Managing Chronic Pain: Live Question and Answer Session
September 24, 2003

Have you been living with chronic pain? Have you tried treatments but are still suffering? Are you ready for helpful advice that could finally help manage your pain?

We will do our best to answer all questions about managing chronic pain submitted in advance and during the live chat session. We look forward to continuing to be your resources for healthcare information, motivation and empowerment.

Q: cindy of west bend - I have fibromyalgia. Is there anything on the horizon that will cure this debillitating ailment?I ache with stiffness from the time I awake in the morning until the time I go to bed at night. However,my mornings are the worst for me, it literally hurts to take a breath deeply in the morning and there are times it is difficult to move around. I am unable to take Ibuprofen or aspirin due to kidney failure I had in 2000. I take a prescription,propoxyphene to help with the pain. I do not take the full dose, between 1-4 during the day depending on the pain factor.Just enough to put an edge on the pain relief. Do you have any other recommendations to help alieviate the stiffness and pain?
A: Moderators - Fibromyalgia is a complex syndrome that frequently gets ignored, misdiagnosed, or people are told that it is all in their heads. This can lead to frustration and depression, which can increase the symptoms even more. If you have never been evaluated by a pain specialist (MD) or an rheumatologist, this would be the first thing to do. There are no new, proven treatments for fibromyalgia but it is finally being recognized as a legitimate illness that needs serious management. One of the most common treatments is a low-dose tricyclic antidepressant because it helps restore normal sleep patterns. Most people with fibromyalgia suffer from distured sleep or "non-restorative sleep" where you do not wake up feeling rested or pain free. This type of medication specifically helps this. Other treatment modalities include physical therapy with careful attention to the tender areas, and acupunture has also been found to be helpful. What you need is a physician who knows the complex issues involved, and the different options available for treatment. There is a national organization for fibromyalgia, you can get this from the library. Good luck.


Q: Donna of Eagle - I have been having headaches for a year now. Last December I saw my family doctor. He decided (after 15 minutes) that since I have a lot of stress, I am depressed and that is causing the headaches. After trying a series of anti-depressants with bad results, I gave up. I don't think I am suffering from depression. I have a lot of pain in my neck. The doctor said that was tension and didn't check it out. I think the problems in my neck could be causing the headaches. Is this possible? I have been trying to help myself by walking regularly. When I tried seeing different doctors in the group, they look at my chart and say, you are depressed, you need anti-depressants.
A: Moderators - It is important to realize that, while depression often coexists with chronic headache, this does not necessarily imply a cause-effect relationship. Some medications show considerable overlap in treating both headache and mood problems. I would encourage consultation with a neurologist. Dr. Mitchell, Columbia-St Marys


Q: Raymond of Milwaukee - I have been having cluster migraines and headaches recently. What can I do to reduce their frequency? I think I might be allergic to aspertame so I stopped eating/drinking items with this artifical sweetener and now the headaches have gotten worse. I usually take ibuprofen which helps okay. My doctor gave me zomig which didn't help at all. Are their more homeopathic remedies that work? Thank You for your response.
A: Moderators - The more natural remedies that have some degree of scientific validity include: magnesium, riboflavin (vitamin B2), and feverfew. These agents have shown benefit in conjunction with more traditional preventative medications. Check with your neurologist to determine what doses are appropriate for you. Dr. Mitchell, Columbia-St Marys


Q: Kate of Fox Point - I've suffered from migraines since the age of 13 but never this frequent or intense since the birth of my second daughter 3 yrs ago. I know they are hormone related. I also know I just gave birth 5 days ago and the whole 9 months of pregnancy I didn't have a single migraine. Even if I had something that would normally be a "trigger". I saw a neurologist about 2 yrs ago and he perscribed a ton of different pain killers but they only work about once. Isn't there a hormone type drug that would help. Obviously something in my system is there when I'm pregnant that prevents them. Thank you!
A: Moderators - Hormones play a significant role in the pathogenesis of migraine headaches. These are sometimes but not always predictable in an individual patient. Many women remain migraine-free during pregnancy ,while other women experience an exacerbation of their migraines during pregnancy. For women who experience menstrually associated migraine, certain hormonal manipulations can lessen the severity of the headaches. These options should be explored with your neurologist. Dr. Mitchell, Columbia-St Marys


