Pain control

[Guest guest]

Granny

I went to see my rheumy last week aand she put me on Tryptizol

(amitriptilin) 10 mg before going to bed, in order to replace valium and

some of the stress I have dealing with my family problems. At 41 I still

have to raise my kids and to help my parents who are getting older and

need caring. So I get stuck in the middle, and sometimes it is hard.I

practice the kind of thumbs massage at the physiotherapy clinic and that

helps a lot. My elbows resent from writing, scrubing and ironing with

muscles and tendons hurting a lot, from neck to fingers. My rheumy says

that has nothing to do with our condition.

I guess it does, from what I´ve read here over these past three or four

years.

I take Celebrex only when I am in deep pain.

[Guest guest]

In a message dated 5/19/02 5:50:34 PM Eastern Daylight Time,

jacinta.quelhas@... writes:

> , scrubing and ironing with

> muscles and tendons hurting a lot, from neck to fingers

Jacinta (Sorry if I'm wrong about your first name?),

What you describe is exactly what many of us suffer. It can be attributed to

other arthritis conditions, but this type of pain is quite common with any of

the spondy diseases. People that have been diagnosed with a spondy are

usually given a prescription for NSAID (Vioxx, Celebrex, Indocin, Motrin, or

any number of other anti-inflammatory agents) as a first line of drugs to be

tried. Unless you have tried Celebrex and it does not agree with you or there

is another reason not to take it, a 2Xdaily dose of celebrex should help some

with your tendon and muscle inflammation. (I believe it comes in 100mg and

200mg pills.) To cut down on the inflammation, you do need a consistent level

of NSAID in your system. NSAID (like Celebrex) do not cause a tolerance or

dependency problem the way that narcotics do. Celebrex is not in the same

category as narcotics. Narcotics do not work on inflammation...they only work

on severe pain.

Best regards, Granny

[Guest guest]

Carol, I hear you. This is a tough one because of all the

controversy. I hate to direct you to the archives (my standard

refrain), but there has been a lot of excellent recent discussion on

pain and pain medicine. Beth went to a press conference in

Washington sponsored by one of the pharmaceutical manufacturers and

apparently really galvanized some people. She worked terrifically

hard in advance of this engagement (she was featured as a speaker) to

gather information from this group and elsewhere on our pain

experiences. Needless to say, as such experiences go, we have had

some doozies.

Did you know you can put " pain " (or any search word of your choice)

into the box for a search term and actually comb through all three

years of our messages that way, having the ones that contain your

term pop up?

Maybe I can give you some more leads later on. I expect that others

will have lots of good advice too, so I'll sign off for now. Except

to say no, you are definitely not the only one with this condition!

Welcome to the group.

-- In , " caroljhoffman "

<caroljhoffman@y...> wrote:

> Hi - I am fairly new to groups. Need to give more of my history. I

am

> certain the topic of pain control has been extensively coverd. But,

> can you direct me to how to get some info. I am now 51 Yrs. old.

Had

> seven surgerie from '69 - '74. Flatback was immediate, but I just

now

> learned that I am NOT the only one with this from Harrington rods.

I

> had two sets. When they took out the first rod, they discovered

that

> a pin had corroded inwards and when they pulled it out, spinal

fluid

> came " gushing out " . Severe pain since. What is the protocol for

pain

> medication now?? I hate to nearly BEG for narcotics. There must be

> something. I don't think they make enough Motrin <grin>, Was on

> Durgesic for one month, last month. Going to get only one more

month,

> then back to Ultram. I need some info please. Carol J Hoffman

[Guest guest]

Hi Carol,

First of all, welcome to the group! It's always great to have another person

join with their opinions, comments, problems and whatever else they bring to

the table.

I, too, for many years had problems getting a Doctor to prescribe something

that would even help keep my pain lowered much less in control. I finally

after many yrs, went to see a pain mgmt Dr. and there has been a dramatic

change in my life ever since even the first visit. It did take quite a few

months to find the right combination of drugs to help me, but during that

time, my Dr.s number one concern was that I was not hurting anymore! Can you

imagine, a Dr. that actually tries to help you and not make you be a

" beggar " . Because I have no health insurance right now, I am limited in the

drugs I can take because of the expense, but we worked together until I can

honestly say that on most days I live a fairly comfortable life. I still

have days where the pain gets real close to that awful # " 10 " , but am at

least able even on those days to make it bearable.

The one thing I might suggest is to see a " Pain Management Specialist " or

Pain Mgmt. Doctor, instead of going to one of the pain mgmt clinics. They

seem to deal more with injections, therapy, etc. instead of using

medication.

Good luck and hope to hear that you're feeling better really soon.

