Strongest pain killer available from hospitals?

[ChomDo]

I was wondering if someone could tell me what for real is the strongest pain killer I could get from the hospital for my herniated disc in my neck. I've been to the hospitals countless time for my neck and back problems (Samitivej, Siriraj, Bangkok Hospital etc.) and had many MRI's. I've been described all the possible pain killers but nothing has been effective enough. In my home county I always got a medicine called Panacod (30mg Codeine/500mg paracetamol) and this is the only pain killer that seems to help for my neck pain. In Thailand I've never got codeine pills from a hospital even though the disk is pushing my nerve and making my arm feel like the bones are breaking. All the ineffective pills I've tried include Tramadol, Neurontin, Norgesic, Myoflex, Arcoxia 120mg, Rivatril, Lyrica 75mg and Ultracet. I recall once getting some pills from Samitivej that contained a very small amount of codeine but nothing like the 30mg tablets I get back home. Anyone know if stronger codeine pills are available in hospitals or do they just not want to give them?

 

 

[Sheryl]

They are available. But Thai doctors are very reluctant to provide them for chronic pain.

 

What has been advised regarding correcting the problem? As taking strong narcotics is not a long term solution...and they will stop working over time.

 

Best spinal specialist IMO is Dr. Wicharn at BNH Spine center. He may not give you the narcotic you want either, but he will give good guidance on long term approach.

[ChomDo]

Well actually my back and neck problems are chronic (for about 10 years now) but this is just a twist that happened over night and is very painful for about a week. Non of the above mentioned pain killers help for this so I would really need the doctor to give me the codeine tablets at least for a week.

 

About correcting the problem long term I kind of gave up with that long ago. I went to many specialists including orthopedic, spine clinics, back rehabilitation centers and physiotherapy. They say that the MRI's don't really explain my pain as the disc situation does not look too bad yet. The rehabilitation specialist at Siriraj said I just have to learn to live with the problems as well as possible. According to him the shape of my spine has developed to cause a lot of problems.

 

Anyway I've had this sudden neck pain that affects my left arm badly just a few times and it usually passes in a few days. It's just that it's really painful and I can't do anything right now so I would think that the doctor could prescribe codeine for short term use?    

[ChomDo]

39 minutes ago, Sheryl said:

They are available. But Thai doctors are very reluctant to provide them for chronic pain.

 

What has been advised regarding correcting the problem? As taking strong narcotics is not a long term solution...and they will stop working over time.

 

Best spinal specialist IMO is Dr. Wicharn at BNH Spine center. He may not give you the narcotic you want either, but he will give good guidance on long term approach.

Just to add to the above. The Thai doctors I've been to seem to give long periods of medication to chronic pain. Last time I was asked to take Ultracet for 30 days. I stopped it after 2 weeks because it lost it's effect. Not that it had much of an effect in the first place though. Just the same as Tramadol and Rivatril, they make me slightly drowsy but don't help for the pain.

[ajarngreg]

2 hours ago, ChomDo said:

Well actually my back and neck problems are chronic (for about 10 years now) but this is just a twist that happened over night and is very painful for about a week. Non of the above mentioned pain killers help for this so I would really need the doctor to give me the codeine tablets at least for a week.

 

About correcting the problem long term I kind of gave up with that long ago. I went to many specialists including orthopedic, spine clinics, back rehabilitation centers and physiotherapy. They say that the MRI's don't really explain my pain as the disc situation does not look too bad yet. The rehabilitation specialist at Siriraj said I just have to learn to live with the problems as well as possible. According to him the shape of my spine has developed to cause a lot of problems.

 

Anyway I've had this sudden neck pain that affects my left arm badly just a few times and it usually passes in a few days. It's just that it's really painful and I can't do anything right now so I would think that the doctor could prescribe codeine for short term use?    

       I know through my personal experience that doctors even prescribe morphine sulfate, but not when a patient rules out all other pain killers as you do and basically  asks for codeine only, as your own personal choice. That's really waking up all sleeping dogs. 

