All posts by Abbie

Ever Have A Bad Epidural?

I’ll try an make this as short as I can. I was receiving a lumbar epidural steroid injection. I’ve had three different kinds of pain shots over the years – so I know what to expect.

This though went terribly wrong IMO. As soon as he hit me with that needle the most undescribable pain went throughout my entire body. I feel like I flipped like a fish or something, lunging off that table. There was the doc who gave the injection and two other people in the room. As soon as it happened I turned over blood red pissed and the doc said “that was normal, you’re ok.” I said “pal, I’ve had over 10-12 of these since 93, that ‘was NOT normal’.”

I could tell from the look on his face he knew he screwed up. Usually after a shot, it takes maybe thirty to forty seconds to wipe you off and pull up your britches and get in the wheelchair. I GUARANTEE it took two of those guys (not the doc – he hightailed it out of there) a little over three minutes to wipe off both the injection concoction along with my freeking spinal fluid that sprayed all over my back /shorts/ shoulders and even in my hair!

If he’d been honest or even apologized it wouldn’t have been as bad, but I feel he tried to play me for a fool. Shortly after that, I had the most incredible headache and I don’t do headaches. It lasted for a little over a week to week and a half. I crapped my pants and one other time three days later I walked down my hallway in baggy shorts with no underwear and literally unknown to me at the time – dropped a poop log right on the hallway floor. I was so numb “down there” I didn’t even know. When I would wipe my ass – for a couple weeks at least – I could hardly tell I was whiping – follow me? I don’t want to describe what can happen if that goes down, use your imagination.

The day after the shot, from my calves down to my feet looked like busted blood vessels, with the blood pooling mainly at the top of both of my feet. My legs and feet are now scarred and every now and then there is another break in a vessel in my feet and the blood comes to the top and then dries (I guess) or goes wherever leaving another nice scar. My legs and feet are now shot, both visually and physically. I now have pain down both legs and feet all the time 24 hrs. a day and before that shot – it was just pain in my lower back. I’d have maybe a little soreness in my knees but I don’t know if that was attributed to my back.

The day after the shot, their office was calling me (which they never did before -three times over eight business days) and was asking realllll nice “how I was doing” – which I responded not too nicely and I let them know I shit myself and crapped on my floor and didn’t even know it. Their response “well, it wasn’t anything Dr. At**** did (Cincinnati doctor BTW.)” I about busted out laughing and pissed at the same time.

Sooooo. At least for me, there will never again be a doctor sticking a needle in my back ever again. The most relief I ever received to begin with – was three months. Now knowing what CAN happen – nah baby nah – ain’t happening. I can PROMISE you that when it happens to you, and it will – sooner or later if you get enough of them….you’ll never let them do it again unless you’re into someone inflicting pain on yourself. I look forward to any response or anything I can contribute….I will try and everyone hang in there.:-)

My Story

My name is Ivy Goss. I am a 37 year old mother of 4.Recently I was diagnosed with a disease that is very uncommon; Loin pain-hematuria syndrome. Not much is known about this condition. There are no known cures. Once known as idiopathic hematuria, LPHS simply means you have blood in your urine, and pain in the kidneys and, or lower back, with no known explanation.

My mother and sister have the same symptoms, yet no diagnosis for the condition. They live in Pennsylvania. I live in Washington State.

Pain pills may be given to help make you more comfortable. In my opinion, this seems a lot like playing bare foot in a snowstorm when you have a common cold. Every pain pill offered to me has had an adverse effect on the kidneys or liver. Some of these pills have an addicting factor.

There have been days recently that my pain is at a disabling level. If not for the patience of both my employer, and fellow co-workers, unemployment would be likely.

My 16 year old daughter exhibits the same symptoms, blood with no infection; being the first sign that she may also have this disease. I am on a personal mission to discover what triggers this disease, and how to control the symptoms in a way that is not harmful to the future health of me and my daughter.

Meeting with a fitness trainer is at the top of my list. Diet and exercise will be the first avenue we explore.

Accidental painkiller deaths rose 91 percent, between 1999 and 2002.

A report, published in the online “Early View” edition of Pharmacoepidemiology and Drug Safety, listed 4,451 deaths for opioids without cocaine or heroin, while cocaine alone caused 2,569 or heroin alone 1,061 deaths.

