THE NHS NEW WAY TO TREAT CHRONIC PAIN AND FIBROMYALGIA…

As most of my readers will know I moved from the Midlands last July to the South. For the past 20 years, I had a great Pain Team looking after me in the Midlands and registered with a new Doctor the minute we arrived in Sussex so I could get the ball rolling to sort me out with a Pain Management Team here.

Just before I left the Midlands my Pain Consultant had referred me to a new PICS service which had just been set up near me. “PICS does not treat pain, they treat the patient which means using more holistic methods. Chronic pain can often lead to low mood, depression and anxiety because of being in pain all the time, so they work to try and get people back to what they enjoy and give them some quality of life. They have wellbeing practitioners who focus on support and activities. Hobbies and distractions are very important. Working through the pathway is proven to be successful with reduced GP visits and people returning to meaningful function – they start to do more in their daily lives.”

Unfortunately, with the move to Sussex I was unable to take advantage of this new facility for treating chronic pain, but a similar method is run here in Sussex, and yesterday I had my first meeting with my pain team which consisted of a Pain Consultant, a Clinical Nurse Specialist and a Clinical Specialist Physiotherapist.

Before the meeting, I had been given a number of Q & A’s to fill in all about my pain and how I dealt with it and I have to admit I was hoping that they would simply slot me in for some more injections and just discuss my medication.

We probably chatted for a good hour where they explained their program similar to PICS. The main points they felt about me was that I was not dealing with my pain well at all. They basically said that if the pain medications we’re working then I would not be asking for an injection and so they clearly were not working for me. They said I need to come off all my medication some of which I’ve been on for over 20 years. They made it clear that I will never have any more spinal surgery as the last two have left my spine in such a mess. “Your pain is never going to go away”, they said, “In fact it will probably get worse, so the only option is to show you how to cope and manage it”.

The sort of surgeries I had in the past is just not done anymore as they can now see how it affects the rest of your spine. ”Morphine”, was also given year’s ago they said but they now realise it’s the last drug they would ever give. With time everything changes and so I am about to embark on a journey I have never been on before.

All three of the team felt I was not pacing myself properly which is something they can teach me. I thought I was in control as long as I had my afternoon rest but they felt I was permanently pushing myself too hard.

Some of what they said did truly take me by surprise as deep down I thought I was doing ok and felt slightly intimidated by their opinion that I am actually not dealing with it well at all.

When I told my daughter she actually asked how I felt when they said “you obviously do too much”, ( as my family constantly tell me this ) and I said I guess it had to come from someone in the medical world for me to realise that maybe I am “sometimes” pushing myself too hard.

I was then sent for a blood test and they are organising a bone density scan ( which I’ve never had before) and the Pain Consultant told me to go and buy some Turmeric tablets as they are brilliant for inflammation.

One thing they could not stress more is how they say “ I will feel” when I am eventually of all my meds ( except for Paracetamol) as I am dealing with so many side effects from all the different medications I take. I guess I am quite anxious about coming off my meds but I would love to feel normal again.

My next appointment won’t be until after the scan and blood tests results are back. I will then be slowly cutting my meds down while being introduced to other ways of coping with my pain. I think this is going to be a very interesting journey to write about on here.

DIFFERENT TYPES OF TESTS FOR BACK PAIN PROBLEMS…

The first thing that most doctors will do when you see them about a persistent case of back pain will be to ask you a series of questions. They’ll want to know when the pain started and for how long you’ve been having it. You may be asked if your family has a history of back pain.

All these questions serve a purpose. The doctor is trying to ascertain if you have chronic pain, acute pain or if there’s some other underlying cause. In most cases, back pain tends to diminish and disappear after about a month or six weeks.

However, if the pain persists, there are a few diagnostic tests that your doctor may resort to. These tests have several purposes. They’ll be able to detect if the back pain is due to a tumor, cancer or some other problem.

If the patient has lost bladder control, it could be a serious problem where the spinal cord is under pressure. These tests will be able to detect why the problem is occurring. There are many possible causes from spinal infections to osteoporosis. These are best detected using advanced diagnostic tests.

X-ray

Of course, this is the most popular and common one that doctors resort to in the first stage. The high frequency radiation, will detect bone problems, tumors, infections, etc. It’s a painless process and this test will reveal several issues that aren’t outwardly visible.

Computed tomography scan

Also known as the ‘CT scan’, this diagnostic test is similar to an X-ray and often done together with a myelogram. A CT scan can detect nerve issues in the back, affected discs, spinal stenosis and much more.

Unlike an X-ray which can be done standing up, a CT scan will require you to lie on a table while your body is scanned.

