Let's Talk Pain.

[DustyKat]

Okay, so pain is assessed in a variety of ways but it is generally referred to in category types:

Acute - This is sudden onset and may be severe.

Sub Acate - Acute pain may progress to sub acute when it's duration is of 3 - 6 months.

Chronic - The pain is persistent and can range from mild to severe. It lasts for longer than 6 months.

I well imagine that many of you here fall into the the last category...chronic pain.

Anxiety and depression are recognised as co morbidities of IBD due to the chronic and incurable nature of the disease and these can then be exacerbated by chronic pain.

The pain many of you experience is called visceral. This type of pain is caused by the activation of sensory afferent nerves that innervate internal organs such as the stomach, kidney, gallbladder, urinary bladder, intestines or pancreas. There are a number of causes for visceral pain but the two that would be most appropriate to mention here are blockage and inflammation.
Visceral pain often produces the added symptoms of pallor, sweating and nausea, familiar to many of you I'm sure.

Then there are the pain issues associated with the extra intestinal manifestations of Crohns...arthritis, eye inflammation, skin disorders, headcahes and so on.

Since most of these pain issues, visceral and otherwise, stem from inflammation this automatically places the IBD sufferer behind the eight ball. Whilst inflammatory disorders that do not affect the bowel can proceed to the first line of treatment IBD sufferers cannot...that being NSAID's.
In my mind this muddies the water from the outset and complicates the management of pain.

In treating inflammatory disorders, or injuries to bone and tissue, the general consensus is to start out with a NSAID and then perhaps move to a co combination of NSAID's and a weak opioid such as Panadol. Failing this the move is then made to strong opioids.

Of course everyone's pain and perception of pain is different and for some weak opioids are sufficient to treat the pain they experience. But my goodness, isn't there a gaping void when NSAID's are removed from the equation. There are other paths that may be tried like the SSRI's and anti convulsants but their effectiveness can be quite hit and miss.

Is it any wonder that pain is such a frequent symptom and topic here. I think it's about time that many a health professional sat and considered what he/she is dealing with when approached by an IBD sufferer, why their pain is so complex and often difficult to relieve......

No doctor, I am not a junkie in search of my next fix......I can't take NSAID's.

Dusty. :heart:

 

[Dexky]

I swear Dusty!! You should get paid!!!

This would make a good Wiki article too!

 

[beth]

What she said!

 

[archie]

thanks for the up-date I treat patients pain daily and it's nice to have the technical side refreshed. Pain and people's perception to pain is very complex and by no means black and white. NSAIDS are very effective in the 1st line of defence but unfortunately are a no no for people suffering from IBD. There are other non pharmecutical options to treat pain e.g exercise, movement, acupuncture, heat, ice and distraction techniques etc etc that should be tried although what works for one doesn't always work for someone else. Past experiences and pshycological factors also contribute to differing pain levels and coping mechanisms. It is a very interesting subject.

 

[Carrie630]

What I've wondered is, what is our option for an anti-inflammatory since we can't take NSAIDs? is it only steroids?

 

[kllyeve]

Another thing I should print and take to Emergency with me so they can tell I am not fooling around when I come in with pain!!!

 

[DustyKat]

What I've wondered is, what is our option for an anti-inflammatory since we can't take NSAIDs? is it only steroids?

In true drug terms it is only steroids or non steroids.

There are other options in trying to induce remission, Flagyl has the ability to reduce inflammation but is normally used in conjunction with a steroid.
Enteral therapy has shown to be as effective in inducing remission as Prednisone is.
Of course these treatments are designed to reduce inflammation in an acute phase and don't really address the problem of chronic pain.

There are preventative type treatments to hopefully keep inflammation and disease at bay...fish oil, krill oil, probiotics and other supplements that I am not familiar or knowledgeable enough with to list.

Chronic pain also has other treatment sources outside of the drug realm as archie has stated.

I think my reason for broaching this subject is the issues people face with not only their pain but how they perceive it and health professionals perceive it when moving to the stronger opioids. Removal of the NSAID's can often leave little room for movement and stronger opioids often come with negative connotations and can have negative side effects and fears associated with it.

Just out of interest...I have read many stories on here of people suffering with chronic and debilitating pain. Considering their gut is already under seige by disease I am somewhat surprised that doctors continue to go down the path of copious amounts of oral medication. Even weak opioids, such as Panadol, taken 4 times a day equals 56 tablets a week. I wonder if moving to a low dose weekly morphine based patch isn't a better alternative. Just tossing ideas around.

Dusty. xxx

 

[ekay03]

outlier, I LOVE this chart!!!!

