pain meds not working

[garysathome]

HI i've been having muscular pain in the shoulder area around the teres major/minor or infraspinitus it feels like somebody is twisting the muscle sending pain shooting down my arm, my doctor has prescribed first co codamol 30-500s then gave me gabapentin then changed the co-codamol to dihydrocodine, the problem i have is that the amount i was prescribed to take is not working , I have increased the dosage of gabapentin (as suggested by doctor) to 900mg and the dihydrocodine (not by doctors advice) to 90mg however i feel that this is already too high a dosage and it still isn't working to relieve the pain, I have also been taking diclofenac and have also taken paracetamol  to try help but I am still climbing the walls, im not sure if it is safe to take more meds i will need to get appointment with doctor when they reopen after holiday but in the mean time im stuck any advise will be appreciated

[garysathome]

im aware that i can up the gabapentin to 1200mg it is the dihydrocodeine  that i feel im already at to high a level with they usually work fairly fast and peak level is around an hour later however the interaction of gabapentin and dyhydracodeine has me worried as 90mg of dhc is already fairly high level.
Thanks for the advise on theracane i will look into it.

[femmy29]

I am sorry to hear that you are having such a tough time getting adequate pain relief.  I am, however, concerned that you have been experimenting with higher doses to see if it provides better pain relief.  This can be dangerous, especially with medicines such as methadone that has a really long half-life.  So you can end up taking more in hopes that it will relieve the pain when the previous dose that you took earlier hadn't begun working yet; hence, the body can overdose on the medication this way.  Methadone works really slow but once it begins to work, the pain relief is quite stable.  I have never tried Methadone but I thought it was a good example of the dangers of not getting an updated prescription that states that your medicine can be taken more frequently or at a higher dosage.

Please consult with you physician if your pain isn't adequate.  The max dose for gabapentin is 3600 mg per day so even with the increase you are still on a pretty low dose.  I take 1200 mg of gabapentin and I find that it helps a lot when combined with my other pain relief tools.    

Have you tried self-accupressure?  It is amazing!  And, I read that you have a lot of muscular pain and with the use of this modality, you may get significant pain relief.  I do self-accupressure with a theracane.  If you google "theracane", there are a lot places to purchase one.  You can then get instructions directly from the manufacturer for free just by going to their website.  The theracane is a candy cane shaped object that you use to apply pressure where it hurts.  Back, legs, feet, gluts, etc.  It is very affective at loosening tight bands of muscle that send pain signals to the brain.  You have direct control of how much pressure you can apply.  I like extremely deep pressure and no massage therapist could apply that amount of pressure.  And those self-massagers are absolutely worthless at reducing my pain.

As for medications, it can take several titrations and maybe additions of other prescription medicines that when optimized, adds up to significant pain relief.  You have to be persistant.  Don't act "up-tight" with the doctor.  Be honest and express how much pain hinders your life like a close friend.  And I am hopeful that the doctor will be willing to help you achieve a better quality of life.