Pain meds not covering other acute pain?

[Kira]

As you guys know, I take pain meds daily for chronic pain. My chronic pain is pretty well controlled most of the time by my meds.

But I woke up today with an ear infection... and it hurt SOOOO bad. It just plain HURT. Granted, I would still gladly choose the ear infection pain over pain from rhabdomyolysis... but man, I know why babies scream so much about these things!

Because illness & fever are triggers for my rhabdomyolysis attacks, it's really important to get my fever down and get the infection treated. My PCP didn't have any available appointments, so his nurse told me to go to the urgent care clinic. Sure enough, the doc at the urgent care clinic said my ear looked pretty bad (plus my temp, with ibuprofen, was 101.2 while I was there)... so she prescribed antibiotics and these ear drops for pain (they have a numbing agent and an anti-inflammatory agent).

The weird thing is that, even with my fentanyl patches and oxycodone for my everyday pain, this earache hurt really, really bad. Before I put the numbing/anti-inflammatory ear drops in, it felt like my eardrum was going to explode or something, and it was radiating into my jaw/teeth and into my head behind my ear (mastoid process, if anyone knows what that is).

I used the ear drops and it feels a little better, but WOW, a simple little ear infection can REALLY hurt.

I would think that the opiates would mask pain from stuff like this, but they don't seem to even really affect it.

I wonder why that happens?

[Kathi49]

Kira,

I know how badly that hurts...busted my eardrum last summer. :eek:

Anyway, do a search on occipital neuralgia AND mastoid. It will mention the mastoid process and that probably explains why you had referred pain into your jaw, teeth and behind your ear. I have this all the time; but with me it FEELS like I have an earache, but through experience with this condition, I know I don't. It is just referred pain. And even with the tight sternocleidomastoids I had recently did the same thing...referred pain to my inner ear. And nope, the opiates don't work very well and why sometimes we have to resort to the nerve meds. So...just a thought because I know you really have an infection.

Oh, and I was given similar ear drops last summer; can't remember what it was though but it had an anti-inflammatory in it as well. But, it burnt like fire. And I suppose it would since there was a hole in the eardrum, lol, but the doc changed it right away. Maybe he thought it wouldn't burn...but it sure did.

[claudia029]

Narcotics do nothing for the nerve pain I have from Clumping of the Nerve Roots at L3-L4. I didn't believe my Neurosurgeon, so I tried Avinza, it didn't do anything.

Lyrica & Tramadol (an anagelsic) aids a bit.

When I had my last surgery, 9/11 I had a morphine pump the 1st night. Five hours with it & I had a migraine. Demerol with phenegram pump the next night & I had a headache.

I was like you & thought pain meds would take care of any kind of pain - NOPE.

Hugs To Ya!
Claudia:)

[Mark N]

Kira,
I hope you get the ear infection taken care of soon. I don't have a real answer for you but I do know that with an abcessed tooth my pain med didn't seem to help. i found out though that I didn't feel it for a long time and it wasn't until it got bad enough to override the pain med that I felt it. Maybe you didn't notice the ear infection as early as you should have because the pain was suppressed until the pain got too bad.

[BrokenBladder]

Good point Mark. Although last summer I had a bad ear infection and m pain meds didn't touch it either. It was a maddening pain that just wouldn't go away until I finally got the drops that Kira refers to.

It's truly weird how the pain meds mask some pain and yet let others come through and hurt us ALOT.

I hope you're feeling better now Kira. I found that putting my head on a heating pad, set on low, helped with the pain.

[gambles]

Sometimes I feel like I process narcotics the same as water. They help a little, but definitely not a lot. I haven't had the ear problems in years, but I do know that my meds do absolutely nothing for tooth problems. I just laugh when the dentist offers me meds!

Is it completely because narcotics don't touch certain pain or because we are so used to processing them and "using them up" for our regular pain? I read in a pain textbook once that the reason that pain patients don't usually get high is because the narcotics are working on the pain instead. I'd love to know if there is truth in that.

Good luck with your ear. Hopefully it will go completely away soon.

Suzanne

[OncRN]

Kira,
Sorry about that ear :( . Hope you're feeling better soon!
I get this 'icepick in the ear' pain sometimes...severe, knock-ya-to-yer-knees kind of pain (suspected TN)....so I can empathize. Oowwie!!!! (And I will cross appendages that fever doesn't stir anything up!)

