Diabetic Neuropathy & Excruciating Pain - page 2

Anyone else ever had a case like this? Homecare patient, 50 yr. old male, NIDDM, has had 2 episodes of severe pain in his shoulders (alternating sides, about a year apart.) His pulse was up over... Read More

  1. Visit  Disablednurse profile page
    0
    I have diabetic neuropathy in both of my feet. I am on Neurontin 900mg TID, MS Contin 60mg TID and oxycodone prn for breakthru pain r/t intractable back pain from failed back syndrome and it does not completely relieve the pain from my back much less the neuropathy. Doctors also have started me on elavil 100mg to try to help get the pain under control with no results. The doctors told me that I would never be able to nurse again. I feel for this gentleman, as I know what he is going thru. I am only 45 years old. It is difficult to adjust to the pain.
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  3. Visit  Buddha profile page
    0
    fab4fan:
    They have tried to work with a lower dose of oxycotin but she starts having extreme pain. She can fully function on the medication shes is on and is sharp as a tack. Most of the staff think shes faking her pain well I say thats bullpucky. I was taught "pain is what the patient says it is" and have seen this poor woman when they try to lower it and her doctor agrees.
    He came in the other day and ripped my Don who called another doctor to lower her medication d/t state regulation. The reg state the quaterly we have to try to lower her psychotropics and class three narc's. Then if she needs it we can put her dose back. So the patient has to be in pain for a state reg. Pure stupidity!
  4. Visit  fab4fan profile page
    0
    No, no...I mean that the amt of Duragesic should be converted to the equanalgesic dose of oxycodone, then factored into the present OxyContin, to give you the new dose of oxycodone (which will obviously be higher than the present one).

    Very difficult to titrate when you are using 2 different long-actings. Either that, or do the same with the oxycodone, and factor it into a new Duragesic dose, then use a short acting like OxyIR/MSIR for breakthrough.
  5. Visit  Dave ARNP profile page
    0
    While it may not be approp. to use two long actings together, it can and sometimes HAS to be done.

    Case and point,
    I have a middle aged female with multiple dx's contributing to her pain. Tried Duragesic in all doses, got no result. Then switched to MS Contin. Also tried Avinza and Kadian, but go no where. At one point, she was taking 800 of MS Contin BID. Still had severe pain. Added a third daily dose, which was titrated up to 800mg TID. Still no pain releif.

    One day, patient was very desperate, and stuck one of her old 25mg Duragesics on. The difference was NIGHT & DAY! Brought her MS Contin dose down to 100mg TID, and just use that plus a Duragesic 50mcg. Patient has 10x the QOL that she had before, and lives with MINIMAL pain.

    I agree, that we should try to use ONE long acting... but for some people, it will never work.

    Dave
  6. Visit  Dave ARNP profile page
    0
    Also failed to mention that (if not already done) Neurontin needs to be maxed up to 800mg TID. If you find that this isn't working very well, then and decide to try another drug in this class... be very very very careful with Tegretol. Older folks and Tegretol do not fair well.

    Also, did I mention how well Methadone treats this particular type of pain?

    Dave
  7. Visit  angelbear profile page
    0
    Dave, I have recently read a couple of articles stating that the use of neurontin is pretty much a hoax. Know anything about this?
  8. Visit  Dave ARNP profile page
    0
    Angelbear,
    Are you speaking about the use of Neurontin in Bi-polar disorder? I know that several months ago there were a couple of studies that basically said if you were treating BP disorder c Neurontin, then you were doing the equivlant of providing NO TREATMENT AT ALL! I never used Neurontin for BP Disorder, as I have found several other drugs that work much better for BP Disorder.

    I know that alot of clinicians beleive that using the combo of Neurontin and Ultram is useless. For mild pain, I think it does work really well, but for anything above very mild/mild.

    I still say that Neurontin is good for neropathic pain.

    Dave
  9. Visit  aimeee profile page
    0
    Neurontin is well tolerated by many but there seems to be a growing number of reports of people who had difficulties on it. There has been a lot of flak about the manufacturer marketing it for off-label uses.

    I have seen it work nicely in terminally ill cancer patients with neuropathic pain where we were able to bring their pain down to a tolerable level, and sometimes even reduce the narcotic dosage, greatly increasing their quality of life.
  10. Visit  aimeee profile page
    0
    Originally posted by Disablednurse
    I have diabetic neuropathy in both of my feet. I am on Neurontin 900mg TID, MS Contin 60mg TID and oxycodone prn for breakthru pain r/t intractable back pain from failed back syndrome and it does not completely relieve the pain from my back much less the neuropathy. Doctors also have started me on elavil 100mg to try to help get the pain under control with no results. The doctors told me that I would never be able to nurse again. I feel for this gentleman, as I know what he is going thru. I am only 45 years old. It is difficult to adjust to the pain.
    If you don't get improved results with the elavil, you might ask about trying effexor. I read about good results with that on medscape. It was a very limited study...still, if it worked for some, it might work for you. I copied the report here:

    http://allnurses.com/forums/showthread/t-23225.html
  11. Visit  Dave ARNP profile page
    0
    (What my drug rep told me)

    This information is based largely on the testing of Lilly's new Anti-depressant, Cymbalta.

    Cymbalta show's alot of promise for those with chronic pain, and may actually get an indication for that. To shortly sum it up, Cymbalta will do what Effexor XR will do when given at doses
    > 150mg.

    Sadly, Cymbalta hasn't been approved (was susposed to be approved last year, hasn't yet been). Still waiting

    Effexor XR is WONDERFUL, ALL AROUND! Most of my patients are on it. Depression, anxiety, chronic pain, social anxiety.

    I LOVE IT! And am on it myself.

    Dave


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