Pain Management and UCPPS CPPS Prostatitis IC

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Pain Management and UCPPS CPPS Prostatitis IC

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Pain Management in Chronic Prostatitis / CPPS

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Sometimes seen as the “last resort”, pain management has been a life-saver for many men with chronic pelvic pain syndrome. Certainly you should explore quercetin, flower pollen extract, trigger point treatment and the many other treatments discussed on this forum before thinking about taking heavy duty pain medications that have the potential to addict you.

If you fail all other treatment options and your doctor will not provide you with this option, ask for a referral to a Pain Management Clinic. There are many such clinics today. These clinics usually provide you with opioid drugs, among others. These drugs are potentially addictive, so please be very careful about your use of the drugs. This forum has many warnings about using various pain relieving drugs for this condition!

Opioid drugs seem to break the pain cycle for some men, giving them a chance to start healing. Opioid medications all work to relieve pain in the same way – by attaching to opioid receptors on nerve cells, which causes a decrease in the transmission of pain impulses to the brain

We want to emphasize that you first need to try a variety of other avenues before resorting to this option. And put a time limit on this option. Don't allow yourself to stay on these drugs for months and months and become yet another victim of the Sackler family.

The best drug for pain management for chronic pelvic pain is Ultram (Tramadol), which is not as addictive as most opioids and does not trigger mast cells to the extent other opioids do.

Here’s a positive experience with pain management:
I just wanted to share my positive experience with Pain Management. The first onset of CP occurred in 1996, and lasted for 3.5 yrs. I had all the proper tests done. Pain level was always a 7 or higher, and then it went away. Just like that. Well it came back in Feb 02, and just as bad as ever. The doctors wanted to put me through all the tests again and I did a few, nothing showed. I then started to research pain management and took advice from the webmaster. I had to actually have an argument with my GP for him to refer me to a pain doc. When I went he did an exam then spoke with me and my wife at length and prescribed Tramadol (Ultram) 50mg, Amitriptyline 25mg, and Neurontin 900mg per day. I am happy to say I now have my life back. The sad thing is that I wasted quite a few years, but I know I am one of the lucky ones who found help. I always trusted doctors, but after this experience I do as much research as possible prior to going to the doctor now
Our comment on pain management

Note from webmaster: Tramadol and amitriptyline (Elavil) can interact, so do not mix these drugs without doctor’s instructions. Amitriptyline may reduce metabolic clearance of tramadol, increasing the risk for serious adverse events including seizures and serotonin syndrome.

Pain management has the benefit of allowing the pelvic nerves to quieten, and this can sometimes be all that’s required to reverse the neural wind-up and hyperalgesia that underlies the condition.

Pain Management advice from an expert

Q & A with Robert Bennett, M.D.
Chairman of the Arthritis and Rheumatic Diseases
Division at Oregon Health Sciences University.



Q – What is the number one pain management medication that you prescribe for chronic pain and is there any rationale to help you determine what to prescribe?

A – Ultram (tramadol). By the time most patients get around to seeing us, they have already tried numerous types of NSAIDs, as well as Tylenol. Patients with severe pain control problems are often prescribed hydrocodone in the form of Vicodin and occasionally oxycodone in the form of Percodan or Percocet. My colleagues will often refer patients who require more powerful opioids to our pain clinic, headed by Dr. Brett Stacey. I have patients who I treat with the long-acting opioids, such as OxyContin (contains oxycodone) and methadone.

Q – What percentage of patients taking Ultram get significant pain relief and at what dose?

A – As a first-line analgesic, roughly 70% of my patients get reasonable pain relief with Ultram. By reasonable, I mean greater than 50% improvement. This degree of pain relief usually enables patients to become more functional and reduces their level of distress. A typical dosage range is 50 mg twice per day to 100 mg four times per day (100-400 mg/day). About half of our patients take Ultram on a regular dosing schedule, whereas the other half take it as needed—depending upon their severity of symptoms. For patients who are not getting adequate pain relief with a reasonable dose of Ultram, we consider using more powerful opioids.

Q – What about side effects to Ultram and how do you work around them?

A – About 15% of our patients complain of side effects on Ultram. The most common ones are nausea (which reduces with time or by using a slower-paced dose titration), drowsiness (although we have occasionally had patients feel energized), constipation, and an itchy rash. Paradoxically, some patients on Ultram develop headaches. If a patient is having good pain relief, it is worthwhile trying to overcome these problems. For instance, the nausea will often diminish with time, but I have a few patients for whom we prescribe anti-nausea medications such as prochlorperazine (Compazine). Constipation can usually be controlled with diet, but the occasional use of a mild laxative may be needed (e.g., Bisacodyl). If drowsiness is significant, I limit the use of Ultram to nighttime. An itchy rash seems to be a true hypersensitivity to Ultram in a small group of patients and usually recurs when it is reintroduced. These people are not good candidates for continuation of Ultram.

Q – If a person doesn’t respond well to Ultram, what pain management drug alternatives do you recommend for relieving pain?

A – First one must understand how Ultram works. This drug is a weak opioid itself and it breaks down into a metabolite that has stronger opioid action. However, the analgesic properties do not rest entirely on its activity as an opioid. It also inhibits the re-uptake of serotonin and norepinephrine in the central nervous system (increasing their concentrations). These transmitters help filter out some of the pain signals coming down from the brain that would otherwise generate the sensation of pain in the tissues. So Ultram has the dual action of both an opioid and an antidepressant such as Elavil.

Those patients who cannot obtain adequate pain control on appropriate doses of Ultram will often be switched to more powerful opioids. The next in line is usually hydrocodone (e.g., Vicodin which contains 5 mg of hyrocodone plus Tylenol) in a dose ranging from one tablet twice daily to two tablets four times a day. For patients who are requiring high doses of Vicodin on a frequent basis, I will often try switching them to OxyContin (a sustained release form of oxycodone). OxyContin comes in various strengths (without Tylenol) and is usually used two, maybe three times a day. For a patient who has already been on Vicodin, I will usually start out at the 20 mg strength of OxyContin, but I do have some patients who take the 40 or 60 mg pills. For patients who do not respond to this level of opioids, I consider the use of methadone at 5-10 mg two to three times daily.

The use of opioids in non-malignant pain is still controversial in pain management, but it is slowly gaining greater acceptance as more doctors become educated on this topic. Although nearly all patients on opioids become physically dependent (they will suffer severe pain and anxiety if the drug is abruptly withdrawn), true addiction (which means craving the opioid for the psychological lift it might provide) is rare in chronic pain patients. As a general rule-of-thumb, if prescription opioids result in patients being less distressed and more functional, continued prescription is usually worthwhile. Occasionally a person may remain dysfunctional despite adequate relief of the pain, and in these instances I refer the patient to a comprehensive pain clinic or to a specialist who can discern if there is an addiction problem.

Q – What about combination pain therapies? Why might more than one drug be used for chronic pain management?

A – Even when pain is fairly well controlled with a drug like Ultram, patients may still require the occasional prescription of Vicodin to help them cope with flare-ups. The same could be said for patients using OxyContin. I have not found that such rescue therapy is necessary for people taking methadone. I should point out, however, that the addition of one opioid to another will result in more side effects, including nausea, constipation, and even respiratory depression in some patients. Needless to say, the use of such combination drugs in pain management must be very carefully supervised. Patients and their family members also need to be educated on the adverse reactions that may occur with these agents.
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