Be safe and God Bless,

Debbie

>From: " caroljhoffman " <caroljhoffman@...>

>Reply-

>

>Subject: pain control

>Date: Wed, 01 Oct 2003 07:36:15 -0000

>

>Hi - I am fairly new to groups. Need to give more of my history. I am

>certain the topic of pain control has been extensively coverd. But,

>can you direct me to how to get some info. I am now 51 Yrs. old. Had

>seven surgerie from '69 - '74. Flatback was immediate, but I just now

>learned that I am NOT the only one with this from Harrington rods. I

>had two sets. When they took out the first rod, they discovered that

>a pin had corroded inwards and when they pulled it out, spinal fluid

>came " gushing out " . Severe pain since. What is the protocol for pain

>medication now?? I hate to nearly BEG for narcotics. There must be

>something. I don't think they make enough Motrin <grin>, Was on

>Durgesic for one month, last month. Going to get only one more month,

>then back to Ultram. I need some info please. Carol J Hoffman

>

>

_________________________________________________________________

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[Guest guest]

Randy, some pain killers had no effect on me. One that worked well,

but I'm not sure if it's available with the same name where you are

(I bought it in Spain) is called, " Tradonal " , 50 mg. It is available

with a prescription. You might want to do a Google on it if you're

interested.

Best to you,

Staninfr

> Until my THR...I am continueing to work ((construction)). I was

> wondering what medicine controls pain better..ibupofren

> 800mg...vioxx...or celebrex. Thank you for your help.

> Randy

[Guest guest]

Randy,

Some of these meds are really expensive and at least for me - worked differently. Ask your doctor to give you some samples to try before getting a prescription. In my own case, Ibuprofen was very good - but didn't last through the night - celebrex was not very good at all, Bextra was quite good, and Vioxx was the best. But - each person is different - and will find the med that works best for them. The pharmaceutical companies provide most doctors with liberal amounts of sample product. I understand there are other, even more powerful ones to try if these don't work for you.

Martie

-- Pain Control

Until my THR...I am continueing to work ((construction)). I was wondering what medicine controls pain better..ibupofren 800mg...vioxx...or celebrex. Thank you for your help.Randy

[Guest guest]

> Randy, some pain killers had no effect on me. One that worked well,

> but I'm not sure if it's available with the same name where you are

> (I bought it in Spain) is called, " Tradonal " , 50 mg. It is

available

> with a prescription. You might want to do a Google on it if you're

> interested.

>

> Best to you,

>

> Staninfr

>

I googled and here is their website

http://www.viatris.com/index.cfm?

siteid=81 & CFID=42535 & CFTOKEN=38326088 & jsessionid=803076141092325303718

Market situation

• Launched for the first time in the UK in 1996

• Marketed in the UK, France, Spain, Belgium, the Netherlands,

Portugal, Italy and Germany

• Marketed in other territories by licensees or distributors

(Germany, Denmark, Brazil, Central America, Philippines, Thailand,

etc.)

Hmm, I wonder if it will soon be available in Canada? I could do

with a trip to Vancouver.

Carolyn

cogito ergo google

[Guest guest]

In a message dated 8/11/2004 11:05:49 PM Central Standard Time, randycocco@... writes:

...ibupofren 800mg...vioxx...or celebrex.

______

You need to try them for yourself. Your MD should have samples you can try of celebrex, vioxx, bextra.....all cox 2 inhibitors. My favorite is still Naproxin, and it costs half of what the others do. I think you can take it in conjunction with Tylenol, too.

y

[Guest guest]

Thanks, Carolyn, for doing the homework. Hmm. Not yet avaiable in

the US?

What does " cogito ergo google " mean after your name, " I know,

therefore I google, " or what?

Staninfr

Post hoc, ergo propter hoc

----------------------------------------------------------

> > Randy, some pain killers had no effect on me. One that worked

well,

> > but I'm not sure if it's available with the same name where you

are

> > (I bought it in Spain) is called, " Tradonal " , 50 mg. It is

> available

> > with a prescription. You might want to do a Google on it if

you're

> > interested.

> >

> > Best to you,

> >

> > Staninfr

> >

> I googled and here is their website

>

> http://www.viatris.com/index.cfm?

>

siteid=81 & CFID=42535 & CFTOKEN=38326088 & jsessionid=80307614109232530371

8

>

> Market situation

>

> • Launched for the first time in the UK in 1996

>

> • Marketed in the UK, France, Spain, Belgium, the Netherlands,

> Portugal, Italy and Germany

>

> • Marketed in other territories by licensees or distributors

> (Germany, Denmark, Brazil, Central America, Philippines, Thailand,

> etc.)

>

> Hmm, I wonder if it will soon be available in Canada? I could do

> with a trip to Vancouver.

