Pain Management

Pain Management is the practice of controlling chronic pain by the use of drugs and therapies.

1,453 Questions
Physical Therapy (physiotherapy)
Pain Management
Arm and Leg Pain

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It can be purchased in Dhaka.

Pain Management

Why is elbow skin less sensitive?

Because the skin on ur elbow has non nerves in it So I'd you pinch it u dont really feel a lot

Pain Management

Does a ruptured disk repair itself?

A disc can repair itself very slowly over time, and with good, proper movement.

All parts of the body repairs itself. Some parts repair itself faster than others. Muscle repair very quickly because of the good blood supply. Intervertebral discs repair very slowly because they have no blood supply. They get their blood supply from the adjacent bone, and it soaks up the nutrients like a sponge. The discs need full working articulation of the joints to soak up the nutrients and squish out the metabolic wastes that build up.

Chiropractic care can help restore the proper movement of the spine by specifically adjusting the segments that are stuck and inflamed.

Medication and Drugs
Pain Management

What is Tramadol Hydrochloride used for?

Tramadol is a precription only drug. it is also known as Ultram, Ultram ER, Ultracet, Tramal, Zydol, Contramal and other names.

It is a synthetic analog of codeine and commonly referred to as a pseudo-opioid. Tramadol has mild agonist actions at the μ-opioid (mu-opioid) receptor; the primary receptor morphine and other opioids bind with. Tramadol also has antidepressant actions by reducing reuptake of norepinephrine and serotonin much like SNRI class antidepressants such as Cymbalta and Effexor. Antidepressants are occasionally used in pain control because they can modulate pain, presumably like Tramadol does. It also is a mild norepinephrine agonist and it has unique anti-inflammatory actions. It is FDA approved to treat moderate to severe pain, both acute and chronic.

Before using Tramadol you should let your Doctor know of all other drugs you take.

There are known side-effects from using these drugs. Always use under the guidance given by your Doctor and in the package leaflet.

Tramadol has been shown to be particularly effective in treating people with neuropathic (nerve pain) pain, which tends not to respond to most "classic" opioids like morphine, oxycodone, or hydrocodone. Tramadol is approximately as effective as codeine in treating pain. However individual results greatly vary, some find it to be highly effective and others find it to provide no noticeable analgesia. Many doctors believe that the analgesia Tramadol produces is a result of synergism of the mu-agonist action, the inhibition of norepinephrine and serotonin reuptake, and the anti-inflammatory action.

It is sometimes used off label for restless leg syndrome and it is used in a wide variety of neuropathic problems like diabetic neuropathy. There are have been cases were Tramadol has been given to people with refractory depression who do not respond to other drugs. Tramadol can also be an effective antihypertensive (it lowers blood pressure) if other measures fail to succeed. Often people taking Tramadol have much lower blood pressure.

Tramadol is used for pain control. It is used in Motor Neuron Disease, Fibromyalgia and with symptoms like back/spinal pain.

Tramadol is not a controlled substance like codeine, morphine, hydrocodone, methadone, Demerol, or oxycodone is. However in a few US states Tramadol in a schedule IV drug under state law. Arkansas, Georgia, Kentucky, and Massachusetts have placed restrictions on Tramadol.

Tramadol Hydrochloride

Class: Opiate Agonists

VA Class: CN101

Chemical Name:(±)-cis-2[(Dimethylamino)methyl]-1-(3-methoxyphenyl) cyclohexanol hydrochloride

Molecular Formula: C16H25NO2•HCl

CAS Number: 53611-16-8

Brands: Ultram, Ultracet

See Sources and Related Links below for more about Tramadol or Tramadol HCI.

General Brand Name: Ultram (Manufacturer: - Wyeth Pharmaceuticals - U.S.)

