I'm seeking advice as this is an ongoing issue for me that seems to be getting worse. As the title indicates, I process analgesics incredibly quickly (confirmed by genetic testing.) Anything other than a relatively shallow filling becomes a harrowing experience. I'm providing maybe too many details below, but I want to make clear how bad this is.
As I'm aging (49f), I'm needing more dental work done. I've also got some cards stacked against me: genetics, dry mouth from medication, perimenopause/HRT, autoimmune issues.
Last week, I had my final wisdom tooth extracted (bottom left.) It decided to emerge only two years ago, and hadn't been an issue until it was, ie., it caused decay on the molar in front of it, necessitating a crown for that tooth. It was decided to do both procedures together (extraction, temporary crown.)
At my request, my dentist prescribed halcion as this helped when I had my other late-blooming wisdom tooth removed a few years ago. That was the most pleasant dental experience ever. I don't even remember it.
Not this time. He started with the temporary crown so as to not get debris into the extraction site. As per usual, it took repeated injections just to get through that without pain. Immediately after the part where he widened the socket area for the wisdom extraction, the analgesic again started wearing off. He had only one more dose he could give me without cardiac risk, which he gave me. This should've been enough had it come right out; however, the tooth was well-seated so it took way longer than anticipated. Needless to say, I was in absolute agony - and there was nothing he could do but to keep going (I guess?) Sidenote: I'm grateful there were no children in the waiting room...
Each time I go through a procedure, the recovery is lengthy and painful - typically not for the actual issue, but for the site of the injections. Here I am on day 5, and the extraction site is fine; however, the injection site is mincemeat (let's just say x8 injections @ x3 pokes = 24 pokes in the same area.) This gets worse at night. I keep waking up in severe pain that no painkiller can help (hydrocodone, naproxen, ibuprofen/acetaminophen; I've even tried oxycodone that I had from the aforementioned extraction. Yes, I've been careful about what/when I take.) The only thing that has brought any relief at all is clove oil on a wet qtip applied to the area for ~15mins, along with repeated application of an ice pack. The latter I did probably 4x throughout last night.
I've still not tried eating anything that requires pressure to chew, ex., last night I got daring and added tuna to Mac & cheese simply b/c I've been living on applesauce, pudding, yogurt, etc. That repeated, though very slight and slow opening of my jaw was too much though, ie., last night's pain was the worst yet.
I want to stress also: I have a very high pain threshold, and am not a "baby" about pain. I also loathe taking painkillers as they make me dizzy and nauseated (besides, it seems I process those quickly as well, making them fairly useless imo.) But that extraction really hurt. And this jaw pain really hurts. I missed two more days of work because of it (Th/F.) And I rarely call in - maybe 2x/year.
So my question is this: What should I do going forward, re., dental procedures? I can't deal with this every time I need a deeper filling, a crown, etc. I do stay on top of my dental health: 2x/year cleanings, etc., and I like to address issues promptly. But all things considered, I'm wondering if I shouldn't let issues "rack up," and then once a year, go under general and get them all taken care of at once. I know that sounds crazy, but I'm desperate for solutions.
Thank you in advance.

I am 28F, Caucasion, 175cm tall and 100kg. I want to preface this with I have a condition known as Dissociative Identity Disorder (DID). If you are unfamiliar with the disorder it is the most complex and extreme trauma disorder that exists. If PTSD was a level 1 and CPTSD is a level 2, then DID is a level 5 on the trauma disorder scale.
One of the key features of this condition is that it can only develop during early childhood, while neural networks in the brain are still connecting. As a result many neural networks are left disconnected. This is a very simple explanation but can be referred to as structural dissociation.
Like with PTSD, a trigger can activate flashbacks, and these memories will be contained within the certain disconnected neural networks. This effectively means that neural networks can switch on and off and all of the associatied functions with it.
For example- I have a neural network that is mostly cognitively akin to a 3yo. When it is switched on I have the motor skills, impulse control and delayed gratification of a 3yo as well as childlike interests and perceptions.
Here is the problem with medications- it is not very well understood of researched but many medications are completely ineffective or have very little effect compared to a typical patient.
I know that all opioid medications are ineffective, because dissociation produces endogenous opioids, and I believe to the extent that I have experienced this has made my opioid receptors extremely downregulated. I now take naltrexone that assists to lower my dissociation and up regulate my receptors. (But yet opioid meds still dont work at all whether i am taking naltrexone or not).
I have also discovered that meds like benzos have no effect. From my research I have found that this probably means my Gaba receptors are down regulated as well. I have previously tried gabapentin for other symptoms and this was ineffective too.
I even had a lung operation and every single med they put me on felt 90% ineffective. I had a paravertable block, a PCA with morpheine, oral tramadol and other pain killers and still I would find myself viscerally screaming seemingly out of my control from how painful the procedure was.
I have recreationally taken drugs and things like cocaine have no effect.
I have felt the effects of MDMA once (and taken many times). Unsure if that pertains to quality or other factors.
I have had psilocybin- this has had profound healing effects for me- however sometimes I can take 10g dried with no effects, other times I am tripping akin to a heroic dose. Yes i have considered factors such as what I ate that day etc- there is no indetifiable pattern.
Cannabis i have been prescribed has similar effects, and some days It has effect and other days none (and vice versa- no patterns with tolerance. I could have 3g one day and feel nothing, the next day one puff of the same strain and I am baked).
My theory is that certain parts of my brain have extremely down regulated receptors, others not so much. So with the neural networks switching on and off seemingly at random changes the effects of how I feel the meds if at all.
I am wondering if anyone here has any ideas, similar experiences or suggestions? Does anyone have any insight into what may be haopening beyond my basic understanding, and if there are any treatments, specialists, supplements etc you could recommend?
I have been doing research to find things that could help upregulate these receptors and honestly I have already tried most of these (for 3+ months minimum each, up to a year or more).
I have tried these supplements/ meds. I am listing everything even if it ties to other conditions as I feel maybe thats important to consider (and probably forgetting a few).
My other conditions are PCOS, chronic fatigue, iron deficiency, suspected fibromyalgia and hypermobility ehlers danlos syndrome (awaiting screening), possible POTS (however when i went on prorpanolol for anxiety it cleared every POTS symptom I had), ASD level 2, ADHD (though i question if this is just trauma), CPTSD. I also likely have FND and am awaiting screening. I currently struggle with extreme chronic pain and fatigue. I am going crazy thay no pain meds work.
Supplements (hard to say whats effective) - various medicinal mushrooms - maca powder (feel effects) - ashwaganda - Bioceuticals brand "adrenoplex" ( mix of adaptogenics) (was once very effective, now not) - saw palmetto - spearmint - damiana - so many types of magnesium - b12 - iron - iodine - zinc - d3 - b12 - inositol (very effective)
Medications (ineffective) - diazepam - lorazepam - alprazolam - codeine - oxycodone - tramadol (slow and fast release) - morphine - local anesthetic (need huge doses) - dexamphetamine - modafinil - atomoxetine (slight effect possibly)
Medications (unsure if effective or not, if so very mild) - pregablin - gabapentin - paracetamol - aspirin - melatonin - cbd oil - spironolactone - several anti biotics (cannot remember, but every time I need anti biotics I nees more rounds than expected or they change to something stronger)
Medications (effective) - propranolol - orphenadrine - clonidine - metformin - meloxicam - naproxen - ibuprofen - cannabis (higher thc strains)

The following summary was created with the Recall Browser extension, you can save this summary to your own knowledge base or create your own here.

Dr. Sean Mackey (00:00:00)

• Dr. Sean Mackey) is a medical doctor and a PhD who is the chief of the division of pain medicine and a professor of both anesthesiology and neurology at Stanford University School of Medicine.
• Pain is a complex and subjective experience that serves to keep us away from injury or harm.
• Pain is both a sensory and an emotional experience and is incredibly individual.
• Chronic pain affects about 100 million Americans and costs about half a trillion dollars a year in medical expenses.

Pain, Unique Experiences, Chronic Pain (00:06:13)

• Pain is a complex and subjective experience that serves a crucial role in keeping us away from injury or harm.
• Pain is both a sensory and an emotional experience.
• Pain is incredibly individual and can vary significantly from person to person.
• Chronic pain is a persistent pain that lasts for more than 3 months and can have a significant impact on a person's life.
• Chronic pain affects about 100 million Americans and costs about half a trillion dollars a year in medical expenses.

Pain & the Brain (00:13:05)

• Pain is not simply a physical sensation, but also involves emotional and cognitive components.
• There is no single "pain center" in the brain, but rather a distributed network of brain regions that contribute to the experience of pain.
• Brain-based biomarkers can be used to identify common brain networks that represent the experience of pain.

Treating Pain, Medications: NSAIDs & Analgesics (00:16:15)

• NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen are not technically analgesics (painkillers).
• NSAIDs reduce inflammation and sensitization in the injured area and the spinal cord.
• Opioids are analgesics that can potentially cause harm if taken in high doses.
• The threshold for treating pain should be based on its impact on quality of life and daily activities.
• Common over-the-counter NSAIDs include ibuprofen, naproxen, and acetaminophen (Tylenol).
• Aspirin is not considered an NSAID but has anti-inflammatory and anti-hyperalgesic effects.
• It's important to balance pain relief with the potential delay in healing caused by NSAIDs.
• Individual variability exists in the effectiveness of NSAIDs, so rotating them can be beneficial.
• NSAIDs should be taken with food and plenty of fluids to minimize side effects.
• Talk to a doctor before taking NSAIDs if you have any underlying health conditions.

Inflammation, Pain & Recovery; Ibuprofen, Naprosyn & Aspirin (00:22:46)

• Prostaglandins are one of the main ways the immune system responds to injury and creates inflammation.
• Inflammation sensitizes the injured area, making it more sensitive.
• NSAIDs can help with pain and function but may delay the healing process.
• Balancing pain relief with healing is crucial, and the lowest effective dose of NSAIDs should be used.
• NSAIDs should be taken with food and plenty of fluids to minimize side effects.
• Individual variability exists in the effectiveness of NSAIDs, so rotating them can be beneficial.
• Aspirin in low doses (81 mg) acts as an antiplatelet agent and may benefit heart health.
• Higher doses of aspirin (325 mg) have anti-inflammatory effects similar to NSAIDs.

Caffeine, NSAIDs, Tylenol (00:30:19)

• Caffeine can potentiate the analgesic response and be effective for headaches and migraines.
• Caffeine can cause stomach irritation, so it's best to take NSAIDs with food.
• Tylenol (acetaminophen) is safe on the stomach but should not exceed 4,000 milligrams per day.
• COX-2 inhibitors like celecoxib are less irritating to the stomach but require a prescription.

Pain & Touch, Gate Control Theory (00:32:34)

• Gate control theory of pain: rubbing, shaking, or running water on an injured area activates touch fibers that send signals to the spinal cord, inhibiting pain signals.
• Kissing an injured area can reduce pain due to the activation of touch fibers and positive emotional salience.
• Transcutaneous electrical nerve stimulation (TENS) devices use electrical stimulation to activate touch fibers and reduce pain.
• The mechanism of action for mechanical interventions like rubbing or shaking occurs in the spinal cord, not at the site of the injury.

Pain Threshold, Gender (00:38:56)

• Pain threshold is the stimulus intensity that results in the onset of pain.
• Men generally have higher pain thresholds to heat stimuli than women, but there is significant individual variability within both genders.
• The difference in pain thresholds between men and women is often overstated due to the focus on group averages rather than individual variability.

Pain in Children, Pain Modulation (Pain Inhibits Pain) (00:44:53)

• Pain perception is influenced by beliefs, expectations, anxiety, and early life experiences.
• Pain inhibits pain, a phenomenon called conditioned pain modulation (CPM) or diffuse noxious inhibitory control (DNIC).
• CPM involves activating a brainstem circuit that sends descending pathways to the spinal cord, inhibiting pain.
• CPM may explain why some parents' reactions to their children's pain, such as smacking them, might inadvertently reduce the pain.
• However, ignoring a child's pain or sending the wrong message can have negative consequences.

Tool: Heat, Cold & Pain; Changing Pain Threshold (00:53:20)

• Cold reduces inflammation and slows nerve firing, reducing pain.
• Heat increases blood flow, relaxes muscles, and feels good.
• Individual variability exists in preferences for heat or cold.
• Cold should be used with caution to avoid frostbite.
• Numbing an area with cold can be effective in reducing pain.
• Regular exposure to safe pain, such as deliberate cold exposure, can raise pain thresholds through habituation.
• Cross-modality changes in pain thresholds are possible, but more research is needed.
• Cognitive control, such as avoiding looking like a wuss in front of an attractive person, can temporarily raise pain thresholds.
• Exercise can also increase pain thresholds over time by building inhibitory tone.

Tools: Psychology, Mindfulness-Based Stress Reduction, Catastrophizing (01:00:54)

• Mindfulness-based interventions lack specificity, granularity, and mechanistic logic.
• Attentional distraction engages specific brain networks and can reduce pain, but it may not be effective at night when people are trying to sleep.
• Non-judgmental acceptance of pain has been shown to be effective in reducing pain.
• Cognitive reframing about the meaning of pain can be helpful in managing pain.
• Catastrophizing pain can worsen the experience of pain.

Tool: Hurt vs. Harmed?, Chronic Pain (01:08:29)

• The distinction between hurt and harm is critical in pain management.
• Pain that is not causing harm does not need to be avoided.
• Chronic pain conditions are often complex and require more than just education.
• It is important to seek medical attention for pain that is getting worse or may be a sign of a serious medical condition.

Emotional Pain, Anger, Medication (01:12:38)

• Dr. Mackey does not distinguish between psychological and physical pain, instead treating all pain as pain.
• Pain is a sensory and emotional experience, so treating the whole person is important.
• Anger, especially anger in (simmering, self-contained), is associated with worse pain.
• Medications used for pain include antidepressants, anti-seizure medications, and anti-arrhythmia medications.
• A holistic approach that addresses the whole person, including psychological, physical, and social factors, is most effective in treating pain.

Tool: Nutrition & Pain; Food Sensitization & Elimination Diets (01:20:43)

• Nutrition plays a critical role in pain management.
• Identifying and avoiding trigger foods can significantly reduce pain.
• Elimination diets can help identify trigger foods.
• Food sensitization can occur after a gut infection, leading to chronic pain.
• Food sensitivity is a growing public health issue.
• Research is needed to explore how foods impact local and systemic pain responses.

Visceral Pain; Back, Chest & Abdominal Pain (01:28:45)

• Visceral pain is different from somatic pain.
• Visceral pain is more diffuse and has larger receptive fields compared to somatic pain.
• Visceral pain can cause referred pain to other areas of the body due to visceral-somatic convergence in the spinal cord.
• Examples of referred pain from visceral organs include:
  • Pelvic pain causing lower back pain.
  • Heart attack causing pain radiating down the left arm.
  • Abdominal surgery causing shoulder pain.

Referenced Pain, Neuropathic Pain; Stress, Memory & Psychological Pain (01:34:02)

• Referred pain is pain that is felt in a different location from the source of the injury or damage.
• Neuropathic pain is pain caused by damage to a peripheral nerve or the central nervous system.
• Neuropathic pain can have different qualities and characteristics, such as shooting, stabbing, shock-like, or burning pain.
• Stress can contribute to pain by impacting the end organ or tissue.
• Chronic stress can lead to chronic pain.
• Early life events and injuries can sensitize individuals to future pain vulnerability.
• Pain can be associated with memory, and stress can trigger pain in areas previously injured or affected.

Romantic Love & Pain, Addiction (01:40:23)

• A study explored the intersection of romantic love and pain perception.
• The study found that being in love significantly reduced pain, with a correlation between the intensity of love and the level of pain relief.
• The brain circuits involved in romantic love and addiction were found to be similar, suggesting that the early phase of a romantic relationship engages the same reward circuitry as addiction.
• Attentional distraction was also found to be effective in reducing pain, but it worked on different brain circuits compared to love.
• The strength of a romantic relationship a year later was found to be correlated with the love-induced analgesia and brain activity in the caudate nucleus and insula.

Endogenous & Exogenous Opioids, Morphine (01:48:57)

• Endogenous opioids are natural painkillers produced by the body.
• Higher endogenous opioid levels may lead to less emotional reactivity.
• Morphine was the first exogenous opioid derived from the poppy, and medicinal chemists have since created variations of morphine and purely synthetic compounds like oxycodone.
• The use of poppies for pain relief has a long history.
• Opioids can positively transform people's lives by relieving suffering and improving quality of life, but they can also destroy lives due to addiction.
• Opioids should be treated as a tool to be used in certain circumstances and not as a first-line agent.
• The opioid crisis is a complex issue that requires a nuanced approach, considering both the benefits and risks of these drugs.

Opioid Crisis, Prescribing Physicians (01:53:17)

• Opioid crisis is often attributed to overprescribing of opioids.
• Opioids can be beneficial for pain management when used appropriately.
• Overprescribing occurred due to lack of education among physicians about pain management and alternative treatments.
• Some physicians overprescribed due to marketing messages and lack of alternatives.
• A small group of physicians engaged in illegal activities related to opioid prescribing.
• Fear of legal consequences led many physicians to abruptly stop prescribing opioids, leading patients to seek illicit sources.
• Current opioid crisis is driven by illicit fentanyl.

Opioids & Fentanyl; Morphine, Oxycontin, Methadone (02:02:21)

• Fentanyl in street drugs is the primary cause of opioid-related deaths, not fentanyl prescribed by physicians.
• Compassionate opioid weaning can be successful for patients who want to reduce their opioid use.
• Commonly used opioids include morphine, oxycodone, fentanyl, Tramadol, hydromorphone, and methadone.
• Opioids work by binding to opioid receptors in the periphery, spinal cord, and brain.
• Benzodiazepines are rarely used for pain relief, except in specific cases where anxiety contributes to pain.

