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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by CarolAnn on November 30, 2000, at 19:12:42
Long story short, I'm being treated for chronic facial pain, and after some improvement have relapsed, and NOW the doctor cuts off the prescription pain meds(hydrocodone), there's no reasoning with him. I've never asked for extra drugs, in fact have consistently stretched each one week script into two weeks of doses. He won't switch meds. either. OTC stuff has only minimal effect, even large doses, example: today at 10am I took three Aleve, at noon three extra strength tylenol, at 2pm three Ibuprophen, and never had significant pain reduction.
Any recommendations for other OTC stuff or effective mixtures of stuff? AND how much of this stuff and in what mixes can I take without killing myself. I am NOT good at being in pain! CarolAnn
p.s. also taking Doxepin (antidepressant for pain)100mgs. thanks ya'll!
Posted by Ted on November 30, 2000, at 19:30:24
In reply to help, anyone? Cam? pain relief questions...., posted by CarolAnn on November 30, 2000, at 19:12:42
Hi CarolAnn,
Please be careful witht he OTC drugs! Just because they are OTC doesn't make them harmless. Also, I have first hand experience that an excess of acetominophen (tylenol) will make it stop working until it is eliminated.
Now, about the pain, many clinics and hospitals have pain specialists and groups of doctors. Also, there are many university hospitals which do research on pain management. The UCSF medical center in San Francisco has a pain management group that is supposed to be excellent. Try looking around -- I am sure you will find a professional close by.
Good luck, and PLEASE take it easy on the meds!
Ted
> Long story short, I'm being treated for chronic facial pain, and after some improvement have relapsed, and NOW the doctor cuts off the prescription pain meds(hydrocodone), there's no reasoning with him. I've never asked for extra drugs, in fact have consistently stretched each one week script into two weeks of doses. He won't switch meds. either. OTC stuff has only minimal effect, even large doses, example: today at 10am I took three Aleve, at noon three extra strength tylenol, at 2pm three Ibuprophen, and never had significant pain reduction.
> Any recommendations for other OTC stuff or effective mixtures of stuff? AND how much of this stuff and in what mixes can I take without killing myself. I am NOT good at being in pain! CarolAnn
> p.s. also taking Doxepin (antidepressant for pain)100mgs. thanks ya'll!
Posted by michael on November 30, 2000, at 19:31:03
In reply to help, anyone? Cam? pain relief questions...., posted by CarolAnn on November 30, 2000, at 19:12:42
CarolAnn,
I'm no doctor. But I can tell you that I've seen tramadol available on the web from overseas pharm's... And if you look enough, fairly reasonably priced.
I have used it, and found it to be good for pain... but like I said, I don't know anything about mixing meds, safety, relative dosage strength, etc. So, I know it goes w/out saying, but be careful, especially w/recommendations from some clown on the internet (e.g.: me).
Sorry I don't have more to offer. Hope you get/find/learn what you need. michael
> Long story short, I'm being treated for chronic facial pain, and after some improvement have relapsed, and NOW the doctor cuts off the prescription pain meds(hydrocodone), there's no reasoning with him. I've never asked for extra drugs, in fact have consistently stretched each one week script into two weeks of doses. He won't switch meds. either. OTC stuff has only minimal effect, even large doses, example: today at 10am I took three Aleve, at noon three extra strength tylenol, at 2pm three Ibuprophen, and never had significant pain reduction.
> Any recommendations for other OTC stuff or effective mixtures of stuff? AND how much of this stuff and in what mixes can I take without killing myself. I am NOT good at being in pain! CarolAnn
> p.s. also taking Doxepin (antidepressant for pain)100mgs. thanks ya'll!
Posted by ksvt on November 30, 2000, at 22:49:02
In reply to help, anyone? Cam? pain relief questions...., posted by CarolAnn on November 30, 2000, at 19:12:42
> I don't know what to suggest, but if you don't mind my asking what's the history and diagnosis of this? I only ask because I went through about a 12 month period seeing specialists and having tests to figure out the sourse of a chronic facial pain? ksvt
Long story short, I'm being treated for chronic facial pain, and after some improvement have relapsed, and NOW the doctor cuts off the prescription pain meds(hydrocodone), there's no reasoning with him. I've never asked for extra drugs, in fact have consistently stretched each one week script into two weeks of doses. He won't switch meds. either. OTC stuff has only minimal effect, even large doses, example: today at 10am I took three Aleve, at noon three extra strength tylenol, at 2pm three Ibuprophen, and never had significant pain reduction.
