Pain management

My TAH is not scheduled for another 8 weeks in early Dec. The main reason is a failing uterus after an ablation and adeno. The pain that is associated with my cycles from the adeno is now the toe-curling stars-in-your-eyes type that is endless for about 10 days. I feel like the lady in the Mervyn's ad but instead of saying "open, open" I'm saying "hyster, hyster"! I'm at 800mg/motrin 4-5x/day and it really only just takes the top edge off the pain but not much else. What are some of the pain management tools others have used to cope with this sort of pain? I don't want to ask for a heavy duty Rx that will make functioning in life not possible - of course that's where I am with pain, but for some reason taking "drugs" seems to be a worse option!

Hi Aussiegrl,

I know the pain you speak of and like you don't like to use much pain relief that is heavy duty. When I was admitted to hospital when all my problems started I was first given pethidine which made me groggy then I had the female registrar prescribe indocid suppositories which I found to work quite well. Perhaps something like this will work...can't hurt to try!

Hope the pain settles soon..........Karen

I know well the pain you describe. The last six weeks before my surgery was non-stop excrutiating pain. The reason the Docs don't like to prescribe heavy painkillers, like vicodin, etc, is because your body quickly builds a tolerance to them and it makes it more difficult to manage the post op pain. I pushed my Doc into prescribing Darvocet the last two weeks before my procedure. I am here to tell you that whatever advantage you might gain from not going heavy painkiller pre-op is worth the conservative effort. I had a difficult surgery and would have appreciated even a slight bit more reduction of post op discomfort that may, or may have not, been more evident because of my pre-op meds.

Hi Aussiegrl,

Please share your concerns with your doctor to see what they suggest so you aren't suffering so much. I know how awful it can be. Hope they can help you.

s,
Beth

	Quote:
Originally Posted by Aussiegrl I don't want to ask for a heavy duty Rx that will make functioning in life not possible - of course that's where I am with pain, but for some reason taking "drugs" seems to be a worse option!

Hi there, nice to "meet" you. I haven't been around here for a while, then thought I'd drop by this evening.....And lo and behold, at the very top of the board is my "pet" topic!

I've been on narcotics--oxycontin plus vicodin for breakthrough pain--nonstop for some five years now. This is for nerve pain problems unrelated to my "female issues," which thank heavens went away beautifully after my procedure. So this subject is near and dear to me.

Please don't be afraid that a stronger pain medication will make life unliveable for you. Give it a try. The worst that can happen is that you *will* find you can't deal with the meds. But chances are the pain will "eat" all the medication and you will not feel a bit stoned or impaired, once you find a med and a dosage that works for you.

It is also a myth that postop pain management will be harder if you use stronger medication now. Your surgeon needs to know what you're using so as to adapt the pain management instructions to comply, but it's *not* a difficult thing. I had no trouble whatsoever with postop pain management. Indeed, within a couple days of discharge my postop pain was completely covered by my usual dosages.

Please don't go on like this and let fear of "drugs" or "addiction" keep you from getting the help you need and deserve. They *might* give you some trouble, and if they do, you can always discontinue them. But if you don't try, you'll never know.

Hi again Here's an excerpt from a paper on pain management from the University of Rochester that comments on the fear of addiction and some related topics. The full paper is at http://www.urmc.rochester.edu/smd/gm...20addiction%22

