Pain Management in a world without NSAIDS

Miscellaneous and Personal Stuff I Must Share
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Before writing my O.P., a nod to the accepted norms regarding any medically related question here:

I am aware that soliciting medical advice on the SDMB is in no way a sound approach and speaking directly with a medical provider is strongly encouraged.

Now, then. On September 21, 2000 I broke my back in a fall. Since that day on a near-consistent basis I’ve ingested 1,000mg-2,000mg of Tylenol, Alleve or Advil per day.

At the time and in the first few years, a pain management specialist had started me on a series of non-NSAID meds. First Bextra. Then Celebrex. Then Vioxx. The Vioxx lasted less than a week because a widely-publicized report came out from the FDA showing that Vioxx led to increased strokes and heart attacks.

I was opposed to trying to use THC on a daily basis to manage the pain. For one thing, I couldn’t very well have a career or safely manage driving or being around my kids while stoned. ( I’ll save those of you who are angrily reaching for your keyboards the caloric expenditure of flaming me at this juncture: Everyone reacts to drugs of all classes differently. That last statement was fact FOR ME IN MY LIFE, not a judgement call or swipe at anyone else’s ability to manage THC in their lives. )

A recent awareness of the damage of long-term NSAIDS use and the possibility of winding up on dialysis for the rest of my life has caused me to simply stop. I may take an Advil here and there but 90% of my NSAIDS intake stopped a few weeks ago.

Well, this sucks. The number of pain-generating things going on in my body are legion. And now I feel them all !!

So, Dopers. Who has anecdotal evidence to share on pain management? Are there different classes of non-NSAIDS out there that are not in the Bextra family?

Narcotics writ large are completely off the table. Even something like Gabapentin wrecks my cognition. I was on it for a week or so post-spinal surgery last April. Gosh, that stuff is just Satan’s M&Ms, isn’t it?

Thoughts on options? I appreciate any and all possible solutions.

As Always,
Cartooniverse

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A tough situation, my friend. I can’t take NSAIDs due to renal and cardiac issues, and acetaminophen does nothing for my musculoskeletal and neuropathic pain so I do empathize. And tricyclics, GABA meds, and other neural modulation meds mess me up too much.

I’m retired so no longer doing any pain management, but I haven’t forgotten the basics. You won’t find an NSAID that you can take safely regularly, given the history you relate.

Any particular reason for opioids being completely a non-option? Some pain specialists are comfortable prescribing mixed opioid agonist/antagonists like buprenorphine or tramadol for select patients. I found benefit for some of my toughest pain patients with those meds. They are far far less sedating than the mainstream opioids like codeine, morphine, oxycodone, etc. Also they seem better tolerated than the GABA-type meds. They’re not free of side effects, but then no effective pain med really is. It appears they’re also far less abused than agonist opioids.

Just a thought. Good luck!

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I’m having the same problem. I used to take naprosyn to help with my knee pain, but now with my heart issues I’m only allowed acetaminophin for pain. Which, as you point out, does nothing for joint pain. My doctor did suggest that I use Volteran salve on my knees, which does help.

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Yes, topical NSAIDs like Voltaren (diclofenac) can be a big help for localized problems, but I’d need to soak in a tub of it, and then would get too much NSAID absorption anyway. :skunk:

Appropriate physical therapy, regular focused and general exercise, relaxation and stretching have also helped improve my function overall.

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My mother used tramadol for a while, and it was a godsend. It helped with her pain and didn’t knock out her limited (moderate dementia) cognitive function. They had started her on morphine, but that totally wiped her out, she couldn’t function at all.

Also, i know you said you can’t function on THC, but i know people who swear by CBD, which is another cannabis product that generally doesn’t make people “high”. It’s also legal in every state now, i believe. The regulation is iffy, because of the legal morass that is cannabis, so the stuff available is all over the map in terms of purity and concentration. But it might be worth trying, both to see if you tolerate it and if it helps you.

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Yes, I remember reading the cautions on the amount of Voltaren to apply either above or below the waist, and to be sure to wash my hands afterwards.