> Any recommendations for other OTC stuff or effective mixtures of stuff? AND how much of this stuff and in what mixes can I take without killing myself. I am NOT good at being in pain! CarolAnn
> p.s. also taking Doxepin (antidepressant for pain)100mgs. thanks ya'll!
Posted by medlib on December 1, 2000, at 0:41:05
In reply to help, anyone? Cam? pain relief questions...., posted by CarolAnn on November 30, 2000, at 19:12:42
Carol Ann--
I'm so sorry about your pains--facial and M.D.! Sometimes it's a tossup whether they relieve as much pain as they cause. FWIW, his abrupt cutoff of your meds probably is related to guidelines from his practice, HMO, state medical board, insurance carriers, etc. regarding maximum number of narcotic doses to one patient/diagnosis over given time period. The hassle of justifying an exception may be bigger than his supply of compassion.
I second the recommendation of a pain clinic:
--They treat chronic pain and have more lenient narcotic restrictions.
--They are conversant with *all* types of pain relief--med and non-med. (Muscle-based pain like TMJ sometimes can be helped by biofeedback; nerve-based pain like TN can sometimes be helped by acupuncture or antiepileptics; some conditions can be alleviated by surgery.) The best pain relief is not only diagnosis-specific; it is tailored to the individual.
--They often are covered by insurance, although some require a referral.
--There are clinics that deal specifically with facial pain (i.e., at NYU).Perhaps, a different doctor could refer you to a pain clinic and supply you with enough meds to cover the period until you're able to see them.
If you are interested in, and up to, finding out more, try www.google.com. Searching on "treatment facial pain" brought up a number of useful hits.
Hope you're able to find some relief soon. Please keep us posted.
Well wishes---medlib
Long story short, I'm being treated for chronic facial pain, and after some improvement have relapsed, and NOW the doctor cuts off the prescription pain meds(hydrocodone), there's no reasoning with him. I've never asked for extra drugs, in fact have consistently stretched each one week script into two weeks of doses. He won't switch meds. either. OTC stuff has only minimal effect, even large doses, example: today at 10am I took three Aleve, at noon three extra strength tylenol, at 2pm three Ibuprophen, and never had significant pain reduction.
> Any recommendations for other OTC stuff or effective mixtures of stuff? AND how much of this stuff and in what mixes can I take without killing myself. I am NOT good at being in pain! CarolAnn
> p.s. also taking Doxepin (antidepressant for pain)100mgs. thanks ya'll!
Posted by quilter on December 1, 2000, at 1:24:11
In reply to Re: help, anyone? Cam? pain relief questions.... » CarolAnn, posted by medlib on December 1, 2000, at 0:41:05
I'm so sorry to hear this, Carolann. I had a bout with migraine/trigeminal neuralgia this fall so I understand how miserable facial pain can be. It seems to be mostly under control now. I ended up trying several meds to try to treat it. I got relief from some inpatient IV meds, and continue to take max doses of Neurontin, a muscle relaxant, and as much ibuprofen or naproxen as my stomach can handle. I also use imitrex and Tylenol-3 p.r.n. Tricyclic ADs can help as well. I hope this is useful and your M.D. starts treating you better ( in both senses of the word).
Quilter
Posted by Cam W. on December 1, 2000, at 7:07:08
In reply to help, anyone? Cam? pain relief questions...., posted by CarolAnn on November 30, 2000, at 19:12:42
CarolAnn - That nerve stuff is a bitch to treat. My suggestion, until the doc decides how he is going to handle this (low doses of Elavil or Inderal may be worth a shot, ask him) try using just one OTC pain killer (but not Tylenol - too toxic).
Since you guys have Alveve down there, use it. The dose you can use is up to 1000mg per day (8 x 125mg tablets split into 2 to 4 doses, depending on how your tummy handles it). Take the tablets with meals. Tell your doc that you are doing this, and could he please help out, before he has to trat you for stomach ulcers. That high Aleve dose is fairly safe for the short term (a month or two), but you do really start to risk ulcers if you take 1000mg a day for an extended period.
Outside of this, have you tried cold (or hot, at different times) compresses (wet facecloths) on the back of your neck or over the painful spots? It may or may not help, but it gives you something to do to take your mind off of the pain.
