Tell Me About Back Pain

[lulu]

Kaleigh, are you at least on some kind of pain meds? I hated the side effects, but 2 vicodin per day got me through until I had the epidurals. I think pain specialists can get pretty specific with a "cocktail" for you.

 

[ilovesparkles]

AG - thinking about you this weekend! Hope you are able to get out and do some walking, if it isn''t painful, its one of the BEST things you can do for your back. Not sure if I remembered to tell you that! I was really tired when I was posting the last few times. WALK WALK WALK. If it isn''t painful that is. Another tip with the walking is to do it naturally, don''t hold your cell phone, let your arms down at your sides and swing slightly. Its frustrating but comforting to know that I am not alone.

 

[AmberGretchen]

Date: 4/18/2009 7:15:52 AM
Author: ilovesparkles
AG - thinking about you this weekend! Hope you are able to get out and do some walking, if it isn''t painful, its one of the BEST things you can do for your back. Not sure if I remembered to tell you that! I was really tired when I was posting the last few times. WALK WALK WALK. If it isn''t painful that is. Another tip with the walking is to do it naturally, don''t hold your cell phone, let your arms down at your sides and swing slightly. Its frustrating but comforting to know that I am not alone.

Thank you ils! The tramadol (ultram) is really helping so far, and the effects of the acupuncture helped as well, so between the two of those, I am still a bit drowsy/loopy, but doing better in terms of pain.

My DH and I are taking our three kitties to the vet today for their annual checkup, so I think that will be most of my exercise, although I think I''m going to let my DH do most of the kitty carrying

 

[Pandora II]

Date: 4/18/2009 1:13:54 PM
Author: AmberGretchen


Thank you ils! The tramadol (ultram) is really helping so far, and the effects of the acupuncture helped as well, so between the two of those, I am still a bit drowsy/loopy, but doing better in terms of pain.

My DH and I are taking our three kitties to the vet today for their annual checkup, so I think that will be most of my exercise, although I think I''m going to let my DH do most of the kitty carrying

Just one word of warning, and I don''t want to scare you, but as someone who has been on tramadol for 7 years - be VERY careful about how long you take the stuff for. Almost all doctors and pain specialists I have seen have tried to tell me that you don''t get withdrawal from it - except the two who have chronic pain issues and have taken it themselves!

I''ve watched people try and stop taking it and it''s seriously terrible. I can come on and off morphine, codeine, you name it with zero issues, but tramadol is just horrendous.

I''ve run out of tablets in the past when I forgot to get my Rx done in time and the chemist had to order them in and it is seriously my worst nightmare. It is a fantastic med and works wonders for me with almost zero side-effects, but it is hell to come off (one of the reasons that I will be in hospital for at least a week after the baby is born as the NICU will be helping her through withdrawal.)

If you are on a low dose and only for a couple of weeks you will be absolutely fine, but if you need longer-term analgesics I would try to avoid this one.

Glad the acupuncture helped!

 

[MichelleCarmen]

Date: 4/18/2009 5:02:58 PM
Author: Pandora II

Date: 4/18/2009 1:13:54 PM
Author: AmberGretchen


Thank you ils! The tramadol (ultram) is really helping so far, and the effects of the acupuncture helped as well, so between the two of those, I am still a bit drowsy/loopy, but doing better in terms of pain.

My DH and I are taking our three kitties to the vet today for their annual checkup, so I think that will be most of my exercise, although I think I''m going to let my DH do most of the kitty carrying

Just one word of warning, and I don''t want to scare you, but as someone who has been on tramadol for 7 years - be VERY careful about how long you take the stuff for. Almost all doctors and pain specialists I have seen have tried to tell me that you don''t get withdrawal from it - except the two who have chronic pain issues and have taken it themselves!

Pandora - how many mgs of Tramadol are you on per day?

 

[Pandora II]

Currently 200mg 24hr SR.

I know a lot of people have no problems - especially at low doses - but it worries me that it''s a med that is actively promoted as not having withdrawal problems (being a synthetic opiate) and yet my own personal experience and that of my pain consultant wth other patients is that it can cause them.

 

[AmberGretchen]

Thanks for the warning Pandora! My Dr. says I have the least addictive personality/physiology of anyone he''s ever treated, partly because I have such strong reactions to most meds, but that is really good to know about the Tramadol. I think I will have to come off it ASAP in any case, since I have to be able to do lab work, and its not really safe for me to be taking that and working in lab at the same time. But now I am going to be extra careful about keeping the dose down - I''ve been taking it about twice a day at a 50mg dose, and will probably not go any higher than that if I can help it.

