How do you ask for pain meds?

[vamah]

I am at a point where I need prescription pain meds. I have tried everything OTC, in increasing dosages, and they 1) have stopped working and 2) make my stomach a hot mess. I have brought this up with two doctors and neither have taken me very seriously. I do not know how to ask for these things without feeling like a drug-seeker. Doctors all seem to care far more about theoretical addiction then about actual pain. Do people have suggestions on narcotic and non-narcotic prescription pain medications that have worked for them? And how do you ask for these medicines without being written off as a hypocondriac or an addict?

 

[Calathea]

1) Use a pain scale. They like those and it's a good way of monitoring progress.
2) Do NOT use emotive language, such as "agony", and make sure you have the conversation on a day when you're feeling calm, rather than particularly stressed or upset due to your pain levels. Talk about things like what activities the pain is preventing you from doing instead, or if it's keeping you up at night, that sort of thing. "It's a burning, shooting pain in my left leg, about an 8, and I can't stand on it for more than two minutes," will get a much better reaction than, "Oh my God, my leg is KILLING me, please give me something for it."
3) Tell them what you've tried and how much difference it's made. So, for instance, your pain might be a 7, but the painkillers you've tried only bring it down to a 6 for a couple of hours.
4) Discuss the risk of addiction openly with them. They generally appreciate this, in my experience. Talk about how often a week you think you'd need the medication, and if you don't drink or smoke and generally avoid prescription drugs rather than overuse them, it's helpful to make sure they know that. Saying things like, "Now, obviously I don't want to develop problems with tolerance or addiction. If I have three bad pain days a week, will I be OK using [painkiller] for that?" helps them assess the likelihood of your becoming addicted, and makes it clear that you are responsible about this sort of thing.
5) Find a local patient-led pain organisation and chat to them about all of this. They tend to be excellent.

 

[Xandoff]

I am at a point where I need prescription pain meds. I have tried everything OTC, in increasing dosages, and they 1) have stopped working and 2) make my stomach a hot mess. I have brought this up with two doctors and neither have taken me very seriously. I do not know how to ask for these things without feeling like a drug-seeker. Doctors all seem to care far more about theoretical addiction then about actual pain. Do people have suggestions on narcotic and non-narcotic prescription pain medications that have worked for them? And how do you ask for these medicines without being written off as a hypocondriac or an addict?

You have to respect your needs and ask for your Doctors respect. Don't under estimate how much internal stigma we all feel. Respect yourself. Pain is very isolating. Calathea's advice is excellent too! Good luck vamah!

 

[Tristen]

Great advice from Calathea. Share the level of your pain severity and the resulting limitations. Being unable to sleep is a good one.

I would just be open and honest about all of it.....your pain, it's limitations, and your concerns about being perceived as a drug seeker. Add that has not been an issue for you and that you intend to be completely honest with him/her.....you just need some pain relief. My experience is they respect the honesty and feel they can trust you.

 

[Hugocfs]

I had problems with intermitant pain in the front of my shins close to the ankle area. With more activity, the pain got worse and every day by the end of the day I was in some degree of pain. Mostly it was a burning sensation, but sometimes when it was worse it was more like plain-old pain. Maximum intensity was about a 5 or 6. I found that low dose naltrexone (ldn) has helped me immensely. I take 3 mg nightly. Previous to taking ldn, otc pain relievers like tylenol, naproxin, and ibuprofen wouldn't even touch the pain. Fortunately, it was never constant and bad enough that I felt the need to ask for anything stronger. I hope you get some relief soon with something, but seriously consider ldn. Remember it is not an instant cure. It takes some time titrating to the right level for you, and then at least with me, the pain relief improved over time once I settled in at 3 mg. Take care.

 

[heapsreal]

tramadol which is a narcotic but not scheduled as high as morphine type meds and many docs feel comfortable prescribing this med, it is a med that people either like or its not for them. It can help improve energy too.
Then there is anticonvulsants which help turn down pain signals in the nerves that cause pain and are used alot in chronic pain conditions eg gabapentine, lyrica, topamax.
Muscle relaxants like baclofen, tizanadine etc and they both can improve sleep too.

