Nerve pain meds

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Bill in Oregon
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Nerve pain meds

Post by Bill in Oregon »

My back surgeon wants me to consider trying either gabapentin or Lyrica for the nerve pain associated with "post-laminectomy syndrome" in Lumber 4-5. It's still pretty bad at times in the right leg more than a year after the laminectomy. But after reading all the literature on these two meds, there are a bunch of side effects and interactions I would rather avoid -- dizziness, memory loss, worsening of depression/suicidal thoughts and it will interfere with my danged beer that gets me through the evenings. I no longer have friends or family support closer than about 600 miles, so the potential for trouble here is very discouraging. Anyone else been on these?
I see in the back pain forums some get relief from some of the non-intoxicating CBD extracts from the marijuana plant, but for some reason I am very reluctant to go down that road. It just seems ... un-American ... or something.
Feel free to PM if you'd prefer, and thanks in advance.
Last edited by Bill in Oregon on Mon Jun 04, 2018 3:03 pm, edited 1 time in total.
Alan in Vermont
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Re: Neve pain meds

Post by Alan in Vermont »

I tried Lyrica for pain from nerve damage incurred during shoulder surgery. It helped the pain but left me way to close to a zombie so I ditched it and toughed it out, it finally went away with time.
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Re: Neve pain meds

Post by Ray »

Billy, i know nothing about pills but do pray that GOD will at least ease your pain if not outright heal its source....

I've got that unfinished grey-rat uberti remington that I bought from you loaded that i need to go empty before this awful humidity cakes the powder. You can be sure I'll be thinking of you when I slay that tree stump with it.
m.A.g.a. !
Bill in Oregon
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Re: Nerve pain meds

Post by Bill in Oregon »

Alan, that's just one of the side effects that concerns me.
Ray, go give that stump what for! If it is the one I am thinking of, there is a rumor that it has been making impertinent remarks about President Davis's horsemanship, but we all know that man could ride like the wind.
8)
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Re: Nerve pain meds

Post by piller »

Bill, I think Gabapentin is better than Lyrica, BUT, neither is the best idea. Anything which messes with nerves can mess with your brain. T.E.N.S units usually help. Diclofenac gel may help. Lidocaine patches may help. Capsaicin cream usually helps after the burning goes away.

There isn't a good one size fits all solution. I hope you and your Doctor can get things worked out. Prayers sent.
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Old No7
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Re: Nerve pain meds

Post by Old No7 »

After trying many meds and even more surgery, my best friend got the best and most long-lasting and symptom-free pail relief from...

Accupuncture.

And he's the most conservative guy you'd ever meet; but he was so desperate for a good solution, he finally tried this "alternative" and "unconventional" therapy.

He used to go 2X weekly for 2 weeks, then weekly for a couple of months, and then 1X monthly, and now he only goes there if he overdoes it or gets sUpEr StReSsEd At WoRk (which is a trigger point, no pun intended, for him).

Seriously, you might just want to give this a try.

Good luck Bill!

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Re: Nerve pain meds

Post by piller »

It might help. Some of my patients have come off of their pain meds after trying it. I do work retail and need to sell to remain employed, but I am ABSOLUTELY against causing harm. If the medicine causes harm, I am the first one to tell you to stop taking it. I am in favor of using something which works as long as it does not cause harm. If acupuncture works, then that is great. I happen to have some anomalous liver issues. It causes most Doctors to get angry when treating me because they have to listen to me. I have a printout I give them which shows which medicines are broken down by which liver enzymes. I also have a printout from a laboratory showing which liver enzymes I am genetically missing. A simple matchup is all that is required to see if the medicine will fail/harm me. Every Doctor who graduater from Baylor School of Medicine has been infuriated by me.
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Bill in Oregon
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Re: Nerve pain meds

Post by Bill in Oregon »

Piller, thank you for those thoughts. My internist prescribed Diclofenac and maybe I should try that. I get TENS treatments with my P.T. and have a TENS machine myself -- just don't use it much. For muscular pain, I am a believer in Pain Wizard, recommended here by someone several years ago. It is a mix of capsaicin, camphor, menthol and MSM. Not sure it will help an "insulted" nerve bundle.
Darryl, as far as I can tell, acupuncture is like the CBD stuff -- works great for some, not much for others. I'll keep it on the list.
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Re: Nerve pain meds

Post by Pisgah »

Don't make any snap judgements against the CBD. My cousin suffers from diabetic neuropathy and has been through the gabapentin/lyrica, etc., route. All of those meds helped -- for a while. But all seemed to lose effectiveness after a short while. On the advice of a chiropractor friend, and with the knowledge of her regular doctor, she started using CBD a year ago. The difference has been miraculous. She still has some pain from time to time but it is manageable, and the side effects have been zero.

