Every med that I take goes through my MDs and are written only by my MDs. The are the professionals. Just wanted to make this clear :)
What seems to be the most popular narc for breakthrough pain? For TN2/facial neuropathy/paresthesia shocklike pain in the teeth/jaw? My Norco 10/325 that I have been on for years for intestinal pain isn't helping. I upped it to my allowed max dosage. I can't think straight, it's unbearable and difficult to even type this now!!!
I'm not going to take ANYTHING w/o my MDs consult. I just wanna know what has worked for others on here so I know how to approach my MD.
I started Triliptal 2 weeks ago and upped it to 300mg 5 days ago which I know is low. Started Amitriptyline a week ago and am at 50mg.
I hope I am not breaking any rules by posting this. If so please delete it.
My orofacial pain specialist says that most narcs don’t work well for TN pain. I was prescribed Percocet when it first started (Acetaminophen/oxycodone). It wasn’t very effective, like you describe.
For quick relief, I would suggest topical lidocaine. I find that it works very well. I’ve heard good things about topical ketamine, although I have not tried it. And if all else fails, ask your doctor about cannabinoids.
I wonder if the topical could work even though my pain is mostly in my teeth roots? Do you mean like "Lidocaine Ointment USP 5%. Thanks Toothache!
Toothache said:
My orofacial pain specialist says that most narcs don't work well for TN pain. I was prescribed Percocet when it first started (Acetaminophen/oxycodone). It wasn't very effective, like you describe. For quick relief, I would suggest topical lidocaine. I find that it works very well. I've heard good things about topical ketamine, although I have not tried it. And if all else fails, ask your doctor about cannabinoids.
Lidocaine is available as a 2% oral solution in Canada, which can be applied inside the mouth. You could also try a benzocaine product like orajel.
Tracks said:
I wonder if the topical could work even though my pain is mostly in my teeth roots? Do you mean like "Lidocaine Ointment USP 5%. Thanks Toothache!
Toothache said:
My orofacial pain specialist says that most narcs don’t work well for TN pain. I was prescribed Percocet when it first started (Acetaminophen/oxycodone). It wasn’t very effective, like you describe. For quick relief, I would suggest topical lidocaine. I find that it works very well. I’ve heard good things about topical ketamine, although I have not tried it. And if all else fails, ask your doctor about cannabinoids.
Keep in mind that it can take several weeks for Trileptal or Tegretol and even Amitriptyline to start working for you. And keep in contact with your doctor if the pain becomes unbearable for you. Best wishes, Min
The "Devils Drug" prednisone has come into vogue again, but not every Doc got the memo. Its used differently than it was before and that has pretty much eliminated the problems...... Generally now for TN they are prescribing a 3 - 5 day burst of around 20 mg once a day in the morning, rather than the old tapers. Pretty extensive research points to low doses being as effective as the old high doses.
The big thing that has come out of the recent research for use of Predi, is the body produces naturally about 7.5mg a day. Low dose regimes (under 7.5mg) don't often cause adrenal fatigue. Now that Mayo has found a connection between TN and early connective tissue disease, Docs are better recognizing the inflammatory aspects of TN. It doesn't take much inflammation to make you want to pull your teeth out (DIY dentistry is strongly discouraged)
It may be worth a discussion with your provider team. For many the Devil Drug is a Miracle Drug............. One thing that will help and I know its hard is to track your pain level through the day. Curiously pain that peaks about 4:30pm seems to be helped the most with predi. There is a long drawn out explanation, that really isn't all that important.
I really do understand that it could take several weeks but I have heard from reliable sources, that the TN dose range for Tegretol is 200-1200mg per day, whereas the dose range for Trileptal is 600-1800mg per day. So when people start out on the Tegretol, right out of the box they are close to the botton end of 200mg or even start at 200mg and up if they we establish on something else.
I may be wrong and please correct me someone. I'm only at 300mg after 2 weeks and I gotta get up that ladder to fall into the starting low end 600mg range.
Min said:
Keep in mind that it can take several weeks for Trileptal or Tegretol and even Amitriptyline to start working for you. And keep in contact with your doctor if the pain becomes unbearable for you. Best wishes, Min
Yeah, I call that drug lucifer. I have Uc/Crohns and can't take it. Because of it I developed avascular necrosis in both hips 12 years ago and had my right hip replace in 09 at the age of 45. It has caused me many other health issues. This is good info to know for others who might need it short term though IMO.
My spiking pain usually gets aggressive from 1:30pm till I take my sleeping meds around 10pm.
Thanks ModSupport!
ModSupport said:
The "Devils Drug" prednisone has come into vogue again, but not every Doc got the memo. Its used differently than it was before and that has pretty much eliminated the problems...... Generally now for TN they are prescribing a 3 - 5 day burst of around 20 mg once a day in the morning, rather than the old tapers. Pretty extensive research points to low doses being as effective as the old high doses.