The deaths from opioid-based painkillers — including oxycondone, hydrocodone, fentanyl and methadone — have increased in recent years, as the drugs themselves have become more popular on the black market.

Indeed, the profile of those who registered a significant number of accidental painkiller overdoses in the study — men in their 40sdoes not match “those of people who typically experience chronic pain, who are more likely to be female and older.”

Ultram ER

Ultram ER (tramadol HCl) is the first extended release tramadol product approved in the United States for relief of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time. Ultram ER is available in once-daily dosage strengths of 100 mg, 200 mg and 300 mg tablets.

The U. S. Food and Drug Administration (FDA) approved Ultram ER in September 2005 based on clinical and safety data obtained from four well- controlled clinical trials. More than 3,000 patients have been treated with Ultram ER in clinical trials.

Tramadol is a non-scheduled centrally-acting synthetic opioid analgesic that has been used in the treatment of moderate to moderately severe pain since its introduction in the United States in 1995. Ultram ER uses Biovail’s innovative Smartcoat(TM) technology* to produce an extended-release tablet that provides appropriate patients effective pain control over a 24-hour period in a convenient once-daily form of tramadol. In contrast, patients may need to take immediate release tramadol tablets every 4-6 hours for pain relief.

Ultram ER is contraindicated in any situation where opioids are contraindicated, including in those patients with a history of anaphylactoid reactions to opioids.

Seizures have been reported in patients receiving tramadol. The risk of seizure is increased with doses of tramadol above the recommended range and in patients taking certain medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors or opioids. Administration of tramadol may enhance the seizure risk in patients taking MAO inhibitors, neuroleptics, other drugs that reduce the seizure threshold, or in patients with epilepsy, those with a history of seizures, or in patients with a recognized risk for seizure (such as head trauma, metabolic disorders, alcohol and drug withdrawal, CNS infections).

Tramadol, like other opioids used in analgesia, can be abused. Ultram ER should not be used in patients who are suicidal or addiction-prone, or taken with alcohol-containing beverages.

In clinical trials the most frequently reported side effects associated with Ultram ER were dizziness, nausea, constipation, somnolence, and flushing.

Ultram ER Extended-Release Tablets are intended for oral use only and should be swallowed whole. The tablets should not be chewed, crushed, or split.

Ultram ER should not be administered at a dose exceeding 300 mg per day.

On the Net

ortho-mcneil.com
ultram-er.com/
Ultram description on medicinenet.com
Ultram description on opioids.com

Agreement form recommended for use before opioid treatment is prescribed

I understand that Dr ____________ is prescribing opioid medication to assist me in managing chronic pain that has not responded to other treatments. The risks, side effects, and benefits have been explained to me, and I agree to the following conditions of opioid treatment. Failure to adhere to these conditions will result in discontinuing the medication.

  1. The medication must be safe and effective. The goal is to use the lowest dose that is both safe and effective.
  2. The medication must assist me to function better. If my activity level or general function gets worse, the medication will be changed or discontinued.
  3. I will participate in other treatments that Dr ____________ recommends and will be ready to taper or discontinue the opioid medication as other effective treatments become available.
  4. I will take my medications exactly as prescribed and will not change the medication dosage or schedule without Dr ____________’s approval.
  5. I will keep regular appointments at the pain clinic.
  6. One doctor. All opioid and other controlled drugs for pain must be prescribed only by Dr __________.
  7. If I have another condition that requires the prescription of a controlled drug (narcotics, tranquilizers, barbiturates, or stimulants) or if I am hospitalized for any reason, I will inform the pain clinic within one business day.
  8. I will designate one pharmacy where all my prescriptions will be filled.
  9. I understand that lost or stolen prescriptions will not be replaced, and I will not request early refills.
  10. I agree to abstain from all illegal and recreational drugs and will provide urine or blood specimens at the doctor’s request to monitor my compliance.