 

    

 

              

 

   

         

 

              

    

 

      

[tutsiwarrior]

at the military hospital after orthopedic surgery on my broken leg they only offered panadol when I knew that tramadol was available...I was in pain and sufferin'...

 

no probs, I survived and I reckoned that the painkiller limitation was a tactic by the doc to keep me in pain and in bed so as to preempt any attempt to move about with the new hardware that he had installed that required no movement at all...

 

a good move as now, two months later I'm tutsi boogaloo...but still shy of gettin' down to the market to go shoppin' fer veges...

 

 

[wpcoe]

My experience with requesting codeine from a doctor is anectodal, but may be more universal:  Whenever I ask for codeine they almost always issue some other pain killer.  Codeine for me seems to be a magic bullet for severe coughing bouts from bronchitis, or occasional intense headaches I get.  Nothing else works as quickly and effectively as codeine for me.  e.g. Tramal takes a good 3 to 4 hours to kick in.

 

However, if I don't open my mouth to request codeine, I find that 50% of the time I get codeine.

 

My conclusion is that doctors are (unduly...) concerned about me being an opiate addict by begging for codeine.

 

That said, I'm with Sheryl about consulting with a spine/neck/back specialist like the BNH clinic to treat the cause of the pain on a long-term basis, as well as getting the short-term relief that you need.  When I had a ruptured disc in my lower back, I consulted with Dr. Eakpatipan at the BNH Spine Center and was very impressed at his approach.  Some doctors seem to want to cut and operate as a first choice, but for him, it was a *last* choice and he effectively cared for/treated my problem.  Others (including Sheryl) have equally praised Dr. Wicharn.

[Chivas]

Sorry i have to laugh at responses along the lines of certain tablets will cause long term further problems. Clearly that poster has not been in continuous pain as the op and myself. If i stop the tramadol my symptoms with chronic fibromyliga go off the scale and other posters unaware of what was causing it to themselves would call 999 within 5 minutes. Frankly you take the strongest available of whatever to deal with the problem right now

[Livebynight]

Op, go to the government hospital in your province and visit the pain clinic there. They do prescribe morphine sulfate. 

[ChomDo]

In my case I don't think they would think that I just want to have some codeine pills for fun because I always go to the hospital with all my papers, MRI pictures, previous medication prescriptions. So they can see that I really have a problem. Also if I ask to have codeine+paracetamol medication (such as Panacod or Paramax Cod) I'm only asking for like a 5 days dosage to help for this serious pain.

 

So two days ago I went to Ramkhmhaeng hospital because the Arcoxia, Tramadol + muscle relaxant prescribed to me earlier did not help. When I went to see the doctor I was in serious pain feeling like the bones in my arm are breaking. The doctor concluded that it's because the dick in my neck is pushing the nerve and causes pain in the arm. I told him that all the medicines have no effect on me and that I know from previous experience that codeine helps well for this pain. He said that their hospital does not have codeine. Hard to believe that but he did then say that they can give me a morphine injection or an epidural injection to the neck if necessary. He even told me to continue to take Tramadol even though I told him it has no effect on me. This is all very silly for me because I know very well that codeine is the only one that would take this strong pain away and they just don't have it. I told the doctor that I can try some other medication for a few days and see how it goes before thinking about any injections.

 

He prescribed Ultracet, DeAnxit, Lyrica 75mg and Rivotril. It's all just as useless as the previous medication. No help what so ever. Only that the Rivotril is great for getting trough the night. Just a waste of money again, instead of just giving me what I really need. 

 

[Sheryl]

Again, I suggest you see Dr. Wicharn.

 

He typically treats pain from a protruding disk -- if this is what it is (bear in mind protruding disks are a temporary condition, they do not persist) with a mixture of short term steroids and Lyrica, the steroids reduce the swelling around the nerve while the lyrica helps the nerves recover.  This is IMO a better approach than just trying to mask the pain with codeine (he may or may not also give a temporary supply if pain killer, I really do not remember).

 

While an epidural steroid injection might work, you can likely get the same effect, more safely, with a short course of oral steroids.

[BruceMangosteen]

Codeine is available over the counter in Cambodia, Phnom Penh. Both combined with Para and on it's own. Made in France last time I got some there.(2016) It's not that far if a person is always in pain and, well, you get the point. God Bless You and OO.