>

> Carolyn

> cogito ergo google

[Guest guest]

Hi randy,

I'm similar, in that I'm working pre-THR, but not as heavy a job as

you. For me I worked my way through the meds to see which worked

best for me.Everybodies opinions differ. Dont forget about

paracetamol (tylenol in the US?) as well as anti-inflammatories, as

it is good for pain believe it or not. I take that and I am new to

Vioxx and loving it. I tend to take one anti-inflammatory and then

after a few weeks it wears of so I change drugs again. Also at the

end of the day I take a muscle relaxant drug if I'm really sore,

thats my pain relief, cant wait till have THR in november,

Best wishes,

Leigh

[Guest guest]

PS

The 'muscle relaxant' drug is a non opiate one called Accupan

(nefopam hydrochloride), here in the UK.

Leigh

[Guest guest]

> Thanks, Carolyn, for doing the homework. Hmm. Not yet avaiable in

> the US?

>

> What does " cogito ergo google " mean after your name, " I know,

> therefore I google, " or what?

>

> Staninfr

> Post hoc, ergo propter hoc

I like to do research-should have been a librarian.

My bad latin for I think, therefore I google.

or Je pense, donc je google

Carolyn

[Guest guest]

Carolyn

Oui, Le Google, c'est magnifique pour faire l'investigation, n'est-

ce pas?

Staninfr

> > Thanks, Carolyn, for doing the homework. Hmm. Not yet avaiable

in

> > the US?

> >

> > What does " cogito ergo google " mean after your name, " I know,

> > therefore I google, " or what?

> >

> > Staninfr

> > Post hoc, ergo propter hoc

>

> I like to do research-should have been a librarian.

>

> My bad latin for I think, therefore I google.

>

> or Je pense, donc je google

>

> Carolyn

[Guest guest]

Lynn,

I hate to sound so cliche', but honey, you sound like a pretty typical,Flatback/chronic pain patient and my heartfelt sympathies go out to you...and your amazing husband. I, too, am very blessed with one of those wonderful husbands minus the fusion part! But enough of the sympathy part...I know that's absolutly the LAST thing you want or need at this point. You want answers not pity...you need advice not sympathy...a few hundred sturdy shoulders to cry on, we feisties are always here for that! We're also pretty good at sharing our own trials and errors when it comes to seeking and hopefully finding solutions for our deformities, aches and pains.

After quite a few years of being frustrated with the Pain Management I was receiving, I was pouring my heart out to my wonderful family doc about my frustration only to have him say "why haven't you said something before now? I happen to be a Primary care physician who's also certified as a Pain Management specialist! I just don't advertise it because I don't want that to be the bulk of my practice. If I only saw patients with chronic pain I would probably end up as a patient myself...on some shrink's couch!" And that began our joint exploration into the world of pain control for a patient with Flatback Syndrome. It took a lot of trial and error but between the 2 of us we finally hit on a pretty good combo of meds.

I currently take that following meds: 120 mg of OxyContin CR 2X's a day (since they no longer make the 120mg CR's I have to take 80mg+40mg twice a day); 1200mg of Neurontin 3X's a day; 350mg Soma (1-2) in AM and/or PM as needed for the spasms. It may seem like a lot of medication and I certainly didn't start out at those doses. We have built up to those doses over the course of almost 4 years. As new and different problems have cropped up and/or gone away we've delt with them as a team...and to me, that has been the most important part of my treatment.

All along the way, my doctor and I have worked together. One of the most important aspects of good pain management is a trust between doctor and patient. To emphasize this, I signed an Pain Management contract with my doctor. As the patient, I agreed to never seek meds from any other doctor (that's what "drug seekers" do); I understand that if I miss more than 2 appointments in a year,I'm out of the program and I agree to never attempt to self-medicate. Those are the highlights of the contract. As the physician, my doctor agrees to never change my meds or dosages without first explaining why the changes are being made; he also agrees that at NO time will I ever have to wait longer than 24hrs to have a phone call returned or a prescription refilled ( and we all know how frustrating THAT can be!)

My doctor also knows that he's dealing with a patient who is not only "a bit knowledgable" about medicine ( 20+ yrs. working in Pathology and Orthopedics) but whos' also very involved as a patient advocate for better quality, more accessable pain management. Because of that (and plus he knows I have a short-fused Irish temper!) he's always on the look-out for better meds, better therapies, etc. ; it's not unusual for me to open my e-mail and find a posting from him that goes something like this..."b. found article on [blah,blah,blah] in this mo. edition of [such-and-such med. magazine]. check it out on-line at www [website] & send me your feedback". And it won't end there...he may not see me for 3 months after that ( that's usually how often I have to return for follow-ups) and he will have seen hundreds of patients in-between yet amazingly, the next time I see him he'll say, "hey, so what did you think about that article I sent you?"...now THAT's amazing in my book.

