Suggest Treatment For Pain Management

Posted on Mon, 28 Apr 2014

Question: Hi Dr. I have a question that I am unable to make a decision on. I have Fibromyalgia, Spinal stenosis, Arthritis, extremely bad lower back pain and just terrible neck pain due to bone spurs. I also have osteoarthritis. I have been on oxycodone, morphine, opana er, kadian. m My Dr. now would go to see a specialist so that I may be put on methadone. I have read up on this course of action and I am not sure. Right now I take lyrica, clonzapem, and Norco as needed. This pain is unbearable. I have had shots in my back, fingers, knees along with synvisc. Thanks and I hope you can help or give me another way or in your opinion a different drug. Thank you, XXXXXXX

Answered by Dr. Mukesh Chugh (49 minutes later)

Brief Answer: Conversion from Buprenorphine to methadone is easy Detailed Answer: Hi Thanks for writing After going through your suffering, I would prefer putting you on Subutex (buprenorphine) as it has following advantages as compare to methadone- 1. Chances of drug abuse are less with buprenorphine (subutex) as it has a ceiling effect that is the response does not increases proportionally as the dose increases after certain safe level. 2. If issues of cost are ignored, then Buprenorphine is the drug to start with. Because, it is easier to shift from Buprenorphine to methadone if required then vice versa. 3.Opioid treatment programme (OTP),require daily presence for methadone treatment while on Buprenorphine you may have to visit monthly to collect medicine, so if you are working it suits. My advice would be discuss with your primary care physician or doctors at the pain clinic to make a team decision that is best for you. Beside taking drug’s, I suggest you to follow the below mentioned measures to reduce your back pain and knee arthritis- 1. Usually 1-2 days of bed rest will calm severe back pain. Do not stay off your feet for longer, though. 2. Avoid lifting weights as it imparts more strain on your back 3.Change your daily activities so that you avoid movements that can cause further pain, especially bending forward and lifting as it will worsen the intervertebral disc problems. If you want to bend forwards, do it with your hips and knees flexed. 4. Use a lumbosacral back support to stabilize your spinal muscles and to provide support for your spinal column. 5. After the initial pain has subsided, remedial exercises to strengthen the spine are very important to restore normal spinal movements and muscle strength. The main aim of exercise is to encourage mobility, reduce muscle spasm, prevent further deterioration in the muscles and speed recovery. 6. You should maintain an optimum body weight. 7. At times, spinal steroid injections and Facet blocks will help in alleviating the lower back pain. I do hope that you have found something helpful and I will be glad to answer any further query. Take care Regards Dr.chugh, Orthopaedic surgeon

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Above answer was peer-reviewed by : Dr. Prasad