Q: Joan of Shorewood - My daughter is 25 years old and her headaches began when she was 12. She was finally diagnosed as having clusters. She takes a beta blocker, uses Frova when the headache seems more like a migraine (immitrex will give her rebounds) and Oxygen. The Clusters seem to come in the spring or the fall and often will start by getting sinus pressure or even an infection. If she has the clusters in Spring they will come back about a year and a half later. She appears to be in a cycle now where she has had a sinus infection, a migraine and is starting to feel the sharp pain on one side of her head. Is there anything else she can do to not have the debilitating pain where she is out of work for a month? The last time she had the clusters she had them for over 9 weeks. Are there any support groups? Please help! Sometimes the pain is so bad she will lay on the bathroom floor and scream and want to die!
A: Moderators - It sounds like she may require more effective preventative medication for her headaches during her more susceptible times during the year. There are several other options that she should discuss with her neurologist. These include antiseizure medications (used in lower doses) and calcium channel blockers. Dr. Mitchell, Columbia-St Marys


Q: Diane of Milwaukee - I take Maxalt when I have a migraine. It helps the pain but makes me dizzy and I don't take it if I'll need to drive. Are there new medications that don't have dizziness as a side effect?
A: Moderators - I would recommend trying one of the other "triptan" medications which may be better tolerated. Perhaps your physician has some samples that you could try after discussing with him/her. Dr. Mitchell, Columbia-St Marys


Q: Lisa of Brookfield - For the last seven months I have had daily headaches, for the most part they are 24 hours a day, as well as lower neck pain. They are not migranes, but can sometimes be disabling. I have been to my physician, a physical therapist for three months, a neurologist, and had two MRI's and a CAT scan. I still do not have a difinitive answer and my doctors seem to be treating the symptoms, not the problem. I have been perscribed imitrex, midrin, ultracet, neurotin, zoloft, tylenol 3, hydrocodone, tizanidine,celebrex, plus OTC drugs like ibuprofen and tylenol arthritis. Is there anyone or anything you can reccomend for me to do to ease my pain, I am in pain and frustrated that I have exhausted every avenue and I am starting to loose hope and faith in any recovery....any suggestion would be much appreciated1 I will be at work when your call in is taking place...would you mind emailing me the answer at LisaMarieBing@aol.com Thank you again
A: Moderators - While your headache situation appears challenging, it is not hopeless. I presume that serious causes of headache have been ruled out. It may be that the right combination of medications and lifestyle changes has not yet been tried. Please talk to your physician about a re-evaluation. Dr. Mitchell, Columbia-St. Marys


Q: Kathy of Milwaukee - My husband was recently hospitalized and diagnosed for a pituitary tumor. He is currently taking Hydrocortisone (oral) to shrink the tumor. What is the success rate of a this type of tumor going away in this manner? Is surgery almost always the end result?? Does he have to take this steroid for the rest of his life?? Due to low testosterone due to this tumor, he is also on a trial study for a gel called Testim which he applies to his shoulder areas every morning. Have you heard of this?? The side affects scare me and I was wondering what your opinion on it was. What are the chances of pregnancy when testosterone is low?? Thanks much.
A: Moderators - These are important questions that are best answered by your husband's treating physicians. An endocrinologist may be best informed to answer your specific questions regarding the Hydrocortisone and Testosterone. Dr. Mitchell, Columbia-St Mary's


Q: tricia of milwaukee - I have had migrains since I was a teenager. I'm in my early thirties now. Lately no matter what medication I take it doesn't seem to help. I take imitrex, tylonalx3 tabs extra strenghth . Any other suggestions?
A: Moderators - Migraines are almost always amenable to treatment. If you experience a disabling migraine at least twice per month, prescription medication aimed at prevention may be quite helpful. This may allow a decrease in the frequency and/or intensity of your headaches, and increase the likelihood that the acute pain medication will be effective. Be careful about overusing any acute pain pill as it may provoke rebound headaches. Dr. Mitchell, Columbia-St Marys


Q: Gwen of Milwaukee - I'm having constant headaches for the pass 2 months and I've try every product of tylenol and excedrin and nothing helps. What should I do?
A: Moderators - After seeing your doctor in order to exclude any serious causes of headache, the focus then turns to therapeutics such as preventative medications and lifestyle changes. It is equally important to avoid overuse of acute pain medications such as the products you mention. These medications work better for headaches when they are not used on a daily basis. Dr. Mitchell, Columbia-St Marys


Q: Phil of Glendale - My wife has been out of work for a week because of severe back and leg pain due to failed back syndrome. We've done some research on the internet about it but find that no one really knows what causes it, and no one knows how to cure it. Is anyone doing research on treating failed back syndrome and if so, how can my wife get involved?
A: Moderators - There is no ongoing research I know regarding the origin or best treatment of FBS (Failed Back Syndrome, possibly due to the multiple origins including a wrong diagnosis prior to surgery and scar tissue formation. There are treatments available through Pain Clinics, including accupuncture, massage, medical management, and some pain proceedures to minimize the symptoms she is experiencing.

