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Can you tell me the effectiveness of the use of the Lidoderm patch in cases of severe osteoarthritis with degenerating discs? Is this anything like the Duragesic Fentanyl that you recommend?

Thank you.Mary L.


Thank you for your inquiry.

The Lidoderm patch contains Lidocaine 5%, similar to Novocaine. If you apply two or three of these on top of each other sometimes relief is immediate and effective.

Duragesic Fentynal patches are very helpful to many people, including some of my patients. Although some of my patients have experienced side-effects. Remember, that pain medications don't always work for everyone. Thus I suggest you experiment and try both patches.

Good luck, the Doctor at Painlab.com


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I am hoping (and praying) that you might help me.

In September of 2001, I had Reconstructive Knee Surgery. I tore my ACL, MCL and Meniscus. They call it "The Unhappy Triad." Being always active (running, all sports) I was 40 when I managed to do this landing the wrong way playing volleyball.

I was out of work for 5 months. I had a grueling, and very painful recovery in where I went through 2 different physical therapists. I feel strongly, to this day, that my surgeon botched my operation. My knee has never felt right. I am, and have been in constant pain since I had injured my left knee.

However, I did mange to keep the pain at bay with the help of a pain management doc in NYC. I was prescribed Oxycontin (80 mg - 3 to 4x a day) I work for Amtrak - onboard -- working the cafe car between NYC and Niagara Falls, Canada. I am on my feet from 3:30 am when I awake to when I arrive in Canada at 5:00 PM. The Oxycontin was the breakthrough drug that enabled me to endure the rigors of my job. I was also able to play around with my 2 daughters (9 and 5 ) and maintain a healthy lifestyle with my wife. I was taking Oxycontin until around 2005 when I (foolishly) wanted to see how chronic my pain truly was without any medication. I went outside of my pain doctor to a specialist who weaned me off the Oxycontin with Buprenorphine. It was a total disaster. Not only was I in total agony feeling sick with all the side effects, it felt like my knee was on fire.

When I returned to my pain doctor and told him about what I had did, I was shocked with his reaction. He felt that I broke a breach of trust by going to another doctor. He then told me that he would not treat me no longer. I was only being honest with him. I did not know from that day I would go through hell.

He referred me to another pain doctor on the upper east side. This doctor decided to go a different route by prescribing me Methadone. I decided to give it a shot as he explained it was an underrated and cost effective medication.

Methadone has made me feel like a "zombie." I have no energy, I am always tired. I also get tingling in my hands, it's like they go numb sometimes.I have taken off many days at work. Most important -- it does not do anything to take my pain away. I feel trapped now, on account if I stop taking this medication - I will get sick! This new doctor has claimed my pain is neuropathic.The pain I feel is real, in where I am limping around, in where my knee just buckles from under me and I just fall down. It sucks to say the least.

I had an MRI a couple of months ago and it has shown that I have a ruptured ACL, there is a tear in my MCL and there is advanced ostoearthritis in all 3 compartments. I seen an orthopedic surgeon (Stuart Springer) in NYC and he advised me to have surgery on May 23. He said he would tighten up my ACL and fix the MCL and also clean out the Meniscus.

At this point, first off, I am still in a lot of pain. When I asked him about the pain issue after the surgery, he said he doesn't believe in pain meds!

When I look back and fairly access everything, I was fairly pain free when I was taking the Oxycontin. Now its like pulling teeth even mentioning Oxycontin to this pain doc and the surgeon. I do not know what to do regarding having the surgery or not. I am afraid of having the surgery -- developing more pain and not being able to treat it is looming as very likely.

Can you offer me any advice on my situation? Can you explain to me why when I explain to a doctor what has effectively worked for me in the past, he vehemently denies me this medication? Why he will continue to prescribe a medication that has given me serious and unpleasant side effects?

Today, I called his office to ask if they could refill the prescription. I was told I would have to come in and pay his $350.00 fee for that to happen. I am totally disgusted. He does not take my insurance (United Healthcare) so all I get back is only $140.00. United Healthcare deems his services "unreasonable"

I would appreciate any help you can offer me. I live in Bayonne, NJ (about 30 minutes from NYC) I have copies of all my MRI's, photos of my surgery, prescription history.

After living 5 years with my injury and the pain it brings, I feel I can attest to what medicine has worked for me and what medicines have not. I am hoping I can find a doctor or pain clinic to successfully treat my pain.