The biggest obstacles for 90% of patients who suffer from chronic, intractable, life altering pain are 1) finding a qualified, compassionate Pain Medicine physician and 2) building an honest, trusting relationship with that doctor. The first obstacle is something we Feisties can try to help you with; the second is up to you and your husband. I added your husband there because if he's anything like mine (and from the little bit you've told us, I'm guessing he is!) he's been by your side through all of this... holding your hand, speaking words of love and encouragement, holding your hair away from your face while you've puked your guts out either going on or coming off yet another wretched drug that once again didn't help, (oops, I'm projecting there!)...but family is an extremely vital part of a good pain management program.

To help with your search for a Pain Management specialist, here are few good starts for your research:

The American Pain Foundation - www.painfoundation.org

American Academy of Pain Medicine - www.painmed.org

American Board of Pain Medicine - www.abpm.org

American Chronic Pain Association - www.theacpa.org

American Pain Society - www.ampainsoc.org

National Chronic Pain Society - www.ncps-cpr.org

Natinal Pain Foundation - www.nationalpainfoundation.org

Also, e-mail the American Pain Foundation and ask them to send you some of their brochures, ESPECIALLY one of the Pain Notebooks. This is an invaluable tools to assit you and your current/future physicians evaluate your pain on a day to day, hour to hour basis. When I first got my pain notebook I carried it around with me for days, recording each and every change in ativity, pain, medication,etc. Wgen you're pain on a daily/hourly basis, it's difficult to remember all the info when you go in to talk to a doctor, nurse, nurse practicioner, etc. That's where the Pain Notebook comesin handy...you have it all right there in front of you.

There are some ideas for you and some places to start. Taking control of your own medical care is in itself somehow theraputic...you won't feel quite so helpless or frustrated. Keep us posted on your progress, Lynn. We're all out here to help you as much as we can...and don't forget all those hundreds of shoulders we Feisties have to offer...venting is also quite theraputic!

Best wishes for a peaceful, painfree day,Beth B.

Best wishes for a peaceful, painfree day,Beth B.

[Guest guest]

I know this sounds kinky, but tonight I saw a report

about this new craze www.cuddleparty.com it is

supposed to help stress and pain.

Ellen

--- Bbunce0917@... wrote:

> Lynn,

>

> I hate to sound so cliche', but honey, you sound

> like a pretty

> typical,Flatback/chronic pain patient and my

> heartfelt sympathies go out to you...and your

> amazing husband. I, too, am very blessed with one of

> those wonderful

> husbands minus the fusion part! But enough of the

> sympathy part...I know that's

> absolutly the LAST thing you want or need at this

> point. You want answers not

> pity...you need advice not sympathy...a few hundred

> sturdy shoulders to cry on,

> we feisties are always here for that! We're also

> pretty good at sharing our

> own trials and errors when it comes to seeking and

> hopefully finding solutions

> for our deformities, aches and pains.

>

> After quite a few years of being frustrated with the

> Pain Management I was

> receiving, I was pouring my heart out to my

> wonderful family doc about my

> frustration only to have him say " why haven't you

> said something before now? I

> happen to be a Primary care physician who's also

> certified as a Pain Management

> specialist! I just don't advertise it because I

> don't want that to be the

> bulk of my practice. If I only saw patients with

> chronic pain I would probably

> end up as a patient myself...on some shrink's

> couch! " And that began our joint

> exploration into the world of pain control for a

> patient with Flatback

> Syndrome. It took a lot of trial and error but

> between the 2 of us we finally hit

> on a pretty good combo of meds.

>

> I currently take that following meds: 120 mg of

> OxyContin CR 2X's a day

> (since they no longer make the 120mg CR's I have to

> take 80mg+40mg twice a day);

> 1200mg of Neurontin 3X's a day; 350mg Soma (1-2) in

> AM and/or PM as needed for

> the spasms. It may seem like a lot of medication

> and I certainly didn't

> start out at those doses. We have built up to those

> doses over the course of

> almost 4 years. As new and different problems have

> cropped up and/or gone away

> we've delt with them as a team...and to me, that

> has been the most important

> part of my treatment.

>

> All along the way, my doctor and I have worked

> together. One of the most

> important aspects of good pain management is a trust

> between doctor and patient.

> To emphasize this, I signed an Pain Management

> contract with my doctor. As

> the patient, I agreed to never seek meds from any

> other doctor (that's what

> " drug seekers " do); I understand that if I miss

> more than 2 appointments in a

> year,I'm out of the program and I agree to never

> attempt to self-medicate.

