what to say?

[dame_wilbur]

I was doing okish for a while, and now I'm back down. I'm seeing my neuro on the 1st, and I'm trying to figure out how to explain what's going on with me to him. The best way I can describe it (so far) is that my functionality is improving while my pain is actually getting worse. It's like there's this total disconnect between my brain and my body in a way that wasn't there before. I can (and have) been at a high 8/10 pain wise, but am able to function like I used to at a 6/10. However, I don't like this trend, as it's very draining emotionally/psychologically. I don't have the periods of rest that I used to have, and that makes me feel like I'm running on empty in terms of spoons.

I really want to ask my neuro for some kind of painkiller that will actually help, as the tramadol he's given me does nothing. It used to make me functional and not care, but now it doesn't seem to be even doing that. I'm not sure how to approach the issue tho, as he knows my propensity for rebounds.

Suggestions on how to talk to him?

Thanks,

~Dame

[rudyhorse]

Sometimes Drs see what they want not always what is actually true...not that this is true in your case, but I think it is good to access ourselves also, or get a good friends opinion.  That sounds like a wonderful article Marilee!   Maybe this makes sense then again if not LOL just ignore me. :)
Hope you get some relief,
Tracy

[dame_wilbur]

Unfortunately, my neuor DOES see me as an addiction/abuse risk because I accidentally seriously abused Excedrin Migraine back several years ago. I didn't know about limiting it to 3 days a week, or something like that, and was taking the max dose, every day, for a couple of months. I ended up getting really bad rebounds, and totally lost his and Mom's trust in my ability to control me need for pain management. (The fact that I was 13-14 seems to be besides the point.)

I also just have an addictive personality where I'll go on kicks where I'll basically only eat/do one thing for weeks/months at a time, and then totally avoid that for a long time, before coming back to it. So that means that I'm probably not a good candidate for opiods.

[marileew]

If your doctor is worried about dependency/addiction issues when it comes to treatment with opiates, I can send you a good peer-reviewed article on the subject that you could share with your doctor that might address some of his concerns. My neuro was the one who shared the article with me, so it's the sort of article that a doctor would take seriously.

[marileew]

Hi dame,

How has this been going for you? Have you talked to your neuro about this yet? If you are in extreme pain then you need better pain killers because, the longer you stay at a 8/10 pain level, the higher chance you have at staying at that pain level due to the way chronic pain develops, and you absolutely do not want that, you want to break this pain cycle as quickly as possible so that you don't have to rely on strong pain killers in the future... better to rely on them now for a short period of time, then forever in the future.

As for rebound headaches, rebound headaches are a very unlikely side-effect of opiates. Dependency, on the other hand, can be a worry when it comes to something like opiates. But, addiction is a very small risk factor for those who are in real serious need of strong pain medication. It is up to your doctor to decide if you are a candidate for opiates, and you can always get a second opinion if you believe your doctor has denied you pain medication without reason. Good reasons for denying a patient treatment with opiates are that the patient has a history with addiction or appears to be at a high risk for addiction due to family history or personal behaviour factors (such as heavy drinking, frequent recreational drug use, non-substance addiction behaviours such as gambling and non-compliance with prescription medications). If you know that you have any risk factors for addiction, do not hide them from your doctor as they will not necessarily rule you for a prescription for an opiate, but it is essential that your doctor is aware of these risk factors for your own personal safety.

As I mentioned before, rebound headaches are very unlikely when it comes to treatment with opiates. Although, opiates also are not a first-line treatment for migraines, because they often don't work for migraines. But, you obviously have passed the first-line treatment stage a long time ago. Also, your headaches are complicated migraines, and they are transformed migraines, so again... first-line treatment options and rules don't really apply in your case. A conversation with your doctor about a pain killer that will match the level of your pain is absolutely necessary at this point.

Keep me posted, dame. I hope things are better now... sorry I wasn't around when you posted this. My meds changed lately too, and I've been getting used to the side-effects, so I haven't been online much lately. Anyway... yeah... hope things have been improving for you since you posted this... but, update me. Thinking about you and hoping you are well,

- marilee *hugs*

[dame_wilbur]

Thank you for confirming what I've felt for a long time. I needed to hear that tramadol doesn't work for other people too. I thought it might have just been me. But if it's not just me, that makes me feel better, cuz it's NEVER really worked.

[FurballsMom]

I don't think Tramadol is effective on migraines.  My neurologist doesn't think it is either.  My PCP doesn't like Tramadol.  I'm not too crazy about it either.  I still get really nauseous from Tramadol, so it's not the first thing I reach for.  I don't think it's even all that effective on my Fibromyalgia pain either.  I don't know what else to say on your post, since I think you know more about migraine treatments than I do.