I hope you can help me.

Thank you.

Sincerely,

Tom S.


Dear Tom,

Prior to taking any action, it is mandatory that you get an examination by another MD. I have one in mind that I would like to recommend. Please contact me regarding this matter. The MD's information that I will pass on to you is the best in Trauma/Surgery in New York City. Please delay your surgery if you already haven't done so. In my experience, a second surgery is usually not successful.

Normally Methadone will be helpful in relieving Chronic Pain but it doesn't seem to be working in your case. It is not an opiod like Oxycontin.

It is not surprising your Doctor has been unwilling to prescribe Oxycontin again for you. As I have explained to many persons and patients, Doctors work under intense scrutiny these days regarding treatment and the medications they may prescribe. I'm sure you have read many instances in the press over the last 5+ years of Doctors being investigated and/or prosecuted for prescribing what local law enforcement, DEA, State Medical Boards deem as either excessive , unwarranted or just plain negligent (In their opinion).

I truly sympathize with your situation, especially like many pain sufferers, you must continue to pay the bills and look after your family.

Good Luck,
The Doctor at Painlab.com




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What are the biggest dangers using this drug (Darvocet-n), especially in combination with the many other drugs used to treat chronic pain.

My husband is currently taking up to 30 pills a day.

He is 82 years old and suffers from Congestive Heart Failure, Diabetes, Neuropathy and lastly he is also anemic. Currently he is taking the generic form of this drug, Propo-n/Anap. He feels terrible most of the time.

Thanks


Thank you for your inquiry

Darvocet is a mixture of Darvon (propophyxene and acetaminophen) Acetaminophen is basically Tylenol, proven to be toxic for the liver, if taken in high dosage. Especially in an 82 year old.

I recommend you husband get a prescription for only Darvon, which does not contain acetaminophen. Darvon (propophyxene) is a mild painkiller, thus he is not in danger and may take as many as needed (within respectable limits). It is also not harmful to take in combination with other drugs.

Good Luck, the Doctor at Painlab.com


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Hi All,

I have been reading all your postings and feel for each and everyone of you that are experiencing pain. I have been in constant pain since 1982 when I fractured my spine. Since that time I have had 7 spinal surgeries with 5 of them being fusions. Four of my fusions were done postearally and the otherwas antearally. My final fusion was done in 1992 at Shand's Teaching Hospital in Gainesville, Florida. Because of all the surgeries and scar tissue associated with them I am in constant pain.

After each surgery I would have a new and different pain. I have had bone grafts done from both of my Iliac crests - The back of the pelvis and from the second bone that is in your lower leg. I have pain also in all of my donor sites. My pain never goes below a 3 and at times elevates to a 10+ where I lie in bed crying. Thank god those times are pretty infrequent. In 1982 I found out I also had hepatitis B & D. It is thought that I received this through my blood transfusions.

I have been on almost every pain medication that is made, Fiorinal, Fioricet, Darvon, Darvocett, Talwin, Vicodan, Percocet, Methadone, Duragesic, Codeine, Oxycodone, Dilaudid, etc. In 1999 I had a very bad scare when I started having liver problems, so my doctor took me off ALL pain medications to see if the medication was causing my liver failure. They were getting ready to start Interferon injections when everything went back to normal. It was suggested at that time that I should be put on Oxycontin for its pain relieving qualities and because it is primarily broken down in the kidneys and had a low incidence of causing liver problems.

I never start a new medication without doing research. I was quite scared after reading up on the Oxycontin because I was afraid of taking something that I would have to take for the rest of my life and also something that could make me sick if I was unable to get my prescription refilled. After a month of discussing this with my physician and his promise that I would be able to get my refills by someone else in his office if he was out of town, I decided to go ahead and give it a try. OH My God....Life is wonderful again. I was lucky enough to start the medication before all of the abuse started. It actually used to be a joke between my doctor and I about how much money I walked around with every month. I used to miss around 10 days a month from work because of my pain and have only missed 6 days in the last 7 years. I take 15mg of Oxycodone for my breakthrough pain. I have had my medication stolen before (twice) I now tell NO ONE what I take and I keep it locked in a small safe under my bed and fill a pill dispenser with a weeks supply each week so if it stolen I am only losing a week or less.