Encouraged by her results, I began taking CBD for my bad right shoulder. Surgery was recommended years ago but, right or wrong, I have resisted it. It had gotten bad enough that I was considering seriously going ahead with the surgery -- but after a week taking the CBD the pain was reduced at least 90%, and I actually sometimes forget I even have a bum wing. Six months on, still getting full benefit, no side effects -- I am a believer.
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Re: Nerve pain meds

Post by piller »

Pain Wizard may help. Give it a try. If it lowers the level of felt pain, then it has helped. Sometimes, you need 2 or more minor, but non harmful, helpers before you get to the point where you can function normally again.
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Re: Nerve pain meds

Post by piller »

I don't know a lot about Marijuana extracts, but there doesn't seem to be a single reason to refuse to try them as long as your employer does not do random drug tests. Many natural products are helpful when used with appropriate caution. I mean that you don't cause yourself or others any harm. Pretty much the same warning I give about muscle relaxers.
D. Brian Casady
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Bill in Oregon
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Re: Nerve pain meds

Post by Bill in Oregon »

Pisgah, are you applying oil or cream topically, or taking a capsule? Somehow I have less of a problem with a topical application, but heck, if it works ...
Piller, I have a prescription for cyclobenzaprine but do not care much for the stuff and avoid if possible.
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Re: Nerve pain meds

Post by JerryB »

We have a grandson that we raised that is a chiropractor in North Carolina. He has been asking patients to try the CBD capsules and the cream. He orders it from Colorado and said the patients are getting good results with both of them. I read about it and there is not any of the stuff that messes with your head in CBD.
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David
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Re: Nerve pain meds

Post by David »

I assume 4-5 from the back, that can be nasty.
I know pain, I fell from 4 stories, was paralyzed and spent nearly a year in the hospital.
I have 6 rods, another plate, and a dorsal spin cord stimulator that runs inside of the spinal column, 8 surgeries directly on the spine, 10 more fixing other broken and "lost" pieces.
I'm completely immune to normal opioids vic, norco, tramidal, damitall, you name it.
I lived on max Fentanyl for years (50 mic) more and they are supposed to have a tub down your throat Prince died w/ 68.7.
I've again moved off because I should and I'm willing because I just don't care quite as much as I used to.
Anyhow Gabapentin is lighter then Lyrica and if you can see if they can argue for Grelease it's a time release but it's newer (or was) and insurance companies weren't to excited about paying for it. Max Gabapentin is 1800 and you might need it, Lyrica taking over 300 really doesn't make sense that where it's increased effects pretty much drop off in everyone.
One of the things to know about these are they are a nerve blocker not (just) a pain blocker, if your old enough to still care there are side effects the description of what exactly probably isn't fit to print here.
CBD (ALONE) will do you absolutely spit, CBD is NOT for pain it's for seizures and several other things and if you get HEMP your really p... away your money.
THC is what you primarily need (with or without a little CBD) and depending on where you live there maybe a whole lot of options or you'll have to call the dealer down the street, the good news is the price has dropped like a rock and "street" is probably as good as medical, I'm not sure who's suppling who actually.
The only THC "version" you can get that won't effect you otherwise is the patch but that is a bit on the pricy side.
Also note that this also will have some effect on the if you care that much anymore.
It doesn't stop it but certainly the frequently can be significantly reduced.
You get used to the effects of THC, my behavior has changed however I believe it's more because I'm not in pain other then being buzzed.
Smoking will give you near instant release from pain but is typically more short lived, approx 2 hours considering the balance of pain relief but not being, well stoned. Editable's take longer to take effect (soluble in fat) that's why everyone is cooking it with butter and making things, it's quite easy to do, but they also last longer.
I wasn't all to excited about this but my doctor actually pushed me in this direction, a mix of Lyrica and Cannabis is keeping me off Fentanyl.
Both solutions have their plusses and minuses but long term Fentanyl recommended.
I've probably had every drug in the book, cyclobenzaprine is not for nerves it's for muscles that have problems not related to nerves. It however may resolve problems that seem identical, especially something like restless leg which Gabapentin is a good fix for if it's nerves.