Kratom, Cannabis, CBD & Pain; Drug Schedules (02:07:44)

• Kratom has opioid-like properties and is available over the counter.
• Some people find kratom helpful in reducing opioid use, but its safety and efficacy need further research.
• Cannabis) has been shown to reduce neuropathic pain in small studies, but large-scale studies show mixed results.
• Cannabis is not a uniform substance, and THC to CBD ratios and doses vary.
• Cannabis remains a Schedule One drug, which hinders research.
• Rescheduling cannabis) as a Schedule Two drug could facilitate research and regulation.

Pain Management Therapies, Acupuncture (02:18:12)

• Acupuncture is one of six broad categories of therapies for chronic pain.
• Acupuncture has been shown to activate peripheral adenosine receptors and engage different brain regions compared to sham acupuncture.
• The exact mechanism of acupuncture's pain-relieving effects is still not fully understood.
• Acupuncture can be effective for certain types of pain, but it's important to find a qualified acupuncturist.

Finding Reliable Physicians, Acupuncturist (02:22:19)

• To find reliable physicians or acupuncturists, seek recommendations from trusted sources such as primary care doctors or colleagues.
• Be cautious of inflated patient ratings, as they can be manipulated.
• Consider using an independent platform that provides genuine patient experiences and ratings to find the best healthcare providers.

Chiropractic & Pain Treatment; Chronic Pain & Activity (02:26:36)

• Chiropractic and acupuncture are different professions with distinct approaches to pain management.
• Acupuncture has shown some effectiveness in certain patients and circumstances, and is now covered by Medicare for back pain in patients over 65.
• Chiropractic care has mixed evidence for its effectiveness in treating low back pain.
• High-velocity chiropractic manipulations may pose a risk of vertebral artery dissection, especially in the neck.
• Chronic pain often leads to reduced activity and deconditioning.
• Physical therapy and rehabilitation are crucial in addressing chronic pain by helping patients safely engage in activity and improving biomechanical issues.

Physical Therapy & Chronic Pain; Tool: Pacing (02:31:35)

• Physical therapists play a vital role in chronic pain management by providing rehabilitation, goal setting, and education on body mechanics.
• Pacing is a critical tool in managing chronic pain, involving setting small, incremental goals for physical activity.
• Avoid overdoing activities on good days and recognize that bad days are normal.
• Consistency in pacing helps prevent the negative reinforcement cycle of pain and inactivity.
• Effective pain management involves collaboration between different healthcare providers, including primary care doctors, pain psychologists, and physical therapists.

Supplements: Acetyl-L-Carnitine, Alpha Lipoic Acid, Vitamin C, Creatine (02:36:35)

• Acetyl-L-Carnitine:
  • Improves mitochondrial health.
  • Studied in the Sydney trials for diabetic neuropathy.
  • Shown to improve nerve conduction velocity.
• Alpha Lipoic Acid:
  • Has antioxidant and calcium channel modulating properties.
  • May benefit neuropathic pain.
  • Can cause stomach upset.
• Vitamin C:
  • Prophylactic use may reduce the likelihood of nerve pain after surgery.
• Fish Oil (Omega-3s):
  • Beneficial for chronic pain.
  • May reduce the viscosity of the blood, increasing the risk of bleeding.
• Creatine:
  • Shown some benefit in fibromyalgia and other conditions in small studies.

Pain Management, Cognitive Behavioral Therapy (CBT), Biofeedback (02:42:25)

• Pain psychology and behavioral therapy can help with maladaptive coping and thought processes related to pain.
• CBT involves recognizing unhelpful thoughts and patterns, interrupting them, and teaching goal setting, pacing, and relaxation techniques.
• Biofeedback provides closed-loop feedback to help individuals learn to calm down the sympathetic nervous system.
• Mindfulness-based stress reduction and acceptance and commitment therapy are other tools used by pain psychologists.
• Empowered relief is a brief intervention developed by Dr. Mackey's partner, Beth, that condenses 8 weeks of CBT into 2 hours.
• Digital platforms and online treatments are being developed to make pain management tools more accessible.

National Pain Strategy, National Pain Care Act (02:48:32)

• Dr. Mackey) co-led the development of the National Pain Strategy, a strategic plan for transforming pain assessment, care, education, and communication.
• Full implementation of the National Pain Strategy would make a significant difference in the lives of people living with pain.
• Concerned citizens can help advance the implementation of the National Pain Strategy by contacting their representatives and writing letters.
• Dr. Mackey's nonprofit organization, Pain USA, aims to advance the implementation of the National Pain Strategy and use high-quality data to inform pain care and treatments.

The following summary was created with the Recall Browser extension, you can save this summary to your own knowledge base or create your own here.

Dr. Sean Mackey (00:00:00)

• Dr. Sean Mackey) is a medical doctor and a PhD who is the chief of the division of pain medicine and a professor of both anesthesiology and neurology at Stanford University School of Medicine.
• Pain is a complex and subjective experience that serves to keep us away from injury or harm.
• Pain is both a sensory and an emotional experience and is incredibly individual.
• Chronic pain affects about 100 million Americans and costs about half a trillion dollars a year in medical expenses.

Pain, Unique Experiences, Chronic Pain (00:06:13)

• Pain is a complex and subjective experience that serves a crucial role in keeping us away from injury or harm.
• Pain is both a sensory and an emotional experience.
• Pain is incredibly individual and can vary significantly from person to person.
• Chronic pain is a persistent pain that lasts for more than 3 months and can have a significant impact on a person's life.
• Chronic pain affects about 100 million Americans and costs about half a trillion dollars a year in medical expenses.

Pain & the Brain (00:13:05)

• Pain is not simply a physical sensation, but also involves emotional and cognitive components.
• There is no single "pain center" in the brain, but rather a distributed network of brain regions that contribute to the experience of pain.
• Brain-based biomarkers can be used to identify common brain networks that represent the experience of pain.

Treating Pain, Medications: NSAIDs & Analgesics (00:16:15)

• NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen are not technically analgesics (painkillers).
• NSAIDs reduce inflammation and sensitization in the injured area and the spinal cord.
• Opioids are analgesics that can potentially cause harm if taken in high doses.
• The threshold for treating pain should be based on its impact on quality of life and daily activities.
• Common over-the-counter NSAIDs include ibuprofen, naproxen, and acetaminophen (Tylenol).
• Aspirin is not considered an NSAID but has anti-inflammatory and anti-hyperalgesic effects.
• It's important to balance pain relief with the potential delay in healing caused by NSAIDs.
• Individual variability exists in the effectiveness of NSAIDs, so rotating them can be beneficial.
• NSAIDs should be taken with food and plenty of fluids to minimize side effects.
• Talk to a doctor before taking NSAIDs if you have any underlying health conditions.

Inflammation, Pain & Recovery; Ibuprofen, Naprosyn & Aspirin (00:22:46)

• Prostaglandins are one of the main ways the immune system responds to injury and creates inflammation.
• Inflammation sensitizes the injured area, making it more sensitive.
• NSAIDs can help with pain and function but may delay the healing process.
• Balancing pain relief with healing is crucial, and the lowest effective dose of NSAIDs should be used.
• NSAIDs should be taken with food and plenty of fluids to minimize side effects.
• Individual variability exists in the effectiveness of NSAIDs, so rotating them can be beneficial.
• Aspirin in low doses (81 mg) acts as an antiplatelet agent and may benefit heart health.
• Higher doses of aspirin (325 mg) have anti-inflammatory effects similar to NSAIDs.

Caffeine, NSAIDs, Tylenol (00:30:19)

• Caffeine can potentiate the analgesic response and be effective for headaches and migraines.
• Caffeine can cause stomach irritation, so it's best to take NSAIDs with food.
• Tylenol (acetaminophen) is safe on the stomach but should not exceed 4,000 milligrams per day.
• COX-2 inhibitors like celecoxib are less irritating to the stomach but require a prescription.

Pain & Touch, Gate Control Theory (00:32:34)

• Gate control theory of pain: rubbing, shaking, or running water on an injured area activates touch fibers that send signals to the spinal cord, inhibiting pain signals.
• Kissing an injured area can reduce pain due to the activation of touch fibers and positive emotional salience.
• Transcutaneous electrical nerve stimulation (TENS) devices use electrical stimulation to activate touch fibers and reduce pain.
• The mechanism of action for mechanical interventions like rubbing or shaking occurs in the spinal cord, not at the site of the injury.

Pain Threshold, Gender (00:38:56)

• Pain threshold is the stimulus intensity that results in the onset of pain.
• Men generally have higher pain thresholds to heat stimuli than women, but there is significant individual variability within both genders.
• The difference in pain thresholds between men and women is often overstated due to the focus on group averages rather than individual variability.

Pain in Children, Pain Modulation (Pain Inhibits Pain) (00:44:53)

• Pain perception is influenced by beliefs, expectations, anxiety, and early life experiences.
• Pain inhibits pain, a phenomenon called conditioned pain modulation (CPM) or diffuse noxious inhibitory control (DNIC).
• CPM involves activating a brainstem circuit that sends descending pathways to the spinal cord, inhibiting pain.
• CPM may explain why some parents' reactions to their children's pain, such as smacking them, might inadvertently reduce the pain.
• However, ignoring a child's pain or sending the wrong message can have negative consequences.

Tool: Heat, Cold & Pain; Changing Pain Threshold (00:53:20)

• Cold reduces inflammation and slows nerve firing, reducing pain.
• Heat increases blood flow, relaxes muscles, and feels good.
• Individual variability exists in preferences for heat or cold.
• Cold should be used with caution to avoid frostbite.
• Numbing an area with cold can be effective in reducing pain.
• Regular exposure to safe pain, such as deliberate cold exposure, can raise pain thresholds through habituation.
• Cross-modality changes in pain thresholds are possible, but more research is needed.
• Cognitive control, such as avoiding looking like a wuss in front of an attractive person, can temporarily raise pain thresholds.
• Exercise can also increase pain thresholds over time by building inhibitory tone.

Tools: Psychology, Mindfulness-Based Stress Reduction, Catastrophizing (01:00:54)

• Mindfulness-based interventions lack specificity, granularity, and mechanistic logic.
• Attentional distraction engages specific brain networks and can reduce pain, but it may not be effective at night when people are trying to sleep.
• Non-judgmental acceptance of pain has been shown to be effective in reducing pain.
• Cognitive reframing about the meaning of pain can be helpful in managing pain.
• Catastrophizing pain can worsen the experience of pain.

Tool: Hurt vs. Harmed?, Chronic Pain (01:08:29)

• The distinction between hurt and harm is critical in pain management.
• Pain that is not causing harm does not need to be avoided.
• Chronic pain conditions are often complex and require more than just education.
• It is important to seek medical attention for pain that is getting worse or may be a sign of a serious medical condition.

Emotional Pain, Anger, Medication (01:12:38)

• Dr. Mackey does not distinguish between psychological and physical pain, instead treating all pain as pain.
• Pain is a sensory and emotional experience, so treating the whole person is important.
• Anger, especially anger in (simmering, self-contained), is associated with worse pain.
• Medications used for pain include antidepressants, anti-seizure medications, and anti-arrhythmia medications.
• A holistic approach that addresses the whole person, including psychological, physical, and social factors, is most effective in treating pain.

Tool: Nutrition & Pain; Food Sensitization & Elimination Diets (01:20:43)

• Nutrition plays a critical role in pain management.
• Identifying and avoiding trigger foods can significantly reduce pain.
• Elimination diets can help identify trigger foods.
• Food sensitization can occur after a gut infection, leading to chronic pain.
• Food sensitivity is a growing public health issue.
• Research is needed to explore how foods impact local and systemic pain responses.

Visceral Pain; Back, Chest & Abdominal Pain (01:28:45)

• Visceral pain is different from somatic pain.
• Visceral pain is more diffuse and has larger receptive fields compared to somatic pain.
• Visceral pain can cause referred pain to other areas of the body due to visceral-somatic convergence in the spinal cord.
• Examples of referred pain from visceral organs include:
  • Pelvic pain causing lower back pain.
  • Heart attack causing pain radiating down the left arm.
  • Abdominal surgery causing shoulder pain.

Referenced Pain, Neuropathic Pain; Stress, Memory & Psychological Pain (01:34:02)

• Referred pain is pain that is felt in a different location from the source of the injury or damage.
• Neuropathic pain is pain caused by damage to a peripheral nerve or the central nervous system.
• Neuropathic pain can have different qualities and characteristics, such as shooting, stabbing, shock-like, or burning pain.
• Stress can contribute to pain by impacting the end organ or tissue.
• Chronic stress can lead to chronic pain.
• Early life events and injuries can sensitize individuals to future pain vulnerability.
• Pain can be associated with memory, and stress can trigger pain in areas previously injured or affected.

Romantic Love & Pain, Addiction (01:40:23)

• A study explored the intersection of romantic love and pain perception.
• The study found that being in love significantly reduced pain, with a correlation between the intensity of love and the level of pain relief.
• The brain circuits involved in romantic love and addiction were found to be similar, suggesting that the early phase of a romantic relationship engages the same reward circuitry as addiction.
• Attentional distraction was also found to be effective in reducing pain, but it worked on different brain circuits compared to love.
• The strength of a romantic relationship a year later was found to be correlated with the love-induced analgesia and brain activity in the caudate nucleus and insula.

Endogenous & Exogenous Opioids, Morphine (01:48:57)

• Endogenous opioids are natural painkillers produced by the body.
• Higher endogenous opioid levels may lead to less emotional reactivity.
• Morphine was the first exogenous opioid derived from the poppy, and medicinal chemists have since created variations of morphine and purely synthetic compounds like oxycodone.
• The use of poppies for pain relief has a long history.
• Opioids can positively transform people's lives by relieving suffering and improving quality of life, but they can also destroy lives due to addiction.
• Opioids should be treated as a tool to be used in certain circumstances and not as a first-line agent.
• The opioid crisis is a complex issue that requires a nuanced approach, considering both the benefits and risks of these drugs.

Opioid Crisis, Prescribing Physicians (01:53:17)

• Opioid crisis is often attributed to overprescribing of opioids.
• Opioids can be beneficial for pain management when used appropriately.
• Overprescribing occurred due to lack of education among physicians about pain management and alternative treatments.
• Some physicians overprescribed due to marketing messages and lack of alternatives.
• A small group of physicians engaged in illegal activities related to opioid prescribing.
• Fear of legal consequences led many physicians to abruptly stop prescribing opioids, leading patients to seek illicit sources.
• Current opioid crisis is driven by illicit fentanyl.

Opioids & Fentanyl; Morphine, Oxycontin, Methadone (02:02:21)

• Fentanyl in street drugs is the primary cause of opioid-related deaths, not fentanyl prescribed by physicians.
• Compassionate opioid weaning can be successful for patients who want to reduce their opioid use.
• Commonly used opioids include morphine, oxycodone, fentanyl, Tramadol, hydromorphone, and methadone.
• Opioids work by binding to opioid receptors in the periphery, spinal cord, and brain.
• Benzodiazepines are rarely used for pain relief, except in specific cases where anxiety contributes to pain.

Kratom, Cannabis, CBD & Pain; Drug Schedules (02:07:44)

• Kratom has opioid-like properties and is available over the counter.
• Some people find kratom helpful in reducing opioid use, but its safety and efficacy need further research.
• Cannabis) has been shown to reduce neuropathic pain in small studies, but large-scale studies show mixed results.
• Cannabis is not a uniform substance, and THC to CBD ratios and doses vary.
• Cannabis remains a Schedule One drug, which hinders research.
• Rescheduling cannabis) as a Schedule Two drug could facilitate research and regulation.

Pain Management Therapies, Acupuncture (02:18:12)

• Acupuncture is one of six broad categories of therapies for chronic pain.
• Acupuncture has been shown to activate peripheral adenosine receptors and engage different brain regions compared to sham acupuncture.
• The exact mechanism of acupuncture's pain-relieving effects is still not fully understood.
• Acupuncture can be effective for certain types of pain, but it's important to find a qualified acupuncturist.

Finding Reliable Physicians, Acupuncturist (02:22:19)

• To find reliable physicians or acupuncturists, seek recommendations from trusted sources such as primary care doctors or colleagues.
• Be cautious of inflated patient ratings, as they can be manipulated.
• Consider using an independent platform that provides genuine patient experiences and ratings to find the best healthcare providers.

Chiropractic & Pain Treatment; Chronic Pain & Activity (02:26:36)

• Chiropractic and acupuncture are different professions with distinct approaches to pain management.
• Acupuncture has shown some effectiveness in certain patients and circumstances, and is now covered by Medicare for back pain in patients over 65.
• Chiropractic care has mixed evidence for its effectiveness in treating low back pain.
• High-velocity chiropractic manipulations may pose a risk of vertebral artery dissection, especially in the neck.
• Chronic pain often leads to reduced activity and deconditioning.
• Physical therapy and rehabilitation are crucial in addressing chronic pain by helping patients safely engage in activity and improving biomechanical issues.

Physical Therapy & Chronic Pain; Tool: Pacing (02:31:35)

• Physical therapists play a vital role in chronic pain management by providing rehabilitation, goal setting, and education on body mechanics.
• Pacing is a critical tool in managing chronic pain, involving setting small, incremental goals for physical activity.
• Avoid overdoing activities on good days and recognize that bad days are normal.
• Consistency in pacing helps prevent the negative reinforcement cycle of pain and inactivity.
• Effective pain management involves collaboration between different healthcare providers, including primary care doctors, pain psychologists, and physical therapists.