Just a couple thoughts (not thinking very clearly, lately). - Cam
Posted by CarolAnn on December 1, 2000, at 9:23:21
In reply to Re: help, anyone? Cam? pain relief questions...., posted by ksvt on November 30, 2000, at 22:49:02
ksvt, I have a long history of grinding and clenching my teeth at night and have worn a 'night' guard for years. Early this year I started having chronic pain on the left side of my face. The official diagnosis is something like 'massiter' myalgia. it has to do with the jaw muscles being overworked and then over compensating for being overworked, which shortens them , sort of a vicious cycle. The pain is very far ranging, from deep behind my left eye to my left back teeth and jaw and on down the left side of my neck. treatment involves two new mouth guards (medical term "splints") upper and lower teeth, worn nightly or more often, which is supposed to help the jaw muscles "relax" enabling them to eventually lengthen out back to where they should be. I, as is typical for me, am in the doctor's words, "a difficult case", so will be starting physical therapy on monday to augment the splint therapy. And, (just to throw in a personal gripe), none of this is covered by insurance, as it seems to fall into a no man's land of being neither a dental nor a medical problem!
I bet THAT was more then you ever wanted to know about a stranger's medical problems! Ha!
CarolAnn
Posted by CarolAnn on December 1, 2000, at 9:35:18
In reply to Re: help, pain relief questions.... » CarolAnn, posted by Cam W. on December 1, 2000, at 7:07:08
I really appreciate all the sympathy and suggestions! Thank you all very much for your time. CarolAnn
Posted by ksvt on December 1, 2000, at 16:34:14
In reply to Re: » ksvt, posted by CarolAnn on December 1, 2000, at 9:23:21
> CarolAnn - I was curious because I went through a year of having these periodic episodes of intense facial pain on one side of my face stretching from my gums to near the bridge of my nose. Lots of nights I couldn't sleep unless I was sitting up with a hot water bottle on my face. I saw a couple of different internists, an ENT guy, had 2 CT scans, went through a full range of allergy test and had a neurological workup. The neurologist simply decreed that the pain had no discernable source and he prescribed me tricyclics for pain management. I finally went to me dentist to be checked out for TMJ, and it took her about a minute to determine that I had a badly abcessed tooth. That this was a dental problem never crossed my mind because I had had a full set of xrays, (done by a different dentist) right before the pain started. Turns out I had a cracked filling which was patently obvious on the xray. I think dentist #1 never read the xray. One root canal and crown later, I am finally pain free, altho I too grind my teeth and this still causes problems particularly since, in my case, my dental roots and sinuses are too close. I have a great deal of sympathy for what your experiencing because the facial pain I had was more acute than anything I can remember. Altho I can feel pretty depressed about all I unnecessarily went through, at least my problem finally found a solution. I hope yours does too. ksvt
ksvt, I have a long history of grinding and clenching my teeth at night and have worn a 'night' guard for years. Early this year I started having chronic pain on the left side of my face. The official diagnosis is something like 'massiter' myalgia. it has to do with the jaw muscles being overworked and then over compensating for being overworked, which shortens them , sort of a vicious cycle. The pain is very far ranging, from deep behind my left eye to my left back teeth and jaw and on down the left side of my neck. treatment involves two new mouth guards (medical term "splints") upper and lower teeth, worn nightly or more often, which is supposed to help the jaw muscles "relax" enabling them to eventually lengthen out back to where they should be. I, as is typical for me, am in the doctor's words, "a difficult case", so will be starting physical therapy on monday to augment the splint therapy. And, (just to throw in a personal gripe), none of this is covered by insurance, as it seems to fall into a no man's land of being neither a dental nor a medical problem!
> I bet THAT was more then you ever wanted to know about a stranger's medical problems! Ha!
> CarolAnn
Posted by S. Howard on December 1, 2000, at 22:53:22
In reply to Re: » CarolAnn, posted by ksvt on December 1, 2000, at 16:34:14
CarolAnn-
Insurance companies try to pull that kind of crap all the time. If you see a dentist, your dental insurance should cover it. If you see a doctor, your medical insurance should cover it. The only exception is if you have an HMO and you went to a doctor without being referred there by your primary physician, or you went to a dentist who does not accept your dental health plan. Otherwise, your doctor or dentist should just keep submitting bills to the insurance company until they cough it up, which they will eventually, but your insurance co. will try to get you to pay for it first. Again, this is common practice, but unfortunately it goes on all the time. I got a CERTIFIED letter from my insurance company saying that they weren't going to pay my hospital bill, but they did. Don't let them bully you. You're responsible for your deductible or co-pay and that's it.
-Gracie
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