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Author Topic: Health: Pain Relief  (Read 694 times)

Morbid

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Pain Relief
« on: August 20, 2017, 06:11:16 am »
So, here's the scoop.  My dad lost his ankle/foot back in 2010, and he's now dealing with chronic pain, to the point he's on hydrocodone and morphine tablets as needed for pain.  Any suggestions for some more natural remedies?  I was looking into kratom powder, making a tea out of it.  Any experience with this? 
« Last Edit: May 07, 2019, 02:38:20 pm by RandallS »
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Noctua

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Re: Pain Relief
« Reply #1 on: August 20, 2017, 04:10:30 pm »
So, here's the scoop.  My dad lost his ankle/foot back in 2010, and he's now dealing with chronic pain, to the point he's on hydrocodone and morphine tablets as needed for pain.  Any suggestions for some more natural remedies?  I was looking into kratom powder, making a tea out of it.  Any experience with this?

I'd like a few more details, if you're willing. You mention an amputation, but don't make it clear if the pain is coming from the site of the amputation, is phantom pain from the missing appendage, or something else altogether. Also, it would be helpful for me to know a little more about the history of the amputation, because any advice I give would be different based on whether the cause was a crush injury vs. diabetic osteomyelitis.

Now disclaimer of bias: I work in the medical field. There's a little part of me that sighs whenever someone uses the words "natural remedies" because it implies that everything we do is "unnatural", when that's really quite a ways from the truth. Yes, hydrocodone and morphine are made in a lab, but it's a lab creating purified and refined versions of a compound that has been isolated from a natural plant (in this case Papaver somniferum, the opium poppy). Drugs like kratom may have a lot of potential benefit that needs looking into- but there also hasn't been any research into what, if any, negative side effects the drug may also have, or even what an appropriate dosing schedule may be. I'd be very leery of self-dosing any opioid agonists since there are so many fatal side effects (respiratory depression being the big one- you just stop breathing and die).

The prescribed opioids like hydrocodone and morphine have been studied extensively, and fatal side effects are extremely rare when taken as directed. There is some abuse potential, but that actually happens a lot less often when people are in real pain, because of how the neural pathways work.  Addiction and abuse typically happens when people keep taking the drug after the pain signals have died down or stopped altogether, and even then there's a lot of complicated brain chemistry behind it that we don't understand.

Anyway, end digression. The reason I ask for clarification on you father's pain is because there may be better alternatives to opioids if the pain is neurologic in origin, because opioids are actually really bad at treating neuropathic pain. Alternatives in that case range from a TENS device to anticonvulsant medications. Also, IANAD (if you're unfamiliar with that acronym, it means I Am Not A Doctor) and so any advice I give should not be considered to be expert advice. ;)

Morbid

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Re: Pain Relief
« Reply #2 on: August 20, 2017, 05:17:23 pm »
I'd like a few more details, if you're willing. You mention an amputation, but don't make it clear if the pain is coming from the site of the amputation, is phantom pain from the missing appendage, or something else altogether. Also, it would be helpful for me to know a little more about the history of the amputation, because any advice I give would be different based on whether the cause was a crush injury vs. diabetic osteomyelitis.

The pain is coming from his stump, from where he has very little muscle and walks basically on the bone.  There's no cushion to soften the blow.  Long story short version of what happened was his foot got wedged in between a motorcycle and a concrete floor.  It was either that or take the fork lift head on.  They tried to save it but it pretty much became a lost cause after you could see straight through his foot. 

Quote
Now disclaimer of bias: I work in the medical field. There's a little part of me that sighs whenever someone uses the words "natural remedies" because it implies that everything we do is "unnatural", when that's really quite a ways from the truth. Yes, hydrocodone and morphine are made in a lab, but).

By natural I mean something more readily available than the highly controlled morphine and hydrocodone he gets through the VA that he's been without for 5 days.  Not aiming as a replacement per se, but rather a supplementry option. 

Quote
The prescribed opioids like hydrocodone and morphine have been studied extensively, and fatal side effects are extremely rare when taken as directed. There is some abuse potential, but that actually happens a lot less often when people are in real pain, because of how the neural pathways work. 