Anywho, I think Mark has a good point. I've noticed hubster constantly gets scratches, bruises and scrapes he isn't aware of; the pain is covered by the narcs. You'd think that'd be a good thing, but pain meds totally masked the deteriorating condition of his gall bladder until it became necrotic and had to come out. His only symptoms were fever and emesis.
The other downside to this is that the surgeons won't even consider giving hub anything for pain postop. So far, in the last year, he's suffered through the cholecystectomy and a complicated septoplasty with only ice and sympathy. Currently, he's dealing with a sprained knee, ankle, broken foot bones, and post-rhizotomy pain; so it's 'gimme a howitzer' on the pain scale 24/7. At least we were able to talk PM into lidoderm patches to help some.

I've been trying to figure this out for years. My feeling is that chronic pain affects the threshold in some way, but that doesn't explain why some types of acute pain messages get through and some don't. We certainly need more studies on this issue!

Hope you feel better soon!
OncRN

PS...Suzanne....yes, there is truth in that!

[houghchrst]

Oh Kira I know how painful that can be, I hope it goes soon. I have the same problem with migraines. THe only thing that can touch them is the occasional Excedrine Migraine (oddly enough,and only if taken immediately) and the Imitrex which works every time. I did find that when i was taking vicodin after my knee surgery that I had less migraines but when i did get them only the Imitrex worked.

Get better soon.

[Tbackpain1]

I agree OncRN, that CP effects the individual threshold for pain of an acute nature. Now, whether its in the brain where things are interpreted or out at the various nerve centers of the periphery, or somewhere in between, I really couldn't guess. I've some theories, but they're probably totally off-base. I loved my neurobiology elective, but that's probably because I took the course when I was in the early stages of this spiney thing.

I'm constantly bruised & scraped and I have no idea where they come from. I've lost two teeth so far from massive infections that were completely masked until the pressure got so bad that when I'd bend my head forward my teeth would throb, and then it was far too late to save the teeth via root-canal. I sprained my knee and while it hurt, the real reason I knew something was wrong wasn't pain, it was the swelling and warmth of the knee that were the give-away.

Theresa

[Kathi49]

Theresa,

I agree. Which is what I was trying to say earlier. I am not sure either how it all ties in but I would assume if TN and ON can refer pain to the inner ear (and it sure did me), I would think it could work in reverse. I can also say my upper teeth would ache terribly when having an attack. And the PM I had at the time looked for acoustic neuromas and had me take some hearing tests as well. So, it is all related somehow. The only other thing he said was, and this is really referring to the neck and my ear, that things are so congested in there (meaning nerves) that they all just crosstalk...and to the auditory nerves (had tinnitus too). So, and I am no doc, I would think an inner ear infection could refer pain to several places. And this is something I said the other day. I was having a flare in the occipital area...and my inner ear was killing me...yet I knew I didn't have an infection. And this kind of thing happens from time to time. Same thing with my upper back teeth.

Why the opiates work and sometimes don't, I don't know. But I THINK it has more to do with the TYPE of pain and what the condition is. And I suppose this is why they never gave me opiates in the beginning...it was all nerve meds. But no, the opiates don't always cover all types of pain. And another reason why a lot of us take different combos.

[kimee100]

Pain meds I heard, are just like antibiotics. Some antibiotics won't do a thing for some conditions, that the infection is immund to that type of antibiotic and you need a med that will attack the infection. I think the pain meds are the same thing, certain pain meds are given for certain conditions. Imitrex will not touch the pain I have from my RA but Oxycontin will and Oxycontin will not touch a pain from a headache, Imitrex or Excedrin does better. This is what I heard anyway.

[Maggie]

I am recovering from interfusion of the trapexometacarpal and there was NOTHING that could touch that pain. Not my Fentynal patch, or, Lortab 20 mgs. I don't normally take that much lortab for breakthrough, but I had to for a week.
I would love to see more study done on why additional pain is like totally different pain.
Maggie

P.S. drugs work different ways, i.e. Imitrex works on blood vessels.