I had also seen a physical therapist who gave me a series of stretching exercises which I really should get back to doing.

@puzzlegal Before I started using the Voltaren on my knees, I had found that a CBD pain stick offered some relief. I had originally gotten it to use on my back at the recommendation of a friend.

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I’m really sorry for you.

Make darn sure you’re not eating or consuming anything that is harmful to joints and muscles.
You can’t eat your way pain free. But some foods cause pain to be worse.
Also don’t neglect your rest and sleep.
I’m much better well rested.

Consider massage therapy. It could release muscle tightness and leave you better able to cope with pain.

Good luck.

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Gabapentin helped me postpone back surgery for several years. Now I’m taking it once again for neck problems. Added benefit is I can sleep all the way through the night, whereas without it I may not even fall asleep until 4 a.m.

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I’m currently taking gabapentin, not for pain management, but as a sleep aid, And I know it works because on those rare occasions when I forget to take it I lay in bed staring at the insides or my eyelids wondering why I can’t sleep.

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Is Metamizole legal where you live? How about Arcoxia ( Etoricoxib)? The latter especially was the only general painkiller that could handle my gout.

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I understand and sympathize with your position. I am now retired and only drive when I want, not because I have to.

My back is trash and my hip is bone to bone, but unless I am willing to have back surgery, nobody will do anything about my hip because it won’t work. I understand this is my life now. I cannot walk more than fifty yards without taking a pain break, use a cane and avoid stairs at all costs. It sucks.

Linalool and Beta-Myrcene terps really do help with the swelling and the THC stops me from caring that I am in constant pain.

You know how folks who take large amounts of pain killers don’t get high off them anymore, they just need them to function? It works that way when you find the right sort of terps and canaboids.

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Chronic pain is hard to treat, and people differ in their response to meds. So the Internet is a doubly sketchy source for information on treating pain.

NSAIDs are good medicines. If you are taking them and your creatinine blood levels remain low with monitoring, you are unlikely to need dialysis. However, these medicines become riskier with age and do not always work for back pain. You can’t take them if on a blood thinner, and ASA is better following a heart attack.

Gabapentin, pregabalin, amitryptilline, nortryptilline and similar medicines have their place. Opioids often work, less so for back and neuropathic pain. Mixed agonist and antagonists like tramadol and buprenorphine may be good choices. But some find others helpful. Seeing a pain specialist might be reasonable given the complicated nature of pain. As you know, good pain treatment allows function and is defined as a subjective improvement in pain exceeding 50%. It is not always possible to eliminate pain. I wish you good luck.

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Metamizole is similar to NSAIDs but with less risk of causing renal problems. However it’s banned in the US, Canada, UK, France, Sweden, Norway and Australia due to its risk of causing agranulocytosis. This is a condition of decreased white blood cells, neutrophils in particular, thus raising risk of infection.

Etoricoxib is an NSAID similar to celebrex, with the usual risks associated that class of meds.

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First of all, Qadgop, you cannot possibly be retired. You’ve….always been out there….on the horizon, in the penal system. This boggles the mind. :slight_smile:
That said, here goes the replies. I’m on an iPad and can’t do one large reply so will work through these MUCH appreciated posts one at a time.

Opioids scare me. My limited experience has not been nightmares/ hallucinations or anything. It’s been seriously stoned. Disabled even.

I took some post-hip replacement and post-cervical spine surgery this past April. I’d love to find some other path.

I understand that witnessing Mom’s reactions to things like Gabapentin or Tramadol aren’t medically accurate but since, well, ,it’s my Mom and I know her so well, I can witness the altered mental ion with each of those meds. Gabapentin is Satan’s M&Ms. However, it’s possible that Tramadol might be useful.

I figure I have between now and end of May to try to find a good game plan. Until then I am working 3-4 days a week and even if I just tried a new medication for sleeping, were I to awaken “hung over” from a dose I cannot go into work and operate a camera crane in such a state. Unsafe, unethical.

Thank you for the good wishes !!

