Tag Archives: Pain Management

Life with LPHS

The pain started November of 2008 and I can remember the day like it was yesterday. I was at work on a break and immediately dropped to my knees in pain and thought my appendix has burst. I left work and went straight to my doctor.

The doctor did not know what was wrong and had ruled out my appendix as a cause. He thought maybe I had a cyst burst on my ovary game me a shot of pain meds and I was sent on my way. Well the pain continued on and I was referred to a urologist because an X-ray showed kidney stones in my right kidney. So off I went to the urologist to hope for some relief. The urologist was not sure how I was in so much pain since the stones were just sitting in my kidney.

At this time I had already had plans to move to NC and was scared of what to do. I was prescribed pain meds and sent on my way. Once in NC I met with a new urologist and he decided to do Lithotripsy, July, 2009 and break up the stones and see if that brings relief. Well to make my very long story short, it did not and then the following year I had more stones and attempted Lithotripsy once again. The 2nd Lithotripsy made the pain worse and it last non-stop.

After, being bounced from ortho to chiropractic to acupuncture….I took control and demanded to be sent to a Nephrologist. At the appointment, the Dr. walked in and told me he knows exactly what is going on and continued to explain Loin Pain Hematuria Syndrome and how all my history and test confirmed I have it.

I felt a weight lift off of me to know I finally have an answer and I am not crazy. However, he explained he felt horrible, but based on lack of studies there was nothing at this time he could do for me other than, send me to a Pain Clinic for pain management.

I was sad to be stuck with this and not have a cure yet happy hear the words pain relief. So off I go to yet another doctor very hopeful to find relief and get back to being NORMAL. The appointment lasted a whole 5 min. and the Nurse told me they could not treat me because they did not know how to and the fact there was no cure. I burst into tears and told her the pain was killing me.

At this point I didn’t even know what happy was anymore. I felt like cutting my own kidney out just to try and make it stop. When I left the clinic I called my nephrologist in tears and told him what had happened. He was very upset and said they should never refuse a chronic pain patient treatment. The next day I was woken to a call from him that he had sent my information to another pain management clinic and that he was so sorry for how I was treated.

This was in October, 2013 and I was not very hopeful anymore and was just like whatever. I have to say though I am so very thankful for the new pain clinic, they have been amazing and trying their best to find a way to manage this rare disease.

I am not 100% pain free but I have had a few pain free days for the first time in 6 years. It still is a struggle and I have my days I just want to lay in a ball and cry in pain but I must strive on and work.

I do agree this condition should be put for permanent disability until they find a cure because it is very hard to make it through the day in such horrid pain.

Ireland, Galway – Centre for Pain Research

http://www.nuigalway.ie/psychology/CPR.html

NUI Galway has formally launched the recently approved Centre for Pain Research (CPR). CPR aims to provide a centre of excellence for interdisciplinary research between the University and colleagues in the health service with the aim of advancing the scientific understanding of pain from the basic sciences to the population level.

Range of disciplines:

Pre-clinical research
Psychological and neuropsychological aspects of pain
Pain treatment and pain management
Population and policy aspects of pain
Integration of pre-clinical pain research and clinical practice

Directors:

Dept. of Pharmacology and Therapeutics
Dr. David Finn
david.finn@nuigalway.ie

Dept. of Psychology
Dr Brian McGuire
brian.mcguire@nuigalway.ie

Department of Psychology
National University of Ireland, Galway, University Road, Galway, Ireland.
Phone: +353 (0)91 493101
Fax: +353 (0)91 521355

Cyclobenzaprine

In another front in the quest to find effective nonopioid pain management strategies, Childers and associates[10] have found that low doses of cyclobenzaprine, a muscle relaxant related to the tricyclic class of antidepressants, when given as monotherapy, is as effective as cyclobenzaprine and ibuprofen combined. In addition, the low dose — 5 mg 3 times daily — is as effective as a higher dose used in other research with cyclobenzaprine — 10 mg 3 times daily. In this 7-day study, Childers and colleagues randomized 867 patients with acute muscle spasm of the back or neck to 5 mg of cyclobenzaprine 3 times daily or 400 mg or 800 mg of ibuprofen. All 3 treatment groups had a significant improvement over baseline (P < .001). The findings led the investigators to conclude that for musculoskeletal pain with a spasmodic component, cyclobenzaprine monotherapy, even at a low dose, is as effective as combination therapy with ibuprofen, a finding that broadens the options for patients who cannot take ibuprofen.

