[Micke Brown, BSN, RN]

I just read your post and so glad you found us. We have a discussion forum about gaming; you might find some fun sharing your perspective. You will also find some recipes from our Home Cookin blog—I do recall that Janice wrote about tips with baking. We also share favorite recipes on the forums. I bet you have some gems. Please do join the chat group. We so much want to help your spirits lift.

[Micke Brown, BSN, RN]

There are NSAID patches too (as well as gels).

I think it is good to know which patches can be cut and which ones cannot. For example, fentanyl patches should NOT be cut. Lidoderm (lidocaine patch which is a numbing agent) can be cut to fit the area.

Also, important to know that fentanyl patches are recommended to be changed every 72 hours—yet with some “high metabolizers” changing them every 48 hours is more effective. That decision should be made with your healthcare provider. Keeping a diary of patch changes and pain levels will help document whether such a change is warranted.

Lidoderm is recommended to be worn 12 hours and taken off 12 hours. Again, using a diary as above can help your pain provider decide with you if that change cycle needs revision for optimal results.

[Micke Brown, BSN, RN]

Gigi,

I am so happy you wrote on the forum and shared snip-its of the struggles you are experiencing with your pain journey. There are others like you who will help both here and in the chat room. We meet every M, W, F from 11am-12noon ET. Please join us and we can share real-time—help answer any questions you may have AND listen to your frustrations.

Some questions I immediately thought of are: Have you ventured out from just conservative treatment? Are you working with a pain specialist who embraces integrative care such as massage therapy, acupuncture, yoga, mindfulness meditation and much, much more?

Another suggestion is: Have you reviewed the wellness section of our website (see Education tab)? There may be some tips you have not considered yet. Just know, all is not lost. We are here to support you the best way we can.

[Micke Brown, BSN, RN]

I would like them to know that when someone reports having pain, not to automatically jump to:

1. That person is drug seeking (when they are most likely relief seeking)
2. That opioids should be automatically prescribed (they may or may not be one of the treatment options to consider)

Most of all: Listen, listen, listen–clues on what might be the cause of the reported pain and the potential treatment options may be offered.

[Micke Brown, BSN, RN]

Please avoid using the term “narcotic” as that is a law enforcement term that includes both licit and illicit substances. Opioids, opiates or opioid pain relievers are the more appropriate medical terms. We, in the pain field, have been working for over 2 decades to correct this terminology. I know as a future pain educator, you want to get this one right.

Thanks for posting the survey!! Please share your results.

[Micke Brown, BSN, RN]

What is your doctor’s reason? Is there concern about the acetaminophen exposure or the hydrocodone? Last summer 2014, combination hydrocodone + acetaminophen was up-scheduled by the DEA to class 2 (from class 3) which means it can no longer be refilled or called in to the pharmacy as was done before; it has to follow the same rules as the other opioids like oxycodone, morphine, dilaudid and fentanyl. Some clinicians have decided to stop or significantly lower the ordering of vicodin (or lortab) for that reason.

Can you take NSAID’s, like ibuprofen or naproxen?

[Micke Brown, BSN, RN]

The FDA has a nice resource to review: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm096386.htm; you can sign up for updates. There is also a PDF version of a consumer brochure: http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/GeneralUseofMedicine/UCM229033.pdf.

Happy Reading. Please see our recent blog on Happy Foods, too.

[Micke Brown, BSN, RN]

Sadly, I am not surprised. We have a long way to go until the medical community (as well as the insurance industry) learns more about and promotes multi-modality, patient-centered, relationship focused pain care. It sounds like the physicians you spoke with are not practicing nor supporting integrative medicine.

[Micke Brown, BSN, RN]

I recently found myself nursing (pun intended) back pain that caused heel pain when standing & walking (most likely a back strain involving L5-S1 and or my SI joint). I am a big fan of thermal techniques, so I started with wearing a Tiger Balm patch during the day and switching to my heating pad at night. NSAID’s helped a tad plus stretching more, elevating my desk chair to improve my posture and wearing supportive shoes during the day. Some days were better than others, but I did not feel I was mending as expected. I had to modify my walk schedule which makes my dogs most unhappy. It dawned on me after speaking with a friend, that I might switch to ice therapy………duh, knock on wood—after a few days, I am feeling better. I guess I had more swelling than anticipated. Fingers Crossed, okay?

[Micke Brown, BSN, RN]

SHBAE45: I have not seen this type of case, however, it does not sound far fetched either. I was wondering if instilling viscous lidocaine might help. What happens with cold temperatures? You might ask this question to the American Association of Pain Management, American Pain Society or the American Association of Pain Medicine where members are healthcare professionals. Since it does sound like a possible neuropathic pain condition, RSDA may share some insight too.

[Micke Brown, BSN, RN]

I have to share a success story. I was traveling with my 81 year old cousin to a family reunion over this past weekend. He has rheumatoid arthritis and becoming less steady on his feet. He also told me that he had pulled his hamstring several times over the recent weeks. However, he insists on walking whenever he can as he fears that one he stops, he will lose it forever. When I offered to arrange a wheelchair for the airport, he refused—so we walked to the gate. I remained close to his side, used the people movers and kept a slow pace. He welcomed the rest during the 2 hour flight, but I could tell he was hurting more once we arrived and had to trek over to the car rental. Luckily, we had a new car with heated seats. So, I suggested that he turn on his seat to warm his legs and back while I drove 3 hours to our final destination. He was feeling great when we arrived and he learned a new trick to add to his pain toolbox. He was able to be active over the long weekend, used a heating pad at our cousin’s home in the morning and evening and heated that seat on the return ride back to the airport. His wife was so delighted to learn at our return home that he did so well during our adventure—so am I.

[Micke Brown, BSN, RN]

One BIG concern that I have and have been following is the combination of opioid pain medications and benzodiazepines (like valium, xanax, klonopin, ativan and others) used as sleep agents or to lower anxiety. A report just came out from the Maryland Dept of Health about this and its role in prescription medication overdose. The warning is this: combining them puts you at higher risk for respiratory depression (slower and shallow breathing). Another way of saying this is that you can fall asleep and may not wake up. It is encouraged that these 2 medications are NOT prescribed at the same time and if they are, close medical monitoring is strongly recommended. If anyone is taking both of these medications, PLEASE talk to your health care provider as soon as possible. See if there are safer options for you. For the full report, see: http://content.govdelivery.com/attachments/MDMBP/2014/06/16/file_attachments/299923/opioids6112014.pdf

[Micke Brown, BSN, RN]

BR: I found this YouTube video that may be helpful. See: https://www.youtube.com/watch?v=FR6Q4Z0GXK0

[Micke Brown, BSN, RN]

How is it going now, Noki4? Going to every other day yet?

[Micke Brown, BSN, RN]

I am thinking that walking is the easiest for most of us to do. You can do it anytime, anywhere, at your own pace, only need a good pair of tennis shoes and you are off. If you need a walking stick, cane or walker—decorate it and strut your stuff!! Walk your dog, grab your partner, a good friend or a neighbor–then go. You may only walk out to the road at first, but each day you will go farther and feel stronger. If you start now, when the weather is not so severe, it makes it much easier to get into the “groove”. I like to walk in the evening around dusk, so not too hot…….I am not a morning person. Others might like to get it out of the way first thing. Some phone apps are promoting 10,000 steps as a goal—which is ambitious but attainable as long as you do not beat yourself up to get there. Check out Fitbit or Argus.

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