Insufficient Pain relief.

[Paddywacks]

Hi,

I broke my neck a number of years ago leaving me in tremendous pain. I cannot function. I spend most of my time immobile on the sofa trying to distract myself with quick fire tele and computer stuff. Horribly superficial though as I can't concentrate on anything. The pain is there every second of the day.

Seeing this site has been a huge eye opener for me (and a source of hope) - the pain relief medication that most of you have access to is way beyond what I have been given in the UK. I only take 600mg of Tramadol and 3600mg of Gabapentin. I used to take dichlofenac but had to stop because of ulcers.

I've asked for morphine but my doctors are reluctant to give it to me. But I've been through the hoops now and they've finally agreed to give it to me -  athough it'll probably take another six months to get the appointments etc.

You guys are on all sorts of stuff that if I had access to, might help me. I've been so upset for such a long time that there was nothing else I could try that might relieve some of the pain. At least that's what the doctors said - I felt it was cruel to allow someone to be in this amount of pain. I couldn't imagine that research hadn't provided a more potent painkiller than tramadol/gabapentin combination. And it looks like I was right - but for whatever reasons my doctors wouldn't entertain it - maybe some are not licensed in the UK.

Can anybody suggest a possible combination that might help me - please make it the biggest impact possible. I could then take it to discuss with my doctors. Also, would it be possible to take morphine sulphate in combination with the Tramadol/gabapentin I already take.

I would appreciate any help - I want some kind of life - one worth living for.

Thank you so much to anyone who tries to help.

Clare

[JadedSweetheart]

I'm sorry that your pain has been out of control for so long.  The difficult thing about recommending a certain medication is that what works for one person will not work for another, vice versa.
I'm not sure about the safety of Morphine with Tramadol/Gaba.
What I think you should do is explain to your doctor how the pain interferes with (or overruns) your life.  Then tell them about your research and ask about a stronger pain medication.  Present it to them like you did here, that you need the biggest impact possible.  Then let them take it from there.  
I'm sorry it may take 6 months for you to get an appt.  I'm not familiar with the way your medical system works in the UK.  Would it be possible for you to pay to see a doctor?  That is what I have to do as I can't find an Insurance company to cover me with my pre-existing condition and the state insurance is difficult to deal with at best.
I really hope you are able to get to a doctor who will take good care of you and help control your pain soon.  Please keep us updated about how it goes for you!

[rwilliams]

Celebrex or mobic would be a good medication to get started on, it helps with chronic pain. I have taken morphine sulfate, while I was on tramadol. My doctors prescribed them both to me, so I see no reason why you wouldn't be able to mix them. I know with the morphine sulfate, I had the liquid stuff that you drink, and it make me really sick to my stomach. I would vomit the blue coloring stuff up.
Good luck.

[skmedlin27703]

I would double check with a doctor about taking all that together. I take the morphine sulfate but my breakthrough medicine is oxycodone so I only attest to the safety of that combination.  It works well for me with no side effects.  Hope you find what works for you and is safe.  Good luck.

[tanglewood]

JadedSweetheart has a good point about what works for one may not for another. I did not "break" my neck, but I have ddd and spinal stenosis in my neck and low back. The neck is the worst area so that is what my doctors focused on in terms of treatment. I take Lyrica and it helps that type of pain better than narcotics - which I also take. Another tool is a spinal cord stimulator. I could not function without mine.
http://professional.medtronic.com/therapies/spinal-cord-stimulation/
I hope you find relief!

[Paddywacks]

Thanks for your answers - they're appreciated.

I've seen the phrase 'breakthrough pain' used quite a lot. Could you tell me quite what that means. Does it mean that with the morphine sulphate (or similar) if you still experience pain doing a particular activity, for example, then you can  use the other drug as well?

I looked at the spinal cord stimulator but it isn't for neck pain - mainly for lower to middle back and limbs. I recently went to a specialist about this.

How strong is Celebrex and why would that be a good one to start with? Is it as srong as morphine?

It's not at all easy to get morphine in the UK. One of the reasons given is that they don't know the long term effects of it. It is now strongly regulated too as it was used by a doctor to end the lives of a good few elderly patients.

I have a feeling that my local doctor will send me back to the pain management consultant and that's why it will take a long time. Appointments take a long time to come through with the waiting lists. It wouldn't be possible to pay a doctor on this one unfortunately.