 

[ilovesparkles]

Pandora and AG - Eeks! I am on 300mg ER I tried doing the generic tramadol 100mg every 6 hours (insurance coverage), but it didn''t work as well. So I just switched back. Given how many others I am on, its hard to say what causes it, but on weekends when I wake up late and don''t take my meds on time, I have hot sweats and feel like I have flu symptoms. And I know its because I am over due for my meds. Its horrid.

 

[Pandora II]

Date: 4/21/2009 12:06:02 AM
Author: ilovesparkles
Pandora and AG - Eeks! I am on 300mg ER I tried doing the generic tramadol 100mg every 6 hours (insurance coverage), but it didn't work as well. So I just switched back. Given how many others I am on, its hard to say what causes it, but on weekends when I wake up late and don't take my meds on time, I have hot sweats and feel like I have flu symptoms. And I know its because I am over due for my meds. Its horrid.

You don't need to tell me about it, it's really nasty. I found switching from 12hr ER to 24hr ER made a big difference in getting the break-through pain and withdrawal. Tramadol only has a 5-6 hour half-life so the withdrawal symptoms kick in much quicker than it would with other analgesics.

If you REALLY want to come off them (I don't because I would just have to switch to something else with possibly worse side-effects), then you coukd try switching to the 50mg normal ones and taking them spread out and cutting one out every other day. I wouldn't do it except with supervision and the possibility of substitutes to get you through.

AG - I hate to say this, but it is not a psychological addiction, it's a physiological dependance issue - big difference between the two. If you have an addictive personality you will perhaps have extra problems, but you can have the least addictive personality in the world and still get a physiological dependance to a substance.

 

[ilovesparkles]

Date: 4/21/2009 6:39:23 AM
Author: Pandora II

Date: 4/21/2009 12:06:02 AM

Author: ilovesparkles

Pandora and AG - Eeks! I am on 300mg ER I tried doing the generic tramadol 100mg every 6 hours (insurance coverage), but it didn''t work as well. So I just switched back. Given how many others I am on, its hard to say what causes it, but on weekends when I wake up late and don''t take my meds on time, I have hot sweats and feel like I have flu symptoms. And I know its because I am over due for my meds. Its horrid.

You don''t need to tell me about it, it''s really nasty. I found switching from 12hr ER to 24hr ER made a big difference in getting the break-through pain and withdrawal. Tramadol only has a 5-6 hour half-life so the withdrawal symptoms kick in much quicker than it would with other analgesics.


If you REALLY want to come off them (I don''t because I would just have to switch to something else with possibly worse side-effects), then you coukd try switching to the 50mg normal ones and taking them spread out and cutting one out every other day. I wouldn''t do it except with supervision and the possibility of substitutes to get you through.


AG - I hate to say this, but it is not a psychological addiction, it''s a physiological dependance issue - big difference between the two. If you have an addictive personality you will perhaps have extra problems, but you can have the least addictive personality in the world and still get a physiological dependance to a substance.

Thank you so much for that tidbit Pandora! Likewise though, unless a miracle were to happen tomorrow, there is no way I am going to be switching off or to anything else. The Ultram works nicely!

Any experience with Celebrex? Its something my MD is trying to add but we are having insurance difficutlies.

 

[Pandora II]

Date: 4/21/2009 10:25:26 AM
Author: ilovesparkles

Thank you so much for that tidbit Pandora! Likewise though, unless a miracle were to happen tomorrow, there is no way I am going to be switching off or to anything else. The Ultram works nicely!

Any experience with Celebrex? Its something my MD is trying to add but we are having insurance difficutlies.

It''s a case of realising that you are dependent and that that is a VERY different thing from being addicted - I also wouldn''t switch as it works so well on my pain levels so it''s worth dealing with the odd break-through and always having an emergency stash in case you run out!

I had Celebrex in the past, but a) it didn''t really do anything for me and b) it''s a COX-2 NSAID which isn''t great on your stomach long-term and there is a lot of controversy over possible increased risk of stroke or heart disease. I have classic migraine with aura so it wasn''t a good choice for me. The controversy blew up while I was on it, so I was taken off it pretty quickly.