I started out on 20mg twice per day and am up to 160mg twice per day. Since there is no "ceiling" to the medication dose I don't have to worry about reaching the max dose. I have also experienced the withdrawals from the medication when it was stolen the second time (my doctor refilled it the first time it happened and a police report was done both times). The withdrawals are something I wouldn't wish on my worst enemy. The heart palpitations, closing of the throat, hot & cold sweats, stomach cramps and explosive diarrhea, the feeling of worms crawling in my joints, inability to sleep.....Not a pretty picture. But, I still would not give it up for anything in the world. I have also experienced the problem of finding a doctor to write my prescription.

I returned to my childhood town in Florida (I now live in Wisconsin) and ended up going to 13 doctors until I found one that would write my prescription for Oxycontin, even though I had already been taking it for 4 years and had proof. They are just so damned scared to write it because of the abuse. Purdue, the manufacturer, told me a while back that they were working on reformulating it like talwin is so that if it is crushed it would release a chemical that counteracts the narcotic oxycodone but this still hasn't happened. I am unemployed and could not afford to fill my prescription so I am also now on Purdue's Patient Assistance Program where, until this year, I received it for free. I now have to pay a $25.00 co-pay.

I know this was long winded but anyone who has chronic pain that is expected to last for a lifetime should be very adamant about asking for something for pain that will actually work enough to give them the quality of life that the rest of us share. People in chronic pain usually will not abuse their pain medication and I for one don't get "high" off my medication. If you need to keep looking for a doctor who understands your situation keep doing so. Eventually you'll find someone who is. Ask your friends about their Doctors. That is how I found my current physician.

I highly recommend the medication that I am on and I am disappointed that Purdue's new pain medication "Paladone" was pulled right after it was released. The medication was a form of Hydromorphone (dilaudid) that was time release like Oxycontin only about 25 times stronger and only needed to be taken once a day. It was removed due to "Dose Dumping" when combined with alcohol. Dose dumping occurs when the whole dose is introduced into the body at one time.

They are working on fixing it. Good luck to all and just remember, there are Dr's out there that understand pain and will do all they can to makelife bearable again.

Persistence is the key word here.

Richard


Dear Richard,

Thank you so much for your "story". well, it speaks for itself. I can also testify to the fact that MD's operate under extreme pressure these days. Many are reluctant to prescribe the drugs necessary for persons in chronic pain for exactly the reasons you mention.

I myself, during the final years of practice in New Jersey, experienced just this kind of scrutiny from the medical board of my respective State.

You are right, although it may take some time, chronic pain sufferers have to continue to persevere until they find an MD willing to assist them.

All the best,
The Doctor at Painlab.com




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I have FIBROMYALIGIA AND OSTROARTHRITIS and suffer pain all the time.

I took Lorcets for about 14 years, 3 times a day. They stopped working. I was in severe pain for all of 2005. In December I was sent to an Arthritis Doctor who put me on Duragesic Pain Patches 50 Mgs. They helped in the initial stage but than in March 2006 they began causing redness and itching where the patch was worn. Thus I was taken off the patches.

My MD than tried Methadone 5 Mgs, 3 times a day. That did not stop the pain. He increased the dosage to10 mgs, 3 times a day. That also did not help. He than prescribed MSContin 15 Mgs every 12 hours. This has helped with the pain. I am free of pain for 8 hours, than suffer 4 hours until its time to take another tablet. I have only been taking this medication for 3 days now.

What I would like to know is whether it will last longer, covering those 4 hours, or will I have to suffer for the rest of my life until I can take my next pill? If I could have the dosage increased to 3 times a day, it would solve my pain but I don't think my Doctor will do so...The MSContin does not hinder my ability to drive a car, make me sleep etc. It simply stops the pain.

Please let me know what you think. Will it start giving relief after a time?

Thanks


Thank you for your inquiry,

Your MD is playing it by the book. The manufacturer also states that it provides relief for 12 hours. In my experience, this may or may not be true. It all depends on your level of pain. You could always ask your Doctor for an increase to the 30 Mg tablet. This may provide the coverage your looking for. To answer your question, it will not cover your pain for the entire 12 hours in the future.

Below is a link which you can download in pdf format. It may help you learn more about the medication.

http://www.purdue.ca/pdf/2006-02-15 MS Contin_ENG PM.pdf#search="ms contin purdue"

Finally, confront your MD with the above story. He should in all likehood at least offer some additional help.

Good Luck, the Doctor at Painlab
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