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Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Posted by Beverly on 8/29/00 at 14:10 (026616)

Dr Z and/or Dr B'

I'm afraid this will get lost without you seeing... so many pieces to my 'tea & sympathy' thread over in the support section. Could you look at my questions about breaking the pain cycle with some of the suggestions you and others made? Sorry if this cross reference is confusing. It's the response post I made today.
Thanks,
Beverly

Re: me too...Dr. Z or B....!

Sue R on 8/29/00 at 14:17 (026618)

I've got a comment under Beverly's regarding stopping the cycle.

Please help!

Sue R

Re: me too...Dr. Z or B....!

Dr. Biehler on 8/29/00 at 14:56 (026623)

I agree with Sue R. Nerves can get caught up in a pain cycle that is sometimes very hard to breack. For long term chronic pain I like the oxicontin ms, it is time released codine, a morphine derivative, with out the acetominaphen. When a person is in pain it is very hard to get addicted. In New York there are Pain Clinics that write the medications and follow the patients. Short term pain I like Hydrocodone or tylenol #3. I think lidocain shots to break a pain cyle can also do a lot of good. Dr. Biehler

Re: Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Dr. Zuckerman on 8/29/00 at 16:43 (026636)

Severe chronic pain- Fentanyl, or oxcycontin

Either a steriod injection or posterior tibial sympathetic nerve block

Or come to my house for the week and let treatment you. I have to ask my wife, first.!!

Re: Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Beverly on 8/29/00 at 20:02 (026665)

Dear Dr. Z / B,

Dr. Z., how I wish I could go to New Jersey to see you. I actually have cousins who live in Jersey. Not a fan of airplanes though...

I like the idea of the nerve block shot better than the pills. I am a TRUE lightweight when it comes to meds. Easily knocked out.

And Dr. Z., if I remember your other posts you talk about mixing steroid with lidacane; do you think that mix of the nerve block and steroid would pack the best punch? Since my pain is in both feet... heels and arches, would that mean getting a shot in both feet on the same day? I understand it is not safe to have more than 3 cortizone shots a year. If I have to have one in each foot, does that mean I've used up 2 of the allowed yearly shots? I've got a collection going to notes about your shot tips, including that small needle.

Thanks,
Beverly

Re: Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Dr. Zuckerman on 8/29/00 at 20:17 (026666)

I would skip the steriod portion of the shot. The posterior tibial nerve block is the best way to get with you. It will increase circulaton to the foot on the bottom and at the same time help to break down this chronic pain cycle. This is very effective in the right hands. If you can't get a doctor to dot the posterior nerve block an epidural sympathetic nerve block is even better. This is done at the level of the lumbar-sacral level of the back. This is done alot and can work.

Re: Dr. Z: Questions about these two choices of shots. Could this fix me?

Beverly on 8/29/00 at 23:12 (026700)

Dr. Z.,

Won't the epidural sympathetic nerve block in the back be painful?
Are you talking about a shot in the spine? How is that better than the
posterior tibial nerve block that if I understand currently will be in the foot?

I'm more than willing to give the nerve block a try. But no one has yet answered my question. Could this permanently shutdown the pain cycle and lead me to recovery or is this a temporary break from the pain?
What are the odds this would stop the pain cycle?
My work does not put me on my feet at all and so it seems like I have every reason to get better. That's what confuses me. I was never a jock. I don't work on my feet. This all came from one failed attempt to go workout some months back. Before that, I never had a foot problem in my life.

Thanks,
Beverly

Re: Dr. Z: Questions about these two choices of shots. Could this fix me?

DR. Zuckerman on 8/30/00 at 02:47 (026704)

This could fix you . You can get a big pain cycle breakup from the back level. I still like to start with the foot. It is so easy to do in the foot. I do about ten a week .

Re: Dr.Thanks. Will ask for nerve block shot and exploring nightsplint.

Beverly on 8/30/00 at 14:20 (026752)

Thank you, Dr. Z., for patiently answering my many questions.
I will ask for the nerve block shot to my feet. I have to wait until Sept. 12 when I see the Sports Med. doctor. He specializes in the lowerbody. He's considered the 'best' guy in town. He has had PF twice, and has enough of an interest to have his own PF video.

I am also interested in trying the nightsplint. I've held off... looks so uncomfortable. But http://www.footsmart.com has a 'passive night splint' that looks pretty comfortable. It looks far less complicated and more comfortable. Have you seen it? Do you give nightsplints to your patients? Do I have anything to lose in trying a nightsplint?

