Make the pain go away!!!

I hear you, Deb. I'm on Arimidex and the last 4 months (out of 4.8 years) have been especially a bear!



I've tried to analysis the reason for the pain:



a. Arimidex



b. Arimidex and Lipitor: turns out Lipitor inhibits Arimidex (NOT the aromatase enzyme) so the Arimidex may have been circulating and circulating, i.e., getting more than usual 1 mg dose per day



c. Lipitor itself. SE's are very similar in profile to AI's



d. Bisphosphonates. Musculoskeletal pain is side effect

Per Saluki today see:

http://www.fda.gov/medwatch/safety/2008/safety08.htm#Bisphosphonates

Turns out these can cause significant bone pain



e. Other



Since this feels so flu like (deep achy, sore, no fever) and muscle-affecting in addition to bone pain, I've decided to go to a therapeutic dose of NSAID. I respond best to ibuprofen (everyone responds differently to these drugs) so this may be 600 to 800 mg per day, divided with food for 2 weeks and see response. My oncologist is aware.



Just to make this more challenging, Jelly Donut posted an article on a well respected Swedish hormone specialist, who notes AI induced pain may be due to too little estrogen to stimulate a type of estrogen receptor called ER beta (different from the ER alpha we're all knowledgeable about). You can read about that here:



http://community.breastcancer.org/topic/73/conversation/698057?page=1#idx_2

Or, just look under the Research Thread: A Different Kind of Estrogen Article.



Wishing you didn't hurt too,

Tender

Shirley, Effexor and amatriptyline contradict.  I just recently started Effexor and I needed to be weaned off the amatriptyline before I could start the Effexor.  Please be careful.

Deb-

NO ONE should go off a narc drug they have been on long term cold turkey.  If you just stopped the drug without tapering off you can have quite a few bad side effects as well as dealing with out of control pain.  If you didn't taper off over the course of a few weeks, I would call you doc and discuss this.

Pain sucks.  I have a lot of pain, but lucky for me it is all low enough of a level I can function without needing narc drugs at the moment.  I just hate how they make me feel....I want too sleep all the time...

Have you tried a TENs unit or accupuncture?  Both things have helped me with pain in the past.

No one should have too "tough it out"  That is just a load of crap!  You should get the pain relief you need. 

I am sending you a gentle hug....I hope your doc gets things worked out for you....

Deb C

Thank you Shirley. 

This is absurd!  I would think he'd jump at the chance to send you to a pain clinic.  the objective is not basically to get you off meds, it' to find the cause and treat it!  Screw him.

Pain clinic docs have  a great deal more education in this field and should be consulted.

I have known local docs who didn't like pain clinics because the clinic would consult, write huge dose orders and then turn it back over the the initail doc to prescribe.  Now we all know that local docs are watched like hawks by the state boards and their records reviewed and they come down on them for "over prescribing" with fines and threats of loss of license.  so, I don't blame them for that.

My pcp won't write for xanax, i get the scrip from my onc.  No one questions his orders for large amounts of ANY med.

I have a good friend who's tried everything including surgery and just recently was put on Neurontin with huge great results in less than 48 hours with pain relief.

Ck out that pain clinic sooner rather than later.

Hugs.

The fibro dx would probably be worth it - then you'd get treated for pain right away.  It was actually very helpful to me to get the fibro dx, because then I actually got help.  A pain mgmt program with a pain mgmt clinic and a pain mgmt social worker and nurse who'd actually help!

I know what they'd say:

a) adequate medication - if the pain is spiraling up and up it turns the volume dial up, and then what would be a little bit of pain hurts way out of proportion - the goal is to catch the pain before it gets out the barn door and keep that volume DOWN

b) diet - no sugar, lots of water, lots of protein

c) deep breaths, hypnotherapy, meditation, positive visualization tapes'

d) walk 

e) anti-anxiety meds if they'll help

for MS, low fat, no red meat right? 

Hope you get the help you need and feel better soon!

Pain is supposed to be a new vital sign, and not ignored.  Sheesh. 

Reducing the amount of pain control medication a patient takes is not something a patient should be required to "tough out" under any circumstances.  This "physician" sounds like a sadist as well as an uninformed, cruel, insensitive moron who is neglecting his reading of the current medical literature regarding pain medications and anxiolytics taken for cancer and it's treatment se's (both immediate and long term) and the necessity for individualized dose reduction programs.