Addiction. The perception that the administration of opioid analgesics for pain management
causes addiction is a prevalent myth that inhibits adequate pain control. Confusion about the
differences between addiction, tolerance, and physical dependence is in part responsible.
o Addiction, as the term is now used, is a complex phenomenon. Its hallmark is psychological
dependence on drugs and a behavioral syndrome characterized by compulsive drug use
and continued use, despite harm. Care must be taken to differentiate a true addiction
(substance use disorder) from drug diversion with criminal intent,
behavioral/family/psychological dysfunction, and pseudoaddiction.
o Pseudoaddiction is patient behavior that mimics addictive behavior (hoarding medication,
seeking prescriptions from multiple providers, repeatedly requesting more medication) but
is due to the under treatment of pain. The behavior disappears with proper treatment.
7
o Pharmacologic tolerance is the reduced effectiveness of a given dose of medication over
time. Tolerance to side effects is observed commonly and is favorable. Tolerance to
analgesia is rarely significant clinically when opioids are used routinely. Doses may remain
stable for long periods if the pain stimulus remains unchanged. When increasing doses are
required, suspect worsening disease rather than pharmacologic tolerance.
o Physical dependence is the result of neurophysiologic changes that occur in the presence
of exogenous opioids. Similar outcomes occur in the presence of exogenous hormones and
other medications (beta-blockers, alpha-2 agonists, etc). Abrupt opioid withdrawal may
result in an abstinence syndrome characterized by tachycardia, hypertension, diaphoresis,
piloerection, nausea and vomiting, diarrhea, body aches, abdominal pain, psychosis, and/or
hallucinations. Physical dependence is not the same as addiction. Physical dependence is
not evidence of addiction. Its presence does not mean that opioids cannot be discontinued.
If the pain stimulus decreases or disappears, opioid doses usually can be reduced in
decrements of 50% or more every 2 to 3 days, and finally stopped. If the dose is lowered
too quickly and abstinence symptoms occur, a transient increase in the opioid dose,
treatment with clonidine, or a small dose of a benzodiazepine (e.g., lorazepam) may be
necessary to settle distressing symptoms.
To manage pain effectively, physicians will need to educate patients, families, and other
professionals about the inappropriate fear of addiction. Opioids by themselves do not cause
psychological dependence. Addiction is a rare outcome of pain management when there is no
history of substance abuse. Since patients with histories of substance abuse can also develop
significant pain, they deserve compassionate treatment of their pain when it occurs. Most will
need to adhere to strict dosing protocols, and contracting may become necessary. Physicians
who are unfamiliar with these situations may need the help of specialists in pain management
and/or addiction medicine.

well said and I echo sentiments of last poster absolutly no reason to suffer so. As far as addiction, my what the public belives is so funny and sad, the chances of you getting addicted are sooooo nil %, people who MUSt take pain relief be it narcotics or those who take other drugs with possible addict affects are just not even in the realm of reality to those who have to be" Dependent" HUGE diffrence, your talking about some relief short term you are NOT going to be addicted unless you are already an addicted person or have the bio chemistry for addiction, its no difffent than other drugs that way, it works uopon nuerotransmitters, seratonin, hypothalmus, I mean if you have a serious issue in past to drug or alcohol addiction then I would clearly be cautious but even then it wouldnt mean for sure you would react chemicly to a narcotic that way. Ok those are the practicle reasons , emotionaly pain is harming you, physicaly its proven those who are in chronic pain with no relief and no structered plan or pain mangament take more than 2 times as long as others to heal (good food for thought). I was and AM the worst about taking my meds, Im practicle I like to have all my facilities meantaly working and no feel drugged out, guess what Im not nor have I ever been except in hopsital after long Brain and or Spinalcord procedures that are so agonizing one couldnt phathom and must be that way or I wouldnt heal becasue I would be fighitng the pain so much and using my energy.

dont waste your energy TALk to your doctors, be honest, dont be shy" Im in Pain, I cannot cope with this right now, we need to try soething diffrent" you WILL function just fine, what you have heard or read is MYTH , and here are 2 people to tell you that, up at night writing you and functioning.

Go get some relief, it donest mean it will be narcotics either, but there should be something you can take and feel ok about taking it.

Senidng you Big hugs and PReayers tonight, (h,aha,ha my writitng getss os bad as I GO on) sorry cant blame it on drugs, its my Brain

Yay Lucky Lady!

I have a dear friend who suffers from dreadful chronic pain due to bad, bad problems after weight loss surgery. It's the kind of pain that can't really be localized and described in specific terms a lot of times, and there's rarely anything that can be seen in an imaging or surgical procedure to be causing her pain. That is the nature of post-abdominal surgery complications. Mess with the gut, the gut will sometimes hurt badlly and forever.

Because she had weight loss surgery, she malabsorbs everything taken by mouth. Plus, she has the tolerance of two horses to narcotics. Add all that up and you have someone with PROBLEMS, bless her heart.

