Posted by ed_uk2010 on April 18, 2010, at 8:44:00
In reply to Re: ultram, really... » ed_uk2010, posted by floatingbridge on April 17, 2010, at 18:50:57
Hi FB,
It's interesting that you mentioned the psych meds which are also used for pain relief eg. Cymbalta. What have you tried in terms of standard pain relievers eg. non-steroidal anti-inflammatory drugs?
Back pain can be an entire speciality in its own right. It's often difficult to treat but there are numerous options.
In terms of medication, the following are normally tried in (approximately) this order....
1. Regular acetaminophen - four times per day
2. Non-steroidal anti-inflammatory drugs (NSAIDs) eg. naproxen, Celebrex. A medication is often given to protect the stomach from the NSAID.
3. Combination analgesics eg. acetaminophen + a low potency opioid such as tramadol or codeine. An NSAID is often taken as well.
4. Potent opioids (oxycodone, morphine) for severe pain, if appropriate.
Muscle relaxants can be useful is spasm is a problem, at least in the short term. Interestingly, cyclobenzaprine (Flexeril) is related to the tricyclic antidepressants.
If nerves in the back are damaged or compressed, amitriptyline or nortriptyline are often prescribed. The TCAs can be quite sedating but some are worse than others. Nortriptyline is less sedating than amitriptyline. As you know, other TCAs are also used. As well as being used for nerve damage, TCAs are also used for chronic pain of other causes if standard pain relievers haven't worked, especially if sleep is impaired or if depression is a problem.
If TCAs are not tolerated, Cymbalta is sometimes helpful. It can cause side effects of its own, however.
Pregabalin (Lyrica) is prescribed mainly for nerve damage or compression. The mechanism of action and the side effects are different to the TCAs so it is often useful as an alternative.
A variety of other treatment are used by pain specialists. Some people have steroid injections into the back. This is not a pleasant procedure.
Physical therapists, osteopaths and chiropractors can all offer treatment for back pain. I have heard that some people who don't benefit from medication have found considerable relief. Some doctors offer acupuncture and I know someone who finds it very helpful.
poster:ed_uk2010
thread:943398
URL: http://www.dr-bob.org/babble/20100416/msgs/943807.html