He takes his exactly as directed, and I've literally seen him seize up in pain.  He tends to run out at the end of the month, and depending on how the VA is running, he might be without a day or two regularly.

Quote
Anyway, end digression. The reason I ask for clarification on you father's pain is because there may be better alternatives to opioids if the pain is neurologic in origin, because opioids are actually really bad at treating neuropathic pain. Alternatives in that case range from a TENS device to anticonvulsant medications. Also, IANAD (if you're unfamiliar with that acronym, it means I Am Not A Doctor) and so any advice I give should not be considered to be expert advice. ;)

He's tried a tens.  It doesn't help.  And don't worry, I can provide as much detail as you like.  I'll show you pictures from when he was in the hospital .  We were taking pictures and stuff.  The doctor showed us how his tendons worked with the exposed tendons.  (My family is really weird)
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Sefiru

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Re: Pain Relief
« Reply #3 on: August 21, 2017, 06:03:46 pm »
The pain is coming from his stump, from where he has very little muscle and walks basically on the bone. 

This may be simplistic, but maybe look into finding a better prosthetic? I mean, ill-fitting shoes are bad enough ...

Morbid

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Re: Pain Relief
« Reply #4 on: August 21, 2017, 07:15:16 pm »
This may be simplistic, but maybe look into finding a better prosthetic? I mean, ill-fitting shoes are bad enough ...

He's actually getting a new one soonish (next month or so?) so we'll see if that helps any.  But he'll still have chronic pain.  Now I'm not 100% sure but I think because the way his stump is limited in the prosthetics he can wear. 
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Noctua

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Re: Pain Relief
« Reply #5 on: August 22, 2017, 04:16:06 pm »
He's actually getting a new one soonish (next month or so?) so we'll see if that helps any.  But he'll still have chronic pain.  Now I'm not 100% sure but I think because the way his stump is limited in the prosthetics he can wear.

I'm glad to hear that, because a better-fitting prosthetic is also one of the things I was going to ask about. Also, I'm sorry to hear this is all going through the VA- I've known some really good providers who work in that system but "bureaucracy" doesn't even begin to describe the insane levels of red tape BS you need to get through to get anything done, both as patients and providers.

I think a good next step is to try and get a consult for a pain management specialist- which I know is an uphill battle in any health system, and even worse in the VA. They at least will have tools in their arsenal other than "throw more opiates" to try and attack the problem, but will also get a better assessment of what might be some of the possible physiologic causes for the pain than I could ever do over the internet. Some of the adjuvants they may feel are appropriate would be antidepressants and antispasmodic medications- when given at low doses they have minimal effect on brain chemistry, but instead help to interrupt the transmission of pain signals at the neural synapse.

Another possibility, if you live in one of the lucky states, is medicinal/recreational marijuana. Activating our brain's cannabinoid receptors is also a good way to interrupt the pain process in the brain. They are currently doing trials on some synthetic cannabinoids for pain relief, but thus far the only cannabinoids I know that are on the market are specifically tailored as antinausea/appetite stimulant meds. The good news is that once one of those drugs they're testing makes is past stage 3 trials, it will be available even in states that don't allow marijuana- probably as a schedule II much like opiates, but it's better than nothing.

My concern with kratom, besides the whole dosing thing I mentioned, is that it functions on the same neuroreceptors as his prescription opiates. Which means his risk for becoming tolerant to opioids, and requiring a higher dose to see an effect, becomes greater. In the interim, there are also a lot of non-pharmacological things we can try, including things like meditation and guided imagery (both things I'm sure you're familiar with). There's also a possibility that he may need a revision surgery to the residual limb, if there's issues such as nerve entrapment going on- but that's something that would have to be assessed by his doctor as to whether it would be a good option or not (and it may be moot if he doesn't want to undergo another surgery- a valid choice).

Sorry this whole thing is sort of rambly, train-of-thought writing, my semester is picking up now and it's hard for me to remember to eat dinner sometimes much less give thought to complex medical issues. ;) I hope I didn't lose you anywhere in that, if I was confusing in any way let me know and I'll be happy to talk more about it.

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