My miracle discovery was the anti-epileptic Lamictal, which had an amazing effect on the nerve pain in my legs. Within 3 days of starting it - and a teeny dose of 25mg - I had cut from 240mg of codeine a day (which I''d been on for 5 years) to zero. I now take 125mg Lamictal - I was prescribed it for bipolar disorder so the higher dose is for that - but even when I cut back down to 25mg for the first 14 weeks of pregnancy I still didn''t get the nerve pain back.

The side-effect profile for Lamictal can be bad - but titrating up in very small and well spaced out doses minimises any risk of developing them. I did get a bad headache with every increase for a couple of days each time, but now have absolutely no side-effects at all. Apparently it has good results for about 20% of people with nerve pain - I was one of the lucky ones! The generic lamotrigine is NOT the same as the branded Lamictal in my opinion.

I don''t know if you have kids or plan to, but I thought I''d put my experience down just in case it''s useful to you or others who are on long-term meds and worry about the issue. I have taken the tramadol, Lamictal and codeine throughout pregnancy with the full support of all my doctors, who have never tried to make me feel bad unlike a lot of my relatives and others who have suggested that a) I come off the meds (er, yeah, like I take them for fun), b) that I shouldn''t have children at all if I am on medication and am cruel and heartless.

I cut the Lamictal to 25mg (tapering down 25mg a week from when I got the positive on the HPT as it can take a long time to get pregnant and I couldn''t risk being off my normal dose for an extended period of time) until week 14 as it ''might'' have an adverse effect on palate formation and certain heart abnormalities - although the latest results from the Lamotrigine Pregnancy Register don''t seem to show an greater chance of abnormalities than the normal risk that everyone faces. It is far and away the safest of the anti-epileptics on the market especially when used as mono-therapy. Lamictal crosses the placenta at 100% of the maternal dose. It''s vital to take 5 MILLIGRAMS (as opposed to the normal 400 micrograms) of folic acid a day throughout pregnancy as anti-epileptics are anti-folates and so you need additional cover to help prevent neural tube defects.

Because I was on Lamictal, the hospital carried out a separate cardio-scan at 21 weeks and my anomaly scan was a level II and carried out by a consultant radiographer in the fetal medicine unit rather than by the normal sonographer in the antenatal clinic.

I was referred to the hospital''s pain clinic to look at my opiate use in the context of pregnancy and they dredged up what research there was on tramadol in pregnancy - ie pretty much zero - and agreed that it was a pretty benign choice. For additional pain I was allowed to take up to 120mg of codeine up to 3 times a week but they didn''t want me to go any higher. Tramadol also crosses the placenta - 80% of the maternal dose I think.

Also saw the anaesthetist to discuss pain relief in labour - epidural is the best choice as long-term opiate use would mean that you would need huge doses of pethadine, morphine or any of the others that they use for blocks etc and these would also cross the placenta and adversely affect the baby. You should continue to take your normal meds at the usual time even during labour. The really vital thing is that no-one gives the baby naxolone after birth (given to babies to reverse any sedative effects from meds that the mother has taken during labour) - it will give opiate-dependant babies seizures.

Then saw the neo-natologist in the NICU who discussed the post-natal implications. The baby can have no issues at all or a degree of ''neonatal abstinence syndrome'' that can range from mild to severe and is not necessarily dose related - you can have babies born to heroin addicts who have no problems at all and then people on low dose painkillers whose babies react very badly. The babies remain with the mother and are monitored every 4 hours. If they have a bad reaction they are treated with oral morphine until stabilised and then gradually weaned off over a couple of weeks.

The NICU were very keen that I breastfeed so that the baby will continue to get a small amount of opiates from me - tramadol is present in tiny amounts in breastmilk. They were more worried about the Lamictal as there is always the SJ risk, but it is present at around 40% in breastmilk so much less exposure than the 100% before birth, and to date SJ has never been seen in a neonate.

I''ve been warned that breastfeeding can be more difficult for mothers who take opiates, so the hospital are arranging a ''lactation consultant'' to see me every day for the first week to help.

Opiate use in pregnancy can also apparently lead to low birth-weight... since my unborn elephant/daughter weighed in at 6lbs 10.5 at the 35 week scan last Tuesday, I dread to think what she''d be weighing without them!