Supplements: Acetyl-L-Carnitine, Alpha Lipoic Acid, Vitamin C, Creatine (02:36:35)

• Acetyl-L-Carnitine:
  • Improves mitochondrial health.
  • Studied in the Sydney trials for diabetic neuropathy.
  • Shown to improve nerve conduction velocity.
• Alpha Lipoic Acid:
  • Has antioxidant and calcium channel modulating properties.
  • May benefit neuropathic pain.
  • Can cause stomach upset.
• Vitamin C:
  • Prophylactic use may reduce the likelihood of nerve pain after surgery.
• Fish Oil (Omega-3s):
  • Beneficial for chronic pain.
  • May reduce the viscosity of the blood, increasing the risk of bleeding.
• Creatine:
  • Shown some benefit in fibromyalgia and other conditions in small studies.

Pain Management, Cognitive Behavioral Therapy (CBT), Biofeedback (02:42:25)

• Pain psychology and behavioral therapy can help with maladaptive coping and thought processes related to pain.
• CBT involves recognizing unhelpful thoughts and patterns, interrupting them, and teaching goal setting, pacing, and relaxation techniques.
• Biofeedback provides closed-loop feedback to help individuals learn to calm down the sympathetic nervous system.
• Mindfulness-based stress reduction and acceptance and commitment therapy are other tools used by pain psychologists.
• Empowered relief is a brief intervention developed by Dr. Mackey's partner, Beth, that condenses 8 weeks of CBT into 2 hours.
• Digital platforms and online treatments are being developed to make pain management tools more accessible.

National Pain Strategy, National Pain Care Act (02:48:32)

• Dr. Mackey) co-led the development of the National Pain Strategy, a strategic plan for transforming pain assessment, care, education, and communication.
• Full implementation of the National Pain Strategy would make a significant difference in the lives of people living with pain.
• Concerned citizens can help advance the implementation of the National Pain Strategy by contacting their representatives and writing letters.
• Dr. Mackey's nonprofit organization, Pain USA, aims to advance the implementation of the National Pain Strategy and use high-quality data to inform pain care and treatments.

The cannabis component CBD can alleviate acute dental pain and may provide an equally effective, far safer alternative to opioids, researchers at Rutgers University and the University of Texas say in newly published research.
“Our results indicate that a single dose of CBD is as potent as current analgesic regimens and can manage emergency dental pain effectively,” the authors wrote in the study, published this month in the Journal of Dental Research. They said their work appears to be “the first randomized clinical trial testing CBD for managing emergency dental pain.”
“This novel study can catalyze the use of CBD as an alternative analgesic to opioids for acute inflammatory pain conditions,” the team said, “which could ultimately help to address the opioid epidemic.”
While over-the-counter medications like acetaminophen, ibuprofen or naproxen are the go-to choices for emergency dental pain relief, the study says, some patients can’t take those medications, while others don’t experience sufficient relief from them.
“Dental patients who cannot receive NSAIDs or acetaminophen due to underlying medical conditions or allergies,” it notes, “have no alternatives to avoid opioid prescriptions to achieve pain relief.”
The situation means dentists have historically been among the largest prescribers of opioids, said the study’s lead author, Vanessa Chrepa, a Rutgers dental school professor and director of clinical and translational research at its department of endodontics.
“The rise in opioid-related addiction and death has everyone looking for better alternatives, things that can alleviate serious pain without hurting so many patients,” Chrepa said in a Rutgers press release. While other research has so far focused more on THC, she added, “We studied cannabidiol or CBD because previous research from other specialties suggested that it might relieve dental pain without any psychoactive effects, which is really what everyone wants to find.”

“This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.”

Researchers used the Food and Drug Administration (FDA)-approved drug Epidiolex, an oral solution that consists of pure CBD and is used to treat certain forms of epilepsy. Study subjects—adults with moderate to severe toothache—were given a single dose of either the cannabinoid or a placebo, then monitored for three hours. Those receiving CBD were split into two groups, with one receiving a higher dose of CBD (10 milligrams per kilogram of body weight) and the other receiving a lower dose (10 mg/kg).
Measuring subjects’ reported pain on a numerical scale over time, both CBD groups experienced significant pain reduction compared to both their baseline and the placebo group. Both groups experienced maximum reduction in pain at about 180 minutes after administration, though researchers found that the higher dose of CBD led to a faster reduction in significant pain relief—15 minutes as opposed to 30 minutes with the lower dose.
In terms of the degree of relief, the study found maximum median pain relief was 73 percent at the 180-minute mark.
The study found that CBD treatment also increased subjects’ bite force, especially among patients who received the higher dose of CBD. Reduced bite force, it notes, can “compromise a patient’s nutrition and quality of life.”
Using a metric known as number needed to treat (NNT)—which measures the number of patients needing treatment before one patient experiences a minimum of 50 percent pain relief—the higher CBD dose had an NNT of 2.4, and the NNT of the lower dose was 3.1
By comparison, the study notes, past research has indicated that an opioid mixture standard in dentistry—10 mg of oxycodone and 650 mg acetaminophen—had an NNT value of 2.3.
Authors note the NNT for CBD treatment “falls in the range” of both the dentistry-standard opioid treatment and treatment with ibuprofen alone.
Despite the strong results indicating dental pain relief, there were also some side effects reported, with researchers noting that “sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups.”
Chrepa said the study results “are strong enough to make a compelling case to use pure CBD like Epidiolex for dental pain.”
“A larger phase 3 trial will be the next step to get FDA approval for Epidiolex or other pure CBD solutions to use for dental pain management,” she said. “I am looking forward to translating this into common practice. It will tremendously help patients with acute toothache and possibly other acute inflammatory pain conditions.”
Epidiolex, which won FDA approval for treatment of certain types of epilepsy, is not currently approved for dentistry. Non-pharmaceutical CBD is nevertheless a lawful derivative of hemp, which was legalized nationally through the federal 2018 Farm Bill.
“There are more things to study with follow-up research,” Chrepa said in the Rutgers release. “Can CBD be used to manage postoperative pain for patients who have undergone tooth extraction or root canal? Can we get even better pain relief by combining it with other agents like Tylenol?”
A separate study last month found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
While hemp-derived cannabinoids including CBD haven’t typically received the same degree of attention or political scrutiny that high-THC marijuana has, the market for the products have been growing quickly in recent years, since federal legalization.
Though still largely unregulated, the U.S. hemp industry in 2022 was larger than all state marijuana markets combined, according to a new report, and roughly equaled sales for craft beer nationally. The report found that about $28.4 billion worth of hemp-derived cannabinoid products were sold last year.
FDA has said that it doesn’t have the authority to regulate hemp-derived cannabinoids on its own, and in response, Congressional lawmakers have put forward proposals to establish new rules.
https://www.marijuanamoment.net/cbd-effectively-treats-dental-pain-and-could-provide-a-useful-alternative-to-opioids-study-shows/

I will start this off by saying I have zero medical qualifications and I am not a physician.
I put this list together for my own family because I realized that over time, we had a large collection of things in our medicine cabinet that we forgot what it was for. This list can be used to help describe the function of certain medicines that are common in medicine cabinets but might only be used for short terms. It may be useful as an offline quick reference in the event of grid down.
In all cases, you should consult a qualified medical professional. None of the content of this page should be considered medical advice. I am not a medical professional, and this information is summarized from the manufacturers and other medical websites.
Most of the medicines mentioned below is medicine that would not be for long term use, that's why it made it to this list. If you have a medical condition that is ongoing, it is best to ensure you have enough medicine to last you until at least the expiration date on the oldest batch, or for one year, whichever is sooner.

• Ear infection antibiotic ointments: Antibiotic ointments and creams can be used for external ear infections. One example is Neomycin/polymyxin B/bacitracin (Neosporin). Antibiotic ear drops can also be used to treat ear infections in children who have ear tubes due to frequent ear infections or swimmer’s ear. Ciprodex (ciprofloxacin/dexamethasone) and ofloxacin are two examples.
• Small antibiotic creams: Topical antibiotics can be applied directly to the skin. They work by destroying or inhibiting the growth of susceptible bacteria. Some examples include Bacitracin and Neosporin (also known as “neo-bac-polym” because of its combination of neomycin, bacitracin, and polymyxin B).
• Anti fungal creams: Antifungal creams are topical medications used to treat fungal skin infections such as athlete’s foot, ringworm, and jock itch. They work by attacking the fungi that cause fungal infections and are available over-the-counter or by prescription. Some examples include clotrimazole, miconazole, ketoconazole, and econazole.
• Iodine: Iodine is an element that is used by the thyroid gland to produce thyroid hormones. Humans cannot produce iodine so it must be consumed through food or supplements. It is added to some foods and also to salt. Iodine deficiency can lead to health problems such as goiter (enlarged thyroid gland) and hypothyroidism (low levels of thyroid hormones)
• Aspirin: Aspirin is a salicylate that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina).
• Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that works by reducing hormones that cause inflammation and pain in the body. It is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps or minor injury.
• Acetaminophen: Acetaminophen is a pain reliever and a fever reducer. It is used to treat mild to moderate pain or to reduce fever. Common conditions treated include headache, muscle aches, arthritis, backache, toothaches sore throat colds flu and fevers.
• Naproxen: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that works by reducing hormones that cause inflammation and pain in the body. It is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout or menstrual cramps.
• Diclofenac: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases such as gout. It can be taken by mouth or rectally in a suppository, used by injection or applied to the skin. This medicine works by reducing substances in the body that cause pain and inflammation.
• Ponstan: For menstrual cramps
• Paracetamol: Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. It is commonly included as an ingredient in cold and flu medications and is also used on its own.
• Codeine: Codeine is an opiate mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. Codeine works by weakly binding to a specific opioid receptor but with much less affinity than morphine which means its analgesic (pain-relieving effects) are much less.
• Morphine: Morphine is an opioid medication that works by blocking pain signals from travelling along the nerves to the brain. It is used to treat moderate to severe pain. The extended-release form of morphine is for around-the-clock treatment of pain.
• Oxycodone: Oxycodone is an opioid pain medication sometimes called a narcotic. It is used to treat moderate to severe pain. The extended-release form of oxycodone is for around-the-clock treatment of pain and should not be used on an as-needed basis for pain.
• Paracetamol: Paracetamol is an analgesic and antipyretic drug that is used to temporarily relieve mild-to-moderate pain and fever. It is commonly included as an ingredient in cold and flu medications and is also used on its own. Paracetamol is exactly the same drug as acetaminophen (Tylenol).
• Dexamethasone is a type of corticosteroid hormone that is very effective at reducing inflammation and suppressing the immune system.
• Voltaren oral tablets are used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis.
• Voltaren ophthalmic eyedrops are used to treat pain, inflammation, and light sensitivity after eye surgery or for certain eye conditions.
• Azithromycin is an antibiotic used to treat a variety of different infections. It has the distinct advantage of once-daily dosing; however, diarrhea is a common side effect.
• Normal saline: Used for fluid and electrolyte replenishment for intravenous administration. It can also be used to clean out an intravenous (IV) catheter.
• Rivanol: Also known as Ethacridine lactate, it is an antiseptic used in solutions of 0.1% for cleaning wounds and mucous membranes. It is effective against mostly Gram-positive bacteria such as Streptococci and Staphylococci
• Hydrogen peroxide wound treatment: Hydrogen peroxide (H2O2) is a topical antiseptic used for cleaning wounds. It kills bacteria by producing oxidation through local, nascent, free oxygen radicals. It also removes dirt from the wound due to its frothing action.
• Stomatidin: An antiseptic agent used for disinfection and prevention of bacterial, fungal and yeast infections of the oral and vaginal mucosa.
• Penicilin: Penicillin is an antibiotic used to treat bacterial infections caused by susceptible microorganisms. It works by inhibiting the growth of bacteria by interfering with their cell wall synthesis.
• Gentamicin: Gentamicin is an antibiotic used to treat several types of bacterial infections. This may include bone infections, endocarditis, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections and sepsis among others. It is not effective for gonorrhea or chlamydia infections.
• Lincocin: Lincocin (Lincomycin) is an antibiotic used to treat severe bacterial infections in people who cannot use penicillin antibiotics. It works by killing bacteria or preventing their growth.
• Antitetanic treatments: Anti-tetanus immunoglobulin (TIG), also known as tetanus antitoxin, is a medication made up of antibodies against the tetanus toxin. It provides immediate but short-term protection from tetanus in those who have a wound that is at high risk and have not been fully vaccinated with tetanus toxoid or have HIV/AIDS
• Diazepam: is a benzodiazepine that is used to treat anxiety disorders, alcohol withdrawal symptoms, muscle spasms and stiffness, or seizures. It works by enhancing the activity of certain neurotransmitters in the brain.
• Metamizole: Also known as dipyrone, it is a painkiller, spasm reliever and fever reducer. It has a potential for blood-related toxicity but causes less kidney, cardiovascular and gastrointestinal toxicity than non-steroidal anti-inflammatory drugs (NSAIDs)
• Metoclopramide: A medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people with delayed stomach emptying, and to help with gastroesophageal reflux disease. It increases muscle contractions in the upper digestive tract which speeds up the rate at which the stomach empties into the intestines.
• Ranitidine: A medication that belongs to a group of drugs called histamine-2 blockers. It works by reducing the amount of acid your stomach produces. It has been used to treat and prevent ulcers in the stomach and intestines.
• 5% Glucose (IV solution): Also known as Dextrose 5% in water, it is a form of glucose (sugar) that is injected into a vein through an IV to replace lost fluids and provide carbohydrates to the body. It is used to treat low blood sugar (hypoglycemia), insulin shock, or dehydration (fluid loss). It can also be given for nutritional support to patients who are unable to eat because of illness, injury, or other medical condition.
• Omeprazole: A medication used to treat excess stomach acid in conditions such as non-cancerous stomach ulcers, gastroesophageal reflux disease (GERD), active duodenal ulcer, Zollinger-Ellison syndrome and erosive esophagitis. It works by blocking gastric acid production and is from the group of medicines called proton pump inhibitor.
• Aminophylline: A bronchodilator that works by relaxing muscles in your lungs and chest to allow more air in, decreasing the sensitivity of your lungs to allergens and other substances that cause inflammation, and increasing the contractions of your diaphragm to draw more air into the lungs. It is used to treat symptoms of asthma, bronchitis and emphysema.
• Solu-Medrol: A brand name for methylprednisolone injection, a synthetic glucocorticoid primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is used to treat many different inflammatory conditions such as arthritis, lupus, psoriasis, ulcerative colitis, allergic disorders, gland (endocrine) disorders and conditions that affect the skin, eyes, lungs, stomach, nervous system or blood cells.
• Synopen: Contains chloropyramine which is a strong antihistamine that prevents the effects of histamine, a substance that is created in the body and participates in the development of allergic reactions.
• Spasmex: An antispasmodic, antimuscarinic agent indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency and urinary frequency. According to receptor assays, it displays higher affinity towards muscarinic receptors compared to nicotinic receptors at therapeutic concentrations.
• Adrenaline: Adrenaline (also known as epinephrine) is used to relieve respiratory distress due to bronchospasm and is the primary drug used in the emergency treatment of respiratory conditions when bronchoconstriction has resulted in diminished respiratory function. It is also used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs and other allergens. Adrenaline may also be used during cardiac arrest, croup and asthma when other treatments are not effective.
• Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings, some types of slow heart rate, and to decrease saliva production during surgery. It can also be used as an antidote for overdose of cholinergic drugs or mushroom poisoning.
• Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It is used to treat many different inflammatory conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis and breathing disorders.
• Voltaren gel is used topically on the skin to provide temporary relief of joint pain. This pain remedy is recommended for treating pain and tenderness from osteoarthritis in the knees, hands and other joints. Voltaren pain-relieving gel may also be used to help ease aching joints due to rheumatoid arthritis.
• Lasix (furosemide) is a loop diuretic (water pill) that prevents your body from absorbing too much salt. This allows salt to instead be passed in your urine. Lasix is used to treat fluid retention (edema) in people with congestive heart failure, liver disease or a kidney disorder such as nephrotic syndrome. Lasix may also be used alone or with other medications.
• Tylex is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds and fevers. It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint. Tylex can be used in adults and children over 12 years of age for short-term relief of moderate pain that is not relieved by other painkillers such as paracetamol or ibuprofen alone.
• Voltaren is a nonsteroidal anti-inflammatory drug (NSAID) that contains diclofenac sodium as its active ingredient. It works by reducing substances in the body that cause pain and inflammation.
• Amoxicillin is a penicillin antibiotic that fights bacteria. It is used to treat many different types of infection caused by bacteria, such as tonsillitis, bronchitis, pneumonia, and infections of the ear, nose, throat, skin or urinary tract.
• Ciprofloxacin is a fluoroquinolone antibiotic that belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria and is used to treat different types of bacterial infections. Ciprofloxacin can also be used to treat people who have been exposed to anthrax or certain types of plague.
• Sulfadiazine cream is a topical antibiotic used to prevent and treat skin infections. It works by stopping the growth of bacteria.
• Enterofuryl contains nifuroxazide as an active ingredient. It is an antibiotic indicated in the treatment of susceptible gastrointestinal infections such as acute diarrhea, amoebiasis, amoebic liver abscess, colitis, giardiasis and trichomoniasis.
• Azithromycin is an antibiotic that fights bacteria. It belongs to a class of medications called macrolide antibiotics. Azithromycin is used to treat many different types of infections caused by bacteria such as respiratory infections, skin infections, ear infections, eye infections and sexually transmitted diseases.
• Multivitamin pills are supplements that contain a combination of vitamins and minerals. They are designed to lower your risk for vitamin deficiencies and bridge any gaps in nutrient intake due to increased needs (such as during pregnancy) or compromised absorption (due to digestive troubles or other medical conditions)
• Amoxicillin is a penicillin antibiotic that fights bacteria. It is used to treat many different types of infections caused by bacteria such as tonsillitis, bronchitis, pneumonia and infections of the ear, nose, throat, skin or urinary tract. It works by stopping the growth of bacteria.
• Linex Baby is a probiotic supplement intended for oral use only. It contains B. bifidum BB-12, one of the most clinically researched strains of bifidobacteria. Linex Baby can be used as a preventative and supportive treatment in diarrhea, distension and other digestive disorders caused by either a viral or bacterial infection or as a side effect from treatment with antibiotics.