I drink beer with Lyrica (I did with Fentanyl) it's just how much, I never drink more then two beers unless it's a longer time span.
This is also a consideration because I'm always carrying.

Also if you pain is also associated with "knots" in your muscles and deep tissue etc just doesn't do it, it again takes a bit of extra work from your doctor to get approval but injection of botox (even mixed with anesthesia hurts a bit jammed into your muscles) but it DOES work to relax them, only took treatment.

I'm fused from 3 down to 2, that's a long way, #2 top is currently still jammed into my column and eventually I'll need that removed and a bridge connecting 1-3 at which point turning my head will be completely off the table, it doesn't move that much now.
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Re: Nerve pain meds

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Don`t know anything other than sending prayers Bill.
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Re: Nerve pain meds

Post by David »

JerryB wrote: Mon Jun 04, 2018 9:58 pm We have a grandson that we raised that is a chiropractor in North Carolina. He has been asking patients to try the CBD capsules and the cream. He orders it from Colorado and said the patients are getting good results with both of them. I read about it and there is not any of the stuff that messes with your head in CBD.
These people would probably also respond well to a sugar pill...
This is HEMP CBD, it's illegal to sell Cannabis CBD (online in ANY state) and they all make it sound the same but it's not.
Pure CBD is like tar and a thin syringe of it will cost $60+ nasty tasting stuff.
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Re: Nerve pain meds

Post by JerryB »

Thank you for clearing this subject up for us David, it's always good to know your vast knowledge is available to us.
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Re: Nerve pain meds

Post by David »

JerryB wrote: Mon Jun 04, 2018 10:49 pm Thank you for clearing this subject up for us David, it's always good to know your vast knowledge is available to us.
I've been at this a long time, I wish I didn't have the experience.

I'm sorry if I was rough on the CBD but a whole bunch of people are getting snaked by these people. I get the CBD questions all the time.
All the information/stories they spread sound good but it's nonsense.
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Re: Nerve pain meds

Post by AJMD429 »

I've had some spectacular (and some not) results with Thorne's MethylGuard Plus at three per day. It is designed for the third of us who have a faulty enzyme called methyltetrahydrofolate reductase. However it also helps if you have a single nucleotide polymorphism of one of the other methylation enzymes.

This video is non-branded and pretty in-depth:

https://youtu.be/QRHif2aVPvw

I believe all patients should be tested for this and treated if necessary because it carries a cardiovascular risk similar to having extremely high cholesterol or diabetes and yet is easier to treat than either of those conditions. It also contributes highly to many neurologic conditions ranging from Parkinson's to depression and simple fatigue. I see great reductions in neuropathic pain fairly often using MethylGuard Plus, especially with diabetic neuropathy and spinal stenosis or nerve impingement from disk disease. Less consistent for 'chemo' neuropathy but worth trying. Takes a month or two for full effect.

Perhaps most importantly young women should be aware of it and be treated presumptively when pregnant, because testing their genetics is inadequate since the genetics of the baby would be what determined increased risk of spina bifida, hypospadias, cleft palate, and other midline birth defects associated with this MTHFR issue. In other words if a gynecologist simply tests the mom and then does nothing if her genetics is normal that still fails to protect the infant.

There are also implications involving safety of immunization switch has been a controversy for years. People in the third of the population who have issues with methylation because their MTHFR enzyme is dysfunctional, may be the ones who should in fact delay or avoid certain immunizations because their ability to detoxify the preservative may be compromised.
Last edited by AJMD429 on Tue Jun 05, 2018 6:52 am, edited 2 times in total.
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Re: Nerve pain meds

Post by GunnyMack »

My mother has been diagnosed with both rheumatoid and oste arthritis in her legs and back. Chiropractic helps but not enough. Pain Doc wants to do a nerve block.
You may or may not have seen a product called QUELL pain reliever, it's a TENS unit that you were on your calf. Mom has been using this and it sure does help.
I'm now doc by any means but I feel that your body will eventually begin to build a tolerance causing the need to take more.
Also the CBD is a good option, very knowledgeable person I know told me that we have CBD receptors in our brains, meaning we have evolved the ability to use the properties of it.