    Signature: ___________________________________

    Date: _______________________________________
    (Patient)

    Signature: ___________________________________

    Date: _______________________________________
    (Chronic Pain Management staff)

Principles of opioid maintenance analgesia for chronic pain

  1. Successful management of chronic pain usually does not require the use of opioids; however, some patients with chronic pain can benefit from long-term opioid maintenance analgesia (OMA). These patients function better, maintain improved pain control with acceptable side effects, and continue to use their medications in a responsible, reliable manner.
  2. In some patients, pain cannot be managed with long-term use of opioids. Pain control is marginal, function does not improve, side effects may prohibit ongoing therapy, or the patient’s abilityto keep medication use under control is poor or erratic.
  3. Opioids are rarely adequate as the sole treatment for complex chronic pain, which usually requires a multimodal and often a multidisciplinary approach.
  4. OMA for chronic pain is neither a patient’s right nor a privilege. It is one treatment approach that may be chosen by mutual agreement between patient and physician.
  5. Candidates for OMA should:
    • Have an established diagnosis that is concordant with moderate to severe pain
    • Be reliable patients who are known to the physician and are expected to be compliant with the treatment protocol
    • Have exhausted reasonable alternative treatments and be open to new ments in the future
    • Not be using illegal drugs
    • Not be pregnant or likely to become pregnant during the course of treatment
  6. Patients with a history of addiction or poor impulse control are at increased risk for failing to comply with an OMA regimen.
  7. For daily pain, long-acting opioids taken on a fixed schedule are generally preferred for OMA. Limited quantities of nonopioids or shorter-acting opioids are acceptable for breakthrough pain in some cases.
  8. For episodic pain, limited quantities of opioid analgesics may be prescribed as needed.
  9. Meperidine hydrochloride is a poor choice for OMA because of metabolite toxicity with repeated dosing.
  10. For patients initiating OMA, a signed agreement outlining expectations and responsibilities is recommended (see box below). Failure to comply with the agreement should result in discontinuation of OMA or actions to ensure compliance in the future.
  11. Continuation of OMA depends on the following five factors:
    • The medication is safe with acceptable side effects.
    • The medication is effective; that is, pain is reduced and function and quality of life are improved.
    • The patient is a reliable and responsible participant in the treatment program.
    • The condition causing pain persists.
    • No specific or better alternative treatments are available.
  12. The physician’s responsibilities for OMA include:
    • Initial assessment of the pain problem, including relevant medical, psychological, and social factors
    • Scheduling regular office visits for reassessing pain and related conditions; monitoring safety, efficacy, and compliance; and managing side effects
    • Being prepared to continue OMA when it is working
    • Being prepared to taper and discontinue OMAwhen it is not working
    • Thorough documentation of the responsibilities listed
  13. Techniques for monitoring compliance include:
    • Conducting patient interviews
    • Checking patient’s compliance with appoint-ments
    • Obtaining collateral information from family members, other physicians, nurses, and pharmacists
    • Obtaining pharmacy profiles
    • Scheduling drug screens
  14. When discontinuing OMA, the weaning schedule depends on daily dosage and duration of treatment. No weaning is needed when opioids havebeen used occasionally; daily opioid use may re-quire weaning that ranges from 10 days to a few months.
  15. Referral to a pain specialist for consideration of OMA is warranted when:
    • The cause of pain is unclear
    • Behavioral, psychological, and social factors complicate the pain problem
    • The physician is unsure what additional treatment may be effective, or how to administer such treatment

Adapted, with permission, from Fairview Pain Management Center, Minneapolis.

MD – Pain clinics in Maryland

AGS Foundation For Health in Aging
http://www.healthinaging.org/

Non-profit organization established by
the American Geriatrics Society to build a bridge between the
research and practice of Geriatrics and the Public, and to
advocate on behalf of older adults and their special health
care needs.

American Alliance of Cancer Pain Initiatives
http://www.aacpi.wisc.edu

National organization dedicated to promoting cancer
pain relief nationwide by supporting the efforts of state and
regional pain initiatives.

American Cancer Society
http://www.cancer.org/docroot/home/index.asp

Nationwide, community-based voluntary health
organization that is committed to fighting cancer through
research, education, patient service, advocacy, and
rehabilitation. It provides health information and support for
patients, families, friends and professionals.

American Chronic Pain Association
http://www.theacpa.org

Organization offers support and information for people
with chronic pain, with over 400 chapters and support groups
throughout the U.S., Canada, Mexico, Australia and Europe.

American Pain Foundation
http://www.painfoundation.org

Independent nonprofit organization serving people
with pain through information, advocacy and support. Its
mission is to improve the quality of life for people with pain
by raising public awareness, providing practical information,
promoting research, and advocating to remove barriers and
increase access to effective pain management.