There's been a bunch of questions about Reformkliniken on here but not many detailed writeups, so I (28, NB, no T) figure I'll pitch in with my experience so far, both the day of surgery and recovery. I've had buttonhole DI top surgery not quite two months ago, and like many (all?) patients at Reformkliniken I didn't have drains. Brace yourself, this is going to be half of a novel.
TLDR: I'm super happy with my results, only had a minor complication, recovery is pretty textbook despite me occasionally screwing up.
(Getting to) the consultation
The consultation was about a year before surgery because my savings ended up used for something pretty different and I needed the year to save up again, so I don't remember it in super many details. Key things I do remember:

• it's really hard to get a time through their online booking system, you may have a better chance calling them - that will also take a couple of tries, and their phone tree is in Swedish, but if you don't press anything it'll put you through to the reception
• Dr. Tuve was good at explaining what kind of procedures would work for me, and demonstrated what would be done; he also knew off the top of his head which of my medications would interfere with anesthesia or healing and when I should take medication breaks.
• don’t remember if I straight up told him I had ADHD or if it was just obvious from the medication, but that was no issue either
• I opted for keeping my nipples, but as I recall he posed whether I want to keep them or not as a completely open question
• there was absolutely no requirement for having been on testosterone (never have been, never will, and it was absolutely no issue)
• word of warning, if you speak sufficiently understandable Danish, there's a risk he'll speak... Swedish? Swe-danish?... with you. That said, I understood him even though Danish is my third language, and he understood me even though I could only give my weight and height with the "basically a math problem" Danish words for the numbers. Everyone else at the clinic spoke English with me, though.

Before the surgery
About a month and a half before surgery I got a mail from the clinic with the surgery date, price (42.000 Swedish kroner - I think that's only their starting price by now, but I think I got it because it was the one agreed on at the consultation), payment information, and instructions on how to prepare for the surgery, what to do after the surgery, and what to bring (comfortable clothes and compression socks, plus the antibiotics and pain medication they prescribe you).
Their info materials say top surgery usually is an outpatient surgery, but you'll be able to stay overnight if there's any issues or if you feel safer doing so. That said, there apparently isn't always a doctor at the clinic on Fridays, so if your surgery is on a Thursday like mine was, you won't be able to if it's just personal worry.
From two weeks before the surgery, I had to avoid taking any painkillers that have blood-thinning properties, and cut my nails super close (I already do due to my job, but paid extra attention to it...)
The medication they prescribed me was paracetamol and celecoxib (an NSAID) for the pain and cefadroxil (a broad-spectrum cephalosporine antibiotic) as a prophylactic antibiotic. (My mom's a nephrologist [and incorrigible micromanager], wanted to know about my meds and wasn't too happy about the celecoxib, apparently it's not the greatest for the kidneys - she told me to really make sure I was hydrated. It ended up not being that much of a problem - more on that later.) If you're not in the Swedish healthcare system, they'll tell you the specific pharmacy where you can pick up your medication - I assume if you are you'll probably be able to pick it up wherever.
Since it was just a couple of hours by train for me my sister and I went to Malmö the day before the surgery, picked up the meds, checked into a hotel close to the clinic and went to have a solid dinner to celebrate. I also took the first dose of the antibiotic.
I took a shower (with unscented sensitive shower gel) before I went to bed, and in the morning before I went to the clinic, I showered again. I was allowed clear liquids until two hours before I checked into the clinic, and took advantage of that - being properly hydrated definitely doesn't hurt in terms of helping them find your veins when they give you an IV.
The day of surgery
I checked in early in the morning, at around 7.00, spent a bit of time in the waiting room, and then it feels like things happened pretty quickly.
I was called up, shown a room and asked if it was okay for me to share it with someone (it was). A nurse went over my intake questionnaire (health, medication, allergies, smoking, diet,...) with me and registered all the information. Then I got sent to take yet another shower, this time with antibacterial soap, and change into the clinic's bathrobe and slippers. (Protip for other long-haired folks: braid your hair after you washed it. If you leave it loose it WILL tangle and it'll take forever to unknot because you won't be able to brush it yourself. Ask me how I know.) After the shower, I went back to the room and put on my compression socks, making sure not to stand on the floor without slippers.
A bit of time passed, I think I may have chatted with my roommate (he was also in for top surgery), and then the nurse came with a metric ton of pills and some liquid anti-nausea medication. As I recall, the pills were

• prescription painkiller
• paracetamol (a lot of paracetamol)
• maybe celecoxib
• ...and that's where it gets fuzzy, I think even more anti-nausea stuff?

Protip here: take the liquid anti-nausea medication first, it tastes nasty and the juice you'll get to take the pills with will wash the taste away.
Then I was sent in to Dr. Tuve to talk over the procedure - it was exactly what he'd explained at the consultation, of course, but it was to be sure that we were on the same page. He drew where the incisions would be on my chest and also wrote "FTM BUTTONHOLE" on my chest. Which was weirdly calming to me, because I could tell things were being prepared and documented properly and they were making absolutely sure that they'd perform the right procedure (I'd rather have a surgeon who documents the "obvious" than one who figures it'll be fine and they can remember). He also took photos from the front and side.
Shortly after that it was time for surgery. I had a brief chat with the anaesthesist where he confirmed with me that I'd had a break from the medication I'm taking that could mess with the anesthesia, and then it was off to the OR. Since the clinic isn't super huge, that meant walking like five steps. I got one of these hair nets to put on beforehand so my hair wouldn't shed all over the place, and straight after the door to the OR there was some sort of sticky mat that I think was there to remove any possible contamination on the slippers. I got onto the operating table by myself and... probably babbled the poor anaesthesist's head off to distract myself. He originally wanted to insert the IV line on the back of my hand but since I've still got some residual nerves about needles and have desensitized myself a lot more to needles in the crook of the elbow as a regular plasma donor, he went with that. I got the "oxygen" mask on my face and was told to take deep breaths, tried to name a fruit for each letter of the alphabet in my head... I got to M, then I felt my legs get heavy, and next thing I knew was I was back in the room in my bed, feeling like I'd been woken up in the middle of a really good nap. For everyone concerned about saying something embarrassing: I think I might have talked to a nurse and mixed together English and Danish in the middle of a sentence and when I was slightly more awake I sent my family a very zonked-out selfie and a terrible pun as proof of life, but nothing worse XD
I was "just-woke-up-from-a-nap" groggy for maybe an hour or two and dizzy the first... half hour? at least the first hour (I complained at everyone who'd listen, just found the chat with my poor sister again XD)... but I had zero nausea and immediately said yes when a nurse asked me whether I wanted something to eat and drink. No problems with eating either, except it was kind of hard to swallow with a sore throat. No problem drinking either - they'd provided a straw but I didn't really need it. There was one issue... maybe a bit TMI, but it took me what felt like forever before I could pee again. Three hours, I think? It's a common reaction to anesthesia, but it spooked me, so if any of you all encounter that, here's your reassurance that it'll pass.
At some point one of the nurses came in, both to show me how to use the compression bandage I got and to show me my chest(!!!). When the bandages came off I was just repeating "oh my god I'm flat" for a solid five minutes XD Then he changed the compresses on my incisions, bandaged my chest with some fairly tight elastic bandages that had to stay on until the next morning, and showed me how to put on my compression bandage, which basically was just a long elastic belt thing with velcro.
Skipping ahead here to the binder life hacks I figured out for myself: if you tend to pull the binder too tight, take like half a breath before you put it on, hold your breath, and only release when everything is velcro'ed in place.
Once I'd eaten, walked without getting dizzy, and peed, I was fine to leave. I got a "goodie bag" with more wound care instructions, micropore tape for the incisions, another package of compresses, and some prescription meds - paraflex (chlorzoxazone, a muscle relaxant) and oxynorm (oxycodone) for if the pain couldn't be managed with OTC pain meds, with instructions to first try if the paraflex helped before resorting to oxynorm.
Recovery
Immediately after surgery (day 0-1):
I was feeling pretty good after surgery, but ended up overdoing it (tried to help my sister with buying snacks, even though I didn't carry anything) and spent the evening worrying I'd reopened all my stitches. The night was... well, it sucked. My back and shoulder muscles had probably been relaxed for the first time in five years during the surgery and now were tensing up in new and interesting ways, and the tight bandages were not helping. I didn't want to take the paraflex because combined with paracetamol the risk of liver toxicity is higher, so I... ended up lying in bed staring at the ceiling and got three hours of sleep. (Not that it was better for my sister - the hotel had given us a room with a double bed and they didn't want to risk hurting me, so they ended up sleeping on the floor).
The next morning the tight bandages came off and only the binder remained, which helped a lot with the back pain. However, after breakfast my face started flushing until it looked almost sunburned and felt hot. I called the clinic straightaway, but as it was easier for me to navigate the Danish healthcare system, we ended up deciding I should contact my GP. I managed to just get an urgent time, rushed home with public transport, and made it just in time, while also pausing all my new medication including the painkillers in case it was an allergic reaction to any of them. That was... not fun. The GP determined that since I'd previously taken paracetamol with no worse effect than tiredness, I could keep that, but the celecoxib and cefadroxil had to be replaced with an NSAID I knew I tolerated and an antibiotic from a different class. I picked up the latter at a pharmacy, my sister and I had a boba tea to get our blood sugar back up, and we went home, where I kinda crashed.
I have a blood sample to determine if it was an allergic reaction coming up soon, but my own suspicion is that I'd worn my binder too tight - I got similar but milder symptoms about a week later, and they went away when I loosened my binder.
1-10 days after surgery (recovery with help):
Medication: I'd been warned that the first four days were the worst, and accordingly took my painkillers on a schedule until day 3, then started tapering off and taking them as needed (had some days completely without, and then two with one 250mg dose of naproxen instead).
Mobility/range of motion: the usual - no getting my pulse up, no carrying anything over 1 kg per hand, no raising arms above shoulder height. I fucked up a couple of times, but aside from brief pain it was fine.
Daily life: I took it really slowly on day 2/3, just going for some very short walks while monitoring my pulse like a hawk. As time went on, though, I recovered fairly well, by day 5 I was helping my sister with cooking, by day 7 we went for all-you-can-eat sushi with public transit, and on day 9 we went to visit my best friend a few towns over. I was on sick leave from work the first week and a half.
Healing: my stupid stunts on day 0-1 probably didn't help with healing, so when I was first allowed to check my compresses I had bled enough that I had to use compresses until day 4 (at which point there was no bleeding). I also had one episode of vasovagal syncope - as in, LOL ITS FAINTING TIME - when my nipple bled, but only once, and the warning signs were clear enough I could lie down in time so I didn’t actually faint.
Other things:

• TMI again, but constipation quickly stopped being a problem, and with the new antibiotic I was on, let's say I was very happy that my meals involved all sorts of lactic acid bacteria.
• I slept on my back on my sofa, with the cushions piled up - that helped a lot
• I had zero issues with nausea or lack of appetite - it may have been my sister's great cooking, but I ate a lot. Protein-rich meals, plenty of flavor (without drowning it in salt), and snacks in between. Had been really worried about that since lack of appetite also is a common side effect of my usual meds.
• I was technically allowed to shower but didn't feel comfortable with water touching my chest just yet - that got me told off at the checkup, water just flowing down from my shoulders onto my chest would have been fine and even helpful - and washing my hair required help. That said: get a bunch of washcloths at IKEA to keep the strategic parts clean. They'll also help with the whole "pat your tape dry with a fresh towel every day" thing when showering daily since that way you don't need to have 117 towels or do the laundry every other day
• related to that: 5 days roll-on deodorant is a lifesaver, it helps a lot when you don't have the spoons for putting on deodorant daily.

The checkup:
At the checkup a nurse inspected my incisions and gave me instructions for how to change the micropore tape. The incisions themselves had healed well and there was no excessive swelling, so I got the go-ahead to start leaving off the binder at night. However, I also got confirmation that my nipples, which looked pretty dark from what I'd hoped just was bruising, had had circulation issues during surgery and would scab over and recover under the scabs. I was told to wash them carefully by lathering up some shower gel in my hands and holding the lather over the nips for two minutes, and otherwise cover them with compresses. This is the only complication I've had so far, though, and as they go, it's probably the "best" I could have gotten. Aside from that, my skin kind of reacts to the micropore tape, so I've been told to leave it off for a couple of days if it gets too bad. So far, it's been fine though.
Week 1.5-4 (solo recovery/non-caregiver visitors around week 3/4):
Medication: one single 250 mg dose of naproxen the first day of solo recovery, where I was tired and knocked out and everything sucked and that made things hurt worse.
Mobility/range of motion: same restrictions as before, though it was getting harder to comply - I kept wanting to streeeetch.
Work/daily life: worked from home for two weeks, then took a week off because family came over. Worked the full 8 hours on the first day and I was knocked out afterwards. Hadn't realized the snacks my sister had nudged me to eat in between meals had been so thoroughly necessary, but got better at that quickly, and was way less knocked out after working consequently. Went grocery shopping on foot with a bike trailer that I loaded/unloaded one item at a time, generally got most things done around the house with some workarounds. Cooking was the biggest struggle with the weight restrictions, since the pans I usually used were just too heavy, but I managed to find alternatives in the weeks I was alone and had the family do the dishes in exchange for me cooking the meals in the week they were there.
Healing: I kept being sort of on-off with the binder - left it off for a couple of nights, thought I'd seen swelling, kept it on again,... until about the middle of week 3, after which I consistently left it off overnight, then added an hour before going to bed, then two,... The nipples were two solid scabs and the end of a suture was poking out on the side of one, but aside from poking me in the hand when I showered it didn't do anything, and it fell out when the rest of it dissolved at some point.
Other things:

• at around week 3 I moved to sleeping in my own bed, first with cushions, then flat on my back
• taking off the binder really helped with shrimping, as I felt like it would loosen when I forced my shoulders back down
• protip for long-haired folks: get yourself one of those towel turbans, it's much easier to pat your tape dry after showering when your hair's not dripping water all over the place

Week 4-now:
Mobility: No hard weight, range of movement, or exercise restrictions! (Aside from no pec exercises for the next month and a half.) I've been getting back to cycling to work - the first week I just cycled a bit of the way and took public transit for the rest, then moved to cycling all the way, first with my compression binder, and the last week without. In terms of range of movement I can still get "stuck" sometimes where I'm not sure if it hurts because of the scar or because of the tape, but it's been getting better.
Work/daily life: I've returned to working in person, but am now taking another holiday so I can burn off my time off for this year (had saved up in case work didn't give me sick leave and it racked up to a lot). Don't feel all that many limitations, I feel like I'm close to where I was preop, just with a chest that looks like mine. I am looking forward to being able to exercise my pecs again, though, and during my first workout session earlier this week I was a bit surprised to realize that weights that didn't even register as anything to me before now suddenly weighed something again.
Healing: Wore the binder at work and took it off home, then switched that around because I shrimped so much in it; did that for a week, then only wore it when cycling, and now it's at "when needed". The nipple scabs came off - one a week ago, and the other yesterday under the shower. My nipples look a bit uneven - the right one has more projection than it had before, while the left one currently is maybe a tiny bud - but I'm trusting in the process, since everything has gone well so far. There's still numb spots on my chest, but again, trusting the process.
Overall, in any case, I'm super satisfied with my results! My chest is flat, just the right level of masc-leaning as a sort of "counterbalance" to my long swishy hair (and that without T), I'm happy with the shape of my incisions, and the only complication I've had was a fairly minor one that so far seems to be healing well.

