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4939681 tn?1361299299

Other pain med options?

I've tried aleve, Advil, and Tramadol.  Aleve and Advil were not strong enough.  Tramadol gives me a "drunken" stupor feeling for a full 24 hours (even just 1/2 a dose).  Oxycodone gives me horrible nausea (have to sit in fetal position for a couple of hours til it passes).  Most recently my intern prescribed me low dose morphine ER.  I also gave me horrible nausea and I was so weak that I had to lie still most of the day.
Are there any other options that I could suggest to my doctor?  My holistic md wanted my to try low dose naltrexone (LDN) back when we were just working on treating the hashi, but I've also read that it works well for Lyme, too.  Anyone have any thoughts?
11 Responses
Avatar universal
Well, you have come to the right place because I have literally tried them all...Ha! It sounds like you are a little sensitive to pain meds if Tramadol (also called Ultram) made you "drunk" and two opioids oxycodone and morphine have made you nauseous/weak. If you were to try vicodin or codeine, you run the risk of the nausea feeling again because they have similar reactions as the oxy and morphine. There are a couple other drugs you could try first before going to the higher potency drugs that may not make you feel so out of it.

The first drug is actually used for fibromyalgia patients a lot and it is called Savella. It is not really a "pain medicine" per se but works more like a neurological blocker so it decreases pain overall but you take it daily at a set dose, at a regular time. It's not like taking a Tylenol when you have a headache. You must take it every day and you increase the dose slowly over the course of weeks until your pain is controlled. At least you probably wouldn't get such a severe "loopy" reaction to this one.

The other one is the low dose naltrexone that you mentioned. I haven't tried this personally but I have heard very good things about it. The one thing to be aware of with taking this drug is that you cannot be taking any narcotic pain medication while taking this drug because it works as what we call an "antagonist" to narcotics. This means that the naltrexone makes the narcotics stop working. So, if I were to give naltrexone to someone who takes vicodin, morphine or Percocet (oxycodone) every day then I would wipe out the effectiveness of their pain medicine and they would instantly be in excruciating pain (nevermind the risk of withdrawals such as seizures etc). So...if you are going to take LDN to control your pain, then you can only take LDN to control your pain and not narcotics also.

If you decide to try the opioid route again, there is a new drug on the market that may not give you such a loopy feeling and it is called Nucynta. It seems to work pretty well and doesn't have that "knock you on your butt" reaction that some of the others do. Just start with a super small dose given that the other two opioids that you tried have both given you nausea and weakness.

Due to the fact that oxycodone bothered you...I would be a little careful with codeine and hydrocodone (vicodin) only because some people have trouble with the chemical compound because they are loosely related (the "codone" aspect). Not everyone does but it seems like you are a little sensitive to the meds.

Lastly, you can always consider taking muscle relaxants such as flexeril, norflex, robaxin or meds for nerve pain such as Neurontin (gabapentin), Lyrica, Cymbalta as another poster mentioned...depending on what type of pain you are having, if you want to stay away from the narcotics altogether. They also make patches that you can wear such as Duragesic, Lidoderm, Fentanyl and Butrans but those are typically narcotics and are used when someone has already been taking the pills for a while and needs to go on maintenance therapy 24/7.

Hope that helps answer some of your questions! Feel free to ask some more if you need to~
Avatar universal
There is Vicodin (generic is hydrocodone/acetaminophen)

" hydrocodone/APAP or hydroco/APAP) is a combination of two analgesic drugs hydrocodone (an opioid drug) and paracetamol (acetaminophen) used to relieve moderate to severe pain.[1]"
http://en.wikipedia.org/wiki/Hydrocodone/paracetamol

It of course can be addictive, so just be aware. Oddly enough the package insert has a Black Box warning----- for the acetaminophen! (grin). But that's only when a lot of the hydrocodone/apap is taken at high doses and for a long time.

It's a Schedule ll drug, which may soon become a Schedule lll drug with many more hoops to jump through.

I'm not advising anyone to take it. (grin) Just giving information.

Avatar universal
I'm behind the times on painkillers generally, but some years ago I had truly disabling menstrual cramps and tylenol with codeine worked for me, without noticeable side effects -- and I am very sensitive to meds generally.  And ibuprofen (the NSAIDs generally) didn't work and gave me hives.  Everybody is different.

If your doc was willing to prescribe morphine, then I would guess codeine is something he would do as well, since I think codeine is not as high up on the list of narcotics-of-concern, but don't really know.  

Some pain meds seem to work differently in different people, so I read, so keep trying.  Your doc is a stand up guy to keep trying; too many docs these days seem to be afraid of the feds coming after them for overprescribing.

