I don't know what to do......I've been with pain management now for over 11 years, and I have asked this questionof the Dr, and he acts like it's not possible? I have such pain that the source cannot be located and it's getting worse, involving my left arm, hand, now shoulder but right hand shoulder and now neck are all involved. I've been everywhere, every Dr. I can think of, have had 3 hand surgeries, (after last one is when things really got worse). I keep hearing pain med can make you hurt but can it do something to this extent? I hurt too bad to wean off medication, can barely make it at work already so I feel so trapped, and my mind goes in this horrid circle all day, what if it is, what if I'm causing this problem, but how can I find out, I have to work, can't work without medication!!!!!!!!!! The skins on my arm and hand changes color and hand turns ice cold, I don't see how this could be pain medication, but I keep trying to find a solid answer one way or the other. Thank you!
I see that you have been a member of MedHelp for some time. I am so sorry to hear about your horrific pain.
There's controversy on this subject but many physicians believe that opiates can cause pain. It's from opiate-induced changes in brain chemistry that produce excessive electrical activity in the brain which in turn amplifies incoming electrical pain signals. This is known as hyperalgesia or increased pain. This is a partial and simplified explanation. It's a very detailed theory that had been studied and proven by some researchers. However not everyone "buys" it.
Rather this applies to you or not I cannot say. If your hand and arm is experiencing color and temperature changes that seems to be a real pain issue. The only way to determine how much effect the opiates play in your pain levels is to detox.... and be free of all opiates for an extended period of time. Personally I could not do it... nor has it ever been suggested that this could be part of my pain. However I have several diagnosis that have poor prognosis.
There is some good articles and studies on the web... you may want to do some searching. In my opinion if your physician is confident your pain is not induced or greatly magnified by opiates... believe him.
If your pain is not well controlled you may require additional meds or a change in meds. Finding the right pain management regimen can be a long trial and error process. If you are not consulting a PMP beneficial in your pain control.
Please be active in our community and feel free to ask additional questions or post again. I wish you the very best... you are not alone!
thank you for your reply! I would give anything to go for a length of time without pain medication, but like you, I could not function at this point without it. If God Blesed me enough financially that I could not work for a while, I woudn't hesitate to give it a try, but that is a miracle I'm still waiting on... still expecting though!
Have they ever considered RSD (reflex sympathetic dystrophy)? It's too complex to try to nutshell here, but if you Google it see if it sounds like what you are going through. From just the little bit you have said, to me it has a lot of the traits of it.
Hi There! You know what? that is exactly what I've been thinking, and I did read unfortunately, it can spread. The hard part is not having a concrete diagnosis, especially if I can't make it at work, and it's HELL. I'm on keyboard all day, and I can't think straight hurting so bad, or taking enough medication to not hurt so bad but be dingy in the head! I just don't know who to turn to. I am going to an orthopedic Dr. that is one I've not been too in many many years, not at all for this problem. I don't know what else to do. Again, thank you.
I thought the same, RSD! I thought that may already be your diagnosis.
In regards to your original question, I found this on an informational site regarding RSD and Chronic Pain:
"If you're given opioids that do not fill enough of the receptor sites, you are constantly teasing your body. If the medicine is allowed to wear off before taking the next dose or you use it as needed, or when the pain get severe, you are defeating the proper usage of opioids. Without enough or with the constant pain, relief, pain cycle the body is being teased and learning a pattern of pain. By increasing the dose, and filling up all of the receptors, the pain can be better controlled, then the theory is to reduce the dosage to the lowest analgesic (pain free) level. This is also Dr. Portneoy's belief. ONLY when the opioids are administered directly into the spinal cord, can too much opioids cause pain of it's OWN."
Reflex sympathetic dystrophy (RSD), which is known being called complex regional pain syndrome (CRPS) more often. It is a chronic progressive neurological condition that affects skin, muscles, joints, and bones. It usually develops in an injury. However, many cases of RSD involve only a minor, seemingly inconsequential injury, such as a sprain. And in some cases, no precipitating event can be identified.
Some of the symptoms that say the your sympathetic nervous system is involved in your pain are:
Burning pain, Extreme sensitivity to touch, Skin color changes,
Skin temperature changes. and Pain is usually disproportionate to the degree of injury. It can be triggered by using the affected limb or by stress and can be spontaneous or constant.
RSD/CRPS is often difficult to diagnose. Obviously excluding other conditions that produce similar symptoms is part of the procedure.
I hope this has been helpful. If you have additional questions please feel free to ask.
