new pain management plan 2-23-10

I had an appointment with Dr. Schakel today and we discussed the ineffectiveness of the current pain management plan. We agreed that the goal of the plan was not necessarily to eliminate all pain, but to reduce the pain to a level where I can continue walking, working, and doing the activities that I enjoy. If I need to use a cane or decrease the number of steps I take because of pain, I would consider that unsuccessful.

He prescribed 4" x 6" Lidoderm 5% patches applied to painful areas for 12 hours daily. I will start using Neurontin gel again applied to the areas of neuropathic pain and parathesia. He also tripled my dose of MS Contin to 30 mg three times daily, and maintained my dose of Oxycodone at 5-10 mg daily. 45 minutes after my first increased dose of MS Contin and I felt a wave of relief. I could put a shoe on my left foot and walk without a cane for the first time in a week. I am able to walk around my house and could probably walk an hour or more. What a difference a proper plan is. I feel somewhat normal again. This should greatly reduce my stress level knowing I am more self-sufficient. My current pain level is 4.

It has been suggested lately that my seizures could be caused almost exclusively by the physical pain I have lived with for years. If so, masking the pain by following the above plan should help. Curing the condition would be an ultimate goal, but I think that is unlikely. For now, my team is working to slow the progression and manage the symptoms that affect my daily living.

I look forward to my last seizure. Shortening the time until that happens is now my focus.

today

I woke twice during the night from pain. I used relaxation response to minimize the pain, and was able to get back to sleep. This morning had a pain level of 8 with spikes higher. I took 15 mg morphine, 100 mg Tramadol, 5 mg of Oxycodone, and 1000 mg of acetaminophen again and 45 minutes later was down to 7. At least I could get out of bed and shower, though it's painful. I won't do my walk again today. I think that's 4 consecutive days this week. Not good. I am sitting at the table now where I will spend much of the day. I continue having Lucy run around the house to retrieve things for me. This morning it was my checkbook from the other room to write a check for her school activity. I don't like to put that burden on her but just can't take those steps. Conservation is key, as is planning ahead.

I plan on calling Dr. Schakel today and sharing my current status on this new main management plan.

today's notes

With the strong and sharp pains I have today, I will not be walking now for the third day in a row. I miss it terribly and my mood reflects that. I feel confined to the house, trapped really, which is a strong reminder of the seizure condition I have. I really need to clear my head somehow.

Pain level 8+ when I woke up, 7+ now at 9:30. I took 15 mg Morphine, 100 mg Tramadol, 5 mg of Oxycodone, and 1000 mg of acetaminophen this morning per the current plan. Tramadol and acetaminophen will continue every 6 hours and Morphine and Oxycodone again in the evening. I am suffering now. My lifestyle is affected. I need to plan my house life to minimize the number of steps I take. Mostly I am necessarily stationary through the day.

pain level

Yesterday and today my pain level has been around 7 all day, which prevented me from my daily walks with mom. I use these walks not only for the exercise, but to help clear my head and reduce stress. My pain level this morning was 8+ and I had to stay in bed until the narcotics brought it down a little. My day was much more than uncomfortable.

pain level is back up

Starting last Saturday, my pain level had increased to 7 and unmedicated has remained around 7.

I saw Dr. Schakel on Wednesday and the current plan is to stay on a low level base of 15 mg MS Contin BID (twice daily) and 5-10 mg daily of Oxycodone if the pain is still unmanageable. This is quite a bit less then I had been taking last fall. We will see if this will be enough to keep me walking and active.

I see Dr. Schakel in 3 weeks for a reassessment.

short status

My LV continues to be in remission. My sledding injury is almost completely healed. My seizures continue 4-6 daily.