> Those are the highlights of the contract. As the

> physician, my doctor agrees to

> never change my meds or dosages without first

> explaining why the changes are

> being made; he also agrees that at NO time will I

> ever have to wait longer

> than 24hrs to have a phone call returned or a

> prescription refilled ( and we all

> know how frustrating THAT can be!)

>

> My doctor also knows that he's dealing with a

> patient who is not only " a bit

> knowledgable " about medicine ( 20+ yrs. working in

> Pathology and

> Orthopedics) but whos' also very involved as a

> patient advocate for better quality, more

> accessable pain management. Because of that (and

> plus he knows I have a

> short-fused Irish temper!) he's always on the

> look-out for better meds, better

> therapies, etc. ; it's not unusual for me to open

> my e-mail and find a posting

> from him that goes something like this... " b. found

> article on

> [blah,blah,blah] in this mo. edition of

> [such-and-such med. magazine]. check it out on-line

> at www [website] & send me your feedback " . And it

> won't end there...he may

> not see me for 3 months after that ( that's usually

> how often I have to return

> for follow-ups) and he will have seen hundreds of

> patients in-between yet

> amazingly, the next time I see him he'll say, " hey,

> so what did you think about

> that article I sent you? " ...now THAT's amazing in

> my book.

>

> The biggest obstacles for 90% of patients who suffer

> from chronic,

> intractable, life altering pain are 1) finding a

> qualified, compassionate Pain

> Medicine physician and 2) building an honest,

> trusting relationship with that

> doctor. The first obstacle is something we Feisties

> can try to help you with; the

> second is up to you and your husband. I added your

> husband there because if

> he's anything like mine (and from the little bit

> you've told us, I'm guessing

> he is!) he's been by your side through all of

> this... holding your hand,

> speaking words of love and encouragement, holding

> your hair away from your face

> while you've puked your guts out either going on or

> coming off yet another

> wretched drug that once again didn't help, (oops,

> I'm projecting there!)...but

> family is an extremely vital part of a good pain

> management program.

>

> To help with your search for a Pain Management

> specialist, here are few good

> starts for your research:

> The American Pain Foundation -

> _www.painfoundation.org_

> (http://www.painfoundation.org)

> American Academy of Pain Medicine -

> _www.painmed.org_

> (http://www.painmed.org)

> American Board of Pain Medicine - _www.abpm.org_

> (http://www.abpm.org)

> American Chronic Pain Association -

> _www.theacpa.org_

> (http://www.theacpa.org)

> American Pain Society - _www.ampainsoc.org_

> (http://www.ampainsoc.org)

> National Chronic Pain Society - _www.ncps-cpr.org_

> (http://www.ncps-cpr.org)

> Natinal Pain Foundation -

> _www.nationalpainfoundation.org_

> (http://www.nationalpainfoundation.org)

>

> Also, e-mail the American Pain Foundation and ask

> them to send you some of

> their brochures, ESPECIALLY one of the Pain

> Notebooks. This is an invaluable

> tools to assit you and your current/future

> physicians evaluate your pain on a

> day to day, hour to hour basis. When I first got my

> pain notebook I carried

> it around with me for days, recording each and every

> change in ativity, pain,

> medication,etc. Wgen you're pain on a daily/hourly

> basis, it's difficult to

> remember all the info when you go in to talk to a

> doctor, nurse, nurse

> practicioner, etc. That's where the Pain Notebook

> comesin handy...you have it all

> right there in front of you.

>

> There are some ideas for you and some places to

> start. Taking control of

> your own medical care is in itself somehow

> theraputic...you won't feel quite so

> helpless or frustrated. Keep us posted on your

> progress, Lynn. We're all out

> here to help you as much as we can...and don't

> forget all those hundreds of

> shoulders we Feisties have to offer...venting is

> also quite theraputic!

>

>

>

>

> Best wishes for a peaceful, painfree day,

> Beth B.

>

> Best wishes for a peaceful, painfree day,

> Beth B.

>

>

__________________________________________________

[Guest guest]

Hi,

I, too, have seen stories on "cuddleparties"...and I agree that it sounds pretty kinky! The story I saw showed a bunch of people huddled into a mass on the floor, partially clothed,and supposedly there were some rules about no sex in any form...OK...whatever...personally, just the thought of rolling around on the floor with a bunch of strangers raises my stress level not to mention my blood pressure (and someone on the types of meds I take shouldn't do anything that might further increase my blood pressure!!).

If I'm going to cuddle with ANYONE to possibly reduce my pain, it's going to be with my dog or one of my cats; many studies have shown that "pet therapy" is a terrific stress and blood pressure reducer. Or better yet, I'll cuddle with my husband! He's one of the most comforting forces in my life...and we have no rules about "no sex in any form" when we cuddle! In fact, I've found that a gentle ( or not!) roam in the sack to be quite theraputic!!