Selective Nerve Root Block

What is a selective nerve root block?

A selective nerve root block is a procedure that is used diagnostically to identify whether a spinal nerve is the generator of pain. Additionally, coincident injections of corticosteroid along with the local anesthetic block can be therapeutic and relieve pain.

What can I expect at the Pain Center?

A Pain Management Specialist at the clinic will assess your pain condition, take a medical history, and examine you to see if the procedure is a potentially beneficial option. At this time any precautions that need to be taken based on the status of your health may be discussed. Additional or alternative treatment options can be discussed. After this examination, the procedure can then be scheduled.

What should I do before the procedure?

Do not eat or drink non-clear liquids 6-8 hours prior to your procedure. You may drink a small amount (a few ounces) of clear liquid (water) up to 2-3 hours before your procedure. Take your routine medications the day of your procedure as you normally would with a small amount of water, unless instructed otherwise by the physician. If you take pain medications, do not take a dose 2 hours prior to your procedure time, unless otherwise instructed by the physician. If you take blood thinners (such as Coumadin), or you are a diabetic, you will need to follow special directions which the physician will give you prior to the procedure. It is mandatory that you arrange for someone to drive you home from the ambulatory surgical center after your procedure. Additional instructions may be given by the physician if necessary depending on your health status.

Where will the procedure be done?

In the ambulatory surgical center as an outpatient.

Will I be asleep for the procedure?

Monitored anesthesia care with light sedation may be medically indicated, based upon your health status, or to reduce unintentional movement during the procedure. Your physician will discuss this with you at the time of your appointment.

When will I have some relief of pain?

You may receive immediate pain relief after the procedure. If a patient receives partial improvement, then repeat injections may be indicated.

Will I be able to drive afterward?

No, do not operate motorized vehicles/equipment (ie cars, lawn mowers, power tools, kitchen appliances, etc) until the day after your procedure, especially if you have received sedation.

Will I be able to resume my normal activities after the procedure?

Yes, the next day. Just maintain good body mechanics and posture and continue with physical therapy or your home exercise program.

What are the risks of the procedure?

A full discussion of the risks of the procedure will occur when you meet the Pain Specialist who will perform the injection. Overall, the risks are relatively low.

The use of nerve blocks has also been criticised because of the lack of appropriate double-blind, randomised controlled trials. However, it must be appreciated that these are hard to carry out for non drug treatments, and in such a disparate group of patients as for instance those with low back pain and neurogenic pain. However, it is clear that trials are now being carried out and can show the efficacy of various treatments. On the whole I veer away from permanent lesions for patients with chronic non-malignant pain.

Facet joint denervations have been shown by Lord, Barnsley and Bogduk to be effective for both low back pain and neck pain resulting from whiplash injuries.

Efficacy and safety of epidural steroids have been investigated extensively and recent randomised controlled trials appear to show benefit for their use in limb pain and also in acute back pain or neck pain. It is essential for an appropriate dose to be used and for careful placement of the drug in the correct compartment. I would suggest the use of epidurography at least and the new technique of epiduroscopy is interesting, although as yet completely unproven.

It is understandable and tempting to think of a painful disc as the cause of a significant number of certain patients’ symptoms, and the new technique of disc denervation is another therapy under review at present.

Pulsed radiofrequency has been recommended by Dutch authors, but as yet I fail to see the rationale or the scientific evidence which would lead me to embrace this technique. At least it appears to be side-effect free, although it is a potentially expensive treatment, especially if it is only a placebo!

The use of Botulinum Toxin for muscle spasm is also under investigation at the present time. Clearly the agent has a powerful muscle relaxant effect, which is present from two to six months. Also it appears a relatively safe drug. However a great deal of work needs to be done now to identify the appropriate patients for treatment with this fairly extensive compound.