Doctors' Answers to "Frequently Asked Questions" - Pain

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Pain Treatment [posted 1/12/99]
Question: Is there a sublingual form of any narcotic analgesics? One of my patients has both chronic intermittent pain and severe gastroparesis. She has problems absorbing her po analgesics, so we're looking for a non-po route. Duragesic is out because her pain is intermittent.

Answer: Nothing obvious, have you tried s.l. clonipine? It's not an analgesic, but occasionally effective.

Pain Relief [posted 11/24/98]
Question:  Looking for effective pain relief in ankles for Charcot Marie Tooth (CMT)

Answer:  Try a TENS unit also topical capsaicin cream(available otc). 

Pain Medication After Surgery [posted 11/10/98]
Question: My girl friend had hemorroid surgery and was given demerol now they prescribed something else that isn't working what can she do now she is in serious pain.

Answer: Sounds like she needs a narcotic, she'll need to get that from her physician.

Pain Management [posted 8/7/98]
Question: I was told that a form of alcohol was used in an epidural. Is that true, and if so what kind? What long term effect would this have on a paralyzed person?

Answer: The alcohol is usually used to kill nerves, not anesthesize them. I'm not sure what purpose of the epidural you are asking about. There would be no effect on a patient with paraplegia if given below the level of damage.

Undiagnosed Pain Symptoms [posted 8/4/98]
Question: We have no insurance for another month so I can not go to my doctor, however, I have been experiencing these symptoms: very tired all the time, cold hands and feet, stiff neck, frequent urination, eyes puffy and hurting/itching, persistent and frequent headaches, back pain between my shoulder blades and also middle back extremely bad, increased irritability. In addition to these I just recently got over the flu or some bug and now have a persistent soar throat that flares up and I found two little lumps on the right hand side of my neck. I was really sick without the flu about two weeks ago. My sister in law is diabetic and so we took my blood sugar level one day and it read "in control". I don't know what to think and it just seems like there are too many different symptoms for it to be anything. Do you have any idea's and do you think it is serious that I should get in ASAP? It would be one thing if I just had to pay the $50 to see the doctor then the $20 or for the antibiotic, but I am worried if it is something else that we will not get insurance coverage.

Answer: If your sugar is normal, then there is no clear answer that I can give you over the net. A low thyroid could be causing this or even a low grade urinary infection. Both would require testing. Neither would affect future insurance since they are both treatable and cheap.

Pain
Question: What can I do if I have sciatica pain?

Answer: Heat, non-steroidal antiinflammatories, and physical therapy.

Pain
Question: What could a pain in my lower right hand side (near intestines) that burns and then feels like a popping, be?

Answer: There are lots of things on the lower right side. These include appendix, colon, and several possible hernias. You'll need to be examined or provide more information (onset, character, radiation, inciting factors, duration, etc.).

Magnets and Pain Relief
Question: Do magnets really work as alleviators of pain?

Answer: These were used extensively in the middle ages for all types of problems and did not appear then nor now to have any appreciable medical uses.

Chronic Pain
Question: I was a victim of a violent crime, I suffered massive skull fractures and also neck and spine damage. I have had a MRI that shows protrusions at C-4-5-6-7 in the cervical area and in the lumbar area T 121-13. I have had pain in for over 7 years and for this I started out with T-3 and went to Darvon and always in and out of the hospital for pain shots. The pain is centered like a diamond at the back of my head that connects to the spine to about the bra level. Some times the pain gets so bad all I can do is cry. I have been taking for over the past four years high doses of pain medication from Vicodin to Lorcet to Narco now at 10/325mg 2 tabs every four hours witch goes over what I have read as being safe for my liver. Some times I vomit with the pills in my hand; I don’t want to take them I hate to take them but when I do not take them the pain gets so bad I end up in the hospital. I have a question about Percodan, is this safer for my liver then the narco made by Watson I know it is a triplicate but I don’t know what to do I have tried therapy both mental and physical. I am only 28 years old is there anything I can do to help cope with the pain. I have taken this drug for so long I know my body must be dependent and yet there are some days that the pain is minimal and I don’t take the pain pills. I take over the counter medication and I don’t seem to have withdrawals. Can you help me? Please tell me why this pain has never gone away.

Answer: Chronic pain is one of the harder things to treat or to have. The only advice I would have is to see a specialist in a pain clinic if you have not already. Occasionally, they can find ways to minimize the pain. The liver risk of percocet is the acetaminophen. If you would take narcotics without acetaminophen-long acting morphine or methadone-this risk would go away.

Tooth Ache
Question: What is best pain reliever until I can get to a dentist?

Answer: Two regular aspirin, two regular or extra-strength Tylenol and an antihistamine(benadryl or the like 25 or 50 mg.). Topical benedryl and topical ice is also of help.

Emergency Tooth Treatment
Question: What is the best emergency treatment for a tooth ache?

Answer: Try heat or cold to see which helps the most. The analgesics that I have previously mentioned.

Advil
Question: Is it harmful to take Advil or something similar with alcohol? Is Advil addictive? Is it harmful to take more than 2 Advil at a time?

Answer: Advil is not addictive. It does increase the risk of GI bleeding to take it with alcohol since both are risk factors for bleeding. Minor amounts of alcohol with no history of GI problems is probably not a big deal. The prescription dose for most patients of Advil is 400mg 4X a day or 800mg 2X a day. Advil is 1/2 the prescription dose so in general not a problem-depending on how many you take a day 1600 mg is the usual highest you should take.

New Pain Control Meds
Question: I heard that there is a new medication out which is used for pain control without causing addiction like other controlled substances can. Can you tell me the name of it?

Answer: Ultram is one.

Codeine
Question: My husband is recovering from hip surgery and has been taking Codeine for almost 3 months now. He says he needs it for his pain and extra-strength Tylenol doesn’t help. I know Codeine can be addicting. Should he stop taking this drug or stay with it until he can function without it?

Answer: Usually, the hip pain should be bearable by three months if it is going to improve. Codeine is definitely addicting-discuss other options with his physician.




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