I think the above meds most docs would be comfortable to prescribe for chronic pain conditions and a good gradual step before other narcotics etc.

 

[ahimsa]

vamah

One thing that sometimes helps with pain relief is knowing the cause of the pain. I realize that's not always possible, of course! Just that different types of pain respond to different drugs.

For example, when I was having really bad pain from endometriosis, tramadol (Ultram) did not help me at all. In fact, any basic over the counter ibuprofen (e.g., Advil) relieved the pain better than tramadol. Amazingly, even aspirin was better than tramadol. Naproxen (Aleve) was somewhere in the middle but caused horrible constipation for me.

It seems that most patients who have endometriosis pain respond better to drugs that are NSAIDs. So I just ended up taking about double the OTC dosage (okayed by my doctor) of ibuprofen for a while. When I needed something stronger than ibuprofen my doctor gave me a prescription for ketoralac (Toradol).

The point is that different types of pain respond to different types of drugs (or combinations of drugs). Of course, you also have to factor in the individual reactions of different people. But the type of pain is one thing to keep in mind.

So I definitely agree with advice from Calathea and others about describing when and where you have the pain, what the pain feels like to you, how it restricts you, and so on. But it also might help to ask the doctor what might be causing the pain, what drug(s) might be best at relieving that type of pain, and so on.

I just realized -- maybe you already know the type of pain it is and what's causing it? I just didn't see that in your post.

By the way, I completely understand that drugs, whether OTC or prescription, can mess up your stomach. I had side effects from the Toradol Rx but I really did not care. The problems from my stomach issues were nothing compared to the unbearable endometriosis pain. So I just lived with it. Eventually I had surgery that fixed my endometriosis problems.

Best of luck to you. You absolutely deserve pain relief.

HUGS I hope you find something that works for you!

 

[Ema]

If you are in the US, I highly recommend getting a referral to a pain management program. They are used to people coming in with pain issues and I felt much less stigma there than in my GPs office.

Best case scenario, your GP will be willing to address your pain med needs when you ask for a referral. Worst case is that you will get into a pain management program where they will take your pain seriously.

I found Ultram to be helpful for pain but it was tough to discontinue for me after taking it for about 6 months. I fell into a nasty depression that took several months to subside. Probably because it works on serotonin too. Personally I had much better luck with traditional narcotics (very little withdrawal symptoms and good pain relief).

Ema

 

[August59]

Ultram or Ultracet (Tramadol, one has acetaminophen) will be your first step. If you eventually get referred to a Pain Clinic you will go through sort of a periodic ladder of different meds, injections and\or electrical type therapies.
All through this is a time of building trust and them building a track record on you in case it ever gets into narcotic dispensary. If the DEA, or whatever monitoring agency, should happen to pull your file to review for chronic narcotic treatment they can see all other possible alternatives were perused.

Your past diagnosis and diagnosis that they can make has a lot to do with your course of treatment as well.

I've been in pain management for 8 or 9 years, but it initially started with orthopedic reasons in lumbar and cervical spine. I have only recently in the past couple of years have told them flat out that when my ME/CFS flares it is beyond any pain associated with my orthopedic conditions. I told them that all ME/CFS diagnosis are not the same and I felt like in 10 years ME/CFS will be 10 different diseases.

As much as it can hurt you have to be patient.

 

[vamah]

Thank you for all the advice. In answer to some of your questions, my pain is mostly muscle pain -- arms, legs, back, everywhere. I can tolerate it during the day, but at night it adds to the sleep problems I have, which are already pretty bad. The thing is that OTC NSAIDs cause me more stomach pain than they relieve the other pain -- i.e., they may take muscle pain down from a 6 or 7 to a 5 or 4, but they cause stomach pain that is an 8 or 9.
I am wondering if anyone has experience with Cymbalta. I am currently taking prozac for pain and anxiety and Seroquel for sleep. It looks like Cymbalta can help with all those, plus chronic pain. Has it worked for anyone? Is it available generic? Side effects?