Magnetic resonance imaging scan (MRI)

Like the CT scan, you’ll need to lie down while the scan is being done. Unlike an X-ray machine, MRI scans use radio and magnetic waves to produce the images that you see on the screen. These scans can detect dehydrated discs, facet joint issues and many other possible causes of back pain.

In many cases, the point of pain may not necessarily be where the pain originates. For example, shooting pains down your leg is an indicator of sciatica. The issue is not with your leg, but your lower back.

Bone scans

This is the type of scan you’d expect to see in a movie. It is very useful for detecting the specific part of the spine where the problem is occurring. The test is done by injecting the patient with a chemical that goes directly into their bloodstream.

The chemical will adhere to parts of the bone that are affected. A special camera is then used to detect the chemical in the body. The parts of the bone that are darker are the parts that are affected. This is an excellent way to detect bone density problems, tumors, infections, etc.

Blood tests

These can help determine whether you have an infection or other condition that might be causing your pain like inflammatory arthritis.

Nerve conduction tests

Electromyography (EMG) measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

I have personally had all of the above except the bone scans and I have found in the past that the MRI and nerve conduction tests have shown up my problems the best but everyone is different. The 4 scans above are the most commonly used ones. You can also find out lots more on the NHS website.

Your doctor will be the best person to advise you on the different tests and which ones will yield the best results when used to diagnose your condition.

OVER THE COUNTER MEDICATION FOR BACK PAIN AND FIBROMYALGIA…

This is a question that millions of back pain sufferers ask all the time. Is there any medication that works? The truth of the matter is that it all depends on the type of back pain that an individual has.

If the back pain is acute due to some injury, over-the-counter medication may be enough to relieve the symptoms while the body heals naturally. However, if you suffer from chronic back pain due to more serious issues such as degenerative disc disease or osteoporosis, the medication will only help to a minimal extent.

Medication is not the be-all and end-all of back pain treatment. You’d do well to lose excess weight, maintain a good posture, avoid sitting for long periods and even try out acupuncture or acupressure to help aid in the healing process.

The medication that you take will help to relieve the pain and discomfort so that you can exercise and improve your condition. Most over-the-counter medication will not only provide temporary pain relief, but will also relax your muscles and reduce swelling and inflammation while altering your perception of pain.

Holistic remedies are great, but when the pain is bad, there’s nothing like painkillers or non-steroidal anti-inflammatory drugs (NSAIDs) to bring fast relief. There’s nothing wrong with using these medications.

You’ll need to see what side effects you experience. They can vary from person to person. You may not even have any. You’ll only know when you try.

 

• Acetaminophen

Most over-the-counter types of medication contain paracetamol, also known as acetaminophen. These can be used to treat anything from headaches to fevers to back pain. It works by preventing the body from releasing pain chemicals. In this way the pain signals going to the brain are altered and you feel less pain.

While generally harmless, consuming these in the long run can lead to a toxic buildup within the body, and the liver may be affected.

 

• Opioids

Another type of medication that is used to treat back pain is opioids. Only a doctor can prescribe opioids because they’re much stronger drugs and usually used to treat chronic back pain.

The drugs work by increasing your tolerance to pain and reducing the body’s perception of pain. They’re similar to the acetaminophen, but on a much higher degree.

While opioids are powerful, in some cases, the back pain may be so bad that even though it’s mitigated, you can’t eradicate it. To make matters worse, the body develops a tolerance to opioids over time and they lose their effectiveness.

Therefore, it’s imperative that you use these painkillers as a temporary measure while you go about changing other aspects of your life to make the back pain more manageable. Maintaining a good posture and an ideal weight is far more beneficial to your back in the long run than any opioid or medication could be.

 

• NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs_ are extremely effective for pain treatment. In most cases of back pain, there will be accompanying inflammation of the soft tissues around the area. NSAIDs will reduce the inflammation and bring about much relief.

They’re more powerful than both acetaminophen and opioids. However, they do have side effects like nausea, indigestion, fatigue, etc.

At the end of the day, when it comes to medication for your back pain, it’s best to speak to a qualified doctor, and if possible, get a second opinion too. Use medication as one of several tools to treat your back pain. Don’t rely on it completely. As long as you adopt a multi-pronged approach to treating your back pain, you’ll find relief sooner and may even get rid of the pain totally.

ANTIDEPRESSANTS AS A TREATMENT FOR FIBROMYALGIA…

If, like me you have had Fibromyalgia for some time now you will probably have been given an antidepressant to try for the pain, or maybe even tried a mixture of these type of medications.

If you read all the information on the drug it could immediately put you off trying one but I’ve always felt you should always try before you decide if you want to stay on this type of meditation long term.

