Autonemesis

My closest friend is in a great deal of pain, which seems to be a side-effect to the treatment he is getting. Three years ago, his liver failed from unknown causes, and he received a liver transplant. The anti-rejection drugs cause, among other side-effects, a reduced output of insulin from his pancreas, making him borderline diabetic. He kept it under good control for two years, measuring blood sugar and taking injections as needed. Then he got complacent. He became really good at controlling his blood sugar by diet alone, and eventually stopped monitoring his blood sugar altogether. At least, it seemed to be under control.

But then last week he got really sick with massive headaches and nausea, loss of appetite, and blurred vision. He realized this weekend that his symptoms matched up with high blood sugar, and so he dug out his blood tester from the drawer, and the result was off the scale high. So he called me this weekend in agony, barely able to move, and I took him to the emergency room. They got his blood sugar under control, and while he was in the hospital they also gave him an I.V. for the pain, which eliminated it. But the prescription they gave him for outpatient use (Darvocet) is not taking care of it, and all he can do is writhe on the sofa in agony. He can't eat, thanks to the nausea induced by the pain, and he can't sleep. His doctors don't seem to want to take this issue seriously, but the pain is really debilitating.

There are lots of quackery out there regarding pain control, so I was hoping someone with experience here could guide me. If his doctors don't want to get him pain relief, then I will. Where should I look for some competent pain control information?

Thanks for any advice you can offer.

Viti

This may sound wacky, but look into hypnosis as pain management. Even if it's your own brain doing it, relief is relief

Also, as a recent kidney donor, I have to say he has no choice but to be vigilant in regards to his health. He cannot become complacement because this is what happens. Best of luck and keep us posted.

Lastly, I think this would get better responses in Science and Skepticism

Autonemesis

I don't think hypnosis is a wacky idea at all. He's quite limited in the kinds of pain medication he can take, due to his anti-rejection regimen. Thanks for the idea.

Viti

You're welcome, thank you for ignoring my sad typos ::yikes::

I have recently considered learning hypnosis for these types of applications...it is being used for chronic pain management and childbirth. I am still trying to find data on whether it works or not, but so far it seems to be legit in some cases as least.

Deacon Doubtmonger

Have his doctors indicated why they're holding back on proper pain control -- i.e., do they have legitimate medical reasons, or do they not feel qualified to manage pain properly, or are they just a bunch of coldhearted pricks, or are they scared he might get addicted and sue them, or what? I've encountered all of these.

NOTE TO ANYONE READING THIS: I'm not a doctor, and I don't play one on Internet Infidels, so if any of this post is medically unsound, feel free to correct the info, then savage me at will.

That having been said: I don't know the specifics of your friend's situation with his doctors, but I can offer a few general points:

(1) Is his liver function sufficiently monitored for them to notice whether the acetaminophen (Tylenol) in the Darvocet is affecting it? I understand chronic long-term use of meds containing acetaminophen can cause liver damage.

(2) How many pain meds have they tried him on? Responses to pain meds can vary widely from person to person. In my case, after some righteous kidney surgery, I got only so-so relief from IV Demerol (via PCA pump) and felt seriously woozed-out; one would think I'd get less relief from oral Percocet, but as soon as I was switched to that, I got immeasurably better relief and -- oddly enough -- no sedation at all. Your friend's mileage, of course, may vary. Keep in mind also that there are doctors who have "pet" pain meds which they think work the same for everyone, and they're too lazy to try others; here's hoping he's not saddled with one of them.

(3) He might also wish to consider a physician who specializes in pain management, or a pain clinic. How forthcoming they'd be with pain meds is, of course, a matter of individual practice; such programs might be more concerned with non-narcotic relief, and many will require a psychiatric consultation, but there are some such doctors who feel much safer than nonspecialists in prescribing sufficient doses. His insurance carrier might be able to supply a list of such practices in your area. (Unfortunately, I don't know the name of the board-certification body for them -- can anyone chime in?)

(4) Finally, is it addiction they’re worried about? If so, they should be aware that a new detox drug called buprenorphine has just been approved by the FDA; I understand that (1) it’s much easier on the body, and much less addictive, than methadone, and (2) while doctors have to register with the federal government to prescribe it, they can do so in their own offices – i.e., no more mandatory visits to a government-run clinic. (I understand the methadone clinics are all ca-ca pants over this, as they stand to lose lots of business.)

Here’s wishing your friend successful pain relief and you peace of mind! Keep us posted, OK?

Deacon Doubtmonger

demoninho

Autonemesis, as a MD, I would say it would be really unwise to give advice via the internet especially in the light of the medical history of your friend, who is at a particular risk taking immuno-suppressant (anti-rejection) drugs. There could be numerous serious causes of the pain perhaps missed on the original hospitalization, where they could have been more concerned with the high blood sugar. I would advice your friend to return to doctor responsible for the immuno-suppressants of your friend for further diagnostic steps and adequate pain control.

Best wishes and good luck to you and your friend,
demoninho

Autonemesis

demoninho, I didn't mean to imply that I was looking for a prescription. I was just looking for some avenues to pursue, some things to bring up with his doctor. Hypnosis however, seems harmless enough as far as his immune system is concerned.

He's complained of chronic pain since his transplant (mostly migraine-type headaches) and he's complained to me that he thinks his doctor doesn't take his pain seriously. Add to all this the fact that his current G.P. is new to him, since the old G.P. left the Aetna system (can't blame him), and his liver team is now arguing with the new G.P. about who is going to manage his diabetes now.

Right now, we're waiting on the results of tests done this weekend when he was in the emergency room. They even did a CAT scan, but found only a few calcium deposits, which do not seem large enough to account for his intense migraines, or so I am told.

Also, realize that I am hearing about all this from my friend, not first-hand. They wouldn't let me past the lobby when I took him in.