My pain is not ******* around...... I love it

 

[Carrie630]

Dusty, it amazes me how many pills get shoved at me when the doctors know how nauseous I am and that most of them pass through. I'm guessing that they're just used to prescribing the pills due to ease of use. I'd like patches or liquids over pills. currently 11 pills a day plus up to 8 pills for pain not to mention phenergen, xanax, or zanaflex. Sometimes I feel like I take in more pills than actual food

 

[ekay03]

In true drug terms it is only steroids or non steroids.
Just out of interest...I have read many stories on here of people suffering with chronic and debilitating pain. Considering their gut is already under seige by disease I am somewhat surprised that doctors continue to go down the path of copious amounts of oral medication. Even weak opioids, such as Panadol, taken 4 times a day equals 56 tablets a week. I wonder if moving to a low dose weekly morphine based patch isn't a better alternative. Just tossing ideas around.

Dusty. xxx

Dusty I have often thought the same thing. It would seem that would also decrease the amount of addiction. Seeing that patches and those time release pills are almost abuse-proof. I think its cause those things are all triplicate scripts and general practitioners dont often mess around w/ them

 

[Soybean]

OMG outlier! Isn't hyperbole and a half just the funniest website! I especially love the 'ALOT' post hehe!
xx

 

[beth]

Yup I use slow release transdermal pain relief patches! 5ug/h Butrans (buprenorphine) patches, they are enough when everything is being it's usual niggly self, but when something decides to go acute it's way too little. There are other patches, fentanyl is pretty powerful.

My GP is reluctant to up my patch strength, dont know why since he'll give me vast quantities of tramadol, so we're trying pregabalin to damp down my pain responses. Neuropathic painkillers are another 'weapon'. I'd hesitate to suggest they are an alternative as they have side effects.

 

[ekay03]

we're trying pregabalin to damp down my pain responses. Neuropathic painkillers are another 'weapon'. I'd hesitate to suggest they are an alternative as they have side effects.

Neuropathic painkillers have TONS of side effect. I am currently finding that out. I have tried thus far nortriptoline and amitriptoline. Both have too many side effect for me to deal with. I have decided that any drug with the word trip in it.......... Well is gonna be a trip!

 

[soretum]

I miss ibuprofen :-(

 

[ekay03]

I miss ibuprofen :-(

me too. Sometimes very rarely I will take them when my back is having an extra bad day. I know I shouldn't but I really hate pain!!!!!

 

[Carrie630]

my migraine pills are fiorinal so technically I'm not supposed to take them, but I have them just in case.

 

[scottmyster]

HI all, i am sorry to say no NSAID''s are good for you, bad for anyone who as IBD it will only inflame the intestine. I take Acetaminophen or opioids when needed to kill my pain i don't abuse them. like i said i only take them if necessary i take oxycodone and it does the trick. but, my pain is severe , and like others who are severe and very dibilating so i have no other choice.Best wishes.

 

[notfullyfathomed]

I had actually never heard of the connection between NSAIDs and IBD until I came to this forum...even after having a resection, my surgeon recommended alternating acetaminophen and ibuprofen so I could get off Percocet. Maybe there is a cost-benefit trade off? I've never noticed a relationship between ibuprofen and symptoms but I am being more cautious about it now!

 

[DustyKat]

Opioids and Constipation

Okay, so we know that a side effect of opioids is constipation, not very desirable particularly if you have narrowing and are prone to obstruction.

There is a drug on the market called Targinact (Oxycodone and Naloxone) that is touted to provide all the benefits of pain management without causing constipation.

So I'm curious to know if anyone has used it and did it do as they say it does?

I did a search and only found one post with a brief reference to it. I thought it may have been more widely prescribed overseas, particularly for those IBD patients in which constipation is so risky.
I know Endone (Oxycodone) is used quite widely in Australia and it was certainly the oral pain relieving drug that Matt was prescribed. It is available in Australia at full cost but is awaiting PBS listing...the Queensland floods held up funding.

Dusty.

 

[littlemissh]

Targinact is used in the uk but not that much as it still seems to cause constipation. Generally oxycodone and a laxative more effective if patches aren't tolerated.

What really irritates me is when you say you have pain but not taken analgesia because it doesn't work, you're frightened it will cause obstruction, cause a flare or make you more nauseated/vomit- and the healthcare professional gives you that look of... Well it can't be that bad then! The only ones who don't seem to do this are the ibd docs and nurses.

As you say dusty, our options are so limited. I have yet to find something that works for me when my pain becomes 'acute'- I will take that chart along I think and squirt some tomato ketchup around my eyes.

 

[DustyKat]

Thanks for that! Hmmm, I did wonder if it would live up to it's reputation.

Yeah, there are just too many out there that can't think outside the square. Rather than question you further as to why you can't take a certain analgesic they automatically think you are being difficult or as you say..."well she can't be in too much pain then, can she!"...and no doubt said or unsaid with a liberal dose of attitude!

I think the pain chart might just be the ticket! :lol:

Dusty. xxx