Best wishes for a peaceful, painfree day,Beth B.

[Guest guest]

I'll cuddle with anything warm at this point. I know you have no sympathy for a

southern

Florida girl, but dang, it's cold tonight! And my central heat is on the fritz!

Jill

[Guest guest]

Jill,

Oh the contrary, I have quite a lot of symapthy for a southern girl! While I may have grown up here in this frozen, Lakefront community of Erie, PA, we only recently moved back here to help care for my husband's 91y/o grandmother. We spent the last 10 years in land and while not as far south as you lucky folks in sunny Florida, it was certainly warmer than up here. And while the folks in land and along the east coast may be digging out from their recent N'oreaster, that is just another day-in-the-life for an Erieite. We get what are known as lake effect storms here...these nasty, blustery, snowstorms that whip off Lake Erie; blinding snow fueled by strong, frigid Canadian winds ranging in the area of 40-50mph dumping anywhere from inches to feet along it's path. In the 10 years we spent in land we only experienced one true N'oreaster in Feb.2003 and while it made us momentarily (and I do mean momentarily!) homesick, it was over in 24 hrs. and the snow was gone in 48hrs. Erie snows tend to blow in with a fury and over-extend their welcome by about 4 months!

Our poor dog and cat aren't adjusting too well to this cold weather either. Our cat used to spend hours outside, raoming around the neighborhood. Since moving him up here, he haspoked his nose out once or twice, seen the snow, shivered and made a bee-line to the portable space hearter...where he parks his butt for the duration of the day and night, flipping from side-to-sideonly when he smells his own fur being singed (cats really can be dumb about those things!). And while our dog likes to romp in the snow occasionally, he is almost 11 yrs old, is getting a bit arthritic, and he too perfers that portable space heater.

Best wishes for a peaceful, painfree day,Beth B.

[Guest guest]

In Florida? Wow! Seems like the whole east coast has a bad case of winter. Why would any of us have no sympathy for you??? (I love Florida.) I sure hope you have gotten your central heat repaired by now. There is nothing worse for my own "bad bones" or temperamental joints than the COLD. When our own heat was erratic, we were huddling under piles of blankets, wearing coats and sweaters, anything to feel halfway cozy despite the situation. I wonder how humans managed before they invented heated abodes. You should have no sympathy for a northern Illinois dweller, come to think of it -- who in her right mind would choose to spend her days, including the winter ones, in Chicago? B-r-r-r-r-r. Though, come to think of it, I actually graduated from high school in Fairbanks, Alaska many moons ago. THAT was an adventure in cold living! A friend from

the Panama Canal Zone wrote in my autograph book, "To the girl from Alaska -- where many are cold but few are frozen." Stay warm, Jill! Best, Jill <jill@...> wrote: I'll cuddle with anything warm at this point. I know you have no sympathy for a southern Florida girl, but dang, it's cold tonight! And my central heat is on the fritz! Jill

[Guest guest]

Hi Sharon,Thinking about the 'duty ...  to assure adequate pain control' on part of DCs doesn't bring much to the surface for me.  Not that the question isn't germane, just that so much of what we do is related to pain control.  It is by far the leading reason that patients come to my office.  Even the yoga students start out looking for pain control/management/abatement.  I would suggest that free market economics demonstrate how successful DCs are at pain control.  I use a formula that Weil MD recommends and that I've mentioned here before: 500 mg caps of ginger root powder and curcumin/turmuric powder swallowed down with 3 oz of purple grape juice x 3/day will reduce MS pain by 30-40% in most patients.  This is anti-inflammatory food, so it has to be in the body to be effective.  Maximum relief can be expected after about a month of use, although results should be apparent sooner than that.  I like the idea of using foods for medicine as they produce the least iatrogenic effects usually.Pain control is also a function of daily activities.  Learning basic skills for reducing chronic pain patterns have the added benefit of empowering patients to have greater control over their own health and well-being.  In this regard, I've found simple open-chained resting postures very helpful.  Combined with breath control protocols, patients can feel in the moment how their actions can beneficially change the way they feel.  Moving patients in the direction of active care is powerful long-term strategy for dealing with the inevitabilities of pain.In short, a DC that can't control pain in patients will have a hard time staying busy. SearsNW PDXOn Nov 9, 2006, at 12:11 PM, Sharron Fuchs wrote:Drs.,  An MD can be disciplined for failure to provide adequate pain control. What duty does a DC have to assure adequate pain control in a patient ?  sharron fuchs dc

[Guest guest]

Please think on this as I really meant 'duty'. I should have explained a bit more so in the right context an answer would come...