[Kira]

Kathi, while I agree that pain from other parts of your body can refer to your ear, etc... But right now, I don't have refferred pain... I have a plain, old ear infection after all. The doctor at urgent care looked in my ear and was like "WOW" bet that hurts. Plus I have had a fever for two days now.

I'm feeling a little better with the ear thing right now, but I have the drops in. The drops work great (Auralgan... benzocaine, a local anesthetic---antipyrine, an anti-inflammatory--- and glycerin, which makes them thick so they'll stay in, and the glycerin supposedly does something with the fluid in the ear). I don't know if the ear would hurt this bad without the ear drops, but I'm not stopping the ear drops until I've been on the azithromycin for a few more days and the fever is gone for 24 hrs.

[MamaRider]

When my Pancreatitis hit, NOTHING helped, really, not even IV Dilulidid every 2 hours around the clock. It just freaking hurt for a long time. At first I really thought I was going togo into shock. I use a 175 Patch and have Dilulidid available at home for BT, but it did NADA. It happened after I had a procedure done, and I had no real idea that it would happen. Just later on in the evening it hit, and OH BABY,I thought i was gonna die.

I have also found that there are other things my BT meds do not help. A True Migraine is one. Off to the ER I go for IV Meds for that. Topamax has cut the frequency of those way back, Thank God! And when I have a TMJD Flare. I have arthritis is my Jaw joint and every so often,from laughing too much or something my Jaw will just start to really HURT big time and not even my BT meds help. I just suffer thru the attack then,or goto the ER and get a shot of an NSIAD. Thast seems to help alot. I cannot take them (NSAIDS) orally, but the shot helps the flare.

I think as CP PT's we get to a point we can handle X-amount of pain. We get really good at that amount. When a bit more hits, Y-then we are over loaded and then NOTHING is going to work. My theory is because we have burned out our natural Endorphins from the Narcatics we have taken, and have also built up some tolereance to Narcs also. So, when Y Pain hits, we don't have the Endorphin resources to attack the pain, and our tolereance is such that it takes somuch more Narcs, that we just won't be given...IMHO,only.

[Kathi49]

Kira,

That's why I said in my original post...just a thought...I KNOW you have an ear infection. But YOU mentioned the radiating or referred pain to your teeth, behind your ear and head. That's why I posted what I did. :) I am glad the referred pain has stopped and hope the medication continues to work well. I know when I busted my eardrum the ENT couldn't really figure out why it happened. But his belief was I had had the beginnings of a slight infection, it was allergy season (had been sneezing a bit) so when I went swimming, it just blew. It was intense pain for a few seconds but then stopped. It was only after another week that it really became painful. He also mentioned Eustachian Tube Dysfunction. Anyway, the drops and nasal spray took care of it. But it took several months to totally heal. And during that whole time I wasn't supposed to get any water in my ear. So, that ended my swimming for the summer (had to be careful in the shower too).

[Jo6]

I hope you are feeling better. They say an ear ache/infection is the worst pain you can have. I know my babies all screamed bloody murder when they would have one. take care, Jo

[Kira]

The earache is feeling better but I still have a fever whenever the ibuprofen & tylenol wear off, and I have been sleeping most of the time for days (watching TV or poking around on the laptop when I'm awake).

Kathi, sorry if I misunderstood your first post. I thought you were saying that it sounded like ON pain since it was radiating to all the right places... I thought you missed the part where I said I'd gone to the doc and she saw an ear infection. She said that the eardrum was really bulging and that there was a lot of fluid in there, and that it was really red. Plus I've had fever and tachycardia the whole time.

Because of the mito, I can't tolerate infection or fever very well. Infection/fever are some of my major triggers for metabolic decompensation and/or rhabdomyolysis.

So, I have been very, very careful to just park myself on the couch and not do a thing until this infection passes.

[Kathi49]

Kira,

No problem. I THINK that is why others were mentioning referred pain as well...as in nerves. I would think that any pressure behind the eardrum could cause all kinds of referred pain. Ouch! I know it must hurt...I never in all my life had an earache other than what I mentioned with the ON. And at least when mine burst, yes it hurt, but it was over with quick. So, I know it has to be rough to have it ongoing. I don't blame you for taking it easy. I can remember my brothers (who had earaches ALL the time when they were younger) would just lie in bed and cry with it. I hope your fever goes down soon as well.