 

[heapsreal]

Thank you for all the advice. In answer to some of your questions, my pain is mostly muscle pain -- arms, legs, back, everywhere. I can tolerate it during the day, but at night it adds to the sleep problems I have, which are already pretty bad. The thing is that OTC NSAIDs cause me more stomach pain than they relieve the other pain -- i.e., they may take muscle pain down from a 6 or 7 to a 5 or 4, but they cause stomach pain that is an 8 or 9.
I am wondering if anyone has experience with Cymbalta. I am currently taking prozac for pain and anxiety and Seroquel for sleep. It looks like Cymbalta can help with all those, plus chronic pain. Has it worked for anyone? Is it available generic? Side effects?

I use seroquel occassionally for sleep but i have found it increases muscle pain alot, maybe try replacing it with an antihistamine or another sleep med and see what happens. I think its a common side effect of seroquel. neurontin/gabapentine has helped some with this pain, also the pain could be from seroquel lowering your dopamine too low, try using mucuna dopa in the morning when u wake up as this helps increase dopamine and i have found it helps reduce muscle pain from seroquel. Its still a dam good sleep med but it does cause me alot of pain so why i only use occassionally.

 

[Tristen]

I too have found Seroquel to be one of the best sleep meds. Actually, the best I've found. Nothing else ensures I will sleep 8 hours......this up from my usual (me/cfs) 5. Being an antipsychotic, Seroquel at least for me, has minimal side affects, but the one it does cause, is enough for me to avoid this drug....night sweats. I wake drenched wet, and this on only 25mg. Wish I could take the stuff seeing how much my me/cfs is affected by sleep, but I'm just not willing to make this trade.

 

[heapsreal]

I too have found Seroquel to be one of the best sleep meds. Actually, the best I've found. Nothing else ensures I will sleep 8 hours......this up from my usual (me/cfs) 5. Being an antipsychotic, Seroquel at least for me, has minimal side affects, but the one it does cause, is enough for me to avoid this drug....night sweats. I wake drenched wet, and this on only 25mg. Wish I could take the stuff seeing how much my me/cfs is affected by sleep, but I'm just not willing to make this trade.

I wonder how or why it causes sweats, interesting. Have u looked into how it could be doing this, maybe try and counteract it?? Have u tried other similar meds like olanzapine?? I have never tried it though but i think these meds in low doses to avoid side effects could be very useful to treat our type of sleep problems.

 

[Tristen]

I wonder how or why it causes sweats, interesting. Have u looked into how it could be doing this, maybe try and counteract it?? Have u tried other similar meds like olanzapine?? I have never tried it though but i think these meds in low doses to avoid side effects could be very useful to treat our type of sleep problems.

No, I haven't looked into what could cause it. Sure would be nice to get that 8 hours sleep though. Good idea to look into what may counteract those symptoms.

No, I haven't considered Zyprexa mostly I guess because it's an anti-psychotic, and I don't have those kind of issues. But I probably should keep off label stuff in mind, especially with something as important as sleep. Another issue with Zyprexa would be weight gain. I spent some time working as a psych nurse in residential facilities, and watched a lot of people gain unreal amounts of weight on that drug. Sure worked great for other psychosis issues though.

 

[heapsreal]

No, I haven't looked into what could cause it. Sure would be nice to get that 8 hours sleep though. Good idea to look into what may counteract those symptoms.

No, I haven't considered Zyprexa mostly I guess because it's an anti-psychotic, and I don't have those kind of issues. But I probably should keep off label stuff in mind, especially with something as important as sleep. Another issue with Zyprexa would be weight gain. I spent some time working as a psych nurse in residential facilities, and watched a lot of people gain unreal amounts of weight on that drug. Sure worked great for other psychosis issues though.

the off label use of these meds for insomnia is usually dosed alot lower, eg is seroquel as u may know, common doses for psychotic conditions are in the 800mg area where for sleep as low as 25mg can be effective and i think these doses also have greatly reduced side efffects especially if used infrequently. I think their effectiveness is because they work on many receptors but this is also the reason for side effects. lower doses help sleep through its antihistamine effects and also antagonizes alpha adrengeric receptors, higher doses effect dopamine, serotonin and cholernergic receptors.