[ChomDo]

Ok finally I got what I was looking for. I went to Samitivej (Srinakarin) and showed all the medication I've been getting from other hospitals and told the doctor that last time I had this serious pain codeine/paracetamol combination worked well. So no problem she prescribed 60 tablets of Paramax Cod for 10 days. The dosage in these pills is very small (300/15mg) so I was advised to take 3 at a time. Also got Amitriptyline and Rivotril for the night. I hope this helps! If the pain doesn't get better in a week they suggested to take new MRI's and consider epidural injection to the neck.   

[ChomDo]

Been taking the ParamaxCo tablets (codeine 15mg/ Paracetamol 300mg) for over a week now and the problem is that in Thailand this dose is the only option. So have to take 9 of these tablets per day. The codeine dose I was prescribed in my home country was 60mg 2-3 times a day and that takes my nerve pain away very well. With the Thai tablets you can only take a max of 45mg because if you take more than 3 tablets per time the paracetamol dose goes too high (exceeds 1000mg). Well nothing we can do about that, just an interesting observation how the Thai brand has made the dose that way.

 

By the way any suggestions for a good night time pill so that I could sleep trough the night? Now I wake up every night around 4am with pain and can't sleep after. I take one Rivotril 0.5 mg before bed but it only helps me fall asleep. They also gave me Amitriptyline, which I find useless.   

[BruceMangosteen]

1 hour ago, ChomDo said:

Been taking the ParamaxCo tablets (codeine 15mg/ Paracetamol 300mg) for over a week now and the problem is that in Thailand this dose is the only option. So have to take 9 of these tablets per day. The codeine dose I was prescribed in my home country was 60mg 2-3 times a day and that takes my nerve pain away very well. With the Thai tablets you can only take a max of 45mg because if you take more than 3 tablets per time the paracetamol dose goes too high (exceeds 1000mg). Well nothing we can do about that, just an interesting observation how the Thai brand has made the dose that way.

 

By the way any suggestions for a good night time pill so that I could sleep trough the night? Now I wake up every night around 4am with pain and can't sleep after. I take one Rivotril 0.5 mg before bed but it only helps me fall asleep. They also gave me Amitriptyline, which I find useless.   

As I mentioned, if you really want to take matters and put them in your own hands, head over to Phnom Penh. You can buy the codeine without the para and there are many sleep aides as well. The sleep aides vary from person to person but I've found Still Nox to be the best for me. I think it's "ambien" however you spell it. There are of course many options in that regard. Good luck and God Bless You. OO.

[ChomDo]

3 hours ago, BruceMangosteen said:

As I mentioned, if you really want to take matters and put them in your own hands, head over to Phnom Penh. You can buy the codeine without the para and there are many sleep aides as well. The sleep aides vary from person to person but I've found Still Nox to be the best for me. I think it's "ambien" however you spell it. There are of course many options in that regard. Good luck and God Bless You. OO.

Thnaks but I'd hardly be going to Phnom Penh right at this moment to get medication. Samitivej Srinakarin is about the furthest I want to travel now. I'll just ask the doc then. Rivotril is ok but does not last until morning.

[wpcoe]

8 hours ago, ChomDo said:

 

With the Thai tablets you can only take a max of 45mg because if you take more than 3 tablets per time the paracetamol dose goes too high (exceeds 1000mg). Well nothing we can do about that, just an interesting observation how the Thai brand has made the dose that way.

 

I read on some Canadian web site that that is the reason that the codeine sold there OTC has to be mixed with paracetamol or aspirin:  to keep people from getting too high dosage of codeine, i.e. to  prevent satisfying (causing?) an addiction.  The problems caused by the "overdose" of aspirin or paracetamol would occur first.

[Sheryl]

Thnaks but I'd hardly be going to Phnom Penh right at this moment to get medication. Samitivej Srinakarin is about the furthest I want to travel now. I'll just ask the doc then. Rivotril is ok but does not last until morning.