First off this is not a malpractice issue that I am considering it is a practice question and a concern to me :

90 year old woman has sudden severe onset of low back and leg pain. Pain becomes agonizing, excruciating and she is unable to walk, drags the leg and must use crutches in order to ambulate. DC does no imaging - does the 'treatment' - pain continues as severe, excruciating, agonizing........a few weeks later plain films are taken by an FP - femoral heads ok and DJD and DDD determined. Reflexes ? I don't know. Given Hydrocodone which gives some pain relief but upsets stomach as does all the ASA and supplements and patient loses 7 pounds. After 4-6 weeks there is improvement - eventually able to walk uses a cane but cannot walk normally or the distance they were able to prior to problem. Now the patient (2 1/2 months from onset) will get an MRI and see if a cause can be determined. Current MD says may have blown a disc and if patient was in his care prior they would have been put in the hospital due to the severe uncontrolled pain and then a workup ASAP would have ensued.

Now, a disc may be the true diagnosis - could be a bulge or minor something or it could be something significant that now has nerve damage along with it. Maybe surgical or may not be.

My main concern and question is - in the very beginning and in the acute, acute stage should the patient have been referred out to get on top of the severe, agonizing , excruciating, debilitating pain so the patient could undergo DC treatment ?

Is there a duty to do this ? Call it responsibility or whatever but should this be addressed and the patient be given the benefit of other care in addition to the DC care ?

sharron fuchs dc

From: sunny Kierstyn [mailto:skrndc1@...] Sent: Friday, November 10, 2006 11:45 AMdm.bones@...; Sharron FuchsCc: Subject: Re: Pain control

Thanks for starting this thread, and for asking the question, Sharon. It really pinged my brain and I have spent more than several moments thinking about it since you posed it. It is the word 'duty' that has me intrigued .... what is our 'duty' about it? It is certainly our 'job' but I never thought of it in the context of 'duty' or responsibility.

And - at the risk of being a tease - I will have more time over the weekend to expound on this. To be continued .....

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: Sears <dm.bones@...>Sharron Fuchs <sharronf@...>CC: Subject: Re: Pain controlDate: Thu, 9 Nov 2006 18:37:22 -0800

Hi Sharon,

Thinking about the 'duty ... to assure adequate pain control' on part of DCs doesn't bring much to the surface for me. Not that the question isn't germane, just that so much of what we do is related to pain control. It is by far the leading reason that patients come to my office. Even the yoga students start out looking for pain control/management/abatement. I would suggest that free market economics demonstrate how successful DCs are at pain control.

I use a formula that Weil MD recommends and that I've mentioned here before: 500 mg caps of ginger root powder and curcumin/turmuric powder swallowed down with 3 oz of purple grape juice x 3/day will reduce MS pain by 30-40% in most patients. This is anti-inflammatory food, so it has to be in the body to be effective. Maximum relief can be expected after about a month of use, although results should be apparent sooner than that. I like the idea of using foods for medicine as they produce the least iatrogenic effects usually.

Pain control is also a function of daily activities. Learning basic skills for reducing chronic pain patterns have the added benefit of empowering patients to have greater control over their own health and well-being. In this regard, I've found simple open-chained resting postures very helpful. Combined with breath control protocols, patients can feel in the moment how their actions can beneficially change the way they feel. Moving patients in the direction of active care is powerful long-term strategy for dealing with the inevitabilities of pain.

In short, a DC that can't control pain in patients will have a hard time staying busy.

Sears

NW PDX

On Nov 9, 2006, at 12:11 PM, Sharron Fuchs wrote:

Drs., An MD can be disciplined for failure to provide adequate pain control. What duty does a DC have to assure adequate pain control in a patient ?

sharron fuchs dc

Stay in touch with old friends and meet new ones with Windows Live Spaces

[Guest guest]

Question: What is our duty as a Chiropractic Physician?

Answer: First, to be a Physician. Second, to apply Chiropractic

treatment.

As a Physician we need to use our tools of evaluation and examination

to properly diagnose a patients condition. A couple of obvious tools

this DC should have used on the first visit, with the 90 year old

patient, should have been immediate plain film x-rays followed by a

lumbar MRI.

The correct progression is: examination, diagnosis, then treatment.

It seems as though, unfortunately, this DC went in reverse order.

" My main concern and question is - in the very beginning and in the

acute, acute stage should the patient have been referred out to get

on top of the severe, agonizing , excruciating, debilitating pain so

the patient could undergo DC treatment? "

I understand your main concern regarding the patients pain, but, it

is our " duty " to first examine and find the source of

pain/irritation. Once this has been established, and a diagnosis has

been made, then appropriate care can be determined (whether it be

from a DC or not).

