Can anyone give me advice on painkillers - chronic pain for 10years, at end of tether.

[StripeyKnickersSpottySocks]

I have had chronic lower back pain following an accident where I broke my back 10 years ago.

An MRI 18months ago also found I had a prolapsed disc and I had a hydrocortisone/steriod injection which didn't work. My consultant muttered about the possibility of doing a discetomy if the pain in my leg became worse than the pain in my back. At the time it wasn't but it is now.

My consultant appears to have abandoned me - when I last saw him 8 months ago he said he'd see me over the summer and I never heard from him since. I emailed his secretary last week so am hoping to hear something soon.

In the mean time my GP has given me pills which are 20mg dihyracodine and 1g paracetamol. They barely make a difference so I don't really bother with them. I occassionally take 30mg dihydracodine instead when the pain is worse (not prescribed though). They take the edge off the pain but I'm still in pain and they make me feel a bit spaced out.

Does anyone know what else I could ask my GP for? I've been reading on the internet that antidepressents can be effective in treating chronic back pain Does anyone know anything about that?

I'm worried about going to my GP and asking for the strongest painkillers I can have incase he thinks I'm a junkie. And I'm also concerned about the fact it doesn't look like my back is ever going to be sorted and I am worried about becoming dependent on painkillers. I daren't risk the surgery as have read so much about the chances are it won't work and my consultant told me that there is a fair risk of paraylsis.

have you tried regular treatment by an osteopath - it made a huge difference for me and might help manage the pain better.

Is there any reason why you can't have non steriodals? Things like ibuprofen and volterol. It would probably mean you would need to take additional medication to protect stomach lining (on volterol) but would be good for this sort of pain IME.

I think you should go to your GP and tell him exactly how you are feeling. That your pain isn't controlled, tell him what you have been taking (prescribed and not), that you are worried what he might think of you, becoming dependant, your concerns about surgery etc. See what he has to say.

what about acupuncture? Lots of physios qualified to do this now and you can access via NHS or privately. How about Tens machine - I find this helps manage my arthritis pain in lower back. It may not be the same for you but maybe worth a go? Also think sometimes you need a couple of goes before hydrocortisone works so may be worth investigating that again with your consultant. HTH I do sympathise.

My grandmother has really bad rheumatiod arthritis, her fingers and toes are very badly deformed. She has acupuncture twice a year and controls any break through pain with paracetamol.

I've tried ibuprofen in the past and it doesn't work at all.

I have spent so much money on oesteopaths, chiropractors, physios. Litrally thousands over 10+ years. Never seen any improvement. Saying that I am seeing a new chiropractor next week that my mum reckons has cured her bad back that she's had for 30 years. So am hoping.

I probably do need to go and see my GP but am hoping to get some idea of what to ask for first. GP seems useless and just eeps dishing out painkillers that don't work. I have been to him about 18months ago saying the same and he said he didn't really want to give me anything stronger. But then I read on the net that codine is often ineffective for chronic pain and there is better stuff - well I haven't been offerred any.

Have tried acupuncture. TENS is a good idea, will get one.

stripeyknickersspottysocks my fil has something which sounds very similar, but in his neck. he has been all over the place trying different things, traditional and alternative, none of which has worked very well. however he hasn't got a diagnosis of disc, but something in the nerves, they are still not sure what and it is 2.5 years since it started. consultant says operation is out of the question.

he was prescribed the anti-ds fairly early on, not sure if he is still on them. i think you should go back to gp, nobody should have to live in pain without at least trying more options. my sympathies for you, it is very grim i know, do hope you can find a solution.

Oh this is really horrid for you - I sympathise hugely.

First off you can ask for a referral to a pain clinic. Regardless of the cause of your pain they should look a range of options to help you manage the pain. These should include drug therapies as well as complimentary options such as accupuncture which can be very effective for pain control.

I cope with a mixture of things. I use Butrans patches - these are applied weekly and are a opiate base but it is a very low dose and a constant stream so you don't feel "drugged" at all. I also daily use Diclofenac suppositories - these are the most effective pain relief I know for my back pain and you can feel the relief within 10 minutes. One a day isn't the maximum dose so if it's a bad day you could take two that day, or if you know you will be doing a lot of standing etc. Alongside this I use the Voltarol (diclofenac) gel which can be applied directly to the site. When things are horrifically bad I take tramadol but this makes me feel spaced out so I really only save it for when I am bed bound anyway. This regime is non-addictive but has been very effective for me and although it doesn't take the pain away it does make things bearable.