Generic Name: Tramadol Hydrochloride 50mg

If some is suffering from moderate to severe pain, he/she may be prescribed Tramadol Hydrochloride. This pain reliever is the generic version of the brand name drug Ultram of Wyeth Pharmaceuticals - (U. S.). Tramadol Hydrochloride belongs to Non- narcotic opioid analgesic class of drugs. Tramadol Hydrochloride is the 18th most commonly prescribed drug in the U.S. to help patients manage moderate to severe pain that is chronic. Ultram is designed to provide only short-term pain relief and should not be taken long-term.

Treatment Uses - Tramadol Hydrochloride (Ultram) is used as an addition to anesthesia, for treatment of cancer pain and is also commonly used for moderate to severe dental pain. Tramadol is also abused for its euphoric effects, which has led several states to reclassify it as a controlled substance.

Dosing and Administration - A maximum of 400mg daily is recommended for adults for immediate release given orally every 4 to 6 hours as needed. For chronic patients suffering from moderate to severe pain not on immediate release Ultram(Tramadol Hydrochloride) can be started at 100mg upto a maximum of 300mg incremented every 5 days with 100mg daily looking up to the needs. To switch the use of Tramadol Hydrochloride (Ultram) for a chronic patient from immediate to extended release, calculate the total daily doses of Tramadol Hydrochloride (Ultram)and start extended release tramadol at a dose rounded down at the nearest 100mg increment, not to exceed 300mg daily.

The safety and efficacy of immediate release tramadol in patients under 16 years of age and extended release tramadol in patients under 18 years of age are not established.

Food has no effect on absorption or availability of tramadol; doses can be taken without regard to meals. Extended release capsules and tablets should not be divided, crushed, chewed or mixed with water.

Patients on dialysis or renally impaired patienst with a Creatinine clearance clearance (CrCl) less than 30ML per minute, the dose interval of immediate release Tramadol should be increased to 12 hr. and the maximum daily dose decreased to 200mg. Extended release tramadol is not recommended for use in patients with renal or hepatic insufficiency. . In patients over 65-years-old, tramadol should be started at the low end of the dosing ranges and continued at the lowest effective dose. For patients over 75-years-old, immediate the maximum daily dose of immediate release tramadol should not exceed 300 milligrams. Hemodialysis and hemoperfusion are of no value in tramadol overdose. Tramadol is not recommended during pregnancy unless potential benefits outweigh risks, which include neonatal seizures, withdrawal syndrome and fetal death. There are no well-controlled studies of tramadol in pregnant women or on the growth and development of unborn children exposed to tramadol in utero. Tramadol is excreted in human breast milk and is not recommended for nursing mothers, as there is insufficient nursing infant safety data.

Tramadol's mechanism of action in the body is not completely understood, but is believed to be associated with binding of the parent drug metabolite to the mu-opioid receptors and through the weak inhibition of norepinephrine and serotonin reuptake.

Tramadol comes in multiple strengths, depending on manufacturer. Size, shape and color also vary; immediate release tablets typically come in 50 milligram strength, extended release tablets and capsules commonly come in 100, 200 and 300 milligram strengths. There is at least one manufacturer making a tramadol oral suspension of 10 milligrams per milliliter. Tramadol is also available in combination with acetaminophen. Tramadol tablets should be stored at room temperature (between 68 and 77°F).

Cautions and Warnings - Tramadol is, as previously mentioned, a drug with abuse, misuse and diversion potential. Abusers or prolonged users may develop physiologic and psychologic dependence. Abrupt discontinuation may induce withdrawal symptoms; tapering tramadol when discontinuing therapy is advised. Tramadol is an opioid; users may experience impairment of mental or physical abilities and should be advised not to perform potentially hazardous tasks such as driving a car or operating machinery.

Important Side Effects and Interactions - The most commonly reported side effects in patients taking tramadol are dizziness and vertigo (26%), nausea and/or constipation (24%), headache (18%), somnolence (drowsiness 16%), vomiting (9%), pruritus (itching 8%), and CNS stimulation consisting of restlessness, tremors, euphoria, hallucinations, and emotional lability (7%).

Conditions and Diseases
Pain Management

Why scapular pain in cholecystitis?