Hopefully all will go well after the birth - even if I do have to stay in hospital for 7 days because of possible withdrawal complications!

 

[ilovesparkles]

Again, THANK YOU Pandora! For H and I babies will be at least 4 years out and who knows what will happen with my back between now and then. I currently have a fear of being on bedrest once I get pregnant and the weight starts to pile on. I should have mentioned I am also on Lyrica and would not switch off of it either. The Celebrex is going to be an attempt to replace Robaxin, Tylenol, and Ibuprofin. I also take Vicodin for break through pain. Usually one or two per day. With the increase in Lyrica and returning to the Ultram ER, I have found to be a bit more tired, dizzy, side effects are enhanced it seems. Clearly, when the pregnancy comes along, I will have a slew of specialists! So thank you for the heads up! I hope the last few weeks and birth go well for you and the little one!

Sorry for the thread jack AG, hope some of the info is beneficial to you as well!

 

[AmberGretchen]

NO worries about the threadjack ilovesparkles - I really hope the info was helpful for you - Pandora is definitely our resident expert on this stuff!

Pandora - sorry I wasn''t clear. I totally get the difference between physiological and psychological addiction issues (I actually took a whole class on cigarette addictions in undergrad), and am now in a Biomedical Sciences PhD program, plus my mom is an addiction expert. I meant that my Dr. has observed that both physically and psychologically I''m one of the least prone to addiction of anyone he''s treated. Its partly because I have such a super strong (and often not pleasant) reaction to any kind of drug the first time I take it - I have a very low tolerance for pretty much everything, and he said that makes a big difference.

Regardless, I''m really grateful that you told me about the potential addictive properties with tramadol and your own experiences - I will be extra careful watching for that now, and if I have any symptoms of withdrawal I''ll now recognize them, and will plan to get help for them if that''s what it turns out to be.

 

[Pandora II]

Date: 4/21/2009 12:15:11 PM
Author: ilovesparkles
Again, THANK YOU Pandora! For H and I babies will be at least 4 years out and who knows what will happen with my back between now and then. I currently have a fear of being on bedrest once I get pregnant and the weight starts to pile on. I should have mentioned I am also on Lyrica and would not switch off of it either. The Celebrex is going to be an attempt to replace Robaxin, Tylenol, and Ibuprofin. I also take Vicodin for break through pain. Usually one or two per day. With the increase in Lyrica and returning to the Ultram ER, I have found to be a bit more tired, dizzy, side effects are enhanced it seems. Clearly, when the pregnancy comes along, I will have a slew of specialists! So thank you for the heads up! I hope the last few weeks and birth go well for you and the little one!

Sorry for the thread jack AG, hope some of the info is beneficial to you as well!

Just out of interest, what bit of your back have you messed up? I haven''t ended up on bedrest and my stenotic pain (I have stenosis at 3 levels, 2 herniated discs including one far lateral that completely squishes the L4 nerve plus the NHS system here took so long to get through - 8 months wait for an MRI for example - that by the time they operated I had permanent nerve damage) has actually been better since being pregnant (which my neurosurgeon said would probably happen). I did end up with really bad inflammation of the T7 costovertebral joint which they can''t treat till after the birth as you can''t have anti-inflammatories when you are pregnant. I got an earlyish referral to the physio''s and they''ve tried sticking me in a boob to hip tubi-grip which is not uber-sexy but seems to have helped a bit (I''ve had the pain since 20 weeks and was getting desperate) and also holds the bump up a bit!

Heat, cushions, and comfortable chairs have been vital plus DH is getting very good at massage which really helps as well!

AG - no problem! I''m probably a tad sensitive as I''m forever having to explain the dependence v addiction thing to people and also that you can have withdrawal symptoms without being an addict - even a lot of doctors often don''t get it...

Most of my family and other relatives are medics, and my parents have chronic pain issues - my mother has MS - so I was brought up in a house full of medical textbooks and a larder full of analgesics, and I guess it''s my own personal take on train-spotting: a geeky knowledge of painkillers...

I also have a surgeon who believes in active patient collaboration and gets fuming if you don''t read up on your own condition so you can make informed decisions with him, so I get a lot of the latest research papers on pain and back conditions sent to me. It''s a fascinating area, especially when you look at things like the ''gate theory'' and some of the work that is being done with things like phantom limb pain in amputees. Must be miserable having to spend all day treating people with pain issues though!