Having Severe Chronic Lower Back Pain. Using Tramacet. Suggest

Posted on Sat, 30 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 30 Nov 2013 Answered on

Fri, 20 Dec 2013 Last reviewed on

Question : I have severe chronic lower back pain originating from a car accident and am allergic to codeine, torodol, talwin. I am presently using tramacet, 6 per 24 hours and it barely relieves the pain. What do you suggest for I am desperate at this point. I am a psychotherapist and must have a clear mind for my work. I think a pain management control physician would be best to advise.

Answered by Dr. Deepak Kishore Kaltari (1 hour later)

Brief Answer: Combination drug and Tricyclic antidepressants Detailed Answer: Namaste Welcome to Healthcare-Magic Greetings of the day Combination of NSAID and opioid will be more beneficial and will act synergistically. I would recommend combination of Diclofenac Sodium and Tramadol . Both have different mechanism of action and will act synergistically . Addition of Tricyclic antidepressant Like Amitriptyline is also helpful in management of chronic back ache. I hope you have thoroughly evaluated the cause of backache and surgically correctable cause of backache like disc prolapse are ruled. Apart from Pharmacotherapy I would also suggest you following 1. Proper posture while sitting 2. Using right sleeping mattress 3. Trascutaneous electric nerve stimulation(TENS) may also benefit. I hope it helped Do get back to me if you have any other query. Take care Regards Dr Deepak XXXXXXX MBBS MS MCH Consultant Surgeon

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Deepak Kishore Kaltari (4 hours later)

I have been advised strongly by a physician at CAMH not to take antidepressants of any kind. I believe he feels the tendency of mine to overreact in a highly emotional manner could be exacerbated. Many years ago I was given marcaine injections for reflex sympathetic dystrophy. Unfortunately I was allergic to it although my pain management specialist said nobody is ever allergic to marcaine. I am truly hindered in many ways by pain. Would you recommend a pump should it contain the correct ingredients? Any alternate to tramadol that will not cause my mind to cloud would be so appreciated. Regards, XXXXX

Answered by Dr. Deepak Kishore Kaltari (4 hours later)

Brief Answer: Taking pump is not advisable Detailed Answer: Namaste Greetings Taking pump for chronic pain is not advisable. Alternatively you can take Ketorolac or apomorphine in place of tramadol. Also remember,too much stress or anxiety will provoke more pain in chronic pain. Wishing you healthy life ahead. Take care Best Regards Dr Deepak XXXXXXX Consultant Surgeon

Above answer was peer-reviewed by : Dr. Vaishalee Punj