Thanks again for your replies

[JadedSweetheart]

I'm not exactly sure how to define break through pain, except that I have always understood it to be the spikes in pain that we experience on a daily basis when one has chronic pain.  I know for many it's not always caused by something.  For me it is usually a muscle that spasms or low-pressure systems moving in causing arthritic flare-ups.  Sometimes it's from something I did or over-did or from "wrenching" something by moving.
I would say that if you aren't seeing a PM consultant or specialist now, it may be helpful for you to see one.  Many of the members on this site see PMPs for various reasons.  In my state PMPs are the only ones who can prescribe pain medication long-term.  Part of the reason is that they "Specialize" in the field of CP and know what treatments are best and know more about the medicaitons.  It sounds like you have seen a PM consultant before.  Did they help you at all?  
Another thing is that morphine isn't the only medication that may help your pain.  There are other medications that are as potent or more-so than morphine.  Sometimes if you go to the doctor asking for a specific medication they are reluctant to prescribe that medication or anything because they assume you are seeking only that medication.  I am not saying you're doing that at all.  I'm just explaining why it's best to tell the doctor how the pain is affecting your life and let him decide what to prescribe.
It probably wouldn't hurt to consult with your doctor and ask about a different medication, then if he needs to send you to a specialist maybe he can prescribe your medication until you can see the PMP.  Again, that all depends on how things work where you live.  
I hope you're able to get the relief that you need soon!

[Paddywacks]

Thanks for replying.

I thought that was breakthrough pain was. It almost doesn't apply to me as the pain is so high and so constant. I get up in the morning and it's really high and it gets worse as the day goes by (and this can be with me simply sat or led on the sofa - any kind of movement (slightly turning my head, moving my arm, just any very slight movement really) increases it. By the end of a twelve hour period (that's the amount of time I am out of bed - it takes me so long to get to sleep because of the pain) I am pushing a 10. If I have done any activity during the day - meet someone for coffee etc then I'm way up there. I class a 10 as feeling like I can only go mad as there's no where else to go, or passing out.

And that's where I am. I have tried to explain this to my Pain Management consultatnt who I've been seeing for years and have sat in his office crying time after time. I've spent years on the Ttramadol/gabapentin combination and despite my saying it's nowhere near dealing with the pain  (the description I gave above is with all the pain medication - I'm still right at the top of the pain scale) he says that there is nothing else that he can give me.

And that's why I'm pushing for morphine now. And even then he hasn't offered me any alternative to morphine. I'm at a loss but I desperately need help and morphine seems to be my only option.

Maybe it's completely different in the UK or maybe I've got a useless pain man consultant!

[flower12345]

Hi. I'm so sorry that you have to wait for such a long time. Why do you have to wait so long to see a doctor in the UK? I was talking to my husband about this yesterday, but I couldn't explain why you have that long of a wait.

I'm glad that you're pushing for relief. I can't believe you broke your neck! Oh my goodness...that must be so painful.

Hugs,

Flower

[Paddywacks]

Hi.

Reading all your texts has upset me a great deal. It makes me realise that I have lost years to pain that I needn't have done. And that I've endured pain strong enough to make me pass out for years and I shouldn't have gone through that. You wouldn't be allowed to do that to a dog in this country without prosecution.

As for the waiting time....

I have to wait for two weeks to see my GP (General Practitioner - Doctor) which is fairly standard in the UK. Because I saw a pain managemnt consultant in Bristol to talk about implants (which I discovered won't help me) I'll have to wait until that report reaches my GP. This has taken weeks and could take weeks more. Then the GP organises an appointment for the consultant in Swindon which takes up to three months. Once I've seen him I'm pretty sure it goes back to the GP to administer the Morphine and of course that's another two week wait.

So the whole circle takes a while and I've been through this many times now to get to the point where they've said that it's possible I could get morphine.

Things sound very different here to the US. Pain seems to be taken more seriously and treated more quickly than here. It doesn't sound like we have access to the same drugs that you do either.

And yes, it hurts! On the positive side I wasn't paralysed thankfully, although I do have to be careful now as it's still possible.

[JadedSweetheart]

I'm sorry that you are upset about the pain.  I do understand how you feel.  When I first started realizing that there are people out there who always have their pain under control, I admit it made me jealous.  Now I am trying to use it as inspiration to do what I can and demand the best care possible.
We have had some members in the UK on all different kinds of medications, and sometimes they are on suprisingly high doses.  I have always thought of the UK as being more liberal than the US with pain medications as we are always under fear or some new law or sanction.  Especially in my state.  There IS a lot of abuse on the east coast of the US (not sure about elsewhere), and sometimes it can seem like anyone can get meds, but it's suprising how many legitimate patients cannot.
We had one member in the UK who went to the A&E to have an MRI and I believe they also gave him medication.  If your pain gets unbearable, that's what I would do.  
I hope that you are able to see a doctor soon and get back to living your life!