Dr. Steven Donatello
Columbia St. Mary's Hospital


Q: lillian of port washington - Why do I have back-of-the leg pan at night when in bed? Not in the daytime.Is this arthritis?
A: Moderators - Pain in the back of the legs can be caused by athritis of the spine, disc bulges, or back circulation to the legs. If the pain is only occuring at night and not with activity, chances are it's not related to circulation but rather to degenerative changes of the spine such as spinal stenosis. This is similar to arthritis, although not exactly the same thing.

Dr. Steven Donatello
Columbia St. Mary's Hospital


Q: Kathy of Milwaukee - Is pain medication legal to purchase online. I've seen websites like this. Is it legite?? They claim you can order any pain med without a prerscription. Is this true?? I've considered it in the past but only for pain meds I've already had before and that I know I can take. I have a lot of pain on occassion w/ severe cramps, neck pain, migraines, and back pain. Asprin doesn't work. My doctor always prescribes meds that don't work or aren't strong enough such as Fioricet w/ codeine and Dicofinac or somehting like that. Why is it so difficult to get strong meds? Why are doctors so leary of giving out good pain meds verses ones that don't work at all?
A: Moderators - Hello, I would not buy any pain meds on line. I think some health professionals are leary as some people abuse the medicines. I would ask your doctor to see if you can see a pain specialist if he/she does not feel comfortable prescribing these meds for you.

Dr. Weber
Advanced Healthcare


Q: Kashonna of Milwaukee - Could it be serious, if sometimes I stretch my neck from side to side,back to back and it feels like a shock going thru my spine. The feeling seems scary. What does it mean if I get muscle spasms or "crooks" in my neck at least once a month for at least a week at a time? I stretch if I don't do anything else, to prevent these spasms, but they still occur every month. What does it mean if I get a spasm in my neck and I get knumbness and pain thru my shoulders, arm and fingers? I can't wait to watch, these problems many have on a regular basis and we go to the chiropractor, who does the minimum for 6-8 weeks to keep you there and it doesn't work.
A: Moderators - Your symptoms sound as though they may come from a pinched nerve in your neck. I would recommend a specialist that deals with neck pain such as an orthopaedist or a pain specialist.

Dr. Weber
Advanced Healthcare


Q: Rona of Milwaukee - I have severe pain which travels from my back to my hip into my leg and I am currently in a rehab program. Do you think the rehab is making my back pain worst?
A: Moderators - Hello, I think rehab is a crucial component of treating this type of back pain. Sometimes there is pain to work through to get better but your therapist and doctor may need to adjust treatment to avoid pain.

Dr. Weber
Advanced Healthcare
414-352-3100


Q: Bishop of Seattle - Short and simple....I have tried EVERYTHING TO REDUCE THIS HIDEOUS PAIN I LIVE WIT ALL THE TIME, EVERYDAY. IT IS THE MOST FRIGHTENING THING I HAVE EVE EXPERIENCED. I USE MY HEAD TO TURN THE PAIN DOWN BUT IT BECOMES AN ALL DAY ALL THE TIM PERSUIT. I CANNOT REMEBER A DAY IN THE PAST 5 PLUS YEARS WHEN I WAS NOT IN SEVR PAIN. I HAVE DIABETIC NERUAPATHY. I HAVE TRIED EVERYTHING FROM PEPER CREAM TO OXYCONTIN. THE MOST RELIEF COMES FROM VICODIN BUT I DESPISE MY HEAD BEING SO FUZZY. I HAVE ACCEPTED MY CONDITION BUT STILL HOPE FOR A SOLUTION WHICH IS LESS "NARCOTIC"...WHAT I WOULD GIVE FOR A DAY OR TWO WITHOUT THIS PAIN. ANY SUGGESTIONS? THANKS BISHIKAY@AOL.COM
A: Moderators - Sounds painful for you. Nuerontin and amyitriptiline can be helpful for that problem. I would recommend seeing a pain specialist.

