Pain mgmt

[kimby2007]

Hi All:

After trying every single drop imaginable I have decided I need to see a pain mgmt doctor to see if there is anything that will help relieve me of some of the pain I have, would be very interested to hear any stories of people who pursued that route. Thanks as always.

[Rojzen]

veteran of successful pain management

Kcoffiner - - I think you will get some real help by going this route. . .As I've noted here before, I became a pain management clinic patient some years ago, and got excellent eye relief through a long course of amitripytline. (I now am blessed to get full eye pain relief through Dwelle and Dakrina.) Since then, I have learned that it can take 3 full months for a low dose of amitriptyline to work all of its magic. This drug, like select other tricyclic antidepressants, can significantly interfere with pain signals, often with no side effects. Doxepin, along these lines, has an excellent record on pain control, with added benefits for combating itching. (Hence, this latter drug is used both topically and internally).

I learned recently that anticonvulsants and mood stabilizers, like Lamictal, Neurontin, and Topamax, are also being used successfully for pain control.

Not to mention that over time, some direct pain treatments have evolved quite nicely. If your eye pain is not deemed neuropathic, then there are still quite a few plain old pain meds that could work. Ultracet and Ultram (tramadol) are opioids that are not controlled substances, and very well tolerated by many, for example. Officially, these are not deemed habit-forming. . .Regardless, I doubt you would need even occasional opioids if a good pain doc could find a solid long-term regimen for you...

Recently, I located a brilliant protocol for using the amino acid DLPA for pain control, and I am also exploring potassium supplementation and nutritional alkalinization for pain. As you know, I have several different pain syndromes, and at the moment, all are being very well controlled with supplements and a small dose of amitriptyline.

As I've mentioned, Dwelle, over a period of 7 months, eliminated my eye pain quite fully. .So I'm always recommending that people stick with the Dr. Holly drops for a good, long while before concluding that a second pain treatment is needed. . .For the moment, perhaps a pain doc could get you on something systemic, and this could be titrated down as you got increased relief from just the right topical. . .

[rubyslippers]

Ibuprofen takes the edge off a bit for me, but it causes my acid reflux to act up so I have to weigh the consequences. Don't get me wrong, it is still miserable but I cope just a tiny bit better.

[Rojzen]

the spiritual hurdle in the quest for pain relief

In the early days of my experiencing severe dry eye, I faced a very complicated struggle: Not only did I search in vain for some relief of the physical symptoms; I also struggled against judgments of family and friends who convinced me that relief by any means other than "natural" therapies was not worth pursuing at all. . .My own spouse, who meant well, convinced me, for a time, that if only I would devote many hours each day to "juicing" or to a very prolonged trial and error of homeopathic remedies, all my suffering would end. . .

It took quite a while for me to realize that there is nothing so powerful as simply being able to live again, and beyond the physical limitations of pain. . .and that I would be forgiven if I resorted to palliative medications. . .It took a long while for me to accept that just because I needed chemical help, this did not mean I would have dry eye disease forever. . .

Almost by accident, I found palliation through certain medications, and from there, I eventually got to here, where I discovered the approach that came to heal me more than any other. . .(Dr. Holly's drops). . .

Had I failed accidentally to overcome the early judgments and spiritual hurdles, I would not be up-and-running today. . .I would still be closed in a dark room, unable to engage the world. . .

I offer this by way of anticipating that there will be some who discourage the use of medications to reduce suffering. . .There is lots of truth to the notion that drugs are not a free ride; but then unrelieved suffering has its own deleterious effect on the capacity to heal. . .and so the situation seems to be a draw. . .and the reduction of suffering may just bring one to a place from which a deeper healing is possible...

[lilahp]

question as to specifics - and thanks!

Please forgive me, as I'm sure that you've listed this elsewhere and I should do a thorough search, but I am really sleepy right now. Do you mind if I ask your specific regimen as to supplementation?

I seem to feel better when taking Alka-Seltzer Gold sometimes, and when you mentioned alkinization (though I'm sure it's not the same thing), I perked up my ears. I've been surfing this site for months and have gotten a lot of good suggestions and insight. (Wish I could use any of the drops and most of the meds recommended!)

I have an airplane trip to a conference at the end of this month, with about nine co-workers. I require a nap every day (usually around noon) to function well, and am terrified that I'm not going to be able to do this at that time. I've hidden this need from most people. Also, as you know, airline air is awful, and many conference rooms aren't optimal, either.

Any suggestions you might have would be most appreciated. I have enjoyed reading your thoughtful replies.

[Nikki]

nerve block

Hi,

don't know if this is a smart idea or not, but i ended up going to a pain clinic. the pain doc gave me a nerve block (methylprednisolone) for the trigeminal nerve in my left side only - seems to have helped a bit with the pain.

I spoke with my optometrist. he stated that he thought that the shot shouldn't have interfered with my blink reflex or overall eye health, as only one eye was affected, and the other eye will be blinking as usual. is this right? i hope i didn't screw things up.

the pain doc said it takes about 3-7 days for the steroid to take effect. don't know how long it lasts. am also pursuing a semi-scleral contact through an optometrist whom Rebecca had suggested.

i hate it when you tell ophthalmologists that you have pain and they don't believe you. so you end up doing all the work yourself. pretty much makes them useless besides for verifying that your eyes are status quo. They won't prescribe anything for pain, except for topical eyedrops which lead to corneal problems - so that leads you to your GP and pain clinic for neuropathic medications like elavil, topamax, neurontin, you name it. it's a shame that cornea docs haven't learned that the cornea should be treated as a sensitive surface and an area of neurpathic pain just like any other area of the body. I think that this is an area of medicine in need of major revamping.

