California US
I just changed it slightly , because I left out a couple of things that were good medicine, but didn't work for me. Everybody's different, they are
good meds. I put them in.
here's what I'd choose, pretty much in order, if I could just talk a doc into writing them, and see how far down the line I had to go to get decent pain control. I found I was writing this to someone and thought it might be useful.
IF I could talk a doc into it, I would start from ground zero with:
First, before you see the doc, if you have muscle problems, take magnesium. I'm taking 6 250 mg caps a day BUT that is a very high dose, I have VERY bad muscle spasms, and I tend to be constipated. It can act as a laxative. If you have bad kidneys, this might be a problem. High soy diets are shown to ameliorate pain, as are high fiber diets.
1. a tricyclic antidepressant, maybe desipramine as first choice and this only in low dose unless I were depressed cause the studies say the low dose relieves pain, high dose is for depression but the side effects go with the high dose. Not amytriptyllene, it has more side effects than any of the others including weight gain, sleepiness, dry mouth, and constipation, and the docs always choose it because they remember the dose easier. Use an antidepressant dose only if depressed. If you need an antidepressant, you don't necessarily need to use the first drug and I wouldn't want to probably. Wellbutrin looks like a good choice, but is not for everybody. Paxil looks like a bad choice-it is hard to withdraw from, and it tends to make you gain weight.
2. A muscle relaxant. This is second choice if you still have muscle spasms or tightness in the face of high dose magnesium. If not, skip this step. Most of them promote sleepiness. At bedtime this may be good, but the rest of the time, this tends to be bad. Flexeril is a good one for getting sleepy at bedtime. Skelaxin isn't supposed to make you sleepy, and robaxin I don't think does much of this if you want to be awake. I personally would stay away from Soma/carisprodolol if anything else worked for me.
3. Ibuprofen or an antiinflammatory. They do relieve pain even in the absense of inflammation. But I think they are good medicine, and I like what they say about ibuprofen and Alzheimers last time I looked (I'm not following it.) Based on my experience, I heartily recommend avoiding daily high dose celebrex or vioxx (celecoxib or rofecoxib, I think). If daily use low dose. If using high dose, do it rarely and only for breakthrough pain.
4. ultram/tramadol-almost forgot this because it just didn't help me much, but some folks get a lot of relief from it.
5. an antiseizure drug-maybe neurontin/gabapentin, as first choice but let the doc pick. All of these have to have the dose pushed up a little at a time as you learn to tolerate the side effects. Keep pushing if the pain is still a problem. They are very effective. So effective that they should maybe be much earlier in this list, including maybe number one if the pain is serious and has a burning component. But if the pain is pretty bad, I would guess you will be starting multiple things at one time anyway.
6. zanaflex
7. mexilitene (an oral form of lidocaine), and get the doc's commitment to this one early if you can.
8. hydroxychloroquine/Plaquenil 200 mg twice a day if there is a burning component. This med means one must be seen by an eye doc once or twice a year. This is actually an antilupus drug. It was given to me by a board certified anesthesiologist who is a pain specialist, and I am grateful for it.
9. Some sort of plan for break through pain. it should always be limited so that you are forced to look at how many you are using and report in about it. People get in trouble by not paying enough attention to their breakthrough meds and treating them as if they are daily meds. They are not daily meds. If your pain is that bad, your doc needs to know and your plan needs to change.
10. If those don't work effectively enough that pain is low enough to function reasonably-and don't expect to be pain free- , it is time to talk to your doc about maintenance narcotics, perhaps the duragesic patch. At this point you have tried at least eight medicines other than supplements. He ought to see that you went looking for other pain control first.
These things are not risk free. Every time you add a new drug, you are adding new risks and new side effects. If you are living a life of misery from pain, you may rejoice in better pain control even with substantial risk, but some of us will be the unlucky ones who have very bad effects from these medicines.
here's what I'd choose, pretty much in order, if I could just talk a doc into writing them, and see how far down the line I had to go to get decent pain control. I found I was writing this to someone and thought it might be useful.
IF I could talk a doc into it, I would start from ground zero with:
First, before you see the doc, if you have muscle problems, take magnesium. I'm taking 6 250 mg caps a day BUT that is a very high dose, I have VERY bad muscle spasms, and I tend to be constipated. It can act as a laxative. If you have bad kidneys, this might be a problem. High soy diets are shown to ameliorate pain, as are high fiber diets.
1. a tricyclic antidepressant, maybe desipramine as first choice and this only in low dose unless I were depressed cause the studies say the low dose relieves pain, high dose is for depression but the side effects go with the high dose. Not amytriptyllene, it has more side effects than any of the others including weight gain, sleepiness, dry mouth, and constipation, and the docs always choose it because they remember the dose easier. Use an antidepressant dose only if depressed. If you need an antidepressant, you don't necessarily need to use the first drug and I wouldn't want to probably. Wellbutrin looks like a good choice, but is not for everybody. Paxil looks like a bad choice-it is hard to withdraw from, and it tends to make you gain weight.
2. A muscle relaxant. This is second choice if you still have muscle spasms or tightness in the face of high dose magnesium. If not, skip this step. Most of them promote sleepiness. At bedtime this may be good, but the rest of the time, this tends to be bad. Flexeril is a good one for getting sleepy at bedtime. Skelaxin isn't supposed to make you sleepy, and robaxin I don't think does much of this if you want to be awake. I personally would stay away from Soma/carisprodolol if anything else worked for me.
3. Ibuprofen or an antiinflammatory. They do relieve pain even in the absense of inflammation. But I think they are good medicine, and I like what they say about ibuprofen and Alzheimers last time I looked (I'm not following it.) Based on my experience, I heartily recommend avoiding daily high dose celebrex or vioxx (celecoxib or rofecoxib, I think). If daily use low dose. If using high dose, do it rarely and only for breakthrough pain.
4. ultram/tramadol-almost forgot this because it just didn't help me much, but some folks get a lot of relief from it.
5. an antiseizure drug-maybe neurontin/gabapentin, as first choice but let the doc pick. All of these have to have the dose pushed up a little at a time as you learn to tolerate the side effects. Keep pushing if the pain is still a problem. They are very effective. So effective that they should maybe be much earlier in this list, including maybe number one if the pain is serious and has a burning component. But if the pain is pretty bad, I would guess you will be starting multiple things at one time anyway.
6. zanaflex
7. mexilitene (an oral form of lidocaine), and get the doc's commitment to this one early if you can.
8. hydroxychloroquine/Plaquenil 200 mg twice a day if there is a burning component. This med means one must be seen by an eye doc once or twice a year. This is actually an antilupus drug. It was given to me by a board certified anesthesiologist who is a pain specialist, and I am grateful for it.
9. Some sort of plan for break through pain. it should always be limited so that you are forced to look at how many you are using and report in about it. People get in trouble by not paying enough attention to their breakthrough meds and treating them as if they are daily meds. They are not daily meds. If your pain is that bad, your doc needs to know and your plan needs to change.
10. If those don't work effectively enough that pain is low enough to function reasonably-and don't expect to be pain free- , it is time to talk to your doc about maintenance narcotics, perhaps the duragesic patch. At this point you have tried at least eight medicines other than supplements. He ought to see that you went looking for other pain control first.
These things are not risk free. Every time you add a new drug, you are adding new risks and new side effects. If you are living a life of misery from pain, you may rejoice in better pain control even with substantial risk, but some of us will be the unlucky ones who have very bad effects from these medicines.
Mosken
