Lessons I’ve Learned from Taking Prescription Painkillers (Part 2)

IMG_0001

**Note- these are my personal experiences and should not be taken as medical advice. All prescription medications that I refer to are drugs that I was prescribed by a doctor for orthopedic and neuropathic knee pain following two different surgeries within a three-year period. **

Okay, so you’ve been talked into the idea that it might be worthwhile to take medication for the illness or pain that you are experiencing. What drug will you take? The guiding factors will likely be: your health diagnosis and your doctor’s recommendation.

I think it is important to mention the weaknesses of each of these influences. Within the framework of Western medicine, diagnosis rules treatment decisions. For a multitude of reasons, you cannot get treatment until there is a name or a label for the constellation of symptoms you are experiencing. There seems to be an unquestioned assumption that this is necessary and also immutable. It might be worth thinking about the idea that the majority of this pressure may come from the insurance reimbursement system currently in place. The problem here is that as a patient it often feels like a sort of stifling procrustean fundamentalism. In other words, the process of diagnosis fits you and your symptoms into the box of an easily accessible, trendy, and often fast-acting treatment instead of fitting a treatment to you as an individual.

The idea of placing a diagnosis/label on your symptoms also may make it harder to treat or view flexibly as Dr. Seth Oberst describes here: Labeling, Experience, and Self-Regulation.

One doctor, speaking about brain disorders, says this, “All patients progress differently, and there is a spectrum of disorders. We cannot therefore say that all patients need x medication for x condition.”1 When was the last time that you were treated like an individual when you went to the doctor and not just, “a diagnosis?” I hate to be cynical, but I can’t think of a single time that I did not receive a diagnosis-first, patient-second recommendation or treatment plan from a doctor. Please let me know if I am wrong about this.

Not only may the diagnosis that you are given be problematic, but your doctor’s recommendation may be problematic as well (or at least biased). For a brief discussion on this, see: Lessons from Rx Painkillers Part 1.

So, if you must operate (ha!) under this model, how do you negotiate it? Well, if your experience is anything like mine (and I hope that some day I can help more people so it isn’t!) there will be A LOT of trial and error. Even though I am not thrilled with the diagnostic framework as it stands, I will save that battle for another day and use the diagnostic labels that I was given in order to better organize my decision making process for taking these drugs.

What follows was my journey of rehabilitating my knee and use of prescription painkillers along the way:

0-10 months post-ACL reconstructive surgery

  • Diagnosis: acute surgery recovery, patellar tendinitis/tendinosis, depression.
  • Medications: Hydrocodone, Sertraline

I was experiencing intense post-surgical pain that did not ease up and so was on a course of Hydrocodone as well as over the counter (OTC) pain killers and Non-Steroidal Anti Inflammatory drugs (NSAIDs). For a review on the difference between general painkillers and NSAIDS, see: Advil vs. Tylenol. I experienced some pain relief with the hydrocodone, but also had to put up with the drowsiness and nausea that I experienced from taking it.

I was going to physical therapy full time and also tried Autologous Blood Injection (ABI) (similar to Platelet Rich Plasma (PRP)) treatment. These treatments are becoming more common for tendinopathy and also knee cartilage degeneration.2 An attractive feature of these treatments is that you are not introducing foreign chemicals into your body, but reintroducing your body’s own blood or platelets in order to stimulate a healing effect.

I think it also noteworthy to mention that I took Sertraline (classified as a Selective-serotonin reuptake inhibitor (SSRI)) for the depression that I was experiencing from dealing with the chronic pain and injury. Sertraline also has been shown to have anti-inflammatory effects (kind of a bonus for me, right?)3

10-22 months post-ACL reconstructive surgery

  • Diagnosis: Patellofemoral Pain Syndrome (PFPS), synovitis
  • Medications: Naproxen, Diclofenac, Lidocaine

During this period I was going to physical therapy and seeing a new doctor who was prescribing new medications: Naproxen, Diclofenac, Lidocaine patches. I showed some signs of improvement (i.e., reduced inflammation) with the Naproxen and a little bit from the Diclofenac (topical Voltaren gel). However, my knee seemed to respond most to load restriction, consistent with the treatment paradigm described by Dr. Scott Dye: The Pathophysiology of Patellofemoral Pain. The Lidocaine patches were a bust for me as they only numbed my skin superficially and didn’t touch the deep joint pain I was experiencing.

0-5 months post-synovectomy/chondroplasty surgery

  • Diagnosis: acute surgery recovery, synovitis, Complex Regional Pain Syndrome (CRPS)
  • Medications: Piroxicam

During this time period, I was trying to heal from the acute arthroscopic surgery and treat the pain and inflammation that I was experiencing. My reaction to this surgery was not good and I developed what seemed at the time to be the recurrence of synovitis- experiencing pain and inflammation with any weight bearing. The Piroxicam did not allow me to weight bear on my leg, but maybe kept my inflammation from getting worse? It was hard to tell if I experienced any benefit from this drug.

6-12 months post-synovectomy/chondroplasty surgery

  • Diagnosis: synovitis, PFPS, CRPS
  • Medications: Tramadol, Pregabalin, Duloxetine

At this point it was clear that I was having a very negative reaction to surgery with severe continuing pain and inflammation in my knee. I still was using crutches because I could not weight bear on my leg without exacerbating these symptoms. In my mind, it was time for ANY treatment that held promise for possibly reducing the pain and inflammation. Enter my next drug cocktail: Tramadol, Pregabalin, and Duloxetine. Why these three drugs?

I was using Tramadol for short-term pain relief (it is an opioid, but some claim a less addictive opiate). For me, as well as other patients, a downside to this drug was having some pretty serious and troubling withdrawal symptoms from it. As stated succinctly: “Some people swear that this is the toughest drug that they have ever withdrawn from.”4

Pregabalin and Duloxetine act on the central and peripheral nervous systems (Pregabalin is classified as an anti-convulsant and Duloxetine is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI)). I was taking these drugs for the chronic pain that I was experiencing with the idea that most (all?) of it at this point was neuropathic. After all of the drug trials that I have/had tried, the combination of these three drugs (in addition to a long period of very strict non-weight bearing) were truly what helped me turn the corner on healing my knee.

A Happy Ending…of Drug Taking

Luckily, I have been able to see progress and healing with my knee to the point that I am currently prescription drug-free! I am so thankful for this and I sincerely hope that these experiences will enable me to help others navigate their own medication needs for successful rehabilitation and pain management.

**Note- these are my personal experiences and should not be taken as medical advice. All prescription medications that I refer to are drugs that I was prescribed by a doctor for orthopedic and neuropathic knee pain following two different surgeries within a three-year period. **

References

  1. Doidge, N. (2015). The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from Frontiers of Neuroplasticity. New York: Penguin Books.
  2. Colberg, R. E., and Mautner, K. (2013): http://lermagazine.com/article/platelet-rich-plasma-an-option-for-tendinopathy
  3. Sutcigil, et al. (2015): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2248234/
  4. http://mentalhealthdaily.com/2014/06/25/tramadol-ultram-withdrawal-symptoms-duration/
Advertisements

1 Comment (+add yours?)

  1. Trackback: Lessons I’ve Learned from Taking Prescription Painkillers (Part 1) | Farmer Leda

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: