RSD Puzzle #058

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #58
MEDICATION RESEARCH

You have said that you bet if a doctor were to have chronic pain there would be much more research and understanding regarding the pain. I take your challenge. I empathize with you for your severe pain. You should be on stronger narcotic pain medicines than you are now. The research has been done, such medications are available and totally legal. However, they can not be taken with other pain medications that cause physical dependence (e.g. MS Contin, Duragesic, Lortab, etc). A patient like you who is in severe pain should consider being switched to the following:

1. Trazodone-which is Naloxon reversible analgesic (works identical to relief of pain by Morphine). This should be followed by blood tests to make sure there is enough Trazodone in the blood.

2. Stadol alternated with Ultram. THESE ARE BOTH STRONG NARCOTICS, BUT THEY DO NOT CAUSE PHYSICAL DEPENDENCE.

3. Simultaneously "cold turkey" stopping the strong narcotics that cause physical dependence.

4. After 2 months of this regimen, the Ultram and Stadol should cut down to use one or the other.

5. ACTH injections for your rheumatoid arthritis - ACTH also stimulates your brain endorphines.

6. With this trial of treatment the success rate is over 90%. If all fails and you are one of the unlucky 10%, then the Morphine pump provides another high percentage of pain management (over 80%).

All of these are conditioned upon the total abstinence from alcohol and dependent types of narcotics. The bottom line is in 100% failure cases there will be only 10% residual of failure before the pump and around 3% failure after the pump if one goes through the above protocol religiously. However, we do not live in a utopia and at each stage of such an algorithm everything falls apart. For example, if you are on large dose of Prednisone your adrenal gland undergoes atrophy and causes constant stress. Your physician will be reluctant to put you on ACTH to correct such a process. If you undergo a Morphine pump treatment and the pain is not 100% controlled your physician will keep increasing the dosage of Morphine until the Morphine pump changes to any type of large dose, flooding Morphine treatment similar to MS Contin. If you are being switched to Stadol or Ultram very likely you are slowly tapered off the other pain medicines. The combination of the two types of pain medicine will make you very sick and you wills top taking the medication. The key is to cold turkey and not to overlap such medications. In conclusion, the facilities are there to straighten up the pain but there is a desperate need for the doctors to understand how to use them. In the meantime people are dying from the combination of Methadone and other strong narcotics, and combination of the pump and other narcotics.

Blaming the pump is the same as blaming the F-16 fighter jet crashing when the pilot does not know how to operate it.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.