If it were me I'd try acupuncture, the Quell and CBD.
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Re: Nerve pain meds

Post by Ji in Hawaii »

As many oldtimers on the forum know I have been suffering from chronic back pain since January of 2004, and 4 back surgeries later I'm still in pain. In mid April I also broke my left ankle which added more hardware to my body as well as more pain. I have been using Gabapentin, Meloxicam (long lasting anti-inflammatory), and Tixanidine (muscle relaxant) for more years than I can remember. I use Tixanidine only at night to help me fall asleep unless I'm extra sore because it makes me too groggy for daytime use. I have no side effects to the Gabapentin or the Meloxicam though they both only take the edge off the pain. I personally have a sensitivity to opiates even synthetic opiates like Tramadol, they work great to control my pain but the several days of insane withdrawal symptoms are not worth it for me, I prefer pain over that. I also tried the CBD oil since my BIL raved about it. It had no effect on me so I'm leaning towards the placebo effect of that stuff too.
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David
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Re: Nerve pain meds

Post by David »

I've tried acupuncture it sort of goes along the line of a chiropractor, which I honestly admit I'm not a fan of, if they can help and the continued treatment keeps you going great but theres a lot of them where you are just making their kids college or child support payments.

The Quell probably does work and if she can place it is also key, buying a tens machine isn't very expensive it might be a most cost effective solution and there's just a whole lot of options on how to make it run.

I will however bet big money that HEMP CBD is completely worthless, it's simply not the same chemical. Some people do mix the indica vs sativa and the volume of THC to CBD but THC is predominate for the treatment of pain. You can't sell Cannabis ANYTHING online you can claim to but you would go to jail for a very long time. Even possession (carrying) of cannabis in some forms across state lines (flying) is serious felony. I believe your ok with a joint but not a vape fluid or wax.

If you smoke wax rules ;)
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Re: Nerve pain meds

Post by AJMD429 »

Also consider magnesium if there is muscle spasm. Orally, a dose-ranging from 400 to 1000 mg seems to work for most people. If you can get in and out of a bathtub safely, soaking in Epsom salts is another way to get magnesium into your bloodstream, IF you soak for at least 30 to 40 minutes. Anytime shorter than that doesn't allow for systemic absorption.
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Re: Nerve pain meds

Post by Bill in Oregon »

Thanks for sharing all this wisdom, friends. I believe the journal of human pain is a book that is far from being completed.
Doc, I do have a cramping component, and will add magnesium to the routine.
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Re: Nerve pain meds

Post by Ji in Hawaii »

Amen to the magnesium, I take magnesium citrate power in water along with some lemon juice on a daily basis. I have tried chiropractic, acupuncture, and massage and by far the most effective of the 3 was massage, and I mean very deep bolderline painful massage by a strong massage therapist. Tens unit helps me allot too though I don't use it half as much as I should. Not an option for many up swimming also a great way to get weight off your spine while also getting exercise.
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E piʻi ʻēheu aku nō lākou i luna, e like me nā ʻaito;
E holo nō lākou, ʻaʻole hoʻi e māloʻeloʻe,
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Re: Nerve pain meds

Post by Camel73 »

Hi Bill,
I'm just getting into this game, so I don't quite understand it all yet but I know that if there are any more than a few dishes to do at once I'll have to get on my knees (really one knee) to finish them.

I have experience with Gabapentin and Nabilone. I had to work up to a dose (over a couple weeks) with the Nabilone that was too strong, then I backed off a bit. Now it is comfortable and effective enough for my needs at this point in time - combined with the Gabapentin. Side effects for me was drowsiness, which resolved itself by lowering my dose.

I told my dr that after starting the gabapentin I felt... better, like mentally, lol. He said yes, that might happen. I didn't get into it past that. My gab dose is low and only taken when needed.

I've tried really hard all my life not to take pills. I also don't want to totally mask the pain because I want to know what movements are causing the most aggression.. a reminder to keep with the movements that cause the least pain.

Mri - 4 small posterior disc bulges (L1-L5), Right posterior lateral annular fissure, Mild narrowing the neural foramina (L3-L4), Minor facet arthrosis, mild narrowing of the neural foramina (L4-L5), Mild to moderate bilateral facet arthrosis (L5-S1).