The big thing that has come out of the recent research for use of Predi, is the body produces naturally about 7.5mg a day. Low dose regimes (under 7.5mg) don't often cause adrenal fatigue. Now that Mayo has found a connection between TN and early connective tissue disease, Docs are better recognizing the inflammatory aspects of TN. It doesn't take much inflammation to make you want to pull your teeth out (DIY dentistry is strongly discouraged)
It may be worth a discussion with your provider team. For many the Devil Drug is a Miracle Drug............. One thing that will help and I know its hard is to track your pain level through the day. Curiously pain that peaks about 4:30pm seems to be helped the most with predi. There is a long drawn out explanation, that really isn't all that important.
The only one that works for me is 10 mg fast acting morphine. Brand names MSIR (stands for Morphine Sulfate Immediate Release) or Statex. All the narcotic meds mixed with acetaminophen (which is Tylenol or paracetamol) didn't help. Codeine didn't help. 10 mg is the 2nd smallest dose pill of morphine they make, so I'm ok with taking that when it gets unbearable.
Thank you Sheila W for sharing that with me. That's good to know. I may mention this to my MD.
Sheila W. said:
The only one that works for me is 10 mg fast acting morphine. Brand names MSIR (stands for Morphine Sulfate Immediate Release) or Statex. All the narcotic meds mixed with acetaminophen (which is Tylenol or paracetamol) didn't help. Codeine didn't help. 10 mg is the 2nd smallest dose pill of morphine they make, so I'm ok with taking that when it gets unbearable.
I have Type 2, and find that dilaudid works on my breakthrough pain, however it is a very strong drug, and as with most all narcotics, your body becomes tolerant to the dosage and it needs to be occasionally upped to compensate, so it is a bit of a dance with the devil, and not right for all cases. I got corroboration on this from a nurse, who said that it's known that it is the only one which is effective on neuropathic pain, though this is all hearsay. I would caution against asking for it, it is very strong and should probably be a decision on the doctor's part.
I find that my ketamine/lidocaine/gabapentin (compounded) creme works to ease the pain, especially when used in conjunction with Gallixa. Though they don't seem to help as well when the nerve pain goes farther back into my head.
First, medical science believes that barcs are not effective in treating neuropathoc pain. I have had to fight to have mine. For me, the best option has been oxycodone. It takes a level 8 pain down to a 4. It’s not gone, but it takes the edge off so I am not in fetal position in bed.
Thank you Lily and Lisa! I just want something on the side to bring down the pain level some. Instead of going to the ER or doing something crazy. I understand these meds are highly addictive but are necessary sometimes.
My dr has yet to give me anything that helps first it was topamax and carbamazepine which did help the first flare up but now since this second flare up started it hasnt hwlped so I went back to the dr and she put me on gabapentin which is not helping so I called her and she has still yet to call back im losing my mind
I am on Trileptal (1200 mg.) and Gabapentin (3200 mg). I start hurting more about 2 in the afternoon and get relief only when I go to sleep. Trileptal does take a while to work. I think mine is getting better after being on it a month. My Neuro does not want me to take my Hydracodone 10/325 more than 2 times a week. I find that is a good guide and it does help when I get a bad attack. I also take Soma (an old muscle relaxer) occasionally. Neither one take the pain away but they help. If I take them more often, they stop helping the bad breakthrough pain.
I am on Trileptal (1200 mg.) and Gabapentin (3200 mg). I start hurting more about 2 in the afternoon and get relief only when I go to sleep. Trileptal does take a while to work. I think mine is getting better after being on it a month. My Neuro does not want me to take my Hydracodone 10/325 more than 2 times a week. I find that is a good guide and it does help when I get a bad attack. I also take Soma (an old muscle relaxer) occasionally. Neither one take the pain away but they help. If I take them more often, they stop helping the bad breakthrough pain.
I know this an old post, but how long does your lidocaine last? I can’t tell how much is actually in mine, because my bottle isn’t in English, but it hasn’t worked for me Hope everyone is doing well.
Lidocaine dissipates in about an hour for me. But sometimes it is enough to calm the nerve down and head off later pain. Getting it as close to the nerve as possible is the key and sometimes that is not possible with pain that is deeper in the head.
You might also try other topical anesthetics such as benzocaine, or ketamine if you can get a prescription for it.
I get very good relief from Oxycodone, it makes the pain more of a mild sensation. But it completely stops up my digestive system and I get horrid constipation. Recently I injured my back and was on heavy opioids for three days, I almost thought my neuropathy was gone, but it came back of course.
Diazepam gives me as much relief as an opioid, without the constipation, so that is my “go to” drug for unmanageable pain. But still a drug I don’t want to take very often.
willimus, I use the lidocaine patch – in the USA that’s 5% at prescription strength or you can get it OTC at 4% (called SalonPas). I cut the patch into strips and run the strip along the nerve branch that’s firing. I leave it on around the clock for 3 or 4 days at a time when things are starting to flare, changing it about every 24 hours or when it stops sticking well. I find that if I put it on as soon as I get the vague feeling of “not right” in my face it helps ward off increases in pain.
Hope everyone is doing well.