Dr. Weber
Advanced Healthcare


Q: julie of thiensville - I have adhesive capsulitis (frozen shoulder). After months of physical therapy, two cortisone injections, and anti-inflamatory medicine, I remain the same. I have difficulty getting a good night sleep due to the low grade pain and movement when sleeping. I have severely limited my physical activity where I would be moving my arm where there is pain. Please suggest ways to improve movement in my shoulder and how to deal with daily "low grade" pain? Thank you.
A: Moderators - Hello, This is a frustrating condition. Unfortunately, this condition often takes 3 -6 months to lessen. I recommend daily anti-inflammatories if your stomach can tolerate it and "pushing" through some of the pain to loosen and break through the adhesions. Ice for 10 min as needed can work as well.

Dr. Weber
Advanced Healthcare
414-352-3100


Q: Kathy of Milwaukee - This question is in regards to my mother. She needs someones help immensely, but she won't go to see anyone. She claims she has seen doctors before, and that she needs a hip replacement. She is afraid to go through with surgery because she doesn't think she'll survive the surgery. She seems to think her body won't be able to take it. My mom has been living with severe pain for about 10 years. She hasn't left the house in over 4 years. She doesn't even go get the mail. She lives off of bottles of aspirin and uses a walker, but the pain is so severe nothing helps. She cries a lot due to the pain and frustration of her being cooped in the house. Her legs are bad and her hips are bad. My mom is 74 years old and is overweight. Can you help me help her?? Thank you. Kathy
A: Moderators - Your mother may in fact need to have her hips replaced to get rid of the pain symptoms. Surgery with an anesthetic provided by a Board Certified Anesthesiologist can is almost always very safe, even if several other medical problems exist at the same time. Many Anesthesiologists will do a "Spinal" anesthetic, which depsite sounding scary, is exceptionally safe even in very elderly, fraile patients. If your mother is not able to undergo surgery, then supervised management of her symtoms by a trained pain specialist will likeluy provide good relief and improved function/quality of life.

Dr. Steven Donatello
Columbia St. Mary's Hospital


Q: SHARON of HALES CORNERS - I AM LOOKING FOR A FACILITY WHO HAS A WATER AEROBICS CLASS
A: Moderators - Most YMCA's have water aerobics classes that are not too expensive to participate in.

Omar J. Darr, M.D.
Advanced Healthcare


Q: Michael Rhodes of Spring Green - Any cure for chronic Packeritis? The team stinks, and it's killing me!
A: Moderators - This has been a long term problem in Wiscoonsin, along with Brewerflamatory disease. We find the single best solution for both of these problems to be spending gametime playing with your children, or doing some volunteer community work. It should more than make up for the discomfort of the Packeritis.

Dr. Steven Donatello
Columbia St. Mary's Hospital


Q: marion makarewicz of grafton - I've had spinal stenosis for 5 years. Went through the pain management program at Columbia, taken oxicontin,use pain patches now and have had injections that gave me relief for a short time. Dr. said there is surgery for spinal stenosis but they don't promise much relief and the recovery time is long. Is there anything new that is promising or do I have to learn to live with it?
A: Moderators - Surgery for that condition is a reasonable alternative for some people. It sounds like you have tried the common treatments. I recommend continuing a flexion-based lumbar stabilization exercise program daily at home and another round of injections can help. When you can no longer live with the pain, then the surgery is worth a try.

Dr. Weber
Advanced Healthcare


Q: Janet of Delafield,Wi - I am 70 years old . I have started to take vioxx for knee pain. I am experienceing hot flashes and a feeling of fullness. Have not had those feelings for many years!! Does your blood pressure go up and should you be monitor for that? Does Celebrex have the same symptoms ? How to you feel about a stress test before taking this medicine? What is the different between Glucosamine and Chondroitin?
A: Moderators - Hello Vioxx can cause water retention and increased blood pressure. You should check in with your doctors. Celebrex does not cause those symptoms as often in my practice. I do not feel a stress test is needed unless you have cardiac risk factors. Glucosamine helps to preserve and maybe even rebuild some cartilage. Chondroitin works as a mild anti-inflammatory.

Dr. Weber
Advanced Healthcare
414-352-3100


Q: ROSEMARIE of MILWAUKEE - WHAT ARE SOME SUGGESTED TREATMENTS, EXERCISE, DIET, LIFE STYLE CHANGES, ETC. TO MANAGE THE PAIN OF FIBROMIALGIA?
A: Moderators - Most of the medical journals and studies have shown that 30-45 min of daily exercise is the best consistent way to reduce your symptoms. Other medications help some people but I do not know of diets or foods that help.