3 disks in my neck are on their way out (can't remember the results)

Fractured left knee. Clipped by a suv doing 50 through the crosswalk I was walking through.

Unfortunately this is what I've got to show after half a life of back breaking jobs. The women got the $. I did happen to keep my children through it all though (my guns and bows), which really is all that matters.
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Re: Nerve pain meds

Post by David »

That's interesting (again look a Grelease - time release gabapentin so you don't have to remember to take pills three times a day)

Nabilone is fake pot, INTERESTING, I gave arguing with the DR after he said you can't increase Fenanyl AGAIN after doing several maxes to withdraw and build up.
Fentanyl is one drug you build a resistance to but that resistance is quickly lost so you can start back at the beginning again. It's a PITA to get even if you Dr agree's the insurance Co's are p...

Anyhow so that's a pill and it stays "regulated" in you body as a specific strength?
That's the big problem with real cannabis you smoke and POOF ;) 2 minutes later pain is gone, however 2 hours later it's back.
Edibles will last the maybe 6 hours on a good day but they take a while to hit you depending what's in your stomach, I think eating a chocolate bar with them will expedite them.
But how do you ... balance this while your living your life, I'm still working on figuring this out.
If my spinal cord box needs charging I wake up in the morning and OUCH.
If I forget my second Lyrica (2x150) 3x100 would be better if I could really get the timing down but, OUCH

If you REALLY still care about your tallywagger, ALL of this stuff is bad...
I'm not saying it doesn't but you are no longer going to be able to play long john silver everyday.

I have to investigate this Nabilone.
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Re: Nerve pain meds

Post by Camel73 »

I agree, the timing (and dosages) took a bit to balance, but remembering to stay ahead of the symptom pain is key. ..and medicating as needed for the result of strenuous activities.

I've been trying to quit smoking.. hence the Nabilone. I was told it was synthetic marijuana. And no, it doesn't get you baked. There are two different kinds of marijuana, sativa and indica. One is thc, the other is cbd.

Now a days you can order almost any strain % that you would want to suit your needs.

I think we all know when we are overdoing it and it's really up to us - individually, under the Lord's guidance - to be responsible for our bodies to the best of our own personal abilities .. and not to abuse things available to us, that could help.

I personally don't like being baked all the time, and I'm sure many of you are of the same mind.. especially with our preferred hobbies we enjoy.
I'm also the last person that would want to get people "hooked" on something that is addicting.

I normally don't reply to the medical type posts (even though you're all in my prayers, and I suffer similar pain symptoms) but I saw this one and thought I'd chime in.
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Re: Nerve pain meds

Post by David »

Your insurance must be good, Nabilone is insanely priced.

sativa is an upper - they use the word Euphoric
indica is a downer - sleep / relaxation
THC is primary a pain killer
CBD is more for spasms and seizures
Your results may very thats why there a BAZILLION options.

Yes I'm looking at the menu now ;)
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Re: Nerve pain meds

Post by Bill in Oregon »

It is disheartening to hear from so many just on this forum who are dealing with severe pain issues. It sure is a pervasive problem in human health.
For what it is worth, a physical therapist friend back in Oregon told me there is a lot of work being done on alternative methods to manage pain, which of course is actually in the mind.
This Canadian doctor has a well-regarded workbook on the subject, and the Mayo Clinic just published a new handbook on the same topic:

http://www.greglehman.ca/
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Re: Nerve pain meds

Post by piller »

If we could fix pain, the drug manufacturers (and the Politicians who invest in them) would lose a fortune.
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AJMD429
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Re: Nerve pain meds

Post by AJMD429 »

One thing is that everyone responds DIFFERENTLY to each medication.

Nothing frosts my posterior as much as some physician (or nurse, or whoever) talking about how some patient shouldn't be on whatever they are getting relief from, saying things like "Well, when I had hip surgery, all it took was two Advil in the morning, and one Darvocet at night, so there's no way this guy needs to take six Norco a day just for a twisted knee...", or "When I take even a fourth of a Xanax, I can't function for the next two days, so no way this chick should be taking six of them a day...", or even the more 'compassionate' version - "When I had shoulder surgery, I needed six Percocet a day just to take the edge off, this dude is only taking four Norco, so he's really a good patient (since he's evidently such a martyr when it comes to pain :roll: )"

We have to use our own experiences as a reference point, but using them to establish a 'normal' is ridiculous. Just seeing the responses on this thread of different individuals to things like CBD oil show how huge a variation there is in response to different medications - some guys said it helped well, some said it made them feel funny, some said they didn't sense any effect at all. Most meds are like that.

