Posted by cubbybear on March 19, 2005, at 7:34:32
In reply to Re: Analgesics » cubbybear, posted by ed_uk on March 18, 2005, at 8:18:29
> Did you read my posts to ace about MAOIs/anesthesia? I posted a few days ago.
I had missed it, but just accessed it and printed it out. This is very helpful and I'll keep it if and when the time ever comes for surgery.
I also have had major concerns about going for a routine colonoscopy. If the dr. says that it could be done with local anaesthesia and a sedative, I will certainly go that route, rather than with major anaesthesia. In any case, I need as much accurate info on MAOIs/anaesthesia as I can get my hands on.
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> > I know it could be very difficult in Thailand though, I remember you saying that no one was knowledgeable about MAOIs. If you *could* find an anesthetist who was knowledgeable about MAOIs, you almost certainly wouldn't need to discontinue the Parnate.I JUST got this brilliant idea--that if surgery were necessary, I would enlist the assistance of my psychiatrist (who obviously knows all about MAOIs) and put him in touch with the gastroenterologist (for colonoscopy) or orthopedist (for shoulder). There *are* many doctors who are familiar with MAOIs here; the more important issue, i guess, is whether the anaesthetists are knowledgeable and willing to work with an MAOI patient.
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> >No, there's never pain at rest, but only during certain movements, such as bringing the arm up and out to a horizontal or vertical position.
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> Pain that occurs on movement (incident pain) doesn't usually respond well to opioids, including oxycodone and morphine. There are usually more effective alternatives :-)Are you serious? Opioids might not be effective in my case? So what alternatives could there possibly be, that would also be compatible with Parnate?
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> You'd probably need about 50mg diclofenac three times a day, this is a common for musculo-skeletal pain, a lower dose might be adequate if you are over 65. At 50mg 3x a day, some analgesia may appear straight away. If significant inflammation is present, the full effects can take up to three weeks to develop. Diclofenac is often a good choice for musculo-skeletal pain.Well, this probably explains why I've concluded it's not effective. Since the pain is very much on/off, I've decided to use it as "really" needed, which means ,on some days not at all, and on other days, just once a day. Truthfully, I'm scared of the gastro-intestinal risks, although I'm in the low-risk category for NSAIDs.
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> Did you have any side effects from Voltaren when you took it before?
None.Have you asked your doctor whether it is safe to take a higher dose?
Yes, but he said that in my case, I'd best cut it out after a max. of 2 months. (if used at full dose).
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> I see you are worried about gastric side effects.
> Are you at high risk....
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> 1. Over 65.
No--I'm 56
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> 2. History of peptic ulcers (stomach or duodenal) or bleeding of the gastrointestinal tract.No
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> 3. Takes a corticosteroid eg. prednisone, prednisolone.
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No
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> 4. History of H. Pylori infection, even if eradicated.No
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> If you don't want to take a higher dose of diclofenac, you could consider combining a low dose of diclofenac with a standard dose of acetaminophen (paracetamol).I grew up on good old aspirin. Never heard of Paracetamol until I came to Thailand. Would a combo of Diclofenac and aspirin be as effective, do you think? (come to think of it, I've already tried diclofenac w/aspirin at low doses/as needed and saw no improvement)
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> >Myonal--muscle relaxant --as needed about 50-100 mg. day
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> I just looked this drug up: eperisone, I hadn't heard of it before, very interesting. It looks like it's only available in the Far East.It's made in Japan. Don't know why the distribution is seemingly limited.
It said the usual dose was 50mg three time a day. Is it helping?
Again, my very conservative use of the meds may have led me to believe it's not helpful. I've tried taking it solely as needed, nowhere near the the maximum dose. The website info seems to show little risk of (long-term) side effects with Myonal, so I'd consider upping the dose a lot sooner than I'd do so with the NSAID.
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As is the case with incident pain, pain due to muscle spasm doesn't usually respond that well to opioids.
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Can't believe it! After all the posts and info I've been reading, to learn this is quite a surprise.My plans are these:
1) Continue with 2-3x per week acupuncture for another week or two and assess efficacy. If I see no improvement,2) Consult again with orthopedist to discuss medications, including increased doses of Myonal, low-dose oxycodone, cortisone injection, MRI, etc.
Something tells me that an MRI would be a very good idea at this point, to tell me exactly what damage was done to the tendon, so we could get a more educated prognosis.
Meanwhile, thanks loads for all your help and sharing your knowledge.cubbybear
poster:cubbybear
thread:470781
URL: http://www.dr-bob.org/babble/20050317/msgs/472746.html