Hi, I’m about to lose hope in my doctors but I’ve only just begun to open up about the pain I’ve been in after understanding what I’m going through isn’t “normal” and everyone doesn’t just go through the same thing I currently am. I’m mainly here asking if anyone has similar symptoms and has been diagnosed with anything or even has any input or suggestions!
(Sorry if this is long) Im a 22 F 5’4 83kg, since the age of 14 I’ve had a pain in my knees that feel like they’re inflamed but physically aren’t, they flare up from all sorts of things and back then I was simply told from a gp I have worn cartilage with no testing to say so, so I just went with it being 14 and told by everyone for years prior and going forward how every medical thing I would have come up was nothing because of my age etc. it felt like each year I was getting worse but not noticeable, the last 2 years I have deteriorated very fast, now every joint flares up, my knees, hips, shoulders, fingers and wrists are the main points and my lower back and hips are the worst to the point I can’t get out of bed some days, from the pain point I experience a full aching pain down the limb (from hip down my thigh to my knee or if it’s my shoulder straight down to my wrists) every point cracks and clicks now with little movement needed and my hips now lock on worse days where I need to click it out in pain to move it. When the flares happen it can sometimes be one part or multiple or over days do a circle kind of motion around to the next joint. I’ve had an X-ray on my lower back and hips for osteo, blood tests for auto immunes and rheumatoid, ultrasounds on my knees and shoulders all coming back with no significant problems, following extremely painful periods since 11 I’ve also had a CT on my abdomen 5 external and 3 internal ultrasounds on my uterus and recently told I have IBS. I can tell now My doctor is starting to act like she’s ‘sick’ of me constantly coming in with new problems, in pain or what ever it may be and keeps handballing things to others (I requested an MRI and she said she wants my physio to recommend which one first before she refers it which I thought was stupid), I’m on a wait list for a rheumatologist and gynaecologist but they’re up to a year wait, my doctor refuses to help me with suitable pain relief or management until “I have a diagnosis” which could take months to years and I’m struggling. She strongly believes I have endometriosis and we’ve talked about things like fibromyalgia but gets hesitant more on the body pain than the period pain. Other symptoms include on and off bad circulation/regulating body temperature, sweating on random, constantly getting sick, more migraine like head aches than I used to have, lack of full movement when my fingers get bad, fatigue, muscle weakness (dead arm after holding something heavy for little time now) and pins and needles come on quickly when my leg or arm is a specific ‘normal’ way. I am diagnosed ADHD, anxiety, binge ED, complex trauma background, my physio noted possible dysregulated nervous system and tests have come back negative for diabetes. Cardiology tests have come back normal. Triggers range but include on and off - weather, stress, standing or on my feet for too long, exercise as simple as jogging and sickness. I am taking 30mg vyvanse and 20mg dextroamphetamine daily for my adhd (2months in so can say these aren’t heightening the pain) and 5mg oxycodone once a day during my period but that’s all, nothing for the body pain. She doesn’t want to trial gabapentin, I’ve tried Celebrex and naproxen, and due to interactions I can’t take baclofen.
If anyone can shed light on their experience of similar situation as I am in please let me know, I know you guys are not doctors and everyone is different but anything would help or maybe something I can bring up to my gp.

M20 124lbs 5’6 non smoker
Update 5: the last ER gave me one percocet, one tylenol, and a shot of toradol and sent me on my way. Now I’m at the same ER I saw the PA at except my favorite doctor is here and actually treating me. We tried external lidocaine shots, then 2 percocets and a Valium, then one more Valium, then lidocaine internal, and now we’re tried a 2mg shot of dilaudid along with my regular dose of baclofen and gabapentin. This last one is the pain nuke so it should work after trying every other option. But he got me in with a very good neurologist that I should be able to see today or tomorrow, referred me to an ENT to check everything else out that way, gave me a three day supply of 7.5mg percocets to go home with (apparently I’m not flagged by the DEA and everyone just lied cause they didn’t want to give me narcotics). He also gave me a three day supply of Ativan because my usual pharmacy is out of stock and my psychiatrist is on vacation, so they couldn’t transfer it without her approval and she comes back Monday so it should get me through until then. All around ER visit that was worth it. I have enough pain meds to get me through until I see my doctor and am seeing the right people for more opinions on my condition.
Update 4: the PA I saw said go to a different hospital that may be able to give me the nerve block. Sadly they said they couldn’t so that’s not an option, but they gave me 2 percocets at 4:15am (so 30 minutes ago as I’m typing this) for the time being. I’m waiting until 7am for the doctors to get here to discuss a prescription for the week until Friday when I see my pcp who can continue pain management until I can get in with a pain management specialist. Also gonna ask my pcp for a referral to a more local pain clinic that’s not an hour away so hopefully I can get to one of those sooner. I’m also gonna call a different and more local neurologist that the best ER doctor I had highly recommended for a second opinion. He does pain management too so that also may be a good option for that, and he may be able to do the nerve block. Things seem to be going in the right direction. Hoping the percocet works soon, thankfully if it fails I’m still here for a while so they can evaluate and reassess what they can do for pain.
Update 3: and the pain is starting to come back on the left side now…. so I’m gonna call them now and see what the next step is
Update 2: went to the ER again, saw the same PA I had last night and this time she suggested mixed lidocaine shots. At 7pm she gave me the maximum dose on each side in the back of my mouth and so far its cut the left side’s pain by about 40% and the right side by about 20%. So not great but it’s something. It still hurts a lot though so I’m probably going to call them back and ask what else can be done, I can’t have more of the lidocaine cause it could be lethal and it’s not exactly a long-term solution either. Gonna see what they can do.
Update: Neurologist just diagnosed trigeminal neuralgia.
Tylenol, Advil, naproxen, toradol, none of it works. I have a fractured maxilla and I’ve been having severe nerve pain in my face since I got my wisdom teeth out on June 1st. The surgery went horribly wrong and my insurance is suing them for the costs of all the specialists and ER visits. I have been to the ER probably 6 times now with two hospital admissions for pain management. All of this is well documented and I’ve saved every bit of paperwork I’ve received.
I started 300mg 3/day gabapentin and 25mg 1/day amitriptyline almost two weeks ago, and a few days ago started 5mg 3/day baclofen (switched from cyclobenzaprine). I’ve slowly increased the dose of the gaba to 600mg 3/day since the ER doc 5 days ago told me I should be upping the dose by now. He gave me 600mg there so I adjusted according to that and today took 600mg three times for the first time.
I’ve been on percocet for the better part of a month. I only have taken it once or twice a day, the pain gets really bad at night so I usually take one then but if it’s bad during the day it might be two total. Lately 5mg hasn’t been cutting it which indicates I’ve built a tolerance, and the hospital I’ve been going to seems to have thought so too as 5 days ago they gave me 7.5mg of oxycodone and 10 more percocets that I made last until today when I went back to the ER.
Today they gave me 60mg of toradol, which they informed me was not the usual at all and only for “life or death cases”, which I just interpreted as rarely when they can’t give opiates. I understand they didn’t want to give a prescription which is reasonable as this is a chronic issue that should be handled by a regular physician (even though I couldn’t get in with my PCP until the end of this week which I booked two weeks ago). But they could have at least given me something there right? Is the DEA really that strict that you can’t even give pain medication as a single dose in-house if it’s a chronic problem that brings you to the ER often?
I mean 3 hours later and I’m still in horrific pain, I don’t think any ER is going to give me adequate treatment anymore so I’ve taken 900mg gabapentin and 1mg Ativan to self medicate. I’m down to maybe a 7.5/10 pain after that and hoping it’ll help me sleep sometime soon, though the pain is keeping me up still. I’m just tired of feeling like I’m being tasered and stabbed at the same time on both sides of my face.
I have a zoom consult with a neurologist tomorrow who can hopefully give me something, but he’s affiliated with the same hospital (the second one I was admitted to) that gave me nothing effective and let me writhe and scream in pain for two days straight while loading me up on toradol that didn’t work. The doctor on my case also drug tested me twice for no reason as I had just come directly from the first hospital with all the paperwork in hand, and she still refused narcotics after clean results. It was super traumatic and I have memory loss from that stay because the pain was so bad. They also did not give me the gabapentin that the first hospital gave me which just delayed treatment even more. And they were supposed to be the experts that the first hospital recommended. All they did was torture me and say it could be muscle or nerve related or both, same as the first one said. I just wasn’t treated appropriately so I don’t have a lot of hope that someone affiliated with that hospital will treat me much better.
So what am I supposed to do? Is the ER going to turn me away from now on? Do I just suffer now? I’m so stressed and upset now which is not helping with the pain. Is there really nobody who is willing to help me? Are everyone’s hands really legally tied so that they can’t provide adequate pain relief? I really don’t want to believe this is the state of our medical care

I'm asking because the sciatic pain is out of hand. It's cost me a lot in work I can't do/handle anymore, and I feel like there's no escape from the bear trap on my ass & the invisible iron maiden torture device penetrating all the way down my left leg.
I have been taking prednisone with mild success, but it's "mild success" helped much more than the . . .

• low dose opiates regiment( 10mg oxycodone, 15mg morphine sulfate, 2x a day - morning & night )
• Gabapentin (600mg 2x a day)
• Lyrica (2x a day)
• Duloxetine 60mg 1x daily.
• Aleve/naproxen OTC 1000 -1600ish a day split over 2 doses, 2 weeks on, 2 weeks off
• So much tylenol, 6 pills a day.
• Big Ice bag wrap applied to lumbatail bone 1/2 hour when pain is red.

But now I have to wean off the Prednisone, as the benefits/side effects quotient says t isn't worth it anymore.
Out of all the above, the opiates & ice wraps tend to help most, but the ice helps only during treatment, maybe 20 minutes after. With the opiates, often I can't tell much difference at all, and their might be some placebo effect with it - thinking about the pain level more if I haven't taken the regular dose.
So I know a lot of you either are or have been in the same quagmire, with many days feeling like you've been caught in some Hellraiser movie shite. Have any of you found your own silver bullet? Something the doctors don't push maybe?
My pops is trying to sell me on trying an ozone therapy? IDK about that. My initial web study on it sounds like it is similar to cortisone injections in efficacy but may last longer. Not a fix but an inflammation suppressant. I mean, if it works at all.
Feeling pretty shitty, tired, and desperate over it lately.
Thanks.

Seen some horror stories on here about FFS with some surgeons, so I wanted to share my very positive experience with Dr. Osborn (Boston, Massachusetts).
Consult to Surgery time:
2 months (due to cancellation and being able to get placed in the slot very quickly)
Original time frame - 7 to 8 months
Consultation:
First appointment to consultation was about 1.5 to 2 weeks.
Staff is well-trained, warm and welcoming. They will ask for a few face photos prior to the appointment.
First off, Dr. Osborn is incredibly sweet. Great listener, wants to know about what your goals are for FFS, and will make a few mock-ups of what you could look like after FFS. I wanted hairline transposition, eyebrow plexy, forehead contouring, and rhino/septoplasty, so I got a mock-up of this. Dr. Osborn also did a mock-up including jaw contouring and genioplasty to show me what I could look like if I got those done, but I opted not to and mostly wanted to focus on the upper part of the head.
IMPORTANT: HE WAS NOT PUSHY ABOUT ANY PROCEDURES. He very much understood that we were treating my dysphoria, more than aiming for some idealized feminine form.
Lead-up and Logistics:
Dr. Osborn does charge a one-time $2.5k fee which is his “concierge fee,” so it’s not totally free. That being said, he DOES take several major insurances, and in the case of FFS DOES TAKE MEDICAID (asked him this specifically for some friends).
Depending on your insurance, you may be required to foot 20% of the cost. My job thankfully paid for that 20%, so I was left with only needing to pay the $2.5k, which can also be paid in 5 installments, all due prior to surgery.
After the initial consultation, I had two more appointments with Dr. Osborn: One was a week after to discuss the mock-ups and what the battle plan looked like, and another 2 days prior to surgery to lock everything down and answer any remaining questions.
Also had a CT scan done so Dr. Osborn would know what technique he would be doing for forehead contouring.
Staff was wonderful with communication. Let me know everything I needed to do to get the surgery approved, and we were back and forth daily in the lead-up, since I had two weeks to get everything set with insurance once we found out about the cancellation.
Note that, as a doctor, I generally know how things are going to go, so I may have had fewer questions than the general populace. They are always available by email, and get back to most general questions pretty quickly (at latest 48 hours).
Surgery Day!
Dr. Osborn does his work out of BIDMC. Staff there is wonderful, and I had no issues.
Got to meet the whole surgical team prior to going under, including anesthesiology, the CRNA student, and the plastic surgery fellow who would be assisting with the surgery.
IMPORTANT: the fellow was in his third year of plastics fellowship and about to graduate. While still in training, this is FAR different from a first year resident, and by this point in time, a fellow will have about 8 years of training under their belt. This particular one will be doing FFS after graduating, so 8 I knew I would be in good hands.
Surgery
I can’t remember the last thing I said before waking up and finding out they were done.
Informed me about some slight deviations to the original plan, as I had an unanticipated 3 cm septal horn which required some extra effort to correct. I had nasal packing placed in because of this, but should not experience any complications due to the packing.
Went home the same day.
Post-Op and Healing Process:
I’m two weeks out as of today, and have not taken pain meds for about 5 days. Had low dose oxycodone for pain, which I took for the first three days, then kept it to naproxen and THC gummies after that.
Day 1 post-op: telemedicine appointment with Dr. Osborn. Mostly checking in to see how I was doing with pain and my healing. Told me to take it very easy. Was sleeping like 16 hours a day. Didn’t feel a thing with the oxy and naproxen. Everything was a hazy.
Day 2 and 3 post-op: swelling increased, which I was informed would happen. Still hazy, out like a light from the pain meds.
Day 4 and 5 post-op: stopped oxy on Day 4 since I hate the constipation. Did THC instead, which controlled the pain. Swelling DRAMATICALLY DOWN by day 5.
See Dr. Osborn at his clinic on day 5. Nasal packing removed. Discover what it’s like to breathe like humans normally should. Rhinoplasty/septoplasty becomes my favorite of the procedures done.
Week 1-2: looking human again. Not fully functional, but engaging in light exercise. Regaining feeling in several areas of my face. Parts of my forehead and scalp are still numb. Worst part is when I feel an itch, but the scratching does nothing.
Day 12: telemedicine with Dr. Osborn. Just a check-in and answer any questions I have. Next appointments are going to be 6 and 12 weeks post-op, to take before and after pics since my swelling should be near fully resolved by week 12.
Results and Impression:
Holy shit, am I happy. No longer wearing a fully face of makeup. No longer feel that it’s the only way for me to approximate femininity. Still love makeup, but I no longer fully need it to keep my facial dysphoria in check. Just some lipstick does the trick.
The main thing I wanted from FFS was to look like what I would have looked like had I not been exposed to testosterone my whole life. I wanted to still look like ME at the end of things, but if we needed to aim for something specific, I wanted to look like my mom.
Well, more than I already did, at least.
On all of these fronts, the surgery was a resounding success. I’m not even fully healed yet LOVE LOVE LOVE everything that has been done and the results I’m seeing so far.
Most importantly, I feel affirmed. I feel like Dr. Osborn and his team truly listened to me, and delivered to me exactly what I needed: yes, I wanted FFS, but I still wanted to look like me. The ask probably seemed nebulous, but Dr. Osborn understood my goal and helped me achieve it.
I will always be grateful to him and his team for everything they have done.
TL;DR: Dr. Osborn is a G, whose kind demeanor is only bested by his abilities as a surgeon. If I had to do this all again, I would without a single hesitation choose him and his team again.

So I had surgery today (or yesterday for some of you, May 26th at 7:15am). Septoplasty, maxillary astronomy, and removal of polyps. I have splints in my septum that will be removed on June 1st.This is kind of long but I appreciate anyone who decides to reads this and can give an insightful response. It is quite an interesting case so you might be fascinated by it despite the amount of text.
The medical information provided to me was done so very and there are several red flags in the print out regarding medications.
For one, only 2 days before my surgery, I was notified not to take aspirin (update: they actually didn't even mention aspirin...just NSAIDS in general including severeal which do not cause clotting). So I didn't, unaware that it would prevent blood clotting/scabbing. It's been 16 hours since I woke up from surgery and the bleeding is out of control. I'm not scabbing up much or clotting at all. My stomach is probably 80% blood right now. It's all that goes down my throat. I'm sure that's normal, though. The splints from the septoplasty are likely the source of most of it, it's certainly a great source of pain.
So, about the inconsistencies. Again, they should have notified me within a week not to take aspirin, because that very well could be why I'm bleeding to the point where I feel like bleeding severely. I've soaked up nearly every gauze pad they gave me and I got several boxes of them. Maybe they don't expect me to bleed for too long, but this is a red flag to me that maybe the aspirin use, even though it was a standard 325mg nightly up to that point, was related (enteric coated).
Now, regarding medications, they prescribed the usual, oxycodone 5mg. Only problem is this does nothing but make me queasy, shaky, and feel feverish. It's horrible. I'm not taking another one of these again. They also prescribed prednisone and have suggested Afrin spray several times a day to stop bleeding. The Afrin does not do a thing, really, and is very irritating. What IS irritating is that they did not tell me I was getting a septoplasty until the very day. One of the ENTs, not the surgeon, suggested this was no cause for concern months prior. Maybe that isn't relevant, but I don't know.
So with the prednisone, we all know it's not safe to take NSAIDS while on it because you run the risk of ulcers quite easily especially at high dose (of either). Well, the medication sheet says I'm allowed to take NSAIDS, including aspirin (the most harsh on the stomach, at least uncoated) within 3 days of the surgery. Say you take the max dose of uncoated aspirin each day with the prednisone (40mg, but it tapers down to 10 in a 15 day supply), you are at moderately high risk of developing an ulcer. Even ibuprofen and naproxen they said are OK to use within 1 day. Ulcers are just one thing, you can have intestinal bleeding, acid reflux, inflammation in general. Using famotidine or prilosec for instance will lower the incidence, but they don't suggest this. I developed acid reflux just simply taking prednisone last time, so my G.I is naturally sensitive to it. It would almost certainly harm me to take uncoated aspirin or high dose motrin alongside it.
It's also said that I can return to work in 7 days and lift up to 20 pounds, and fly on an airplane as well. This is one of the biggest red flags to me, because if I do that, I WILL suffer tremendously. This contradicts a letter I got from the surgeon that said I had to be out for 10 days and couldn't bend over or lift more than 5 pounds until another 5 days, and no flying for at least 2 weeks. When I explained this at work, they said just take 14 days off.
So the letter, that's all good. But what about this packet that says I can return to work 3 days sooner and lift 4 times the weight? That I can fly after 7 days? Anyone on here knows 7 days is WAY too soon.
SO
My friend suggested that I file a lawsuit either for the late notice of not to take aspirin, or the inconsistency regarding flying or returning to work after 7 days. It is worth noting the surgeon presented this packet to me, the same one who wrote the letter. Perhaps he didn't type it out himself, but it shows he didn't review it to tell me it doesn't exactly match up with his letter.
Say the letter was delivered to the wrong address (actually, it happens often on my street), and I only go off the packet. Well, I would almost certainly damage my progress. Or say I start taking NSAIDS alongside prednisone and develop bleeding in my G.I or ulcers, with no warning about this interaction.
And lastly, let's say I decide to fly out to Jamaica after 7 days. The sheet says that's fine, why not? I then develop severe bleeding in my sinuses and out of this world pain, possibly damage (I'm not really sure to be honest).
The first suggestion of not being notified to not take aspirin, the only NSAID I can tolerate because it has an enteric coated form within 2 days of the surgery is certainly a big mistake. Is this enough to file a suit? And what about the lack of warnings regarding prednisone/NSAIDS, and the inconsistencies between the packet and the letter?
So, she brought up potential lawsuit about the aspirin and it's potential for why I'm still bleeding so bad (if it continues for days, then yes, maybe). Then she also suggested, hey, why not purposely harm yourself, take the max dose of uncoated aspirin (very irritating to my G.I) along with your prednisone (VERY irritating to my G.I) to develop intestinal bleeding or ulcers? Yeah, this would surely do me in, and with no warning, that might be a suit And then purposely fly somewhere after 7 days. Basically, she's saying, hurt yourself and potentially win millions.
If I could... I don't know if I would, to be honest. I have morals, and yeah, winning a lot of money from a lawsuit WOULD be nice but I can't get past putting myself through pain on purpose just to do it. I'M aware of the risks even if they weren't presented to me the right way or at all. It really sounds like this is possible and I'm so torn. I'm very poor, a lot of my family is very poor, it could potentially be a wonderful thing. But I don't know if any of this is really enough to file a lawsuit. Like I said, my friend is very smart, high I.Q, but can be a bit manic at times. That is why I'm conflicted and unsure if any of those would actually be enough to file a lawsuit.
​
UPDATE: Aspirin was not even mentioned on the chart. Only motrin, ibuprofen, advil (non blood clotting NSAIDS), but did mention aleve and naproxen. This lady actually believes all of those are different drugs... a fucking R.N at a professional hospital not only doesn't know basic OTC brands, but couldn't get critical info to me until 2 days before surgery. I don't know about suing, but I think this lady needs to be fired, as she also wrote the post-op instructions that contradict EVERYTHING my surgeon told me. I will not rest until I let this woman know how god awful fucking stupid she is.