Dr. , please don't kick me off for having an opinion. Thanks.

Shad McLagan D.C.

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pain

> control in a patient ?

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> sharron fuchs dc

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> ________________________________

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> Stay in touch with old friends and meet new ones with Windows Live

> Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575>

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[Guest guest]

I totally agree with you. I too am concerned about the order of things and I am sure if things would have happened in the correct order that pain medication would have been brought on board sooner. I firmly believe this patient could have benefited from pain control - especially this age of patient - they can be so fragile.

sharron fuchs dc

From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 1:10 PM Subject: Re: Pain control

Question: What is our duty as a Chiropractic Physician?Answer: First, to be a Physician. Second, to apply Chiropractic treatment.As a Physician we need to use our tools of evaluation and examination to properly diagnose a patients condition. A couple of obvious tools this DC should have used on the first visit, with the 90 year old patient, should have been immediate plain film x-rays followed by a lumbar MRI. The correct progression is: examination, diagnosis, then treatment. It seems as though, unfortunately, this DC went in reverse order. "My main concern and question is - in the very beginning and in theacute, acute stage should the patient have been referred out to get on top of the severe, agonizing , excruciating, debilitating pain so the patient could undergo DC treatment?"I understand your main concern regarding the patients pain, but, it is our "duty" to first examine and find the source of pain/irritation. Once this has been established, and a diagnosis has been made, then appropriate care can be determined (whether it be from a DC or not).Dr. , please don't kick me off for having an opinion. Thanks.Shad McLagan D.C.> > > > > Drs., An MD can be disciplined for failure to provide> adequate pain control. What duty does a DC have to assure adequate pain> control in a patient ? > > sharron fuchs dc> > > > > > > > > > > ________________________________> > Stay in touch with old friends and meet new ones with Windows Live> Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575>>

[Guest guest]

Dr. McLagan, Addendum to my prior reply : let's saysaid DC thinks their order is correct, would you think that pain control should take a higher priority for patient comfort while treatment ensues ?

sharron fuchs dc

From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 1:10 PM Subject: Re: Pain control

Question: What is our duty as a Chiropractic Physician?Answer: First, to be a Physician. Second, to apply Chiropractic treatment.As a Physician we need to use our tools of evaluation and examination to properly diagnose a patients condition. A couple of obvious tools this DC should have used on the first visit, with the 90 year old patient, should have been immediate plain film x-rays followed by a lumbar MRI. The correct progression is: examination, diagnosis, then treatment. It seems as though, unfortunately, this DC went in reverse order. "My main concern and question is - in the very beginning and in theacute, acute stage should the patient have been referred out to get on top of the severe, agonizing , excruciating, debilitating pain so the patient could undergo DC treatment?"I understand your main concern regarding the patients pain, but, it is our "duty" to first examine and find the source of pain/irritation. Once this has been established, and a diagnosis has been made, then appropriate care can be determined (whether it be from a DC or not).Dr. , please don't kick me off for having an opinion. Thanks.Shad McLagan D.C.> > > > > Drs., An MD can be disciplined for failure to provide> adequate pain control. What duty does a DC have to assure adequate pain> control in a patient ? > > sharron fuchs dc> > > > > > > > > > > ________________________________> > Stay in touch with old friends and meet new ones with Windows Live> Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575>>

[Guest guest]

In the case that I describe the saying 'if all you have is a hammer, everything looks like a nail' keeps chirping in my head.I really think in this instance ,along with good diagnostic work up, the patient deserved the mercy of pain relief in the form of medication.

sharron fuchs dc

From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 2:57 PM Subject: Re: Pain control

Dr. Kierstyn"You are absolutely right....as a new practitioner, you do that with all of your patients. Once you have been in practice for 10 - 20 years and one of your long term patients comes in, you know them well, you've seen them through a number of exacerabations, "this is probably just another" is often the first - and the correct- impression. So the usual routine is skipped over to see how they fare (or to trust that they will fare as they usually do) with a good adjustment."I send my patients out for further imaging when it is warranted. In this case, it is. This should be obvious whether you are a new practitionor or have been practicing for "10-20 years". It doesn't matter if it is an existing patient or new patient. When someone walks into your office with "severe onset of low back and leg pain. Pain becomes agonizing, excruciating and she is unable to walk, drags the leg and must use crutches in order to ambulate", you send them out, regardless. An exacerbation of symptoms (ie, increase in pain) is different than "unable to walk, drags the leg and must use crutches in order to ambulate". This has nothing to do with how long I have been out in practice. Experience does not mean you are a good doctor, even if it is "10-20 years".Shad McLagan D.C.