web sites

[MIKE FOWLER]

HI TOM     Just picking your brains a bit,do you know or heard of anybody
getting Pain relief from the drug NABILONE,I am going to have a trial
testcase taking it orally I know everybody is different, I have taken
everything you can mention, but not this I think I am at the end of the line
funny how nobody has ever mentioned this one.    MIKE
----- Original Message -----
From: "Thom Bloomquist, MS, CRNA" <tcbloom2 at earthlink.net>
To: "Amputee Information Network" <amp-l at u.washington.edu>
Sent: Wednesday, March 06, 2002 1:06 AM
Subject: web sites


>
>
> I would like to know if there is anything out there that works for phantom
> pains with not many side effects. I am having them regularly as I have
been
> for years. But being a single mom I can not be sleepy all the time.
> Susanna
> I can understand that.  I wish I had a magic wand to take away everyone's
> pain.  But our magic wands are working this week.
> The problem is phantom pain as compared to other pain states is one is
> dealing with a nervous system, literally changed by the experience.  The
> nerves that try to resprout form neuromas.  Normally silent high-threshold
> pain nerves have been activated.  The remaining part of the limb is asked
to
> support pressures and stresses -they were never designed for.
Non-affected
> body parts must work harder and sustain extra stresses, which can lead to
> arthritis and chronic musclo-skeletal pain.   Frequently there is chronic
> depression (understandably), anger and such factors can lead to a feelings
> of social isolation.  On and on we could go.
> However, by listing these changes and problems - I don't imply for a
second
> that the situation is lost or helpless - far from it!  Amputees are some
> world's most inspirational survivors.  One lady said it this way; "When
you
> fall down or get knocked down - you get up - put on another coat of
rogue -
> and keep walking"
> It is hard to make recommendations for someone you have not met, without
the
> charts, labs, tests, meds, allergies - in short all that we use to
generate
> a plan.  Thus we can talk only in generalities.
> First - expectations.  Relieving all pain is probably an unrealistic
goal -
> yes?  Making it like "was" also not possible.  (You would be surprised how
> many people actually ask for such things.
> Secondly - a goal.  Focus not on a pain score of this or that - rather
> establish functional goals - what do you want to do when pain impacts your
> life less?
> Third - you must be prepared to make more changes - simple and obvious
> though it sounds - this is hardest for some people.
> Phantom pain is mix of peripheral and central factors.  Central factors
are
> changes in the pain signaling system.  These central changes are
aggravated
> by more pain alarms.  For example - a poor fitting prosthesis can be a
> constant source of alarms.  So first do all that you can do to limit those
> things you can control.  Get the best prosthesis fit you can get.  If you
> need an assistive device  to take stress off that other leg, now asked to
> work harder - do it.  Be mindful of your posture.  Keep you weight down,
do
> stretch/exercise - everybody can do something.  Stretched muscles are more
> resistant to spasm.  (I know this may be all review for you - but I can't
> know what you know) .
> We use two camps of tools.  The first camp is low potency but safe. This
> includes massage, biofeedback, acupuncture/pressure, assistive devices,
> micro-currant technology and nutritional supplements.  (I advise most of
my
> chronic pain patients to take extra magnesium).  The second camp of tools
> are more potent but also have more side effects and complications.  This
> includes potent meds, specialized injections, implantable devices like
nerve
> stimulators and brain transplants (just kidding).
> We try to get as much mileage out of the first group as possible before
> adding in the second group.  For most people, phantoms are a form
> Neuropathic pain.  This form of pain generally does not respond well to
> drugs like morphine or NSAIDs like ibuprofen.  (But pain from other parts
> might).  Neuropathic pain tends to respond better to anticonvulsants. I
> don't know what country you are in -  specific names may be different.
> Some things that don't work - valium like drugs do not work well on this
or
> most forms of pain. (But might be helpful is patient also has an
> anxiety/panic problem)   We don't recommend mixed agents like nalbuphine
or
> butorphenol.  (Stadol or Nubain). We do use a multi-modal approach with
> different types of drugs and measures.
> We have an electrical device that works at the mirco-currant level (.5MA
x.5
> hz).  Several devices by different companies and names.  We have the Alpha
> Stim.  It takes my phantoms away immediately and completely.  (However -
to
> use it I must be off my leg).  It's a camp 1 item (Low potency and safe)
No
> chance or sides effects or allergy, no needles -it's external skin
contact.
> In the US, it's by prescription only but in Europe its over the counter.
> (such differences drive me nuts)
> Then there are camp II drugs like gabapentin, mexilitine, calcitonin and
> beta-blockers.  All these work for someone people but nothing seems to
work
> for everyone.   Adjunctive medicines like amytryptyline, drugs in that
class
> can help and make real differences for people.
> Adequate sleep is crucial!  Not just the number of hours but waking
feeling
> rested. Biofeedback and hypnosis can be very effective at reducing pain
> generated by muscle spasms. Some people get locked into thinking about a
> "pill" to take away their pain.  Biofeedback and hypnosis are real -
> effective therapy for people who learn how to use them.  (some of those
> changes I mentioned)
> Remember we are speaking in generalities here  -this isn't medical
advise -
> don't do this at home - I was never here....:)
> I must toddle off to work - more later...
>
> Thom
>
>