I got a pretty nasty sunburn on my forehead and both ears, and it's making it very difficult for me to sleep (as a side sleeper). I have acetaminophen PM, but I read that ibuprofen or naproxen would be better for inflammation.
I didn't have any of that, so I asked my mom if we have any in the communal drug pool. She expressed concern over the severity of the burn, and offered me some of her leftover oxycodone from a recent surgery.
I was a bit taken aback by this suggestion, but told her that I'll stick with the naproxen. I got two of those from her and am also taking the PM acetaminophen to help further with sleep.
My main question is, would the oxycodone even be effective in treating sunburn pain? Would it be more effective than the OTC drugs I took? If I can just nullify or significantly reduce the pain coming from my ears, I could fall asleep much easier. If my pain is the same or worse tomorrow, and the OTC doesn't help much tonight, should I take her up on her offer? I'm already operating on minimal amount of sleep due to outside factors, so if I don't get some meaningful rest tonight that will start to be a problem.

phoenixfirebird33:
Jan 12, 2021
11 weeks out and then pain keeps getting worse for me. It's debilitating now. Let me know if you find anything that helps. I am miserable and desperate. My doctor is no help at all.
http://www.reddit.com/Vasectomy/comments/kw842h/pain_and_swelling_4_weeks_post/gj2zod6/
I have debilitating post vasectomy pain 11 weeks after the surgery. I talked to a specialist today who said I might be dealing with this for months or even years more.
It's been the worst decision I have ever made.
My life was great before, now I am in debilitating pain. All the time. Just typing this makes me want to cry. If I could go back in time I would scream at myself to stop.
http://www.reddit.com/Vasectomy/comments/kw4rv8/talk_me_down_please/gj2zw99/
I wish I could go back in time and never do this to myself.
I am absolutely miserable. I feel like I have been kicked in the balls by a horse all the time. I can't sleep. Can barely walk. Can't play with my kids. Can't be intimate. I spent Christmas week balled up on the couch in awful pain.
All my doctor says is "I don't know...maybe more ice and pain medicine." Oxycodone blunts the pain, but makes me dizzy and nauseous and feel depressed when it wears off. Hydrocodone doesn't even touch the pain. Anti-inflammatories do nothing.
Is there anything anyone here has done to alleviate pain besides opioids and anti-inflammatories?
I am desperate for help and relief. Are there any doctors who specialize in PVPS anyone can point me to?
Can someone just share with me some hope? Or some list of things I can do to survive and not descend into an endless abyss of pain and depression. I feel like I ruined my life.
http://www.reddit.com/postvasectomypain/comments/kw9lin/11_weeks_post_surgery_with_debilitating_pain_help/

I had a very rough recovery as well...took me 4 months to back to some normality and able to sleep and sitting on my couch comfortably. I was so worried and stressed about having pain for life. It took another two months to be almost pain free...

The physical pain is unbearable, but the mental battle of constant pain, feeling like it will never end, is taxing and depressing.
I'm glad to hear your story and that you got back to normalcy. Do you feel like you are mostly back to normal?
http://www.reddit.com/Vasectomy/comments/kw9dqm/11_weeks_post_surgery_with_debilitating_pvps/gj3c0ph/
Jan 15, 2021
Thank you for this. I'm in excruciating pain all the time. Trying different meds etc. My Dr. is no help and offers no suggestions or solutions except Percocet and ice. Percocet will blunt the pain (not remove it), but when I come off of it, the pain comes back and I feel such deep depression, it's hard to explain. The mental and emotional effects are bad. My stomach muscles are in a constant state of contraction so they cramp and spasm all day and keep me up at night. Just taking it one moment at a time and trying to get centered and calm as much as I can. I've had my share of physical trials and injuries... broken ribs, broken bones, chemical burns, concussions, torn patellar tendon. Nothing compares to this.
I have new and deep and abiding compassion for anyone with chronic pain that I never could have fathomed before. That's one blessing I can take from this so far. Other than that... it's just hell and all negatives. Thank you again for your post. I appreciate it so much..
http://www.reddit.com/postvasectomypain/comments/kw9lin/11_weeks_post_surgery_with_debilitating_pain_help/gjec9be/
Jan 17, 2021
I have tried warm baths. They seem to give a little temporary relief.
I'm trying everything I can find. Which is probably an issue. I can't tell what is working and what is not because I keep switching and mixing meds in desperation..
Going to talk to a specialist this week to discuss options.
My urologist is completely clueless. Like literally clueless. I'm telling him what I'm reading online and he's prescribing it. Very disappointing.
I spent yesterday curled up on the couch in agony. Today on oxycodone I can walk around a bit. When it wears off, though, then I pay for it (mental lows + pain increase).
I cant keep going like this. Complete misery.
:(
I'm still proactively searching for something.
http://www.reddit.com/Vasectomy/comments/kw842h/pain_and_swelling_4_weeks_post/gjo5i9g/
No scalpel. And nothing went wrong according to Urologist. He did say it was hard for him to find the vas on the left side and that he had to palpate left testicle more than normal.
I recovered from initial surgery pretty well. At 3 weeks I felt almost normal...just a little bilateral tenderness. 4 weeks out pain started to slowly build. By 6 weeks it was really bad. 8 weeks, debilitating and excruciating and non-stop. Left side is the most painful, by far, but both hurt.
http://www.reddit.com/Vasectomy/comments/kw4rv8/talk_me_down_please/gjoj6h6/
March 3, 2021
Here’s my story… I got a Vasectomy 4 months ago today. It’s been the worst 4 months of my life. I cannot even describe the pain I have been through. The constant excruciating pain is unrelenting and excruciating. I would walk to the ends of the earth for a cure, if only I could walk for more than 100 meters without experiencing even more pain. This has ransacked my physical, emotional and mental health. I have had suicidal thoughts - anything to escape this pain.
I didn’t know this was a possible outcome or that PVPS was even a thing until I found reddit and this forum. How was this not disclosed to me as a potential outcome from Vasectomy? This is unconscionable and a failure or modern medicine at every level and the lack of disclosure is unethical. I am considering suing the urologist who did this to me for lack of sufficient disclosure.
I cannot sit for more than an hour without exacerbating the pain. I can’t walk without pain. I can’t pick up my kids. I can’t exercise. I know I am preaching to the choir here, but it does feel good to type it out and know there is a community of people who will read and actually know what I am experiencing.
After my surgery, the discomfort never went away, but the real, terrible pain didn’t start until 4 1/2 weeks post surgery. It came on like a freight train during intercourse one evening and took my breath away and sent me to my knees in agony. And it never went away.
I feel like I have tried everything except surgical intervention and the only things that seem to give real help are are narcotic pain medicine, THC and Lyrica. They are all temporary fixes, or course. Here’s a list of things I have been doing to try and get relief and healing and pain reduction:
Supplements/Vitamins:

• Papaya Seed Powder - No noticeable effect/relief
• Turmeric - No noticeable effect/relief
• Various other supplements and vitamins - No noticeable effect/relief

Medications:

• NSAIDs (Ibuprofen, Diclofenac, Naproxen, etc) - No relief
• Hydrocodone - Almost no relief
• Oxycodone - Blunts the pain.

This is the best medication for short term relief.
Very concerned bout long term dependence or addiction..
THC - aka Medical Marijuana - This helps to reduce the pain.
I take it at night because the levels I have to take to get the pain to subside also make me very sedated and unable to focus or do my job well. It definitely helps me to sleep.
Lyrica - I noticed pain reduction and especially reduction in referred/radiating pain in the abdomen pretty soon after taking this.
Again, I have concerns about being on it long-term, and I have major brain fog and slurred speech, but it does seem to help with the pain..
Clothing:

• Specialty underwear - I tried so many different brands.
• I now wear two pairs of underwear at the same time, all the time.
• Sweat pants - I only can wear sweat pants. Anything else will cause pressure or increased pain..

Other things I’ve tried or considered:
Ice - Almost no relief
Ultrasounds - I’ve had two and they don’t show anything particularly damning except for some mind swelling in the epididymis and varicose veins.
Nerve block - I had one scheduled, but backed out because I don’t trust the pain clinic and have read too many stories of the blocks making things worse unless they are done by a specialist on the spermatic cord.
Prayer - No immediate reduction of pain, but some sense of peace and calm
So that’s where I’ve been. I have a reversal surgery scheduled for 3 weeks from now. That bit of hope keeps me moving from one day to another. I’m desperate for it to work and if it makes things worse or doesn’t eliminate this pain, I’m honestly not sure what I will do. By the time I get the reversal, I’ll be 5 months post vasectomy. I have had two urologists tell me I should wait until 6 months, but frankly, I’m not sure I can make it that long, and I’m desperate to just try and get “put back together the way I was” or at least as close as possible.
March 28, 2021
I wanted to post an update…
I had reversal surgery with Dr. P in Florida..
I researched every specialist I could find in the country, talked to a few and felt most comfortable with him (by far). He’s really kind and sympathetic, has a stellar reputation, leading edge equipment and a really helpful and proactive staff..
I am a few days post-reversal now.
Now that the block from surgery and numbing has worn off, I have pain, but it’s a different type of pain now. Hard to explain…but this now feels like inflammation and not so much congestion. Still some referred pain into the lower abdomen and pelvis but that has eased a lot.
Dr. P said the pain will probably get worse before it gets better and that I really should not expect pain reduction until 1 to 2 months post surgery. So patience is a virtue I will continue to employ.
I’m taking my time and trying to just be careful and keeping my thoughts positive and hopeful. If anyone has suggestions for how to aid the recovery process, I would be very thankful.
March 30, 2021
I’m feeling hopeful even though I’m still in quite a bit of pain.
I read your most recent thread with details about your reversal. Interestingly, like you, the second night after my surgery, I also had morning wood. It’s been 5 months since I’ve experienced that.
I still feel, what I think is, congestion pain. It was gone for 2 days after reversal, but has returned somewhat. I am hoping that starts to go away soon, perhaps after I am able to ejaculate.
When did you notice that congestion pain dissipate for you?
My Dr said to not expect much relief for a month or so. So I’m just focused on patience right now.
Even though I am still feeling pain, my wife and close friends who have seen me post-op have all said I look healthier and seem more relaxed and happier. And that alone makes me feel good about things.
https://web.archive.org/web/20210417083532/https://www.postvasectomypain.org/t/unrelenting-unspeakable-chronic-pain-ive-tried-almost-everything-reversal-is-next/6085
May 12, 2021
I would echo what others have said. Most men who simply recover, don’t find their way here and don’t post. They just get better and move on with their life..
Stay positive and focus on pain management day to day.
There is always hope and there are always options and things you can do.
For me, what worked was to set a date on the calendar. I said “If I’m not functional, with just minor discomfort by x date, I’m booking a reversal surgery with Dr. P”. That gave me the hope I needed to get to that date. Then, once I got there, I followed through and I booked the reversal and that gave me hope to get to that date. Then I put another marker to try Ketamine Infusions. Then another to try another medication. And other markers on my calendar much further out to consider what else I would do. Trying to stay positive and focus on the fact that there is always something to look to in the future that can help.
Give yourself long term dates and goals and also focus on just managing pain and reducing discomfort and suffering in the short term. There is ALWAYS a next step and there is ALWAYS hope.
Google Cached copy of "Help me stay hopeful, please - Post Vasectomy Pain - Post Vasectomy Pain Forum.html"
August 21, 2021
9 months after vasectomy
My wife can relate to you for sure.
And this is hell for him, as I know first hand.
I got a reversal and am on Lyrica and Cymbalta. I have done a number of other things as as well and am on 6 different supplements etc Overall I am slowly getting better and getting my life back.
I can’t run yet, but I swim laps every day. And someday In convinced I will be pain free. Some day..
Have you had a consultation with Dr Sijo Perakattill in Florida? He will do a phone consult. He is the one who did my reversal and he is very knowledgeable. He is very busy and always seems to be in a rush, but he’s a brilliant surgeon and very, very kind. He was the first Dr to give me hope.
You might also want to reach out to Dr. Amin Herati at Johns Hopkins.
He does a targeted MRI guided denervation higher up, outside of the scrotum and has other outside of the box thinking. I like him A LOT..
Good luck to you! Don’t stop searching.
And God bless you for searching on his behalf
Google Cached copy of "I need some advice from you guys - Sandbox - Post Vasectomy Pain Forum.html"
Dec 12, 2021
13 months after vasectomy

How are you doing now, OP?

I have had a reversal which has helped.
But still have of pain. Lots of pain most days. Moderate pain others. Can't hardly move some days. It's been 9 months since reversal.
Trying to decide what is my next move and trying to just survive one day at a time.
http://www.reddit.com/Vasectomy/comments/kw9dqm/11_weeks_post_surgery_with_debilitating_pvps/ho7na23/
Apr 12, 2022
17 months after vasectomy

any change?