American Society For Pain Management Nursing
http://www.aspmn.org/

An organization of professional nurses dedicated to
promoting and providing optimal care of individuals with pain
through education, standards, advocacy and research.

Beth Israel Medical Center Dept. of Pain Medicine & Palliative Care
http://www.stoppain.org

Resource and information center with support
and information for patients, caregivers and professionals.

JCAHO Standards For Pain Management Revisions 2001
http://www.jcrinc.com/subscribers/perspectives.asp?durki=3243&site=10&return=2897

Develops professionally based standards and evaluates
and accredits general and rehabilitation hospitals, long term
care and assisted living facilities, clinics, home care
agencies and other health care organizations and programs in
the United States.

Johns Hopkins Chronic Pain Treatment Program
http://www.hopkinsmedicine.org/jhhpsychiatry/pain.htm

Comprehensive, multidisciplinary pain center for
the reduction of intractable chronic pain and its accompanying
emotional and medical complications.

Maryland Cancer Plan
http://www.marylandcancerplan.org

A new comprehensive cancer control planning
initiative to update the Maryland State Cancer Plan. It is
housed under the office of the Maryland State Council on
Cancer Control and includes subcommittees on pain management
and end of life issues.

Maryland General Assembly
http://mlis.state.md.us/

Provides information about the Maryland State
Legislature, including names and contact information of
Maryland Senators and Delegates, who sponsored a bill, what
the bill is about and what actions were taken.

Maryland Health Care For All!
http://www.healthcareforall.com/

Grassroots coalition working to ensure that all
Marylanders have access to quality and affordable health care.

Maryland Quality Care End-of-Life Council
http://www.oag.state.md.us/Healthpol/SAC/

Created in December 2002, the
Council advises the Office of the Attorney General, the
Department of Aging, and the Department of Health and Mental
Hygiene. It also advises the General Assembly on changes in
laws related to the provision of care at the end of life.

Maryland State Advisory Council on Pain Management
http://www.dhmh.state.md.us/ohcq/council/home.htm

Established in November 2002 to provide advice and
recommendations regarding issues of acute and chronic pain
management by Maryland health care providers, as well as the
pain management needs of adults and children.

Medbank of Maryland
http://www.medbankmd.org/

Non-profit organization whose mission is to provide
access to prescription medications for chronically ill,
low-income, underinsured/uninsured Maryland residents. MEDBANK
assists healthcare providers and patients in completing the
paperwork required to enroll patients in Pharmaceutical
Company Patient Assistance Programs.

National Initiative for Rheumatoid Arthritis
http://www.rheumatologycme.org/

Independent multi-component education program
offering online CME course, case studies, slides and other
resources for healthcare professionals.

Pain and Addiction Medicine Information Site (ASAM)
http://www.asam.org/pain/pain_and_addiction_medicine.htm

Information and resources on addiction
medicine and pain management from the American Society of
Addiction Medicine.

Pain Connection
http://www.pain-connection.org/

Non-profit human service agency in
Maryland that provides monthly pain support groups, information,
referrals and community education.

Pain Law Initiative

Mary Baluss, an attorney from
Washington, DC, is the Director of the Pain Law Initiative and
specializes in pain management cases, hospice care and end of
life care issues. She has developed and litigated legal
concepts intended to improve access to pain relief. She
advocates for both patients and the physicians who prescribe
opioids for chronic pain. She is also the General Counsel for
The National Foundation for the Treatment of Pain
http://www.paincare.org/. Ms. Baluss can be contacted
at the following address, phone numbers and/or email:

Mary Baluss, Esq.
Pain Law Initiative

2850 Arizona Terrace NW
Washington, DC 20016
202/244-0710 (phone)
202/361-2775 (cell-preferred number)
202/318-3027 (fax)
mbaluss@yahoo.com

Sickle Cell Information Center
http://www.scinfo.org

Sponsored by the Georgia Comprehensive
Sickle Cell Center at Grady Health System, the site o patient
and professional education, news, research updates and
worldwide sickle cell resources.

Stronger Bones
http://www.strongerbones.org/osteoporosis.html

Resource devoted to promoting bone
health and preventing osteoporosis, provided by the Maryland
Department of Health & Mental Hygieneís Office of Chronic
Disease Prevention.

University of Maryland Medicine Pain Center
htttp://www.umm.edu/pain/

Comprehensive, multidisciplinary pain center for
the assessment and treatment of chronic pain syndromes.