

[althea]

Do you and your doctor/consultant really and truly know why your back is not healing?

Pain is there for a reason (Ok the surgery is a massive trauma and you can expect pain relative to that for sure) its a signal, and asking you to listen to it, not block it (again I do understand if you need to do something to alleviate it do a degree)

What might be causing your continuing problems?

Well, have you looked at the rest of your body? Whats happening with the shoudlers, hips, knees and ankles????????

The body is a unit, check out Postural Alignment Therapy, this is non-manipulative and starts to recruit posture muscles in a functional way, it can be gentle and doeable.

Where are you based? Google Egoscue and MBF

Good Luck........its never too late.

Pam

 

[Ad astra]

Hi Pam,

The reason the pain is there is due to herniated disc material on my nerves causing immense, raging, right leg sciatica.

Rest assured, I am listening to the pain signals loud and clear 24 hours a day and would try anything to relieve them...

Based in Surrey.

Cheers,

J

 

[Nico]

I am so sorry to hear about your back trouble. Have you tried Reflexology as I as a reflexologist treat lots of people who have back problems, so with long standing problems and we manage their pain.
I myself for several years had a terrible back and was given the option of an operation but declined as I had heard how there was a bad success rate and being a complentary therapist I wanted to go that route even if that meant pain. I can remember thinking would I ever be normal again and was I to be old for the rest of my life even though I was young. I know how debilitating it is. Reflexology may help but it will take time and probably weekly treatments and then going on to fortnightly. Check out a reflexologist in your area by going to the AOR web site as they have a good pedigree and qualified practitioners as oposed to beauty therapists. I wish you well and good luck
Francois Garcia

 

[kid dynamite]

EDIT: sorry, guess I didn't read the thread very well... failed to notice you've had surgery already!!

Hey,

Sorry to hear you're in so much pain - it's that sort of level that made me ultimately go for microdiscectomy. I couldn't do the exercises etc that one would do towards the end as the bulge was just too far advance and causing too much pain.

On a positive note - now that I've post-op far enough and comfortable enough I've decided to start doing pilates... always thought it a bit 'girly' for want of a better way to put it. Anyway, my physio has been so great so far am going to take her advice and get going next week... hope to report positive results.

Very best wishes to you Jcee!

Olly.

 

[hoxffuxa]

OK, here is my story...after a lot of building finishing an extension and some garden walls/patio 2 years ago (While listening to the ashes win) my backpain started, I couldn't stand up straight at the end of the day. (I'm a healthly 55 year old male) Following some brief exercise advice from the NHS I tried an ostopath for a few months - only temporary relief, then a physio - again the same, then another (highly recommended of course) and another + pilates, followed by a chiropractor that made it much worse - sent me flat on my back for a week. By now my quality of life was really low, in and out of work (although I had almost a desk job!) couldn't walk more than half a mile without pain, then the sciatica started with all the associated numbness and shooting pains and occasional leg collapse. I decided to take this into my own hands, went to my GP and and asked for a referal to a spinal surgeon. Went a couple of days later, and this guy gave me a referal for an MRI. Couldn't wait around, so found a private clinic that would do one for £218, as opposed to the £400 - 600 most wanted. Instead of waiting the 7 working days for the formal report to get back to the consultant, I took to scans to him two days later - Thurs 24th April. A very short viewing showed a classic L5S1 herniated disc. While I was there the consultant took a phone call which was a cancellation for his list the next lunchtime, would I like to take this slot? I went home and asked my wife to sit down, I had a very quick decision to make. I wouldn't know the cost until I was in the private bed the next morning, but I didn't really care by then. I turned up and put the all in cost of £2775 on my VISA card.
So as this is a bit long I'd better summarise. After recovery I took ALL the morphine the nurse was allowed to give, which made me sick, but worked. After dozing the afternoon away, and some more painkillers and anti nausea drugs I woke up the next morning pain free for the first time in 2 years. I must admit I shed a few tears. Over the next few days the pain reappeared as a general ache in the lower back, but, although stiff I could get up and walk, but not sit. Today (2nd May) one week on, I've been for two short walks which have been just a little achey, if you know what I mean, but the leg pain has gone, and the numbness 90% gone. I still need the painkillers when the ache wakes me up in the middle of the night, and I just hope hope hope I've not just replaced one type of pain with another...still it's only a week, and I've never been known to wait for anything you can do something about. I'll update as anything changes, but so far not bad...go see a good specialist as well as your favourite herbalist/crystal gazer etc!

(I'd rather have a full bottle in front of me than a frontal labotomy)