I am feeling a lot better! Made a lot of strides over the last few months. When I got COVID, for some reason that really kickstarted my recovery. That led me to think some of my pain might be vascular related, so I started doing a bunch of things to treat varicocele and its working! For those who are still having issues, don't lose hope!
https://www.reddit.com/Vasectomy/comments/kw9dqm/11_weeks_post_surgery_with_debilitating_pvps/i4e1j7o/
Metadata:
ID: 2eb58363
Name: phoenixfirebird33
Vasectomy Date: 2020-11-03
Source: self
First Seen: 2021-01-12
Last Seen: 2022-04-12
Storycodes: LTP,SGR,BDR
Reversal Date: 2021-03
Onset Delay: 1
Months: 15
Resolved: Mostly

Hi All,
I had my RPLND at UCHealth Anschutz (Aurora, CO) with Dr. Cost last week. Figured I’d share a few (ok many) thoughts/observations having done it as I found the other posts helpful.
32M / 6ft. / 165 lbs. / Active but not athletic by any means.
Clinical stage IIA. Diagnosed 6/2 with AFP of 42 with other markers normal. Radical left orchiectomy 6/4.
The tumor biopsy after the orchiectomy showed:
Non-seminoma mixed germ cell tumor (Teratoma 45%, Yolk Sac Tumor 35%, Embryonal Carcinoma 20%). 4.2 x 3.1 x 2.9 cm with lymphovascular invasion.
Subsequent CT on 6/11. Scan showed an enlarged retroperitoneal lymph node of 1.3 x 1.1 cm.
6/22 AFP was 6. 7/1 AFP was 3.3. Other markers (LDH, HCG) were in the normal range throughout though dropped a little bit.
Open RPLND on 7/14. Released from inpatient the morning of 7/18.
So thoughts on the orchiectomy:
(1) Take someone with you to the initial urology appointment. You know in Breaking Bad when Walt is diagnosed with cancer and the room turns white and you can’t hear? Same thing for me. Would have been nice to have someone around for it. My driving was subpar going home.
(2) Recovery took about three weeks before I was running again. Pain was completely managed and I was off the oxy by day two.
(3) Got a little too drunk the day of diagnosis and woke up with a headache. Took a small amount of naproxen and told my surgeon when he was going over the medications I took. He ordered a brain MRI as he wanted to make sure it hadn’t metastasized to my brain. I could have avoided an MRI if I hadn’t drunk so much so there you go.
(4) My surgeon told me to prop up my balls while lying down to avoid fluid buildup. I did this initially but soon gave up. Now there’s a good amount of fluid hanging out where my ball used to be. While not a medical concern, I wish I had started propping up my scrotum sooner than now (after the RPLND).
(5) Overall, the surgery wasn’t that bad looking back at it. You’re going to be fine.
RPLND thoughts:
(1) Talked to my original orchiectomy surgeon, an oncologist, and the RPLND surgeon (Dr.Cost). They gave me three options: RPLND, chemo (4 rounds of BEP), or surveillance. The original orchiectomy surgeon and oncologist recommended either RPLND or chemo given the stage and lymphovascular invasion. The RPLND surgeon said all options would all (likely) result in a cure so the decision was up to me. They put the chance of my enlarged lymph nodes as cancerous at (roughly) 75%.
I decided on RPLND for a few reasons (ranked by importance)
(a) Teratomas don’t respond much to chemo so the thought of going through chemo and either the cancer still growing or never having been there in the first place (the 25% chance) drove me crazy. The thought of not knowing whether I had a tumor in the first place, ditto. I started to think of chemo as ‘exploratory’ chemo as in we’ll just see what happens when we nuke it. Which it isn’t. Chemo is a recommended treatment option but wasn’t for me.
(b) Emotionally, I liked the idea of cutting out the cancer and being done absent more surveillance. Again, I wanted to know exactly what my lymph nodes were doing absent any clinical benefit. Which is weird, but that’s me.
(c) Dr. Cost is one of the most impressive doctors I’ve ever met. My doctor aunt said that you have to trust your surgeon with your life because that is what, in fact, you’re doing. And I did.
(d) My insurance deductible and out of pocket were both fulfilled for the year. If I did surveillance and got RPLND or chemo next year, I might have to pay 5k again. That’s a good amount of dosh.
(e) Peripheral neuropathy (weakness or numbness in the fingers or toes) can be a side effect of the chemo. My primary hobby of rock climbing involves finger strength and toe sensation so that wasn’t going to fly.
(2) RPLND tips and tricks
a. Pain. They gave me an epidural which kept my pain at a 1-2 the first three days. Dilaudid made me itch so the pain docs switched me to fentanyl. That removed the itch a bit but still wasn’t great.
At 615am the fourth day, they removed the epidural which brought my pain up to a 4 by 930am. By 4 I mean I couldn’t read or concentrate for long periods because of the pain. SO HERE’S WHAT I DIDN’T KNOW. YOU HAVE TO ASK FOR PAIN MEDS. IF YOU DON’T ASK, THEY WON’T GIVE THEM TO YOU. My pain doc ordered me 2 5mg oxycodone every four hours as needed for pain. They gave me one 5mg and 1000mg Tylenol around 6ish. So I figured I was on some kind of pain killer schedule. I WASN’T. Around 10, the nurse gave me another 5mg as I asked for one. Crucially, I asked for a third one as it was bad times bears pain wise by then. The nurse declined and, I believe, thought I was trying to score dope instead of reacting to pain. I was kinda… embarrassed, I guess? It didn’t feel good anyway.
The second 5mg oxy relieved the pain and thirty minutes later and I was up for a walk. But that 930 to 1030 hour sucked and it sucked without necessity. SO ASK.
I eventually figured out by that afternoon that ‘as needed’ was a dumb system. If you’re like me, by the time you ask your pain is already ascending and the oxy or tylenol takes times to kick in. Eventually, I settled on alternating between 1000mg Tylenol and 5mg oxycodone every four hours until discharge. But that’s a schedule I came up with myself to avoid that thirty minutes of moderate suck.
Getting my catheter out hurt way more than they told me. A nursing student did it, obviously one of her first times, and man did that suck.
b. Logistics
(i) A stupendously long charger cord is clutch. The distance between your bed and the wall is far and having that extra cord length was great.
(ii) Noise cancelling headphones. Slept with brown noise which was v. pleasant.
(iii) Eye mask. My house has blackout curtains. Hospital rooms do not.
(iv) The hospital cafeteria is not a restaurant. My lymph fluid looked good so my diet was not restricted. The fish tacos I had the first day were a mistake; the tuna fish sandwiches after that point were not. Think simple foods you can’t mess up and you’ll be alright. I lived on cottage cheese, salads, berries, and tuna fish sandwiches and did well.
(v) Gatorade. My electrolytes were low so I dumped a 12oz Gatorade into every liter I drank. Tasted better too.
(vi) Don’t bring a well-packed suitcase to the hospital. I didn’t need 90% of what was in there (especially clothes since you can’t wear them). Really you’re just packing up your anxieties. They’ll give you anything you need.
(vii) Entertainment. I watched two hours of TV on my tablet, read an issue of The Economist, and about five hours of my book. This was much less than I expected but the first three days were real dopey. By all means bring your entertainment but I spent a lot of time calling friends, texting, and napping.
(viii) Get on the hospital’s schedule. Shift change was about 7pm and then things start to quiet down. I wasn’t particularly tired then having catnapped throughout the day but getting ready to sleep by closing your eyes and listening to music was the way to go. You’ll be interrupted various times in the night and woken very early (615 am) by resident rounds and shift change so going down early is real nice. Again, you might not sleep but listening to music with your eyes closed after eight proved to be helpful. Starting at 615 rounds the hospital wakes up which mean, shockingly, that you’re going to be woken up constantly after that point.
(ix) Walk, walk, and walk. It is going to suck. I went vasovagal (fainted) the first few times. It helps if you raise your hospital bed up to a more ‘sitting’ position before you start trying to get out. If you start from lying to sitting you might pass out more easily, or at least I did. Also, ask to go walking if you’re up to it rather than relying on the nurses to ask you. That way you’ll get more walks which aids in recovery, gas passing, and pooping. Again, judge your own strength and advocate for yourself.
(x) Having someone visit everyday is great emotionally. But it is also nice to have them rearrange your table optimally so you can reach things on your tray, rearrange blankets so you don’t have to do it one-balled, etc.
(xi) Get some athletic shorts/pants from goodwill or wherever that are two sizes too big. I was bloated two sizes up and my usual sweats weren't comfy.
c. Don’t discharge yourself. They gave me the option of hanging around my room or the ward but I was ready to GTFO. The nurses and CNAs were all very nice but I wanted to go home even though my parents were coming in two hours. So they let me discharge myself with a rolling suitcase.
Walked down to the pharmacy and outside garden taking plenty of rest breaks every three minutes of walking. I felt perfectly in control but after thinking about it today, it was a risk not worth taking. I saved, max, 30 minutes and might have fallen. So put that category of “legal, but dumb” and maybe don’t do that yourself.
d. RPLND is major surgery and will knock you on your ass. Don't go into it lightly but, on balance, I'm glad I got it done.
3. Insurance. I made sure my insurance preauthorized the RPLND of course but also had my doctor's office email me the preauthorization form the insurance company sent over just to be sure. They do not normally send the preauthorization form to the patient. The insurance company was unable to send it to me. I checked that the code matched the procedure I was having done and how they calculated inpatient days matched the number of days I was staying. Being America, I figured the more legwork I did on the front end the less chance I will get a surprise bill at the end. The insurance preauthorization RN said I was the most involved patient she's ever had so that's a compliment I guess?
For the orchiectomy, the anesthesiologist billed me directly instead of my insurance. I kindly told them to bill my insurance directly. Before this, I didn't even know that was a thing so it took some figuring out.
After discharge has gone well. Pain’s a 0 to 1 except sitting up which reminds me I don’t have abdominal muscles.
Please ask me anything!

A brief guide to different treatment options I wish I knew a little more about before starting intern year. This is definitely an area I don't consider myself an expert on so I am looking forward to feedback, corrections, and suggestions for improvement!
Brief overview of some of the treatment options available to you when a patient is in the hospital and complaining of pain.

Tylenol (650mg q4hr prn or 1000mg q6hr prn)

• Max 4g/day in normal patients, max 2g/day in patients with cirrhosis / liver dysfunction
• I basically put every patient on prn tylenol on admission
• Toxicity isn't usually seen until about 10 grams of tylenol in one day​
• Also referred to as APAP by some people (N-acetyl-para-aminophenol) - I think sticking with tylenol or acetaminophen is better: APAP: An Error Prone Abbreviation​
• Consider scheduled doses in patients with uncontrolled pain​​​
• Oral or rectal are good routes. IV is good but the hospital doesn't like you using it too much because it is expensive.

NSAIDs​

• Make sure patient is not at risk of GI bleed or has an AKI. Not commonly used for inpatients due to these risks.
• Ibuprofen (MOTRIN, ADVIL) - 400-600mg PO every 6-8 hrs
• I like 400mg because the evidence seems to show it has the same analgesic effect and as you go higher you only increase the risk of side effects.
• Naproxen (ALEVE) - can be dosed every 12 hours. Higher risk of GI bleed
• Ketorolac (TORADOL) - IV/IM forms available which can be useful especially in patients with nausea. Useful in kidney stones. Highest rate of GI bleed though debatable. 10-15mg is equivalent to 30mg in terms of pain relief. Q6h x48 hours is an appropriate trial in setting of acute pain, after that can transition to celecoxib to reduce the risk of GI bleed or renal issues (200mg BID) ​
• Indomethacin - commonly used in gout, 50mg TID during flare. For general treatment of pain, 20mg TID (I don't see this inpatient much if ever).
• Celecoxib (CELEBREX) - newer evidence does not show increased risk of heart attacks / ischemic cardiovascular events. May have lower risk of GI bleed (Chan, et al 2017). Might start seeing this used more going forward (although I personally have never ordered this yet).

Lidocaine patch​

• Good for musculoskeletal pain
• Up to 3 patches​
• Placed and removed every 24 hours
• 5% form is hard to get outpatient due to insurance coverage issues​ but there are OTC 2% and 4% forms

Capsaicin cream​

• Some patients like it, others don't like the burning feeling​
• Binds to nociceptors in the skin -> initial excitation and enhanced sensitivity -> followed by refractory period with reduced sensitivity and persistent desensitization, possibly due to depletion of substance P
• Most effective for osteoarthritis (0.025% cream), neuropathic pain (0.075% cream, not available at our hospital), and cancer-related pain
• Double-blind trial showing 80% of patients with osteoarthritis had reduced pain after 2 weeks: https://pubmed.ncbi.nlm.nih.gov/1954640/
• Efficacious, but moderate to poor efficacy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC404499/
• High reports of burning/redness, but patients liked it and continued to take it due to decreased neuropathic pain: https://pubmed.ncbi.nlm.nih.gov/9256142/

Diclofenac gel (VOLTAREN gel)

• 1% gel up to 4 times daily​
• Often used in osteoarthritis
• 3% gel is for actinic keratosis not for pain
• Low systemic absorption​ so avoids most of the side effects of NSAIDs

Opioids​​​​​

• Tramadol
• Partial mu and serotonin receptor agonist
• Side effect = lowered seizure threshold
• Falling out of favor as patients have very different responses​
• Everyone on Reddit thinks its trash
• 50mg q4-6hr prn
  
• Oxycodone​
  
• Commonly start with 5mg dose in patients, 2.5mg if elderly
  
• Onset in 10-30 minutes and lasts 3-6 hours
  
• Extended release version = OXYCONTIN (lasts for 12 hours)
  
• Hydromorphone (DILAUDID)
  
• The reasons patients like it is because it has a more rapid onset of analgesia which can produce more euphoria​
  
• Metabolized by LIVER (don't give in liver dysfunction!)
  
• Morphine
  
• Good for air hunger, decreasing anxiety​
  
• Frequently seen in patients on hospice or comfort care
  
• Has a liquid version called ROXANOL
  
• Has an extended version called MS-CONTIN
  
• Metabolized by KIDNEY (don't give in kidney dysfunction!)
  
• Meperidine (DEMEROL)​
  
• Thought to be good in pancreatitis due to decreased contraction of Sphincter of Oddi​
  
• Useful in patients with rigors
  
• Miscellaneous
  
• Common outpatient meds - hydrocodone-acetaminophen (NORCO), oxycodone-acetaminophen (PERCOCET, VICODIN)​. Can continue this when inpatient
  
• Make sure everyone on opioids has opioid overdose order set (includes naloxone for reversal if needed) Make sure everyone on opioids has a solid bowel regimen (at least miralax and senna)! Constipation common
  
• USE THE CONVERSION CHART TO SEE DOSING EQUIVALENTS
  
• When switching from one opioid you may want to consider initially dose reducing about 75% to account for differences in pharmacokinetics
  

Neuropathic pain treatments​​

• Remember neuropathic pain vs nociceptive pain. Neuropathic pain does not respond well to opioids.
• Duloxetine (CYMBALTA)
• Venlafaxine (EFFEXOR)
• Gabapentin (NEURONTIN)​
• TCAs are also used for this but very unlikely would be started inpatient, lots of side effects

Methadone​

• Used in patients who are trying to wean off opioids - long-acting​
• IV AND PO methadone has QT prolongation which you should be wary about, get pain management involved

Ketamine​

• Consult pain pharmacy you crazy person lol​
• Gaining popularity as an opioid-sparing pain med
• Side effects = emergence reactions, hallucinations

Buprenorphine​

• Also gaining popularity​
• Partial agonist of mu receptor - meaning it acts as an agonist when there's no opioid around. But when there is opioid around it becomes an ANTAGONIST so it prevents people from doing opioids on top of their prescribed pain meds
• Also has reportedly a lower risk of respiratory depression compared to traditional opioids​ ​​

Miscellaneous

• Lidocaine swish & swallow​ - for mouth pain / ulcers
  
• Lidocaine gel (URO-JET) - for painful Foleys
  
• Warm compress (K-PAD)​ - for pain related to localized swelling​
  
• Muscle relaxants​ - baclofen, cyclobenzaprine, tizanidine, etc. - they all basically work just by making you sedated and sleepy from what I learned. Doesn't really actually do that much for pain.​ Baclofen really should only be used for central spastic disease, it's not a great drug, also watch out for baclofen withdrawal in admitted patients (looks kind of like alcohol withdrawal, risk of seizures, etc.)
  
• Long-acting vs short-acting opioids - you shouldn't really ever use long-acting narcotics in the standard patient population. They have high abuse and overdose potential and don't really work well for most acute or chronic pain issues. Their role is really in pain related to cancer or end-of-life related pain. In cancer patients you often will see them combined with short acting in a manner similar to basal-bolus insulin regimens. Per Dominus_Anulorum
  
• Don't forget to make use of consult services
  
• Pain pharmacy consult​
  
• Wound care consult
  

Post-Operative Pain Control

• Per u/MMOSurgeon, read more comprehensive post here
• For midline, subcostal, Chevron, or Mercedes incisions - thoracic epidural is the gold standard
• Standing tylenol is important!
• Toradol is an excellent choice, also order it standing
• Oral medications ALWAYS WORK BETTER AND LAST LONGER than IV pushes or PCAs
• Consider regional blocks
• Read the guide from Michigan for discharge to home / how many opioids to send a patient home on

Formatting this on Reddit was a little difficult, message me if you want a link to a video I made on the subject or to another website where the formatting looks a little better (also has the rest of my guides on there). Hope this was helpful!