This occurs as a result of a concept called?referred pain. ?Essentially, as the signal for pain is sent from the gall bladder to the spinal cord, it gets mixed up with signals from the back of your right shoulder. ?This results in the brain getting the signal that you have pain in the right shoulder blade. ?There is absolutely no pathology in the right shoulder, it is simply a misinterpretation on the part of the nervous system. ?The same process occurs when a person has a heart attack and they perceive left arm or jaw pain. ?In this second scenario the patient has absolutely nothing wrong with their left arm, their brain just perceives that cardiac pain as occurring in the arm.

Medication and Drugs
Pain Management

Are drugs immoral?

Drug use is certainly moral, it has saved probably billions of lives.

Drug abusers can act immorally but I can't say they areimmoral. They are simply lost in a purgatory of craving, falsely perceived satisfaction and chemical withdrawal. They are not immoral, they are pitiful.

Law & Legal Issues
Pain Management

Where is euthanasia allowed?

Three states currently allow Physician Assisted Suicide (PAS), which is the term used in place of euthanasia (my guess is because it sounds more medical). Oregon was the first to allow it in 1997, then Washington state in 2008, and most recently the Montana Supreme Court allowed it in 2009. In Washington and Oregon the patient has to be terminally ill, in intractable pain, and not depressed. They are then given a lethal dosage of medicine, which they can take to end their suffering.

Back Neck and Spine
Pain Management

What is severe bilateral facet arthropathy in the lumbar 4-5 mean?

Picture a tripod, with the body of the vertebra as one leg, and the facet joints as the other two legs. Looking down on the spine from above with the stomach in the front... The body of the vertebra is at 12 o'clock (noon) and the facet joints are at 5 & 7 o'clock [posterior (behind) & lateral (off to the side)] of the main vertebral body.

Facet joints help stabilize the spine, and wear & tear over a long period of time will lead to the body strengthening these joints by depositing more bone to make them stronger. This is called arthritis.

Nerves exit the spinal cord and travel between these facet joints; when there is a lot of bone build-up, the causes crowding in the area where the nerves exit the spine to travel down the body. This narrowing is called 'stenosis'.

If there is enough 'stenosis' of this area the nerve exiting the spine in this area can have some pressure placed on it.

Nerves are like the wiring in the house, except individual nerves fibers are bundled up together, like a lot of individual small wires within the main bundle. Each individual wire (nerve fiber) travels to one specific spot in the brain, traveling all the way from its origin in the body, through the spinal column (cord) to the brain.

If this nerve fiber in affected ANYWHERE along its path, it will make the brain think pain is originating where the nerve fiber originated. So if a nerve bundle in "pinched" in the spine, the brain will get the signal that (let's say, assuming the nerve came from the foot) an area in the foot is hurting.

Pain Management

Can you drink midol and Motrin at the same time?

Yes, because Midol as Acetaminophen and Motrin has Ibuprofen The exception being there has to be a few hours between them or you can take it at the same time but don't do double up often. I usually like Ibuprofen or Advil better the Tylenol and acetaminophen.

Conditions and Diseases
Medication and Drugs
Pain Management

What is the best OTC medicine to take for elbow pain?

You can get OTC painkillers such as Tylenol,Aleve or any arthritis pain medication. If the pain goes severe it's best to have a prescription from a physician,you could get a cortisone shot.

Medication and Drugs
Pain Management

What does generic oxycodone look like?

depends on milligram. whether its instant release or OP (slow release)

Medication and Drugs
Pain Management
Back Neck and Spinal Pain

What is hydroco apap5 500mg tab?

It is hydrocodone, or vicodin 5 mg

Pain Management

What could be the possible treatment for severe Cervical Spondylitis pain that is often nagging towards the end of the day?

My father who is a retired Govt. servant is also suffering from Cervical Spondylitis. In Cervical Spondylitis, the pain usually aggravates towards the end of the day.