And, you would be breaking the law bringing it back to Thailand with you. It needs a special permit to bring it in, whuch in turn requires paperwirk from a doctor. So its being OTC in Cambodia doesn't really help you.

[mommysboy]

On 23/04/2017 at 2:04 PM, Chivas said:

Sorry i have to laugh at responses along the lines of certain tablets will cause long term further problems. Clearly that poster has not been in continuous pain as the op and myself. If i stop the tramadol my symptoms with chronic fibromyliga go off the scale and other posters unaware of what was causing it to themselves would call 999 within 5 minutes. Frankly you take the strongest available of whatever to deal with the problem right now

I find TV posters are generally very brave when it comes to coping with someone else's pain.

[Sheryl]

 2.7 Gm paractemol a day, while below the maximum dose,  is still a lot, be careful - can be neophrotoxic especially taken long term. Might be wise to get a creatnine level and, if you have to ocntinue taking this, then recheck a month later (sooner if elevated and in that case will have to revise the pain meds).

 

BTW Tylenol with codeine in Thailand comes in both 15/300 and 30/300 formulations, and I have known people (post-operatively) to get the 30/300 formulation from BNH hospital. That doesn't guarantee a doctor there will prescribe it to you, but they have it....and an excellent spinal specialist.

 

Regarding sleep, people's responses vary but many find that atarax (25 mg strength, dosage anywhere from 25 -75 mg) works well and it is available OTC. Main complaints is that in some (not all) people it leaves them groggy so when you first try it, do so on a night you are free to sleep in the next morning and will not be having to drive or otherwise be alert the next day.

 

Melatonin also helps many people for sleep maintainance.

 

If Atarax works for you I'd suggest taking it alone not with the rivotril. Among other things, as I assume you know, rivotril is highly addictive and hard to obtain (has to come form a hospital) whereas atarax is neither. In addition, the effect of mixing them is unknown.

 

You had previously mentioned that in your experience the pain resolves in a week, it has now been about 2. If it keeps up you definitely need to have it investigated. It is not necessarily the case that it is the same situation as in the past. Prolapsed discs are not a permanent condition, they retract with time and the pain associated with them goes away if that is all it was.  Cervical spondylosis is permanent and can worsen over time. While this can lead to new temporary disc protrusions , it can also lead to a permanent narrowing of the space where the nerve root exists and/or formation of bone spurs that impinge on a nerve root, either of these is not going to go away spontaneously and if present and if you are a good candidate for surgery, it may be indicated.

[ChomDo]

5 hours ago, Sheryl said:

 2.7 Gm paractemol a day, while below the maximum dose,  is still a lot, be careful - can be neophrotoxic especially taken long term. Might be wise to get a creatnine level and, if you have to ocntinue taking this, then recheck a month later (sooner if elevated and in that case will have to revise the pain meds).

 

BTW Tylenol with codeine in Thailand comes in both 15/300 and 30/300 formulations, and I have known people (post-operatively) to get the 30/300 formulation from BNH hospital. That doesn't guarantee a doctor there will prescribe it to you, but they have it....and an excellent spinal specialist.

 

Regarding sleep, people's responses vary but many find that atarax (25 mg strength, dosage anywhere from 25 -75 mg) works well and it is available OTC. Main complaints is that in some (not all) people it leaves them groggy so when you first try it, do so on a night you are free to sleep in the next morning and will not be having to drive or otherwise be alert the next day.

 

Melatonin also helps many people for sleep maintainance.

 

If Atarax works for you I'd suggest taking it alone not with the rivotril. Among other things, as I assume you know, rivotril is highly addictive and hard to obtain (has to come form a hospital) whereas atarax is neither. In addition, the effect of mixing them is unknown.

 

You had previously mentioned that in your experience the pain resolves in a week, it has now been about 2. If it keeps up you definitely need to have it investigated. It is not necessarily the case that it is the same situation as in the past. Prolapsed discs are not a permanent condition, they retract with time and the pain associated with them goes away if that is all it was.  Cervical spondylosis is permanent and can worsen over time. While this can lead to new temporary disc protrusions , it can also lead to a permanent narrowing of the space where the nerve root exists and/or formation of bone spurs that impinge on a nerve root, either of these is not going to go away spontaneously and if present and if you are a good candidate for surgery, it may be indicated.

