Pain medication suggestion

[richard535]

In late 2004 I was treated with 25 sessions of External Beam Ratiation followed with Brach therapy for prostste treatment.  The EBR kills the capillaries.  As a result of a poor choice of a rectal cauterization two years ago I developed a large rectal ulcer.  The colorectal speciatlist I have been seeing had me use diazapam as a muscle relaxant to heal the ulcer.  I was also on oxycodone or oxycontin to control the pain.  The ulcer is now healed and I am down to 2 mg diazepam 3 times per day and 5-3325 mg oxycodone taking 1/2 a tablet 3 times per day, as needed.  I now have "intractable colorectal spasms".  Specialist said I should control the pain thru my G. P.

It is uncomfortable to stand, sitting (especially on my "whoppie cushion') is mush more tolerable and laying down leaves me pain free.  I do have multiple bowel movements (3 or 4 by 10 AM) and then maybe 1 or 2 more in afternoon.  If I eat, I commonly have to go so after.  The multiple movements leaves the anus burning which I control with a 2% lidocame jell.

Do you have any suggestions as far as muscle relaxants and/or pain meds which would give me more pain relief or to control the spasms?  

[JadedSweetheart]

Yes.  I'm noticing more and more that this oxycodone doesn't have much effect on my CP.  I'm sure it's great for breakthrough pain, but I wake up in the morning and stagger to the pill bottles just to function in the morning.  I also wake up around 6-7 even on days I could sleep in because I just can't sleep through the pain.
I really don't have any options for PM at this point in my life, other than spending $750 for a PM specialist that sees pregnant women, and right now that is sounding pretty good to me, as opposed to lowering my doses to something an OB can prescribe.

Anyway, I didn't mean to hijack richard's thread.

[Tuckamore]

You are correct, pain is pain. Have you noticed that some medications are more effective on different types or locations of pain? At least that has been true for me.

Oxycodone has little effect on my chronic pain. However when I had a nasty concussion last year and had extreme head pain the oxycodone was more effective on my head pain than my usual medication for chronic pain. Go figure.

Peace,
~Tuck

[JadedSweetheart]

I've never taken an antispasmodic, although it sounds like something I would like to try down the road as I have constant muscle spasms in my neck from herniated discs and DDD.  I know it sounds like apples and oranges as far as our different conditions, however pain is pain. (And so much more sometimes)
I have taken flexeril as a muscle relaxer and currently take Soma.  I'm going to need to switch back to the flexeril as I am pregnant, however I think the soma works better and I recommend it.  It may be worth talking to your doctor about it.  If your PCP knows you well, and you are happy with the level of pain relief you are recieving, then I would stay with them.  Pain management just gives you more options.
Certain pain meds like oxycodone/roxicodone/oxycontin are very constipating, just to let you know, and I'm not sure if that would help or hurt your situation.

I hope you get the relief you need soon!

[Tuckamore]

Hello Richard,

Welcome to the Med Help's Pain Mangement Forum. I am so glad that you found us and took the time to post. However I am very sorry to hear about your pain. I know how very painful your type of pain can be, to say nothing of the bowel issues.

I don't know in which state you reside. In my state, Wisconsin it is the PCP (GP) that prescribes for and follows their chronic pain patients, not a PMP (pain management physician). If your PCP will prescribe narcotics he/she may be the best to determine how to approach and treat your type of pain. If you have PMP in your state than I encourage you to request a referral and have them help you with pain managment.

Let me share a bit if my experience. I lost 99cm of my small intestine in a MVA some years ago. It left me with "Dumping Syndrome" which sounds similar to what you are experiencing with frequent bowel movements. I had a protocol. When I reached 25 BM's in a 24 hr period it was time for me to go to ER for IV rehydration. We got so we would laugh that I was 2 quarts low and needed a "fill up."  

However it was no really no laughing matter as I experienced the extreme anus burning (as you describe) excoriation and bleeding. I also developed some ulceration early on during those early years until my body adjusted to the loss of intestine. So in part and to some degree, I know your pain.

I found diazepam to be the best muscle relaxant for me. I tried many others but they were not as effective. However everyone reacts differently to medications.

Have you tried Buscopan?  Generic name is Hyoscine Butylbromide. It is one of the family of drugs known as antispasmodics. It is effective for many ppl in the suppression and relief of spasms and cramping in the GI system. It may not be effective for you but you may want to discuss this possibility with your physician. I know this ppl that have had good results with this medication.

Pain medications in my opinion are highly individualized. What I mean is that Sally, Sue and George may find that MS Contin does wonders for their back pain....and Mary, Alice and Bob obtain little relief from it. They may have better relief from OxyContin or Fentanyl. Pain management or pain control is a trial and error process. It's because we are all unique. Our systems respond differently to different medications. A good physician will work with you to determine the best medication to control your pain and symptoms. There is no right answer for which drug works best.

I hope that you will keep us updated and let us know how you are doing. We are here to support you and offer suggestions. We all learn from one another. Please keep in touch. I hope you are able to find good pain management in the very near future. We all know how very disruptive chronic pain can be in our life and can empathize with you.

Take Care,
~Tuck

[namnam46]

Richard,

We want to welcome you to the Pain Management Forum and tell you how glad we are that you have found us. We also hope that in the future you will share your expertise and experience that you have had with your CP(Chronic Pain).

I'm so very sorry that you have had to endure the debilitating pain for such a long time! It's difficult to even imagine what you are having to go thru.

The suggestions that Molly gave you are great ones. As a CP  Patient that is on the Fentanyl Patch I concur wholeheartedly that you could definitely benefit from the patch. Her other suggestions were excellent also. My Dr. gave me all the choices that Molly suggested and I chose the Fentanyl Patch over the others because I didn't want to take any more pills than I already have (16 with my heart, blood pressure etc., NOT including the Pain meds).

There will be other people along later or tomorrow that will give  you more suggestions also.  Good Luck.......Sherry

[Mollyrae]

Hello:

I am sorry to hear of the pain you're experiencing. Since you are opiate tolerant, I would suggest the Fentanyl Patch. This Patch gives you around the clock pain relief and is strong enough to keep intense pain at bay.

What I like about the Patch is that it doesn't give you the euphoric, lightheadedness all day long. It goes into the system slow enough that you really can't tell you are taking an opiate and at the same time it works wonders on severe pain. Go figure!

It does take some time to adjust to though. You may feel lightheadedness, nausea may set in and seating could be a factor but they do go away with time.

I feel that you should discuss this possibility with your Doctor. It couldn't hurt

Another option is something along the lines of MS Contin. An extended relief Morphine that in my opinion, works better than Oxycontin.

Good luck and I hope you find relief soon.

My best,
Mollyrae

[Sarajmt]

Oh my goodness.  You are in a bad situation. I don't have a recommendation concerning medication.  But I do recommend you see a pain management physician.  They are much more current of pain relief methods than other doctors.

I am glad you found this forum.  There are a lot of knowledgeable people here.  It's a good place for anyone suffering chronic pain.

Welcome!
Sara