But my father is very regular with his exercising schedule and Doctor has advised him to use Volini gelwhenever the pain is nagging. I think it works really well in such cases. He had been following these advices regularly and also has been keeping well now (Thank God!)

Well I think you should also try the same …

Regular Exercise

Volini Gel

Pain Management

Why do you think that tobacco companies add menthol to cigarettes?

To give it a minty flavor so teens cant get caught as easily:p(jk) they just want to make money so if they give it a flavor that people like then it will sell good and in return they make more money

Drug Side Effects
Drug Safety
Pain Management

Is Ibuprofen processed by liver or kidney?

Ibuprofen is processed by the kidneys.

Conditions and Diseases
Back Neck and Spine
Pain Management
Back Neck and Spinal Pain

What causes lower back pain after a fusion?

That's a loaded question - there are so many things that can affect the fusion area. It depends on how much pain we're talking about. If it's bad enough that you've been referred to a Pain Management Program, then it's possible the hardware might be installed wrong. If it's pain that just requires some Percocet or Vicodin on an as-needed basis, it's probably scar tissue buildup and spinal stenosis, which is common in patients who've had fusions.

I've had 3 so far - C5/6/7 in '96, L4/5/S1 in '99, and L3/4 in '06. I've been in a formal Pain program for 11 years, but have dealt with spinal pain for a lot longer than that. In my case, I was told a long time ago it was 'Failed Fusion Syndrome', or Post Laminectomy Syndrome, whatever you want to call it. Essentially if there's no visible cause for the pain, the chalk it up to residual pain from the procedure.

However, I learned prior to my 3rd fusion operation that my problems were due to improper installation of my fusion hardware in both '96 and '99. It was confirmed during surgery (using everyone's favorite tool, an EMG machine" to verify nerve conduction) that 2 of the 8 screws in my lower spine were in fact screwed through the pedicles too far and were into flesh and nerves, specifically 2 leg nerves. In my neck, one screw holding my plate in is actually screwed through a disk - only the last 2-3 threads are actually inserted into the vertebral bone.

For me, my pain started to get much worse about 6 months after my second fusion, and it got to the point where I had to start using Duragesic Patches, which are currently the strongest opiate meds available. For the past 9 years I've used Duragesic 100mcg patches and Percocet 10/325's for my pain as a result of the previous screwup (no pun intended). I use between 120/150 Percocet's per month, and 3 boxes of patches per month (1 every 48 hours). I've had to increase my meds occasionally, as in '06 when my L3 disk collapsed and the L3 vertebrae slipped forward onto the L4, resulting in bone-bone contact. But essentially my dosages haven't changed since 2000.

Post-op Physical Therapy has a lot to do with residual pain also. If you get into a good PT program, your pain will eventually get less over time, but scar tissue buildup is always a possiblity and results in the bulk of post-op pain after a year or two.

Remember also that the primary cause of pain over time for fusion patients is the added stress the fusion puts on the disk directly above the fusion site. In my case, the surgeon should've fused L3-S1, but he stopped at L4. As a result, in addition to the pain from the screws, I had to deal with the pressure on a disk that was already failing for 6 years until it finally collapsed completely. The pressure on the area above the fusion is a result of a fulcrum effect.

You can get an idea yourself where the pain is coming from, since the type of pain indicates the injury, and in the case of spinal nerves, if the pain traces a nerve path, it will tell you which disk is pressing on which nerve. Sharp pain is normally nerve related, as is some pins/needle pain and burning pain. Throbbing and aching is usually deep tissue or muscular in nature; burning/tearing can be nerves but can also be ligaments too. Muscles and Ligaments are often accompanied by stiffness as well.

If you're referring to post-op fusion pain within 6 months of the surgery, you're still likely to have some back muscle spasms - if your doctor didn't prescribe Flexeril or a similar muscle relaxant to deal with the spasms, you should think about another doctor.

One way to tell if it's a possible hardware problem is too look at your 3 month X-Rays. The hardware pedicle screws should be inserted on an even, parallel basis with the screw opposite it. You can look closely and sometimes see if the screw is through the bone or not. Realistically though, that kind of pain is pretty bad, so if it's hardware related you should be a regular opiate patient like me by now, or in complete and total misery and hell.