(Disclaimer - I am not a doctor and am only providing information which you can speak to your doctor about. Sorry for the long post, but I hope it’ll help some of you)
Hey everyone, I see a lot of posts on here asking for advice on medications/treatments, or posts from people who are suffering from severe pain. It breaks my heart to see so many of you suffering, and since I know first hand how we often must be our own advocates when it comes to medical care I wanted to give you the tools to advocate for yourselves by letting you all know about your pain management options.
I’ve worked at an interventional pain management (PM) for 3 years now as a medical scribe and am also currently receiving PM treatment for my endo as well. I’m by no means a doctor (yet), but I’ve learned a lot by working side by side with a pain doctor over the years. I hope this post will help some of you find the relief you’ve been searching for.
Below is a master list of medications and interventional treatment options in regards to PM. This list does not include hormonal options or surgeries, since I don't have enough medical experience in OBGYN to provide those.
I’m going to list the generic names for most the medications since the brand names can vary in different countries. And please know this - if one medication in a certain drug class doesn’t work for you, it doesn’t mean others in that same drug class won’t work either. Many people try multiple medications in the same drug class before they find one that works for them.
Also, if you are suffering with pain, PLEASE go see a pain management doctor as well (if you can). They focus on just treating the pain and have much more resources to do so than an OBGYN doctor. I cannot recommend this enough - a caring, empathetic PM doctor can help you reach the functionality in your daily life that you want.
​
NSAIDS

1. Ibuprofen
2. Duexis (enteric coated ibuprofen)
3. Naproxen
4. Vimovo (enteric coated naproxen)
5. Aspirin
6. Ketorolac (IM injection or oral pills)
7. Sprix (intranasal ketorolac)
8. Meloxicam
9. Celecoxib
10. Diclofenac sodium (oral or topical gel)
11. Diclofenac potassium (works better for some ppl)
12. Etodolac
13. Mefanamic acid

​
MUSCLE RELAXERS

1. Cyclobenzaprine
2. Methocarbamol
3. Baclofen
4. Tizanidine
5. Clonidine
6. Norflex
7. Metaxalone
8. Dicyclomine (anti-spasmodic)

​
NERVE PAIN MEDICATIONS

1. Gabapentin
2. Gabapentin enacarbil (works better for some)
3. Pregabalin
4. Amitriptyline
5. Nortriptyline
6. Duloxetine

​
OPIOIDS

1. Tramadol
2. Codeine
3. Tapentadol
4. Hydrocodone
5. Morphine
6. Oxycodone (IR or ER)
7. Hydromorphone
8. Fentanyl patches
9. Buprenorphine (transdermal patch or sublingual film)

​
OTHER MEDICATIONS

1. Acetaminophen
2. Diazepam (benzo used as muscle relaxer, oral or vaginal suppository)
3. Lidocaine patches
4. Ketamine (intranasal spray or infusions)
5. Methylprednisone (corticosteroid for flare ups)
6. Metamizol (both muscle relaxing and anti-inflammatory properties)

​
INTERVENTIONAL TREATMENTS

1. Trigger point injections (abdominal wall or pelvic muscles)
2. Pudendal nerve block or radio frequency ablation
3. Peripheral nerve block
4. Superior and/or inferior hypogastric nerve block or radio frequency ablation
5. Celiac nerve block or radio frequency ablation
6. Spinal cord stimulator
7. Intrathecal pain pump

​
OTHER NON PROCEDURAL TREATMENTS

1. Heating pad (regular or infrared)
2. TENS unit
3. CBD/THC (many forms of administration)
4. CBD lube (for sex)
5. Kratom (binds to opioid receptors and sold at smoke shops)
6. Massage therapy
7. Pelvic floor physical therapy
8. Pelvic wand massager and dilators
9. Yoga and stretching exercises
10. Acupuncture
11. CBT with chronic pain specialist (for mental health, not pain)
12. EMDR (for trauma associated with pain or medical care)
13. Epsom salt baths
14. Diet management

If anyone has any other suggestions to add to this list please let me know! And feel free to ask any questions regarding these medications and treatments - I may be able to answer some of them. Sending all my love and best wishes to you all <3

Edit:added info and meds im on for it
Mentally im kinda wrecked and drained atm
Nerve pain is no joke, had an early breakfast and tried eating more normal "soft" food but it was too rough aparently and between that and the mouthwash being a bit too harsh " back to Saltwater only"
I tore /shifted etc the granulation tissue and exposed a raw nerve , the pain being the same as dry socket since its nerve pain ,.. I used cepacain to get me to ed straight away which kept it at 8-10 pain "it only lasts 15 to 20 minutes so within 2hrs id had 4 or 5 doses" as we left straight away and got a local and new scripts just in time as it was starting to hit 9.5/10 ,,
When it happened it went from 3/10 pain to 9 out of 10 pain in waves feeling it though the local and oxycodone just under the surface the the ed at armadale thought it was dry socket but luckily the dentist said they were wrong and said that it seems fine enough now, still in pain but managable now as the local I had at about 7am is still working and I just had more meds "its no longer exposed but still feels raw"
Some people exaggerate pain with their pain scales, sadly I've been in real pain before and been in frequent pain for a long time as some know, 8 out of 10 for me is the limit of bearable pain, 9 out of 10 im having uncontrollable effects from the pain "shaking , tremors, roaring sound in your ears, close to passing out from the pain, to list a few of them,
10 out of 10 pain for me is nothing but screaming worst pain you can experience where killing yourself to escape it sounds like the only way to get away from it, you can even become incontinent from that level of pain, it just takes complete control where there is nothing in your life at that moment other than pain
10-10 pain ive only ever felt twice in my life once when my intestines nearly ruptured after some issues where I couldn't have a bowel movement for 2-3 weeks and once when I had a severe dystonic reaction to chlopromazine and it made me clench my teeth so hard all 4 wisdom teeth shattered into pieces and i just came within a hair of a third time so mentally im fd at the moment, so when I say I hit 9 and 9.5 out of 10 I mean it , yall know what im like with honesty lol,
Dentist said likely another week of healing before im out of the woods and that my upper left wisdom site with the hard swelling indicates a likely infection so continuing antibiotics and naproxen for another course, will schedule another dentist appt next week to check on them and do that weekly just to keep an eye on it for peace of mind until they say its healed enough that I don't have to stress about it
Pains down currently using heat packs,ive no idea why the dentist originally explicitly said to not use heat "not just to wait a few days but not to use it at all" but when making a check-up appt for Friday the nurse said I should and you know what it actually helps
Pain meds: oxycodone 5mg x1 3 times a day ,tramadol 100mg x2 3 times a day, panadine forte 60mg x2 3 times a day As needed Anti inflamatory:naproxen 1000mg slow release x1 daily

I just wanted to share my on-going experience. I have had hemorrhoids for years, but they have gotten worse recently, on top of that I had also formed a chronic fissure over the past 6 months or so. The combination had gotten so bad that I was unable to sit long enough to drive anywhere. Around this same time I also had my pilonidal cyst flaring up. I went to my GP concerning the hemorrhoids and the fissure, she for some reason became completely fixated on the cyst and blamed it for all of my pain.
I decided to seek out a second opinion and went to my digestive health specialist, he referred me to a colorectal specialist.
The colorectal doctor talked to me for about 20 minutes as I explained my problems, he listened a shared his thoughts at the same time, he then had me disrobe and put on a gown as he left for a few minutes. He came back and got his instruments out, when he went to take a look he said that I had a horrible fissure and he wasn’t going to look any further because it would be really painful. He suggested a sphincterotomy, but we talked about non-surgical options as well, I also reminded him of my hemorrhoids he said we could do a hemorrhoidectomy at the same time of that is what I wanted. He went over the possible complications and everything.
I had the surgery this past Tuesday, I’m not going to lie, there was quite a bit of pain, the second day after surgery was absolutely miserable. But nothing, no amount of talking, preparing, drugs, etc. could have prepared me for my first bowel movement after the surgery, I cried, I screamed, I howled, I sobbed. The excruciating pain continued for at least 30 minutes, I did a sitz bath, took a hot shower, took naproxen, aspirin, oxycodone. The pain finally subsided, other bowel movements have not been as bad, thankfully.
As bad as it has been I will be thankful to be able to work again and drive again without the pain. I’m only 5 days into the recovery, I’m still bleeding some and bowel movements are still horrible. I just keep reminding myself that it’s going to get a little better each day.
I just wanted to share my experience so far.

Jean D:
Sept 2004
Here are a few details of my vasectomy undergone in December 2003 at the CHUL in Quebec.
Some people wonder if a vasectomy can be life changing.
I'll answer you, be careful ... think twice before embarking on this adventure.
I can tell you a lot about my case. It has been 9 months since I had a vasectomy and I have not started working again (I am a bus driver) and I have endured this pain since the operation. I can't believe it myself. I think about my job, my family and my health. I regret this decision so much. If only I felt supported by the urologists.
It's very difficult for morale and the days are extremely long with nothing to do. I ask myself questions every day such as why did this happen to me. I do not wish this problem on anyone. If the doctors could at least predict these problem cases before the vasectomy, then one could feel better about getting a vasectomy.
To give you an idea of ​​what doctors will prescribe a person with this syndrome, here is an example:

• Naproxen
• Oxycodone/Acetaminophen
• Levofloxacin
• Prednisone
• Scrotal support
• Cipro
• Oxycontin
• Celebrex
• Amitriptyline
• Vioxx

These apart from the ones that I didn't write down. Note that none of them did me any good.
I call it the underside of vasectomy. We cut and we cut. If it goes well, so much the better -- otherwise you will live with your problem for a long time, and consult with many doctors.
It is disheartening to go on cursing. I know that giving this testimony cannot heal me, but I do it for those who would like a little information on the subject and especially so that no one with the same unfortunate story should feel alone.
It is true I am revolted against the health system which put me in this state ... and especially at the follow-up medical care we receive afterwards.
Thousands of vasectomies are done everywhere, it's true, but beware that it is not always without risks. Your quality of life can be totally transformed and not for the better.
You assume it's going to be okay and "If something bad happens to me the urologists will take care of it!" Come back down to earth, based on my experience one has to say good luck! I have met several urologists and many get overwhelmed by this post vasectomy syndrome. They are not able to honestly explain to us what is happening.
I had my vasectomy reversed after 6 months and the pain is still present.
I went to see my urologist again and he told me "I don't know what you have."
It's a nice way to show me the door. This is where the rage overtakes you. Discouragement too and the feeling that everyone is letting you down.
https://web.archive.org/web/20050204182128/http://pages.videotron.com:80/shiraz/Temoignage_JeanD.htm
Comments from Jimmy about Jean D:
Jean had his vasectomy in December 2003. He has suffered excruciatingly since that time. He is off work and hopes to return every day.
At the last news, August 08, 2005, [20 months after vasectomy] he still suffers. After several consultations, he will have both epididymis removed. It is a very delicate operation. Over time it can endanger these testicles according to the experiences of other people. He is under pressure from his employer to come back to work otherwise he loses all social benefits. I hope with all my heart that he will come out of it !!!
https://web.archive.org/web/20090414075215/http://pages.videotron.com:80/shiraz/MonTemoignage10.htm

35/M, wondering if anyone else has similar issues and if this could possibly be IC.
Background:
I suffer from kidney stones, at least two >0.5mm stones per year all out of my left side for the past ~15 years. I know what kidney stone pain feels like. A couple years ago, I started to get pain radiating down my leg (inner thigh) to my knee along with my kidney stones & the pain that usually comes with stones (lower back, groin/scrotum/penis pain, stabbing in the side). Most of the time it would clear up when the stone passed.
Once a couple years ago I got these usual pains, had a procedure to get rid of a decently sized stone, but the lower back, groin, and leg pain didn't disappear. Well, there was still another (non-blocking) stone in my kidney and a couple months later a new urologist got rid of the stone and everything cleared up again.
Unfortunately, a year and a half ago, everything came back full circle again. I had a stone move, got the usual pains in my side, back, groin, leg, had a procedure to remove the stone, but same story as the one I mentioned previously - lower back, groin, and leg pain didn't go away. We chased a non-blocking stone in my kidney for a good 8 months through the pandemic with a number of procedures until my urologist finally said he couldn't see or get anything else out of my kidney (even though some fragments still show up on xray/cts).
Symptoms:
So here I am now, in pain for over a year and a half and it seems like every one of my providers has given up or has no idea what to try next and I happened to run across IC and wasn't quite sure if I fit the bill (I'm going to bring it up to my PCP on Monday regardless of what I hear here).
I have had a lower back MRI which came back perfectly clean. KUB X-rays and CTs (with and without contrast) don't show anything abnormal other than the occasional non blocking stone(s) in my kidneys. I have had a colonoscopy which was clear. I have seen a GI specialist and nothing came back other than lactose intolerance (which I am usually pretty good about). My urologist doesn't think my leg pain can be related to my kidney at all (and we might be so focused on that something like CI slips through his radar). I have seen Neurology and Nephrology and other than managing my kidney stones they haven't had any luck.
My leg pain and lower back pain is pretty constant at around a 6 for me (keeping in mind the 10+ of my scale is passing a kidney stone) and feels like a mild, but always present shooting / stabbing pain but it will flare up to an 8-9 for anywhere from 5-60 seconds randomly. Sometimes these flares happen when I'm standing, sitting, laying down or urinating. The pain is sudden, sharp and usually hits my leg, penis, and testicles all at the same time. I have strained my urine during one of these flares and there wasn't any visible stones that passed so unless I was passing a microstone that caused that much pain with no visible blood, I don't think that was it. My groin/abdomen pain is more on my left side (same as everything else) but occasionally there is a slight pain under my belly button, but that is very rare and minor compared to the other pains.
Ibuprofen / Naproxen don't seem to help. Hydro-/Oxycodone seem to help manage it, but unless I have an active stone no one will give me prescription narcotics for just this "phantom" pain. Heat packs sometimes helps, but not always. Gabapentin never really seemed to do anything for me. I have had 2 nerve blocks, one iliaca block and another epidural at L3/L4 (I think - where ever the kidney nerve is) and neither of those seem to have done anything but we were operating under the assumption that this was referred pain from my kidney.
Nothing I do - stretches, pressure, twists - seems to make any of the pain better or worse.
I never really paid any attention to my urination habits as I used to be on a water pill that would make me urinate frequently, but I have been off that for a bit and I don't wake up in the middle of the night to urinate, but the sensation of having to urinate seems to come on quickly but I don't have to immediately use the restroom. I can, sometimes, go hours between urinating, but if I peed every time I felt I had to, it would probably be a large number (I'm going to try this and count tomorrow). Example I peed right before I started writing this and drank an 8oz cup of water and I have the feeling of having to urinate again (maybe 30ish minutes). Sometimes when I'm in a lot of pain, I'll sit on the toilet for 20-30 minutes and have a couple times when a non-trivial amount of urine comes out.
I wouldn't say it burns or hurts when I urinate (other than the aforementioned rare shooting pain). I also don't really think that I have much bladder pain other than when it is extremely full (and even then it's nothing like what I have read others here describe).
Due to my kidney stones I drink a lot of water (~100oz / 3L a day) as well as copious amounts of coffee throughout the day.
Sorry for the long post, but I wanted to try to get everything in and it's been a long year and a half and I just want to be pain free without opioids so I can enjoy time with my family again. Thanks everyone who reads & offers advice.

Dear Dr Peterson,
​
I just watched your video detailing the struggles and pain you've been going through over the last year and as most of the things you talk about do, this resonated with me a lot.
Just over three years ago on the 17th April 2017 I had an accident which involved me falling around twenty five feet onto metal railings and concrete. I completely shattered my pelvis, I broke my spine in two places and a few inches of my spine actually disintegrated due to the impact of it breaking my pelvis. I broke and dislocated my right shoulder, I broke half of my ribs, my knee, both hands and a bunch of fingers and thumbs. Luckily (debateable) I survived as I somehow avoided hitting my head in the fall and I didn't injure my neck. I did however need three blood transfusions to keep me alive.
I was in hospital for two months where I eventually made it into a wheelchair and subsequently much later onto crutches once my shoulder had healed somewhat. While in hospital I was on the maximum daily dose of morphine. This actually didn't relieve the pain completely and worse still I developed delirium to the point where if I closed my eyes I would relive an endless nightmare of falling into nothingness, worse still though was that whenever my eyes were open I could see around 30 shadowy figures completely surrounding my bed looking down on me. I thought the other patients were trying to kill me, I was convinced I could hear conversations down the other end of the ward and I could actually hear the nurses evil conversations they would have about mistreating me and wanting me dead. Eventually after about ten days they recognised that I had gone crazy and they started me on a dose of antipsychotic tablets which, after three days completely took away all of the craziness thankfully. It was the morphine that was making me crazy, apparently delirium is a fairly common side effect of extremely high doses of morphine. Because the morphine wasn't completely helping with the pain and due to the other nasty side effects they changed my medication to oxycodone. I had no idea what the new drug was all about, all I knew is that it took the pain away a lot better, despite making me nauseous all the time. I'm sure you can see where this story is going now.
I was on the maximum daily dose of oxycodone which if I remember correctly is around 550mg. It's a complete insane dose of opiates and is something like 3000 times the regular dose of tramadol. As I slowly recovered I managed to reduce the amount I was taking from 550mg down to 70mg. I felt happy about how far I had come and looked forward to getting rid of the oxy once the future physio took affect and I was in less pain. They explained to me that I would be in extreme pain for the rest of my life as a result of all the damage I sustained and that I would also start developing different arthritis' in a couple of years. The hospital completely mishandled my transition from hospital to being at home and the physio I sorely needed was never given to me until almost exactly a year later, by which time Id taught myself to walk incorrectly causing more pain, also developing a bulging disc in my spine which was causing me unbearable pain and also full body spasms. My oxy slowly rose from 70mg to 100mg to compensate for the extra pain.
Over the years I've managed to stay at 100mg. I learned how nasty the oxycodone is and how prolific it is in America, often leading to heroin use after not being able to afford the medical fees over there. I'm luckily in the UK and as far as I know I don't have to worry about being cut off. I'm able to walk very short distances but I am in constant pain every minute of the day unless I am laid or sat at a certain angle similar to being half sat upright in bed. I barely see anyone, my girlfriend left me, telling me that she "doesn't want to be with a vegetable." She had misconceived notions about my recovery despite me explaining to her that I'll never recover from this. Life has basically been pretty rubbish the last few years as my condition has worsened and my opiate addiction has remained the same. I get horrendous withdrawals a few hours before redosing, which I do once in the morning and once in the evening (I take oxycontin now so each dose is meant to last twelve hours - it doesn't, it lasts about eight hours) and I've been taking a multitude of medicines every day since leaving hospital - all of which are making me slowly die. 100mg oxycontin, 1g paracetamol, 750mg naproxen, 100mg sertraline, 20mg omeprazole and a bunch of laxatives to try and alleviate the chronic opiate related constipation. I've taken that list of tablets every day now for over three years.
When you mentioned the side effects you were going through I immediately related to what you are going through and I hope that maybe one day, by some miracle I might be able to survive medication free. I was offered diazepam to help with the spasms and while I took it for a week I had already researched it and knew that I didn't want yet another drug that I was addicted to so I've lived with constant tremors and spasms ever since. What I found difficult to comprehend is the fact that if you manage to completely come off your medication there is still the underlying problem that you have to deal with each day. At least if I made it off my medication all I would have to do is deal with chronic pain - I think this is much easier to do than cope with the levels of anxiety and depression that you must have been dealing with.
I barely make it out of my room every few months, let alone create the content and host lectures that inspire a large population of the world like you do. You should feel extremely proud of yourself for managing to do that despite withdrawals, I know this because I go through the same thing for a few hours a day and it's horrendous. I think I understood from the video that you had managed to come off your meds completely now, if that's the case then I wish you all the luck in regaining the life you had before you made the same mistake we both seem to have made. I wanted to explain to you my situation in the hope that maybe knowing that someone else is going through the same things helps you to cope somewhat with the situation yourself, it also helps me to have got it off my chest a little and to know that there is a slight chance you might read this. I hope to one day beat the hold this medication has over me and to meet you to say thank you for all the words of wisdom you have imparted to me this last few years when I've been stuck in this room alone.
Take care,
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Lee.