Thanks a lot Sheryl for your reply. You seem to know this topic well.

 

So I went to the second appointment at Samitivej yesterday after taking all the medications for a week. This time I went to the spine clinic to see an orthopaedic doctor. He as well as many earlier doctors have said that my MRI's (lower back, upper back and neck) don't explain the severity of my pain (now referring to the neck radiating to the arm for the past 2 weeks). He was also extremely surprised of the medication I had been taking for a week which included 9 tablets of ParaCo (codeine 15mg/paracetamol 300mg), 150 mg of Lyrica and 90 mg of Arcoxia per day plus a Rivotril before bed. He said that the doses are so hight that I should be "flying like an elephant". I've never heard a doctor say that such a dose of these meds is that high. I told him that that's a very normal dose for me and I feel nothing from it. Then he said in that case you're not normal and laughed. I told him that in my home country up to 120 mg of codeine per day is quite a normal prescription for severe pain.

 

Anyway this doctor is the first one to tell me that I probably have CRPS which I had never heard of. He said that he thinks my nervous system is too sensitive to pain and triggers much worse pain for me than my condition and MRI's show.

 

He prescribed steroid pills called Prednisolone 5mg (2 x per day) for a week first and he said if it helps I should take it for 6 weeks. Also 50mg of Lyrica per day (I had been taking 150mg which according to him was crazy) and Zolam 0.5mg for night.

 

So any advice on this experience, the medication or CRPS would be welcome!

 

Thanks.

[Sheryl]

Thais have wxtremely low threshold for any sort of sedative drug so what the doctor told you is true for Thais. This fact often causes misunderstandings between foreign patients and Thai doctors. Unless it is a Thai doctor who has worked in the West, they will not know that westerners are different and may well not believe it when told but rather think the patient is a drug abuser (to be frank).

Short term treatment with prednisilone + Lyrica is usual though I usually see a somewhat different dosage schedule. I continue to suggest you see Dr. Wicharn at BNH who is US trained and has treated many, many Westerners.

The doctor you saw is correct that your symptoms are unusually extreme. If these MRIs are not very recent, it needs to be repeated. If it is recent then it may still benefit from being looked at by someone else.

[ChomDo]

23 minutes ago, Sheryl said:

Thais have wxtremely low threshold for any sort of sedative drug so what the doctor told you is true for Thais. This fact often causes misunderstandings between foreign patients and Thai doctors. Unless it is a Thai doctor who has worked in the West, they will not know that westerners are different and may well not believe it when told but rather think the patient is a drug abuser (to be frank).

Short term treatment with prednisilone + Lyrica is usual though I usually see a somewhat different dosage schedule. I continue to suggest you see Dr. Wicharn at BNH who is US trained and has treated many, many Westerners.

The doctor you saw is correct that your symptoms are unusually extreme. If these MRIs are not very recent, it needs to be repeated. If it is recent then it may still benefit from being looked at by someone else.

Thanks again Sheryl! I am still considering going to BNH to see Dr. Wicharn as you suggested. I'm going for a holiday back to my home country (in Scandinavia) soon so I might also see a specialist there. For the coming week or two it's all about the medication for me because I just want to get rid of this pain, but after that I really want to find out if what the Samitivej orthopaedic would be true that I suffer from CRPS. I've been trough over 10 years of seeing doctors and specialist here and back home and seems like there's still no correct diagnosis. I guess the big difference is that if it really is this CRPS I just have to stop worrying or being too careful (avoiding sports and gym etc) and just live totally normal (as from what I understood that CRPS kind of creates fake pain but you body is not really in that bad of a condition). But if it is just the disk problems for real that cause all my symptoms (neck, arm, back..) then I have to keep watching out for my body and avoid certain movements and perhaps get more treatment.

 

My MRI's are from 3-10 years ago (though symptoms have remained about the same, except for neck which was MRI'd 3 years ago) and they all show just slight degeneration of discs, which according to many doctors should hardly cause pain.