The kind of surgeon you used has an effect also. Neurosurgeons are less likely to screw up a laminectomy/fusion, but Orthopedists don't tend to do so well with nerves - they're bone doctors after all.

The original reason for the fusion also plays a role in your post-op pain. If like me you have a disease or condition in which the spine or disks are going to continue to degenerate and get worse over time, then that's a contributing factor. In my case, vertebral slippage over a collapsed disk and bone-bone contact with the vertebrae below it is normal - my problem is hereditary, and was aggravated by things I did when I was younger. If your fusion was supposed to get rid of the disk pain, then I'd start looking for other causes if you still have it, or if it's gotten worse over time. Don't buy the "Post-fusion Syndrome", or "Failed Fusion Syndrome" crap like I did for so many years. Get a CT Myelogram performed and have them do a top-bottom spinal series so you have a baseline record.

There are some sites that you can learn more about Pain and post-op Spinal pain symptoms - the links are at the bottom.

Medication and Drugs
Pain Management

Where can you buy Omega XL?

Omega XL is used for pain and inflammation. You can buy it from the website that is listed under the related links. Additionally, you can find it on, read the reviews on As for stores that have it in stock? Try your local Vitamin Shoppe.

Dieting and Weight Loss
Aging and Life Extension
Senior Citizens
Pain Management

What are the best things to eat for elderly?

i think that the best things to eat for the elderly is lots of fruit and vegetables so your are having a healthy but balanced diet. you can have a few sugary foods but not to many. you should eat some meat especially red meat because it gives you nutrients and it gives you extra tiny bit more fat so that you are healthy and if you don't then you cold get quite skinny. but if you are already a vegetarian then you're used to it so it won't really harm you.

Back Neck and Spine
Pain Management

What exercises can you do for sciatica?

I find walking helps.

I also find it gets worse if I have a lie-in and spend more than about 8 1/2 hours in bed.

Potential ReliefStand close to a wall for support...While supporting yourself on the non affected leg, turn your toes out and lift your affected leg backwards slightly and hold. This is to try balance the active tone of the piriformis muscle. You may have to play with the degree of lift, but this should provide you relief.

In a certain percentage of the population, the sciatic nerve runs right through the middle of the piriformis muscle. This is a muscle that runs from the outside of the femur (the greater trochanter)to the sacrum (the center of the posterior pelvis and the base of the spine.) If this muscle is too lengthened or too shortened, it can cause compression or pressure on the sciatic nerve. This will produce the symptoms along the nerve pathway.

A chiropractor can help to balance the spine and therefore the gluteal muscles. Your problem may be more than muscular compression on the sciatic nerve, and a chiropractor will be able to assess the issue, whatever the causitive mechanism.

Understand sciatica pain and learn treatments that cure sciatica agony and stop it from coming back without drugs or surgery.

Medication and Drugs
Acetaminophen (Tylenol)
Pain Management

Acetaminophen cod 3?

Tylenol 3 is an opioid pain reliever. lt contains Codeine, 30 mg and acetaminophen (Tylenol), 325 mg.

Medication and Drugs
Pain Management

If your pupils are tiny does it mean your on drugs?

Not necessarily. If you are in very bright lighting, your pupils will constrict to limit the amount of light allowed to enter your eye. This protects the retina from damage. Likewise, in very low light levels, your pupils will dilate (enlarge) in order to allow more light into the eye and improve vision. This is a normal process. However, there are a number of drugs that will cause the pupils to constrict, even to the point where they have a "pin-point" appearance. Opioid drugs (drugs derived from the poppy plant) such as opium, heroin, etc., will cause this pupillary constriction to the point of looking pin-point, even if exposed to low lighting levels. If a person is in normal lighting and has pin-point pupils, there is most likely something effecting this abnormal change.