You should also consider pilates specifically for back pain. If you can strengthen your lower abdominals and core stability this will help, and also help protect you from any further damage. Also whilst walking/standing hold your pelvic floors as these will help to act as a brace for your lower back. In time, with practice, it won't even be a conscious thought.

You can also ask your GP for a referral to ahave a visit from your community Occupational Therapist. They can assess your lifestyle and your home to suggest ways and means of doing things to limit the strain on your back. This can be incredibly useful if you have a young family as they can give you advice on the best way to do day to day tasks such as lifting children, getting them in car seats, changing them etc - all the things that require you to repetitively bed over and weight-bear.

Please don't be afraid to go back to your GP and discuss your options further - they are there to help and can only help if they know HOW bad it is.

Must go - DH is calling as he can't cope with bedtime on his own obviously!

I'm back, post bed time!

I have also previously been on Citalopram (anti-depressant) for the pain and I would say that it was effective. The idea is that it changes your perception of pain and it did do that. I came off them not because they weren't working but because I was worried about them being addictive and also I felt I was popping a ridiculous number of pills and didn't feel comfortable with it but they can certainly be useful in the short term to help you get back on top of things whilst you work out a longer term plan.

Good suggestions from Weegle - slight hijack - hello Weegle how are you?

Am going to try and get in to see the GP tomorrow. Weegle did your GP take some persuading to give you such strong painkillers, mine seems convinced I should be ok on paracetamol?

I will definetly ask for a referal to pain clinic if I think I'm not been taken seriously.

Had 5 years of similar problems(three discs prolapsed together). Eventually cured (almost) by discectomy and a lot of specialist physio (pain went almost immediately after the op.), before which I tried most (all?) of the suggestions on this thread.

I would recommend chasing up the operation (although whether this would work depends upon what is wrong with your spinal cord, how much damage there is etc my consultant was quite surprised how well it worked). Other than that, osteo and acupuncture worked for a bit (until the discs got worse), volterol (diclofenac) is good and nonaddictive (arthrotec is a good version of it, I think, but don't consider it if ttc/pregnant I was in so much pain, I couldn't even consider walking or sitting, let alone pregnancy). I ended up on morphine sulphate (in hospital), but that isn't a long term solution for reasons you recognise (actually though, people with severe pain are much less likely to get addicted (a pharmacologist friend told me) so long as they give up when the pain goes away, as I did).

BTW is the pain mainly in your back or your legs? Do you know which disc it is? (This might help.)

Good luck. Back pain is truly horrible.

Try to avoid the heavy pain medication if you can - my dh suffers chronic pain and after years of rather mediocre treatment by GPs willing to hand out ever-larger doses of pain meds, he is now on a cocktail of drugs that would literally kill a normal person (and still in pain).

Referral to the pain clinic definitely a good idea, I would go privately if you can afford it. And keep the pressure on your consultant, dh has slipped through the net with our pain clinic because they sent him for two pointless psychologist appointments and he only went to the first one, so he's got lost in the system.

To be honest, the most effective painkiller I know of for chronic pain is weed. The GP won't prescribe that though!

Hope you can get some relief soon. My MIL posted me a newspaper article about a new magic device that could (allegedly) cure pain, will look for it and post a link.

Pain clinic, and use a TENS machine, available at a well known highstreet chemist for about 15 pounds. Both have provided relief

Chaotica - its good to hear of someone who's had a successful discectomy. My MRI scan showed prolapse at L5/S1 which is about the bottom disc I think.

I have finally got hold of the consultant's secretary and have appt for end of Feb. He has a clinic at the end of this month but I'm away - typical.

I'll ask GP about pain clinc in the mean time.

Well it was a case of trial and error. But it's been predominantly my consultant leading my pain management so my GP has literally just been following instructions.

pinteddy - not too bad thanks. I had a terrible flare before/over Christmas but I seem to be on the up again. Was only managing on crutches for a while though which was pretty demoralising. How about you? My head seems to be in a better place about it all though, not so low!

BTW - how on earth do psychologists help you with pain? Do they reckon that been more positive about it lessens the pain or something? Mmmmm, I've been very positive about it for last 10 years until the pain's got worse

Stripey, my dh's condition has a psychological component in the sense that chronic pain has caused him to be depressed (wonder why that is, eh?). As he has no chance of a meaningful recovery, the psychology was meant to teach him some coping skills / develop positive outlook / whatever. It was a complete waste of time. I genuinely think he would benefit from long-term counselling, but this was just a 2-session "why don't I say 'oh you have a one year old, that is a lot of work' and you say 'yeah it is'" kind of deal. WTF? I had to take time off work to attend this pile of tripe!