[Sheryl]

Do you have  only pain or is there also any  numbness/weakness in the arm?

 

As CRPS would not account for numbness/weakness....only pain. If it is pain only then yes, could be.

 

Have the doctors you've seen so far done detailed physical exam to ascertain if there is any weakness or decreased motor function in that arm?

 

My sister was, like you, told by several orthos in Thailand that her pain was excessive for what the MRIs showed and that the MRIs "weren't so bad". Finally went to Dr. Wicharn who sent her for a regular Xray and promptly identified a bone spur pressing on the nerve which all the others had missed. He had her do a  nerve conduction study first just to be certain he was right abut where the pain was coming from, he was. Operated and she has been pain free ever since.

 

Moral of the story being it pays to get more than one opinion and sometimes the cause is more evident on Xray than MRI. It is quite possible for someone with a long history of spine problems to develop a bone spur  causing pain more severe than before, and more than once I have known this to be missed because it was all assumed to be part of the same chronic problem. If the pain really seems different this time -- either in its nature or how long it lasts - then my guess would be that there is something different behind it.  CRPS is possible, as is just a spiralling cycle of pain --> anxiety --> worse pain brought on by being in a foreign country and your trouble getting adequate pain meds (anxiety definitely worsens pain, and feeling unable/unsure of getting pain relief will certainly feed anxiety). But before chalking it up to either of those, make sure there isn't something new and correctable at the root of it.

 

[ChomDo]

On 5/3/2017 at 9:18 PM, Sheryl said:

Do you have  only pain or is there also any  numbness/weakness in the arm?

 

As CRPS would not account for numbness/weakness....only pain. If it is pain only then yes, could be.

 

Have the doctors you've seen so far done detailed physical exam to ascertain if there is any weakness or decreased motor function in that arm?

 

My sister was, like you, told by several orthos in Thailand that her pain was excessive for what the MRIs showed and that the MRIs "weren't so bad". Finally went to Dr. Wicharn who sent her for a regular Xray and promptly identified a bone spur pressing on the nerve which all the others had missed. He had her do a  nerve conduction study first just to be certain he was right abut where the pain was coming from, he was. Operated and she has been pain free ever since.

 

Moral of the story being it pays to get more than one opinion and sometimes the cause is more evident on Xray than MRI. It is quite possible for someone with a long history of spine problems to develop a bone spur  causing pain more severe than before, and more than once I have known this to be missed because it was all assumed to be part of the same chronic problem. If the pain really seems different this time -- either in its nature or how long it lasts - then my guess would be that there is something different behind it.  CRPS is possible, as is just a spiralling cycle of pain --> anxiety --> worse pain brought on by being in a foreign country and your trouble getting adequate pain meds (anxiety definitely worsens pain, and feeling unable/unsure of getting pain relief will certainly feed anxiety). But before chalking it up to either of those, make sure there isn't something new and correctable at the root of it.

 

Sorry for the late reply. Hasn't been easy typing on the laptop with the soar arm. Anyway thanks again for your reply.

 

I only have pain in the arm and no numbness or weakness. Last time 5 years I ago when I had this same case that time my thumb lost feeling. The fist doctor this time did a quick physical examination and said there's nothing wrong with the strength of my left arm. Now a few days I did have sensitivity on the skin of the soar areas.

 

The pain has changed quite a lot not and really the night time is the big problem. I've been sleeping just a bit here and there like last night from 10pm to 1 am and then again from 3am to 6am. I even took two tablets of Zoalm (same as Xanax) 0,5 mg last night. The doc had prescribed one o.5 mg before bed but even with 1 mg dose I wake up in 2-3 hours with pain. The only solution seems to be that I take the ParaCod pills when I wake up in the night. That way the pain goes away and I can sleep fine. It's just that the doc told me to stop taking the codeine after one week. I'm not sure if it's that big of a deal if I take them a bit longer (though I only have a few left now)? Where as for the steroids they have had no effect yet. I just took the 3rd days dose so I hope it would give some relieve soon.