The OTHER thing that has a huge variation is response to Physical Therapies (including P.T., O.T., Chiropractic Tx, Craniosacral, Acupuncture, etc., etc....). I'll see a patient with a messed up shoulder, and of course I can prescribe meds to ease symptoms, but to actually FIX the problem will require either surgery (IF applicable), or some sort of physical therapy. So what I do is:

a) ask them if they have a Chiropractic Dr. they see - if so I'll have them go there, and if not

b) ask them if they've seen a Physical Therapist - if so, I'll refer them there then.

I have to laugh at how often the patient will say "I don't want no physical therapy - I tried that before and it didn't help at all..." Naturally, I want to know more, so I'll say 'When was that?', and they'll say something like "Well, back in 1985, I hurt my knee, and went to two sessions of therapy, but it didn't help..." Hmmmm.......not only was it for a different problem, AND a different joint, but they only went for two sessions. Plus, you could try a different physical therapy modality every month for five years, and you'd probably still have things you'd yet to try that might help (there are often only two or three surgical approaches, if any, to a particular musculoskeletal issue, and typically only about seven medications [different brands of: narcotics, NSAIDS, steroids, relaxants, acetaminophen, antidepressants, and anti epileptics] to try, but hundreds of therapy modalities).

Anyway, it is always good to share experiences, and RELATIVES do often metabolize medications the same way, but keep in mind that what works (or fails) for one person may do the opposite with yourself.
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Bill in Oregon
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Re: Nerve pain meds

Post by Bill in Oregon »

Doc, thank you for your comments. I do think each person is a medical/chemical mystery in many ways -- and that the continuing unraveling of the secrets of each person's DNA will light the way to more effective individualized pharmaceutical treatments. Your post about MethylGuard Plus is a perfect example.
I am one who has not gotten relief from chiropractic treatment, but my ex-wife got tremendous relief. And with physical therapy, I have found that if I do my homework, it can be very effective -- and vice versa.
mickbr
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Re: Nerve pain meds

Post by mickbr »

I was in the military and saw guys go down with back, knee and all sorts of injuries over time. Without trying to give a cure-all one thing I noticed was the ones who did the best were the ones who stayed the most positive, got as close to their fighting weight as possble( whatever you call it back when you are a fit young 20 something year old) and took up some kind of physical activity that gets the body sweating and good hormones flowing again. Again everyones circumstance and injury is different. But I just seemed to notice a lot of depression and fatter bodies going hand in hand with a poorer outcomes. Some guys recovered from crushed veterbras from accidents and severe herniated discs operations just by becoming physical therapy freaks. I have my own share of injuries, but I am a fan of staying off meds as much as possible and also aint a fan of marijuana. They banned it in the old old days because of links to schizophrenia. Its almost frowned upon to say that these days, you get shouted down by all the happy users, but some folks pre-disposed to mental issues will trigger on the stuff.
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David
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Re: Nerve pain meds

Post by David »

mickbr wrote: Thu Jun 07, 2018 8:56 am I was in the military and saw guys go down with back, knee and all sorts of injuries over time. Without trying to give a cure-all one thing I noticed was the ones who did the best were the ones who stayed the most positive, got as close to their fighting weight as possble( whatever you call it back when you are a fit young 20 something year old) and took up some kind of physical activity that gets the body sweating and good hormones flowing again. Again everyones circumstance and injury is different. But I just seemed to notice a lot of depression and fatter bodies going hand in hand with a poorer outcomes. Some guys recovered from crushed veterbras from accidents and severe herniated discs operations just by becoming physical therapy freaks. I have my own share of injuries, but I am a fan of staying off meds as much as possible and also aint a fan of marijuana. They banned it in the old old days because of links to schizophrenia. Its almost frowned upon to say that these days, you get shouted down by all the happy users, but some folks pre-disposed to mental issues will trigger on the stuff.
I have to plus this it's absolutely state of mind, if I fall down (and I've done that a lot) I just get up and keep going.
I'm not a fan of cannabis, however I did manage to find it with other non-opioids that at least doesn't make me say OH S... in the morning.
Like forgetting to charge my spine stimulator.
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