ok, done with my rant for the night. i just thought that it's rediculous that we have to go to 5 different doctors for pain when our primary doctor - the ophthalmologist - won't prescribe medication to treat the problem. I think ophthalmologists need education in terms of 1) believing patients when they say that they have pain and 2) prescribing systemic pain medications that are appropriate and work at alleviating the pain.

ok, done with my rant

scott

[Lucy]

Scott, this is something I'd consider. Please keep us informed. Thanks,
Lucy

[Nikki]

nerve, continued

Hi,

will do - if you're interested in where i went, i'll send you a PM where I went.

am headed back in a few weeks to follow up with the pain doc for a check up. am also seeing my cornea doc a day before the pain doc so figure he will tell me if he's mad at me or not. i figure if i'm brave enough i'll type up something and give it to him or at least encourage him to prescribe some systemic medications to dry eye patients with persistent pain problems.

i've been going to that clinic for 2 years and the eye clinic has yet to believe me with my pain issues. that's sad.

will keep you updated with the nerve shot stuff.

on the plus side, the pain doctors were the most compassionate and heartfelt physicians that i have ever met. i have never felt so much empathy and love from a group of physicians that i have from such a healthcare facility before.

my suggestion is that if there is a pain clinic in anywhere in the nearby realm - go investigate it. you may be thoroughly delighted. i was.

[Lucy]

Scott, I do have pain management clinics in my town. I have not visited one yet, but am just about to that point. I think you should write your doc a letter. Lucy

[YGB]

I've tried several neuropathic medications in search of relief of my post-LASIK eye pain. I started with amitriptyline which is considered a first line drug. This didn't do much for me except that it helped me sleep through the pain. I then moved to the second line drugs in the following order: neurontin, lyrica, and carbamazepine (slow release tegretol). The neurontin and lyrica just made me gain about 20 lbs.

The carbamazepine has provided moderate pain relief. The first 6-8 weeks on every increase in the dosage makes me sleepy. Also, I'm now on 800 mg and getting close to reaching the maximum dosage. My short term memory is suffering some. If you have to go to the higher doses, it begins to affect your cognitive skills. I'm not quite at the point where I'm carrying a camera around to remember where I've been (see movie Memento for explanation) but it's a noticeable difference in memory. Also, I think many neurologists or pain med MD's are hesitant to put people on carbamazepine because you then have to get your blood drawn periodically to see how your liver is metabolizing the drug. To me, that's not a big deal. My neurologist said that carbamazepine is the gold standard for treating neuropathic pain. If that is the case I don't know why I had to waste several months on neurontin and lyrica. I think all docs should jump straight to the gold standard and not make a patient work their way up from the bronze and silver.

At this point, I'll deal with the side effects for the pain relief. Unfortunately, the pain is still there but it's not as intense and constant as it was for most of the first 20 months (I'm now 2 years post-LASIK). I think neurological drugs can be worth investigating for those that tend to have more symptoms than signs. My schirmer score is between 1-2 but my cornea MD insists that aside from mild staining, my eyes look "good". However, my eyes feel dry and they often throb and ache. I will note that in my case, the pain also refers to my cheek bones and upper teeth which makes it a clearer case of having at least partial neuropathic etiology.

[Redbirdi]

Please be aware!

This is a tender subject for me. All this talk about medicines for pain relief, that is pain from Chronic Dry Eye. It just seems counterproductive to take a medicine that can and have caused DES in order to deal with the pain of DES.

My initial dry eye of 15 years ago started because I was given high doses of pain meds and anti-inflammatory (after a car accident). The obvious stomach damage and ulcers were easily diagnosed but the dry eye that would take away my ability to where contact lens did not show up and get diagnose until the damage was done. I wish I had know the price I’d pay for pain relief at that time… I would have reconsidered a life time of DES or a few months of ongoing pain.

I learned recently that anticonvulsants and mood stabilizers, like Lamictal, Neurontin, and Topamax, are also being used successfully for pain control.

Years later, I learned that the other medicines I was prescribed for the ongoing neurological disorders, and difficulties with depression pretty much dried out the rest of what my eyes had left, and did-in the Meibomian glands. I have proven to be in the 1-2 % of drug sensitivity across the board, from years of reactions to many medicines, but I am still very unhappy with the fact that no one ever warned me of these kinds of permanent side effects. So I feel compelled to share some of my experience here when reading these posts. Please add to your consideration the fact that most doctors don’t consider the painful experience of suffering from dry eye (many years later) and seem to ignore the side effects that include this.

I hope that your experiences with these medicines will be different, but please be aware.

[Nikki]

more on pain

Hello,

Rojzen got me interested in pain management and DLPA and all... so - I did some digging - and in case you're interested, you can also get Phenylalanine without the L component. That is, you can get D-Phenylalanine only. I know FTH makes it. they make 500 mg capsules - supposed to help increase the body's productions of endorphins or rather inhibiting their breakdown. haven't taken them personally yet so can't comment on their effectiveness. may be something to think about

thought it might help for folks interested in the pain-reducing aspects of phenylalinine but didn't want to mess around with their mood or whatnot that comes with the L isomer

Scott

[Lucy]

Scott, I don't have a PM from you. Lucy

[Nikki]

pain clinic

Hi,

sorry, Lucy, i'm a bit dense. I didn't realize that you wanted the info about my pain clinic. my bad! I sent you a PM.

Scott

[Nikki]

pain clinic

ok,

I'm going to stop writing now. in my effort to revise, i now posted twice. whoops! i'm done

Scot