I could just smack all the people, medical professionals included, who have branded her an addict because of her desperation in looking for pain relief that works. This has been a five year long journey for her, can you imagine? She was in detox facilities multiple times, and not ONE of them said a WORD to her about finding REAL EFFECTIVE PAIN MANAGEMENT. They just said she was addicted and had to get off the narcotics. HOGWASH!!!

FINALLY, she found a doctor who listened.... And all it took was a bigger pain patch than she'd had before. End of story as far as the unbearable pain goes. Voila!She can function in life again and has quality of life.

Now "all" she has to do is regain the dignity and relationships and so much more she lost because idiots who had no clue branded her a drug addict. I am so heartbroken for her, and both her experience and my own have given me an almost evangelistic fervor on this subject.

Thanks for writing!

Elizabeth oh thats horrible to hear I hear it so often. Im using my speakeasy so you can read my words now . I was so controlled in my efforts to not take my meds as per PCA, Im allergic to all anti nausea meds, so I would lay there in my puke for days and days, not use my PCA on time thinking outside the box was very hard for someone who was an athlete all thier life and then in a wheelchair having to have people take care of me, hated it at 100%. well after about the 3rd brain surgery or the spinalcord surgeries I got a bit better, it wasnt even great after the aneurysm, continued to hear" you cannot do this you only take enough for a tooth ache, Id be screaming in ICU and CCU from pain and being blind, vomiting and in that kind of pain must have been horrendous for my family to see. One day one of my neuro doctors said to me at a visit, you have to keep pain under control, you are just messing yourself up, you wait too long then its too late, he was right, by this last year yes after doing that for almost 9 years or more I was in so much pain I acutally had to go to ER (shoulder from wheelchair use for years), I couldnt take it and stayed medicated for a few days in there with steroid shots in shoulder and for the first time since 1996 I was pain free, It was a serious revelation for me as I was so accustomed to feeling that way I had forgotten what it was like to not be in that much pain. I still need rotator cuff surgery and large spine tumor removal, but opted for this weds surgery first (I love getting to pick which to do first). I found out in april I have AD (Autonomic Dysreflexia) when my bowel or bladder is in pain (I go up to 40 times per day) with diapers and cathing at urology, if I dont get it under control my BP will go from 80 or 90/40 to 50 up to 145/80 in seconds, VERY dangerous so I cannot allow that anymore.I am so happy about your friend and I hope our dear lady who wrote here reads these and knows we care and do understand on many levels, pain is pain no matter what the cause, I pray one day our "way of thinking in society" will get a grip with reality on such issues and not make it so hard for doctors to help these poor people from needless suffering.

hugs to your friend and anyone who has to live this way with no help, you have my compassion all of you.

Lucky Lady who better hit the hay, the bags under my eyes look like I hit a door with my face tonight,ha,ha,ha,ha.

I am glad to know that so many who have been there feel free enough to share their experiences with us here. Not so glad that you had to go there in the first place and am sending all my love and hugs and prayers to you. After being in indescribable pain after surgery, I cannot imagine how horrible it must be to have pain be a way of life. I am scratching my head and am puzzled by my docs (and others I have I seen before) hesistance and resistance to prescribe what really works. Oxycodone with an anti-inflammatory mix works for me, but the doc is so stingy with it that I find myself in pain because it's not time for my next prescribed dose. I don't drink, don't smoke and have no history of any kind of drug abuse so I don't get the reluctance. My doc blamed my post op pain that I suffered on the fact they were unable to effectively control the pain because I used narcotics for only 2 weeks prior to surgery. They were giving me a drip of some new medication that I've never heard of. It made me high as a kite and didn't help my pain much. I had to demand and beg for morphine for almost 24hrs before they switched me, and the morphine was better. Didn't make me high and it eased my pain considerably. After they took me off the drip they started me on oral oxycodone and it worked well, too. When they discharged me, they gave me percocet and it didn't do much of anything. It was only after I went back to ER 2 days after discharge because of pain caused by hematoma did they give me oral oxycodone. My medication is running out and I've been told they will not refill. So now what? I wonder and worry. Sorry for the typos, but it's difficult to type while flat on my back.