Hi Stripey, my dh has had 5 years of the pain you describe. A prolapsed disc at L4/5 with claudication in his L leg which makes standing still almost impossible and so painful.
He tried every form of treatment and was religious with exercise etc as totally wanted to avoid an operation. Very very scared of paralysis and complications too.

Only pain relief that worked for him was Tramadol which does have the added effect of a bit of an anti depressant. I could detect a "lift" in his over all being when he took medn. Saying that, the pain was always there and he hated the feeling of being a bit spaced out.

He tried everything from acupuncture to TENS machine to various medns. Physiotherapy, osteopathy, chiropractor, remedial massage,pilates........

12 months ago he was really miserable and Tramadol after 5 yrs was really loosing effectiveness. Still very negative about an op and only had one because it was really last resort.

At the advice of the medics in our family he was operated on by a neurosurgeon ( they were all adament this was the way to go rather than an orthopaedic surgeon who could also do the job). He had a discectomy. He ended up in intensive care but that was due to some reaction to the anaesthetic.....4 days later he was home. That was in Feb. He had a morphine infusion for 48 hrs in hospital. Some strong pain killers on leaving hospital for the journey as we are 2 hrs away by road. Since then he has had 2 paracetamol. Our lives revolved around obtaining prescriptions, this is unbelievable.

At day 5 post op he went for a 1/2 hour walk on the beach and this continued daily increasing to 2 hrs+.

From someone who couldn't even have the weight of coins in his pocket, it was enough to trigger the leg pain, he has just returned from doing a 7 day rugged coastal hike carrying all his food and water for a week in his 22 kg rucksack. He didn't have a twinge and 2 weeks later can still hardly believe how good he feels.

My advice is go to another GP. You need someone a bit more proactive and sympathetic. Get a referral to a neurosurgeon and a pain management clinic.

Tramadol worked for my dh. He was allowed to continue working while taking it and he is in an industry where medication is very very restricted e.g can't work if he's even taken a hay fever pill......

Good luck. Tilba x

Hello

I agree with Weegle.

I have had Complex Regional Pain Syndrome for 7 years following a car crash.

It took months but I was eventually referred to a Pain clinic. Pain can be the issue itself rather than a symptom - in my case my central autonomic nervous system is damaged which means that ordainary nerve signals are interpreted as pain. This type of neuropathic pain has a lot of negative knock-on effects.

Get a referral to your nearest pain clinic. They have a rigorous assessment & will be able to help either way (they will either refer you on or if you have a chronic pain condition they'll help.

The great thing about pain clinics is that they take a 3 pronged approach:

1. a consultant will work with you to get your medication right - they aim to reduce your pain by upto 45%/50% using drugs. They do use older tricyclic anti-depressants in some cases (e.g. I take Amitryptaline) the reason being that they help to calm some of the neural pathways which are communicating pain (some anti-epileptics e.g. I take Lyrica, are used in a similar way). In addition they will prescribe anti-inflamatories which will really get to grips with the inflamation (e.g. I take Diclofenac Sodium SR = slow release for 10 hours). They will also prescribe opiates if warranted (e.g. I wear Fentanyl patches which provide a continuous dose of morphine for 72hrs)

!!I'm concerned that you don't take more medication regularly - unless you take it as prescribed it won't work & often it can take a while to build up in your system. Please consider this as it's really important!!

2. a physio will work with you to get your body moving more & to strengthen your back which will help massively.

3. a clinical psychologist will work with you to help you work out strategies to get on top of & live with the pain.

2 & 3 are sometimes done together as part of a group pain management programme.

Finally check out www.britishpainsociety.org/
www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm
www.backcare.org.uk/

Good luck with everything, living in constant pain is terribly draining & depressing but there is help out there x

hi stripey...in a similar situation from a bad head on car crash a few years ago

Have 3 prolapsed discs between L4 and L5 and S1 and S and the upper disc has prolapsed into the spinal canal,which is a tad worrying.

I had traction which actually helped alot ,but it needed a few sessions.

Strengthening your inner core muscles helps too, as the external ones can cause you more pain if exercised wrongly.

Pain is very depressing and would i be right in assuming it has caused some depression for you?
Unfortunately depression causes us to perceive pain differently and it reduces our coping mechanisms.
Amitryptiline is often added in as the antidepressant/assistant pain killer.
I found Lyrica(pregabalin) painkillers very helpful too and it avoided the need for opiates which the docs are reluctant to prescribe

other helpful painkillers for the neuropathic pain are gabapentin capsules which comes in varying strengths...some use carbamazepine. MST tablets,sevredol (both morphine based)Durogesic patches.
Didnt find any topical applications worked as they are not absorbed deeply enough to help.