I will use my own personal usage of these as an example. Back in 2002 when I was first diagnosed with Fibromyalgia I was put onto ‘Fluexetine (Prozac)’ of 20 mg once a day. I seemed to get along well with this during the early years but it wasn’t long before they also offered me Amitryptyline (Elavil) of 10mg x 3 going up to 50mg, which I took alongside my Fluexetine.

I stayed on both these for a number of years but as I increased the Amitryptyline, it left me with one particular side effect of a very dry mouth. I mean really dry whereby I would sometimes struggle to get my words out and I also started having problems with my gums. My dentist suggested eating sugar free gum but to be honest with you I’m just not a lover of gum.

The pain team decided to then change me from Amitryptyline to Nortryptyline (Pamelor) as it was known to not cause as many side effects and could help me sleep better at night which was another symptom of Fibromyalgia that I was suffering from. The dosage was the same dosage as the Amitryptyline.

Fast forward 16 years and this year I was also advised to come off the Fluexetine as I had been on it for so long. They told me to come off it gradually and to see how I felt. I did exactly as they said and even though I was only taking 20mg I struggled so hard not just because I’m in more pain but from feeling extremely low and tearful, which isn’t me.

So, I decided I would go back onto Fluexetine (it’s still on my repeat) but it made me realise how you really can get addicted to these types of medications and that maybe someone should have suggested I tried to come off it a long time ago. I’ve never shied away from taking any medications they have offered me for pain relief and believe you really do have to take them for a few months to see any difference but it is also important that long term use should be taken into consideration.

On the website My Fibro Team they have a page on all the medications offered for Fibromyalgia and its overview of the three I have mentioned are – ‘Nortryptyline Pamelor is a prescription medication originally approved by the Food and Drug Administration (FDA) in 1964 for the treatment of depression. In cases of fibromyalgia, Pamelor can help reduce pain. The drug name of Pamelor is Nortriptyline.

Pamelor should be used with caution in people with a history of depression, bipolar disorder, or glaucoma. People who are recovering from a recent myocardial infarction (heart attack) should not take Pamelor.

Pamelor is a tricyclic antidepressant. It is believed that Pamelor works in cases of fibromyalgia by changing the balance of neurotransmitters in the brain.’

And ‘Amitryptyline Elavil is a prescription medication originally approved by the Food and Drug Administration (FDA) in 1961 for the treatment of depression. The drug name of Elavil is Amitriptyline. In cases of fibromyalgia, Elavil can reduce pain and improve sleep problems and fatigue.

Elavil should be used with caution in people with a history of depression, bipolar disorder, glaucoma, liver or kidney problems, high or low blood pressure, diabetes, seizures, trouble urinating, or alcohol dependence. Elavil is not suitable for use by women who are pregnant or breastfeeding. 

Elavil is a tricyclic antidepressant. It is believed that Elavil works in cases of fibromyalgia by interfering with nerve signals that communicate pain.

And as for Fluexetine- Prozac is a prescription drug approved by the Food and Drug Administration (FDA) in 1987 to treat depression. In people with fibromyalgia, Prozac can help improve mood and reduce fatigue. Prozac may also help reduce pain, sleep problems, and fatigue. Prozac is also known by its drug name, Fluoxetine hydrochloride.

Prozac should be used with caution in people who have a history of depression, seizures, anorexia, glaucoma, and heart problems, as well as those who are taking diuretics.

Prozac is an antidepressant of the selective serotonin reuptake inhibitors (SSRI) class. Prozac is believed to work by changing the balance of neurotransmitters in the brain. 

The My Fibro Team website has lots more information on medications taken for Fibromyalgia and is well worth reading if you are trying something new. Do you take any of these medications and if you have did they help with your pain?

WHAT ARE SOME OF THE MOST USED MEDICATIONS TO TAKE FOR FIBROMYALGIA?…

What are some of the most used medications to take for fibromyalgia?  According to Consumer Reports and Web MD the most popular medications are antidepressants, anti-seizure, muscle relaxants and over the counter pain relievers.

An article in Consumer Reports says that Experts say the best, overall strategy includes medications and nondrug therapies, such as exercise, counseling, and stress relief. The popular medications include antidepressants (amitriptyline, nortriptyline, fluoxetine, paroxetine, duloxetine, milnacipran), a few anti-seizure medications (gabapentin, pregabalin), and a muscle relaxant (cyclobenzaprine). But studies show that the benefits of these medications are generally small. There is no clear evidence that one drug is better than another, and all of them probably lose their benefit over time.

Web MD says that popular medication include antidepressants, serotonin, and norepinephrine reuptake inhibitors (SNRIs), muscle relaxants and include