Vicodin is not the strongest opioid available.  Vicodin is hydrocodone.  Percocet or oxycodone is stronger and often better tolerated at a lower dose.  Darvacet is the poorest performer, strong NSAIDS are better.

If it is indeed necessary to withdraw from Vicodin, the reduction process should be taken very slowly or you risk an increase in pain and the increase in pain will increase anxiety which will increase pain perception.  Cancer pain, cancer treatment pain, and cancer related anxiety are all extremely real and must be removed.  Is this sadistic doctor under scrutiny for over-prescribing narcotics?   Or, in his opinion is it only right to allow a patient dealing with cancer relief from pain when it is terminal?  As in a couple of weeks left?  I think not! 

If in fact, you really need to go off medications, there are distinct regimens to assist in the withdrawal - none of which involve a sudden toughing it out. 

Pain/anxiolytic medication reduction should involve a mixture of medications aimed at a long term goal.  It's not a 'by next week' process if it's to work.  Simply thinking that goal must be reached immediately can throw a patient into a panic that increases anxiety and pain. 

First, xanax is not the best anxiolytic available.  It is an immediate acting however short acting drug.  In quickly, out quickly unless it's prescribed in an extended release form.  It has a tendency to cause the central nervous system to react inappropriately when taken over long periods of time.  The quick in and quick out nature of xanax causes the one who takes it to need it more frequently as tolerance builds up.  When tolerance has built up, the need shortens from .25 every four hours to .25 every 2 hours.  Then the patient feels anxiety symptoms (which unknown to the patient can actually be withdrawal symptoms due to the central nervous system's missing the drug).   Xanax has a short half life.  A drug with a longer half life should be taken alongside a slowly reduced dose of xanax until the xanax can be discontinued. 

The same is true for hydrocodone.  Another drug with a longer half life should be administered concommitantly with gradually reduced amounts of hydrocodone until the hydrocodone can be safely discontinued.  At no time should the patient be made to feel uncomfortable withdrawal symptoms.  Over time, the drug with the longer half life can be gradually reduced until it is not missed by the patient.

It is true that the pain or anxiety symptoms  that led to the prescription of a narcotic or anxiolytic can mimic the symptoms of its removal from the body. 

A relaxed medication management protocol designed by an expert in pain management where the doctor is not "on trial" for over-prescription of controlled substances, enables reduction in medication dosage and can be handled in a far more humane fashion than that ordered by the sadistic excuse for a physician above.

That physician should spend a day with neuropathy before detemining the "right?" way to reduce pain medication. 

Another thing, I thought with the moving forward of civilization, we would not be thrown back in the dark ages of medicine.  It seems as though the disapproval of pain assistance medications has only gained medical popularity in the past...what...30 years or so?  Maybe less?  Why?  Why do patients have to suffer more pain now with physicians in fear of losing their prescription licensure of controlled substances?  Our great grandparents had no trouble acquiring narcotic medications when necessary a hundred years ago. Why should women of any age or anyone of any gender suffer the pain of cancer or cancer treatment with the threat of their pain relief taken from them prematurely or abruptly hanging over their heads?

As you can see, this subject gets me riled up.  I hate like anything to see anyone in pain and just want to help fix it. When I hear of a cancer patient whose doctor "doesn't want them to get addicted" I think what in the heck are you thinking??  The person has cancer pain and getting addicted is the least of their worries at the moment! I get disgusted with obstinate, supercilious physicians who withhold medications from those who need them.  And that's my two cents. I'll tell you all one thing, I will never allow a loved one of mine to suffer in pain as long as I'm around to help.

To you Deb, I suggest you go call the pain clinic and tell them of your trials with the other doctor.  Tell them if you need to reduce your meds, will they help you do it in a humane way that won't cause you more pain and stress.  Tell them there is no way you will make it to the 23rd on 10 tylenol with codeine and keep going up the chain of command until you reach someone who will help you. If you don't get anywhere, go to the ER and tell them you've been a cancer patient on pain meds and they've suddenly been withdrawn and you need help. My guess is you need a combination of anti-anxiety muscle relaxants, and pain meds all with long half lives and a real slow reduction plan. Good luck.