Im not saying you are thinking this way but many people see these meds listed as antipsychotics and are scared off them instead of actually looking into how these meds actually work. I have heard people say that they would never take a psycho med but then dont hesitate to give their children phenergan/promethazine a common antihistamine which was originally developed as an antipsychotic. I think we have to look past the initial stigma of the indications of the medications and look at how the meds work, this is what a smart doctor will do and why they prescribe medications off label. Same reason i suppose why tricyclics are prescribed in low doses for insomnia, not for depression. I have read seroquel is used more for off label conditions then it is for what its indicated for??

So many dam receptors, neurotransmitters and hormones involved in sleep/insomnia that those with severe sleep issues need to investigate many of these as they just cant get by on treating 1 avenue involved in sleep. It all comes back to the hypothalmic dysfunction in cfs/me.

Dam sleep!!

 

[Calathea]

If the OTC NSAIDs help in some way, is there something you could take to stop them attacking your stomach? I could never tolerate NSAIDs before but I can take one ibuprofen now I'm on Omeprazole, and I'm tolerating tramadol better too. Also sometimes pain meds will work much better in combination than they did individually.

 

[Valentijn]

I am at a point where I need prescription pain meds.

I don't doubt that prescription pain-killers might be necessary in many cases, but it can be a good idea to figure out what is causing the pain instead of just blocking it out.

My constant headache was inflammation related, and taking an OTC anti-inflammatory with 0 side effects (omega 3 fish oil) keeps the inflammation low enough that the headache stays away while I take it. I had muscle pain too - but hydroxyB12 (10mg, sublingual) keeps it under control. That plus not pushing muscles past their limits.

 

[Tristen]

the off label use of these meds for insomnia is usually dosed alot lower, eg is seroquel as u may know, common doses for psychotic conditions are in the 800mg area where for sleep as low as 25mg can be effective and i think these doses also have greatly reduced side efffects especially if used infrequently. I think their effectiveness is because they work on many receptors but this is also the reason for side effects. lower doses help sleep through its antihistamine effects and also antagonizes alpha adrengeric receptors, higher doses effect dopamine, serotonin and cholernergic receptors.

Im not saying you are thinking this way but many people see these meds listed as antipsychotics and are scared off them instead of actually looking into how these meds actually work. I have heard people say that they would never take a psycho med but then dont hesitate to give their children phenergan/promethazine a common antihistamine which was originally developed as an antipsychotic. I think we have to look past the initial stigma of the indications of the medications and look at how the meds work, this is what a smart doctor will do and why they prescribe medications off label. Same reason i suppose why tricyclics are prescribed in low doses for insomnia, not for depression. I have read seroquel is used more for off label conditions then it is for what its indicated for??

So many dam receptors, neurotransmitters and hormones involved in sleep/insomnia that those with severe sleep issues need to investigate many of these as they just cant get by on treating 1 avenue involved in sleep. It all comes back to the hypothalmic dysfunction in cfs/me.

Dam sleep!!

Yea your right that it's a bit of the stigma thing for me. That and I just don't have those kind of psych issues. But your right about the dosage issue, and since it only takes 25Mg to knock me old cold, it may be worthy of reconsideration. The average dose I would see in psych was around 600, and yea sometimes 800. I can't imagine taking that high of a dose.....it would surely kick my butt for several days. May give the low dose another go.

 

[vamah]

I use seroquel occassionally for sleep but i have found it increases muscle pain alot, maybe try replacing it with an antihistamine or another sleep med and see what happens. I think its a common side effect of seroquel. neurontin/gabapentine has helped some with this pain, also the pain could be from seroquel lowering your dopamine too low, try using mucuna dopa in the morning when u wake up as this helps increase dopamine and i have found it helps reduce muscle pain from seroquel. Its still a dam good sleep med but it does cause me alot of pain so why i only use occassionally.

Thanks so much for this. I had no idea muscle pain could be a side effect of seroquel. I did have the pain before I started on seroquel, but maybe why it has gotten worse recently. I will talk to my Dr about it this week. I have gone through a number of sleep meds. Almost all worked at first and then I seemed to build up resistance. I have only been on seroquel for a couple months and I feel like that is already starting to happen again. Keeping my fingers crossed that I will start to see improvement from valcyte soon and won't need to rely as heavily on sleep meds.