I realized that I didn’t post a very accurate, rather, a very full picture of the medical issues. I’ll do so out of a Reply window. May be useful in guiding suggestions.

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Puzzlegal: I am not opposed to THC. I got some tincture to use post-cervical surgery this past spring. Under the tongue oil. In NY State it’s legal to walk into a Dispensary. I knew that leaning on the narcotics post-op wasn’t going to cut it.

I ran out of them at the proper time and tapered carefully. Knew that having THC around would be useful. To be honest I cannot remember which “type” is more useful for pain management opposed to getting stoned in a fun way. I was guided by folks in the shop to a tincture used more for pain management.

The first night, I took a reasonable amount a few hours before I wanted to get to sleep. I’d not been stoned in decades, but knew what was up and wasn’t upset by it. I also knew that - as others have mentioned- were I to lean on this every day, that “cherry high” would fade back. That said, I slept quite well considering the intense neck pain post-op. I used it on and off for more than a month until the pain subsided. Since then, just a few times.

I could easily revisit. ( Hell, I wish I’d brought it with me. But I’m paranoid as anything and know I cannot cross state lines with THC in the car. I’m in the Midwest right now with a hot tooth that’s gonna come out sooner than later. Slept 5 hours and I bet that’s all I get tonight……… )

I tried CBD creams before the surgery. Might as well have been rubbing Vitamin E Oil into my neck. But I am a believer in the stuff and if it helped, I’d be using it right now.

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Hi Beck,
Thank you for these thoughts. Due to the nature of the orthopedic - centric pains, any kind of massage therapy is agonizing.

I DID look into the food angle. Various small adjustments didn’t have any effect. Then again, this is real bone and spinal cord stuff, not muscular-skeletal aches.

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I know I slammed it up-thread. Possibly a smaller dose would allow me to sleep without still feeling out of control at noon the next day………

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There’s a Stagehand I work with quite a bit who lives and works on THC. His pain levels would have him disabled and he’s…35? Maybe?

The heavier stuff, no matter what I try to get into with this issue, will be for sleep. I can’t risk having anything affecting me during the daytime.

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The Amitryptelline REALLY worked well pre- and post-op this past spring. I’d developed bone spurs in the cervical spinal cord and quite out of nowhere, had disabling neuropathy from the C3,4,5, area down the right shoulder, arm, wrist and into fingertips.

By the time I had the corrective surgery, I’d lost most muscle strength in that arm along with some of the mass. My handwriting was almost completely gone. It was frightening.

The Amitryp really did the trick with that pain. At first I was on 25mg and that left me pretty zonked the next morning. 10mg was just perfect.

Perhaps that is something to work on when I find a Pain Management Dr.

20

Now then, a more complete picture.

That spinal injury in 2000? The bone never healed. The fracture remained open in the L-3 for 18 months. Eventually a Vertebroplasty stabilized it. It took years for the pain to subside…but eventually the levels were around a 1-2.

The Rt hip was replaced in 2018. I do still have pain in it, sadly. The implant- aluminized ceramic with porous surface- gives me pain sometimes. I’m obese, those micro-fractures come with that territory. At some point the left hip will have to go as well.

The real concerns center around the pains associated with what has emerged in that L-3 area:

Severe arthritis in L 3,4,5, S1. Extreme Stenosis in the same areas.

Laminectory is in my future for the stenosis, or at some point shit ( pun barely intended ) will go sideways and I’ll slowly lose functions in all aspect down there. I’d much rather NOT be in that situation, so I know serious surgery is in the picture.

The arthritis in the facets is a direct result of that fall and vertical compression fracture in 2000. Add to the arthritis the fact that I have bone fusion happening in those Lumber and upper SI areas, mostly the facets, and it is just a painful area.

Sitting is hard, standing is agonizing. Walking is rough. A misstep off of a curb makes me scream.

So- it’s a weird combination of bone on bone pains and spinal cord compression ( the stenosis ) causing intense pains all in the same area.

In all, I must say that NOT going up that step ladder to try to wire the floodlight over the new deck would have been the best choice on the day………my life altered in all aspect in that moment.