Medication suggestions for breakthrough nerve pain

[Lernica]

Just wondering if anyone has any recommendations for breakthrough nerve pain. I have recently increased my daily gabapentin dose but am at kind of a loss as to what to take for incapacitating breakthrough pain. So far I have managed to avoid opiates since I am really afraid of constipation which significantly increases my PN pain.

I have just spent two days trapped in the house, icing and taking sitz baths around the clock, after sitting down for a 1.5 hour hair appointment a couple of days ago. (Vanity, you are my mistress!) Needless to say, Extra Strength Tylenol doesn't cut it! I've also been experimenting with Tylenol 3s and clonazapam (Klonipin) but would welcome other suggestions. I will be seeing my pain doctor next week and will be discussing my options with him.

Thanks very much.

P.S. I vow to never again sit in a hairdresser's chair!

[Faith]

I occasionally use very small doses of Ativan or tramadol but arivan is similar to klonopin. You just have to watch CNS depression with all these drugs. So sorry about the flare. I hope you find something to help.

[donstore]

Lernica,
I have found opiates (hydrocodone and oxycodone) to be effective for me and as long as I take colace and eat LOTS of fiber (broccolli, asparagus, spring mix) constipation has not been a problem. Hope you find relief.

Don

[missyrg]

I take Nucynta which helps quickly. It is narcotic for nreves. I do not have constipation but not sure why. I am so sorry you feel bad. I get flares but the meds help. I also take valium. Missy

[calluna]

Have you tried tramadol, Lernica? It takes the pain down a notch, it doesn't make it go away. I prefer the slow release version, better at evening things out I think. It is not an opiate, and most people don't get constipation with it. Also, I find that it suppresses hyperarousal symptoms.

Alternatively I would think that tapentadol would be worth a try - again, not an opiate, it is like second-generation tramadol but with increased effect on neuropathic pain. If the surgeon can't help me, then I shall be wanting to try this stuff.

[JeanieC]

Sorry about the flare, Lernica. Tylenol 3 is fairly weak as far as narcotics go, it contains 30mg of codeine with a regular strength tylenol. Personally, I find it more constipating and less effective than oxycodone (percocet) 10mg. I am trying Opana right now which is oxymorphone, also 10mg. It might be slightly more effective than oxycodone for me, but not much. I take oxycodone 10mg with .05mg of clonazepam to potentiate the pain relief effect as well as to help anxiety caused by pain. I take a stool softener every night too. I have not tried the ER kind of narcotics, as my pain management doctor thinks those would help me even less. None of these take the pain away, they just make you feel slightly better.

Fentanyl patches seem to help some people on this board but I have not tried this, I think it is the strongest option.

It's good that neurontin seems to work for you at least somewhat, but it would be good to have a better narcotic than tylenol 3 on hand for flares. The only thing you can do is give them a try and see how they work for you.

[Violet M]

Lernica, if plain tylenol doesn't help but tylenol #3 does basically that tells you tylenol isn't doing anything for you -- it's the opioid that is. It's my understanding that Tylenol is hard on your liver -- more so than opioids (used as prescribed) would be. There are lots of ways to prevent constipation so maybe it would make sense to go with the opioids that actually do something for you.

I'm with you though -- I think ice is one of the best things out there except that it doesn't allow you the freedom to do the things you want. I'm sorry you are paying so dearly just for having your hair done.

[Lernica]

Thanks everyone for your very good suggestions. I guess I will bite the bullet and try some opioids because I don't know how much longer my body (and my brain) can take this pain. At times I feel as though all the nerves in my body are fired up and tingling and sensitive to the touch, just because of that damn burning pudendal nerve. And my hips and back and lower tummy and perineum are also all on fire. I feel like I did some permanent damage to the nerve by sitting on it for too long. Do you think I did? I wonder if the hair appointment was the straw that broke the rhetoric pudendal nerve's back and gummed it permanently to the surrounding tissue. I have had no relief from the pain for the last four days, even though I left the house only once (today) to do some errands. Uggghhh. One step forward and two steps back . . .

I see my pain doctor on May 6 which is not soon enough!

[TracyB7777]

Oh Lernica, I'm so sorry you are still in such pain. I'm afraid the only thing that seems to help me is ice, ice and more ice and laying down. Crappy way to live but until we find what works (and each of us seems to be different) hyper avoidance of the triggers is best.