Back Neck and Spine
Pain Management

What is facet arthropathy?

The facet joints connect the posterior elements of the vertebral bodies to one another. Like the bones that form other joints in the human body, such as the hip, knee, or elbow, the articular surfaces of the facet joints are covered by a layer of smooth cartilage, surrounded by a strong capsule of ligaments, and lubricated by synovial fluid. J

Just like the hip and the knee, the facet joints can also become arthritic and painful, and they can be a source of back pain. The pain and discomfort that is caused by degeneration and arthritis of this part of the spine is called facet arthropathy, which simply means a disease or abnormality of the facet joints.

Medication and Drugs
Drug Interactions
Pain Management

Is it safe to take Dilaudid and lyrica together?


Pain Management
Back Neck and Spinal Pain

What causes back pain and you can not walk?

Depending on the kind of pain (sharp, down the back of your legs or pain that goes around the side of one or both legs (sound familiar?), if you can't walk and the pain is such you're looking for someone to put you out of your misery, then you likely have a disk herniation in the lower lumbar area.

Pain down the back of the legs is usually a herniation at L5/S1 vertebrae or L4/L5; pain that goes around the side of the leg and terminates at the inside of the knee is between L3/L4 or L4/L5. The specific nerve pain you feel and where it is can be traced to specific disks.

First, don't sleep on your back or your stomach - those are the worst positions for your spine. Sitting also aggravates it, as does lifting anything over a couple of pounds.

After that, try and sleep on your side; put one pillow in front (by your chest so you can hug it) and one behind you so you can't roll over either way. Put a larger pillow or cushion between your legs that's big enough to keep your legs parallel with each other. This will take the pressure off the hips and the lower back. Make sure you've got a decent pillow to support your neck also.

If that's still uncomfortable or you can only sleep on your back, the other solution is to sleep on your back with a cushion under your legs/knees so that the pressure on the small of your back is reduced (it should be flat against the bed),

If you still can't get comfortable, grab a blanket and pillow and head for the living room. Lie down in front of your couch, and slide your butt up against the front of it, putting your legs on the couch seat (sitting position but on your back). This will take all the pressure off your back; though it's a hard surface, it is comfortable if you've got back pain that's bad enough.

If it persists more than 3 days, you need to see your doctor. Until then, stay off your feet and lie down; sitting and standing also puts pressure on the lower spine and aggravates it.

As far as the pain, in addition to bedrest and getting pressure off the spine, reducing inflammation is the next step. If you don't have any prescription anti-inflammatories, you can use OTC meds to do the same thing. 2 of my favorites when I don't feel like using Percocet or Demerol tablets for my own back problems, which are severe. I use several OTC meds that work pretty well:

Aleve - Naproxen in non-prescription form. If you can get prescription Napoxen get it (500mg). If not, 2 Aleve is 440mg, which is close enough.

Bayer Back and Body Aspirin

Tylenol Rapid Release Gelcaps

Flexeril helps with muscle spasms - ask your doctor for a prescription. In a pinch, Benadryl will also help relax you.

Before you see a doctor, track your pain in a diary. Note the location (draw a simple diagram of your back and indicate where it is) the kind of pain you have (sharp, dull, tingly, needles and pins, burning, etc.), the severity of the pain (1 = hardly any, 10=please kill me or knock me out now), the time of day, the date, and what you were doing when it started or increased. Note pain beginnings and increases. At the top of the diary, note when the pain began and if you did anything before it started (accident, lifted something, unbelievable sex, etc.). Make sure you bring it with you to your doctor.

NEVER ask a doctor up front for prescription painkillers; you run the real risk of being taken lightly as many doctors will just think you're faking it trying to get pain meds. Of course real pain is difficult to fake, and having a pain diary will go a long way to show you're serious about your pain and getting it under control. Let your doctor suggest it first.

Lastly, a Thermophore Pad works wonders. If you get one, get the original Standard 14"x27" pad with the switch you have to hold (unless you have arthritic hands).

I've added some links below that might help you.


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