pharmaceutical vs. botanical

[The Laughing Man]

ok, i have this "friend" who injured his back and neck (strain/sprain of cervical spine and strain/sprain of lumbar spine, both w/bulging discs) and suffers from radiating/alternating pain and numbness in arms, hands, legs and feet. long story short = 1,200 (yes 1,200) pills a month:

oxycodone, percocet, methocarbanol, lyrica, ibuprofen, and lunesta (also trying to ween off norco?).

the problem: (other than 1,200 frickin pills a month) is that very often there is some kind of residual effect where he will get totally wiped out, walk around in a daze and even drive in this condition without realizing it, including taking more pills that aren't necessary. now, he has a valid condition which will never go away and will continue to deteriorate, so just cutting off the pills is not an answer, and he also realizes he is most likely addicted which only complicates the matter. steps have been taken to reduce the pill consumption, but this comes at the cost of added pain. it seems very likely that his pain threshold has been raised due to the mass quantities of drugs he has been taking, and i was hoping for some advice from some of our more learned and experienced members about how to go about compensating, with either different drugs or most hopefully some kind of herbal/botanical remedies that can help alleviate the transition to less drugs and also hopefully compliment the drugs he must continue to take to manage his considerable pain and chronic condition. muscle spasms are considerable in addition to the numbness/pain.

my "friend", his wife and his family are all just about at their wits end with little hope in sight if the current trend continues, and in an act of desperation reached out to me to see if we could come up with some alternatives.

so, my first thought was dlb, and my second thought was Menolly? storm? any advice guys? anybody else i'm not aware of/forgot to mention with experience with these things? anybody?

[Mortice Root]

Hi, Esmer.

A couple of thoughts I had reading your post, in no particular order:


Your friend may want to look into a medication called Ultram (generic is called tramadol). It's a non-narcotic pain reliever that is reasonably effective in treating chronic pain issues.

To go at this from another angle, your friend may want to look into accupunture. I'm generally not a huge supporter of alternative medicine therapies (mostly because most do not show any increased efficacy when rigoursly studied). But, accupunture does show some significant efficacy. Especially for a chronic pain issue, it can be a very effective adjunct to traditional medicinal therapy. As far as I am aware, no one really knows why it works, but studies have consistantly shown that it does work. Of course, it's effectiveness is dependant on the skill of the practitioner, and I'm not sure what the best way to evaluate that would be.

Lastly, who (what physician) is helping your friend manage his chronic pain? It sounds like a pretty complex situation that may be beyond the realm of experience of most primary care practioners, or even beyond some specialists (neurologists). Most health systems are starting to have chronic pain clinics, where the practioners there specialize in cases like your friend's - chronic pain, multiple medications, increasing medication side effects. This might be worth looking into for your friend.

Hope this helps. I hope things improve for your friend.

[Menolly]

Acupuncture may help. As a former chiropractic assistant, chiropractic is the course I would recommend. But, as MR states above, much depends on the practicioner. For sure I would recommend the Activator Method over hands-on manipulation; your friend's condition sounds like the gentler the better to start.

As far as herbals and botanicals go...
I can't think of anything OTC without training that would come close to what he is currently taking pharmaceutically. If there are any Eastern medicine practioners in his area, who may combine various holistic approaches and can guide him through being weaned off of this mix, I would recommend that approach.

[dlbpharmd]

Both MR and Menolly have made some points that I was going to make.

Another thought was a rare syndrome called hyperalgesia - this occurs in a small population of patients, and is a paradoxical reaction to opioids in which administration of a narcotic actually makes the pain worse. Obviously I don't know that your friend is experiencing this phenomenon, but it's a possiblity.

Some other thoughts:
1) Oxycodone - would that be OxyContin or one of the immediate release forms?
2) Methocarbamol is a very weak muscle relaxer. If your friend does not have documented muscle spasms (not always hand in hand with radiculopathic pain,) that might be a drug to discontinue. If he does have muscle spasms, he needs a more potent muscle relaxant agent, such as baclofen.
3) Consider methadone - the drug requires expert consultation such as a pain management specialist and close monitoring, but can be effective in refractory patients.
4) Lyrica is indicated in neuropathic pain caused by conditions such as diabetes; a second indication is for fibromyalgia. Your friend has documented spinal injuries. To my knowledge (I'll do research) no data are available that demonstrates efficacy in your friend's situation.
5) Is your friend a candidate for surgery? Physical therapy? Epidural injections? I had a herniated L4-L5 in 2001, and I'm convinced that physical therapy is the only reason why I'm pain free today.

[The Laughing Man]

thanx guys. mortice, the tramadol sounds interesting, being non-narcotic. i'll have him look into that one. the acupuncture was something we were discussing as well as a possible chiropractic approach. he was going to a pain management clinic thru workers comp, but that was settled and his current insurance (newly added to his wife's policy) did not cover this particular center for some reason and for financial reasons he dropped it. according to him they were just pushing pills on him anyway, so perhaps that was a good thing. i'm certain he will look into an alternate center in the near future tho, hopefully including acupuncture.

Menolly, that Activator Method looks quite interesting and i will be looking into that further as well. i appreciate your advice on the herbals, and that angle was really more of a supplemental rather than a replacement tact. a typical situation involves him taking the usual dosage of pills, them being ineffective, and him then taking more, thereby sending him into a virtual stupor. i was hoping something like a tea or a rub instead of a pill would be sufficient to accomodate the standard dosage not being sufficient. the only real thing i found that seems remotely promising was belladonna, chamomille, and crimson sage, but further research is obviously necessary, especially where mixing them with the pills is concerned, and of course mixing herbals themselves. what we don't want is any adverse reactions or side effects that render our efforts futile or even harmful. this is where i feel absolutely inadequate and my first reaction is to withhold advice until i get my masters in botany, heh. i'm a freak like that. but i'm sure some casual but focused research will be sufficient for the situation at hand, for the time being.

dlb, the hyperalgesia is new to both of us here, and will definitely take that up with his primary caregiver. methadone is also quite a new one on us. i had previously heard of that for heroin withdrawal, and was unaware of it's it's uses in other applications. interesting. you are also very perceptive with the fibromalgia diagnosis, as his dr. had mentioned that as a potential condition regarding his inability at times to manage the pain adequately, and also according to some symptoms he was beginning to experience. the methocarbamol was as exactly as you suggested, completely ineffective, thereby also causing him to overmedicate, and he really didn't bother with taking it at all lately, exacerbating the situation obviously. surgery is quite a last resort in his mind, and something to be avoided at all costs. he is very fearful of undergoing such a procedure only to have it be ineffective, or worse yet cause him even more complications, so thats out. he's rather be a pill junkie than go thru that.

thanx for the awesome advice and insights here guys, you've been a great help and given us some great ideas to look into. it's a pretty messed up situation, and anything we can do to try to alter the current course with your help is incredibly timely and much appreciated. i'll keep you updated, and will probably have more questions and information as we go along here, and once again know that we are deeply indebted to you for trying to help out.