Dr. Weber
Advanced Healthcare


Q: Nancy of Menomonee Falls - Wondering what is the best thing for Sciatica pain. Do you recommend any type of excercise or other treatment. thank you
A: Moderators - Hi Nancy,
Sciatic pain is treated well with strong anti-inflammatories as well as physical therapy for starters. These both help to reduce swelling by the pinched nerve and keep pressure of a disc.

Dr. Weber
Advanced Healthcare
414-352-3100


Q: Geri Freeman of Grafton - I had back surgery, for a herniated disc, 3 years ago. I have chronic back pain, on the right side and down my right leg., from my sciatic nerve being damaged. I am On Neurontion 600 mg. Three times a day, Plus VicodinES twice a day. Many side effects from Neurontin, but tried to cut back, and was limping again. Is there some new medication, for chronic nerve pain, with less side effects. Thank you
A: Moderators - There are a multitude of medications besides Neurontin that are beneficial for your symptoms. If you are having benefit, but side effects, a switch to a different anticonvulsant to minimize the nerve irritation should make you significatly better.

Dr. Steven Donatello
Columbia St. Mary's Hospital


Q: Audrey of Beaver Dam - Is it true that cortisone shots can degenerate bone and tissue when you have up to three or more? I am having two at once tomorrow and am concerned about what will happen in the future if the Dr.'s continue to give me the shots for pain.
A: Moderators - There is some concern that cortisone can speed up the degeneration of cartilage in joints. Usually, doctors do not give more than 3 or 4 into a joint per year. If you have little or no cartilage left in your joint, you do not have much to loose by having the injections.

Omar Darr, M.D.
Advanced Healthcare


Q: Julie of Mequon - What is the proposed treatment for advanced reflex sympathetic dystrophy? Thanks.
A: Moderators - This should be treated by a multidisciplinary pain clinic. Medication and nerve blocks are part of the treatment plan.

Omar J. Darr, M.D.
Advanced Healthcare


Q: Audrey of Beaver Dam - What can you do about a bulging disc that hasn't herniated, but does cause discomfort down the leg by compressing a nerve. Physical Therapy hasn't helped.
A: Moderators - Injections may be a possiblity. Talk to your doctor if these might be right for you. The number for the Spine Center is 414-961-5005.

Omar J. Darr, M.D.
Advanced Healthcare


Q: Deb of Waupun - How do I find relief for my lower back. I know I have arthritis in my lower back and had a hesterectomy last year, which helped quite abit, but lately my lower back is just killing me. I have been in the garden alot and I walk 2 miles monday thru friday, but lately Aleve has not been helping and have gone to a stronger pain med that the docter gave me last year. Still without much relief. I have had all kinds of tests last year and all they came up with is the start of Degenerative Disc Disease. What do I do?
A: Moderators - Medications and physical therapy help in most cases. Sometimes spine surgeons will fuse the segment of the spine that is affected by the disc degeneration. The phone number at the Spine Center is 414-961-5005.

Omar J. Darr, M.D.
Advanced Healthcare


Q: Nikki of Milwaukee - After two discectomies, I continue to experience debilitating pain, mostly down my right leg. I'm told it's called Failed Back Syndrome. I've tried over a dozen medications but can only tolerate a low dose of methadone which helps a bit. Cortisone/epidural shots don't help & physical therapy using an exercise ball caused more pain. At this point I can stand for only a few minutes before severe pain sets in; I can't sit at all. I spend 99% of my time laying down, avoiding pain levels of 6 to 8 or 9. When I move the wrong way it flares to 9 or 10. My husband insists I should be exercising to strenthen the muscles around my spine. Assuming I can do it and withstand the pain, what exercises should I do? Are there any treatments for the scar tissue? Ultrasound? massage? laser removal? Thank you!
A: Moderators - Exercise following failed surgery is an important part of management of your syptoms. As frustrating as the medication failures may be, you may find one that provides excellent relief if you're open to keep trying. Massage therapy, and especially accupunture, may give you very good relief as long as you're able to keep up with treatments which may be needed a few times a month for a prolonged period. If all else fails, considering a spinal stimulator or intrathecal pump may give you relief. Please understand, though, that these should be used ONLY as a last resort.

Dr. Steven Donatello
Columbia St. Mary's Hospital