I'm glad your doc is taking this seriously.  Take care, hang on!
4939681 tn?1361299299
Thanks so much for those suggestions!  I will pass them along to my doc.  I can tell my docs pity me and don't doubt my pain as they used to, so they are really trying to be as helpful as possible on that end.  
I do find it amusing that my docs have no problem handing out pain pills, but refuse abx.  Baffling, isn't it?!
PS- trust me, I have always been super paranoid about addiction and only take pills when I am really in depths of major pain.  My husband says it's to a fault as I pretty much unnecessarily torture myself bc I avoid pills.
Avatar universal
Do you know what type of pain it is? Lyme can give you neurological pain (direct attack on nerves) as well as inflammatory pain.
With neurological pain I've had great results with pregabalin (Lyrica).
4939681 tn?1361299299
I have a combo of neuro pain and inflammatory pain.  The inflammatory pain is in the joints, chest, and everywhere the lymph vessels flow and pool.  The neuro pain is what I think this "flu-like" pain is coming from.  For instance my skin hurts to exist.  I don't want anything to touch it or even the wind to blow on it.  Kinda like sunburn, but as though every nerve ending in my skin is exaggerated 10 fold.  I think the pain in the bottom of the feet is neuro also.

That being said, isn't Lyrica and Cymbalta along the lines of ssri's (anti-depressants).  Back when we thought we were dealing with anxiety, they tried me on every different ssri available.  None of them worked, which should've been my doc's first clue.  Anyway, I was much worse off having tried them, then before the anxiety issues.  I honestly attribute most of that nerve pain to having to starting and stopping those meds.  Therefore, I'm leery, but getting to my breaking point:(
4939681 tn?1361299299
Wow!  Very knowledgeable.  Thank you!  Again, is the Savella like an SSRI type drug.  I had really really discontinuing symptoms from those types of meds and as I just said to youve, I attribute my "neuro pain" to discontinuing them because I didn't have it before.  

After reading your post, I think I really will give LDN a try first.  I haven't read anything bad about it yet.
Avatar universal
Hi,
No, Lyrica isn't an SSRI. It isn't used for depression.
Its original use was for epilepsy but it is now widely used for neurological pain (eg fibromyalgia) as well.
The skin pain you describe definitely sounds like neurological pain from Lyme to me.
I took it along with an anti-inflammatory painkiller. Lyrica for trigeminal pain and ibuprofen for joint pain. By using both types I could use a lower doses of each - the max dose of ibuprofen wasn't enough to deal with the trigeminal (neurological) pain and lyrica alone didn't help joint pain. Taking a lowish dose of both dealt with everything.
5403824 tn?1367443734
I was prescribed Mobic for inflamation and pain. Not sure what type of pain you're experiencing, but it took away my joint pain. I've also used Hydrocodone (Love that stuff but it's addicting). Oxy makes me nauseous. Morphine makes me sea sick for hours. For me, Mobic is best. No hangover, nothing.
Take care,
Sunni
Avatar universal
Tramadol affected me like it did you---- only worse, I think.
Mobic---- same thing, sunni. Glad it works for you.
Morphine, in the ER once, produced a nice emisis almost immediately. :)

I'll be so glad when pharmacogenetics becomes a reality. Then maybe we can find what drugs will work for us or not---- and at what dose. Maybe.

I'm extremely sensitive to medication. An example------ on the very few times I need to take an Ambien I cut a 5mg tablet into eighths (yes it CAN be done).
I always wonder if just licking the Ambien might not give me the same results. LOL

Cymbalta is an SNRI--- so a little different from an SSRI.
Lyrica isn't an SSRI as 'you've' said.
Pregabalin (Lyrica) is a Schedule V drug, classified as a CNS depressant

Anything that messes with my CNS is usually horrible for me. But........

Although the only time I ever took Vicodin (in the ER for back pain that I now know was Lyme) I promptly barfed it on the doctors shoes. No it wasn't on purpose.

But the next time I tried hydrocodone last year I had no reaction to it like that. File under 'go figure'.
Avatar universal
No, Savella isn't an SSRI (selective serotonin reuptake inhibitor) drug. It is actually in a class all it's own for fibromyalgia. There are three drugs in this class: Savella, Lyrica and Cymbalta. The major SSRI drugs that people are prescribed are: Celexa, Lexapro, Paxil, Prozac, and Zoloft (among others). Cymbalta can also be considered a SNRI (serotonin-norepinephrine reuptake inhibitor). Neurontin (gabapentin) may help you because it is used for neurological pain and we used to give it to diabetics a lot for neuropathy in their feet.

As far as the difficulty you used to have with SSRIs in the past, I can honestly tell you that the meds from the past were not as good as the newer meds such as Lyrica, Savella and even Cymbalta. As time has gone on, the advancements in these medications has really been profound so we find that a lot of the side effects people used to get from the SSRI class of meds doesn't seem to happen as much with these newer drugs. But, of course, everyone is different so I am not saying that you won't have a reaction.

I guess you are just going to have to try something and see how you do. There are plenty of things you can do (that are not medications) to help reduce your inflammation which may decrease your pain if you are really worried about taking too much medicine. There are some great websites about anti-inflammatory diets you can try that I had to research for my mother who suffers from severe arthritis. Try to look at your joint pain from the "arthritis" view point and incorporate some of their healing remedies into your regimen, that may help.

For the neurological pain, I do think the neuro meds can help and you can look into neuropathy websites because a lot of diabetics suffer with that condition. Certainly, the LDN remains an option for you because Lord knows we are all suffering enough with this disease and you definitely deserve some relief!! I know that there are A LOT of bath recipes out there that may make your skin feel better, even though that may only be a temporary fix.

Hope you can find some answers soon so you can get a little more comfortable. Hope you had a nice Mother's Day despite your discomfort...
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