I, too, thought RSD. I ended up with that after having hand surgery. (Originally had a joint replacement in my thumb. The implant was defective and I had to have 9 more surgeries and procedures.) Somewhere along the way with all the surgeries, I wound up with RSD.
It's a complicated issue and can be very frustrating. The pain, for me, became all-consuming. There are a lot of things to try with RSD (and I think I've tried all of them!)
If you have specific questions, I can let you know my experiences. In short, I've had stellate ganglion blocks (5 or 6); they sometimes help, though for me, the best I got was a some relief for a short period of time. I also tried 2 or 3 lidocaine infusions which did alleviate the pain as I was having them but it came back the next day.
Everyone responds differently to medications and different doctors also have different ideas on how to treat it. I see a pain management doctor for the RSD. You can also see a neurologist, rheumatologist, primary care, possibly your surgeon to help you get a diagnosis and come up with a treatment plan. If I was starting over again, I think I'd lean toward a neurologist.
For me, this has been a very rough path. Pain medication doesn't always cover this type of pain. I've tried nearly every medication and combination and got very little relief. Cymbalta is sometimes also prescribed for it but I couldn't take it. (To be fair, I am very sensitive to medications and side effects and I don't think my experience with the meds is all that typical.)
Lyrica and Neurontin are also often used to treat RSD. I had some relief with the Neurontin, though not as much as we had hoped.
My original surgery was 5 years ago and I think the RSD came into play around 3 years ago.
I'm going to post about my latest experience and maybe you'll find some of the information useful ... it's unusual what happened, but for the first time in 3 years I am having NO RSD pain!!!
Feel free to message me if you're interested in specifics about any of the procedures or medications I've tried and the different results. As you research RSD, you may get discouraged but please don't let yourself get overwhelmed. Everyone is different and even though there are a lot of difficulties with RSD, there are things to try!
RSD is a very complicated diagnosis and it is often hard to diagnose. The sooner you're diagnosed the better as far as outcome. Mine did spread from my hand up as far as my elbow.
How long have you been on the same opioid medication regimen? It may be time to simply switch to a different opioid. As Tuck said, you may be teasing the receptors and thus causing more pain. I also think that the information Tuck provided was very interesting with regards to coverage of more of the opioid receptors may offer better pain relief of RSD or CRPS.
I just started a new opioid medication called Opana ER (Oxymorphone extended release). It is giving me the best pain relief that I've had since I began experiencing chronic pain over 10 years ago. I have researched a lot about oxymorphone and it is one of the only opioid pain medications that binds to more of the opioid receptors at higher doses. Most opioids only bind to mu opioid receptors but there are also kappa and delta opioid receptors too. Not sure if you have tried oxymorphone yet but it might be worth a shot to see if it may help with the pain you are experiencing.
And as the others have said, definitely get back in to see your doctor to have more tests run to see if you may have a new condition causing chronic pain as getting an accurate diagnosis is very important to getting the right medications to help your pain to the fullest extent possible.
I don't know if I ever got back on to read all the comments you fine folks made, if I did, my memory may be fading too! It's now July...and it's really sad, I logged on (shouldn't cuz I'm at work, suffering like carzy), and saw my old questions and felt like crying. It's the same old stuff but worse. I have been chasing this stuff still with no concrete diagnosis. Without a diagnosis, how could I ever use my long term disability? It seems they all say "sure sounds like RSD, but don't confirm. I'm not sure. I don't have Burning pain, but my skin is super touchy. I really didn't believe in fibromyalgia, but last week was desparte looking for reason of left chest pain other than heart and found a condition related with Fibro that was almost exact, except now both arms/hands are hurting so bad and turning SO SO Mottled/weird looking during the day. This is enough to drive someone insane....... The age old question, can this be mentally generated, OH MY I DON'T SEE HOW, but? I am so depressed and nothing helps, if I try to excersize, things get worse........just my luck! oops, I meant to only say thank you and there I go on and on... God Bless Each of you!!!
I think I have the same problem and in the same boat as u. I have pain in my big left toe that no dr can find a problem to. all kinds of test and nothing to adhere to the pain. so yes I believe pain pills can cause pain. help out if you find any info on pain meds causing pain. ***@****. thanks virginia
I have had the same question I spoke with a Dr and he told me what happens or can is the nerves become over sensitized and can stimulate pain I also had perscribed nerottens sorry about the spelling but they did not work and had their own side effects good luck find a good pain management Dr you can talk to I know it is hard to change I went through it but when you have a Dr you can talk free with it makes a big diffrence
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