 

I'm starting to suspect something else than just a disk problem too because the symptoms first of all do not include the common ones like numbness and weakness. Also now I'm better in the day and can be quite normal without the ParaCod pain killers. Just some odd aches in the lower shoulder area. But as soon as I go to bed it starts getting very bad and gives that deep bone breaking feeling again all the way from the shoulder down (this pain does not go lower than my elbow except for an odd tingle in the wrist if I lift my neck off the pillow).

 

If I go out I'm wearing a neck support collar because my neck feels very weak and tired. If move my neck around it makes the crunching sounds as usual and in some positions radiates the pain down the left arm.

 

Any more ideas based on my symptoms now and the medication?

 

Thanks!   

[Sheryl]

 

 

As mentioned the dose of prednisone and lyrica you are on, are lower than normal for pain  suspected of being due to a protruding disc.

 

Pain that worsens when the head is in certain positions, does suggest either disk protrusion or narrowing of the space where the nerve root exits ( due to gradual compression from disk degeneration or due to a bone spur) - a spinal specialist will know more based on exactly what positions seem to worsen it.

 

I can only continue to urge that you see the doctor I suggested.

[ChomDo]

8 hours ago, Sheryl said:

 

 

As mentioned the dose of prednisone and lyrica you are on, are lower than normal for pain  suspected of being due to a protruding disc.

 

Pain that worsens when the head is in certain positions, does suggest either disk protrusion or narrowing of the space where the nerve root exits ( due to gradual compression from disk degeneration or due to a bone spur) - a spinal specialist will know more based on exactly what positions seem to worsen it.

 

I can only continue to urge that you see the doctor I suggested.

If I can make it all the way to BNH maybe I will. The doctor I'm seeing now is clearly views long term medication too negatively and gives far too low doses. Also the steroids that he said would start to help after 3 days haven't done anything yet (4th day) now. I hope I'll get a chance to go to see Dr. Wicharn soon!

[wpcoe]

@ChomDo: I echo Sheryl's advice to get the the BNH Spine Center.  One thing that she's mentioned before is that Thais are more "sensitive" (not sure that's the right word?) to pain killers, so doctors here tend to prescribe lower doses than doctors in the west would.  That leaves us westerners still feeling pain which we would not if the doctors prescribed the full dosage as done in the west.  That said, I think the doctors in the BNH Spine Center will give you adequate pain relief suitable for our western bodies, but only until they can get to the root problem.

 

I went to a different doctor at the Spine Center, Dr. Eakpatipan, and he also was very effective at diagnosing and treating my back problems.  He was also good at adequately medicating me in the beginning until physical therapy was effective enough to get me off painkillers.  And, he considered that surgery for a back problem should be the *last* choice in most cases, which I found reassuring.

Edited May 6, 2017 by wpcoe

[Sheryl]

A post discussing illegal activity has been removed

 

 

[ChomDo]

On 5/6/2017 at 8:31 AM, wpcoe said:

@ChomDo: I echo Sheryl's advice to get the the BNH Spine Center.  One thing that she's mentioned before is that Thais are more "sensitive" (not sure that's the right word?) to pain killers, so doctors here tend to prescribe lower doses than doctors in the west would.  That leaves us westerners still feeling pain which we would not if the doctors prescribed the full dosage as done in the west.  That said, I think the doctors in the BNH Spine Center will give you adequate pain relief suitable for our western bodies, but only until they can get to the root problem.

 

I went to a different doctor at the Spine Center, Dr. Eakpatipan, and he also was very effective at diagnosing and treating my back problems.  He was also good at adequately medicating me in the beginning until physical therapy was effective enough to get me off painkillers.  And, he considered that surgery for a back problem should be the *last* choice in most cases, which I found reassuring.

Ok thanks for that. BNH seems to get a lot of praise here for spine problems. Last year I visited Siriraj a few times because Thai people believed that to be the best hospital :)

 

What sucks the most now is that the Samitivej orthopaedic told me to stop with the codeine or any other pain killers and just take the steroid pills. Been taking them for 5 days now, NO help whatsoever. Also the Alprazolam does not help me sleep trough the night time pain at all (even 1 mg). I wonder isn't there a medicine that would help you sleep and also relieve pain?