Beverly

Re: Dr.Thanks. Will ask for nerve block shot and exploring nightsplint.

Dr. Zuckerman on 8/31/00 at 17:01 (026834)

I have only used night splint in very few cases. My understanding is that they are for first step pain in the morning and only this condition. The nite splint was researched by Dr. Wolper a foot and ankle orthopedic surgeon in my area. He use it for first step am pain.
The problem I found was sleeping with it very uncomfortable. and if you have to get up at nite for kids. bathroom etc.

Re: me too...Dr. Z or B....!

Sue R on 8/29/00 at 14:17 (026618)

I've got a comment under Beverly's regarding stopping the cycle.

Please help!

Sue R

Re: me too...Dr. Z or B....!

Dr. Biehler on 8/29/00 at 14:56 (026623)

I agree with Sue R. Nerves can get caught up in a pain cycle that is sometimes very hard to breack. For long term chronic pain I like the oxicontin ms, it is time released codine, a morphine derivative, with out the acetominaphen. When a person is in pain it is very hard to get addicted. In New York there are Pain Clinics that write the medications and follow the patients. Short term pain I like Hydrocodone or tylenol #3. I think lidocain shots to break a pain cyle can also do a lot of good. Dr. Biehler

Re: Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Dr. Zuckerman on 8/29/00 at 16:43 (026636)

Severe chronic pain- Fentanyl, or oxcycontin

Either a steriod injection or posterior tibial sympathetic nerve block

Or come to my house for the week and let treatment you. I have to ask my wife, first.!!

Re: Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Beverly on 8/29/00 at 20:02 (026665)

Dear Dr. Z / B,

Dr. Z., how I wish I could go to New Jersey to see you. I actually have cousins who live in Jersey. Not a fan of airplanes though...

I like the idea of the nerve block shot better than the pills. I am a TRUE lightweight when it comes to meds. Easily knocked out.

And Dr. Z., if I remember your other posts you talk about mixing steroid with lidacane; do you think that mix of the nerve block and steroid would pack the best punch? Since my pain is in both feet... heels and arches, would that mean getting a shot in both feet on the same day? I understand it is not safe to have more than 3 cortizone shots a year. If I have to have one in each foot, does that mean I've used up 2 of the allowed yearly shots? I've got a collection going to notes about your shot tips, including that small needle.

Thanks,
Beverly

Re: Dr. Z: Could you look at my questions about breaking pain cycle posted in response to my saga in social/support section?

Dr. Zuckerman on 8/29/00 at 20:17 (026666)

I would skip the steriod portion of the shot. The posterior tibial nerve block is the best way to get with you. It will increase circulaton to the foot on the bottom and at the same time help to break down this chronic pain cycle. This is very effective in the right hands. If you can't get a doctor to dot the posterior nerve block an epidural sympathetic nerve block is even better. This is done at the level of the lumbar-sacral level of the back. This is done alot and can work.

Re: Dr. Z: Questions about these two choices of shots. Could this fix me?

Beverly on 8/29/00 at 23:12 (026700)

Dr. Z.,

Won't the epidural sympathetic nerve block in the back be painful?
Are you talking about a shot in the spine? How is that better than the
posterior tibial nerve block that if I understand currently will be in the foot?

I'm more than willing to give the nerve block a try. But no one has yet answered my question. Could this permanently shutdown the pain cycle and lead me to recovery or is this a temporary break from the pain?
What are the odds this would stop the pain cycle?
My work does not put me on my feet at all and so it seems like I have every reason to get better. That's what confuses me. I was never a jock. I don't work on my feet. This all came from one failed attempt to go workout some months back. Before that, I never had a foot problem in my life.

Thanks,
Beverly

Re: Dr. Z: Questions about these two choices of shots. Could this fix me?

DR. Zuckerman on 8/30/00 at 02:47 (026704)

This could fix you . You can get a big pain cycle breakup from the back level. I still like to start with the foot. It is so easy to do in the foot. I do about ten a week .

Re: Dr.Thanks. Will ask for nerve block shot and exploring nightsplint.

Beverly on 8/30/00 at 14:20 (026752)

Thank you, Dr. Z., for patiently answering my many questions.
I will ask for the nerve block shot to my feet. I have to wait until Sept. 12 when I see the Sports Med. doctor. He specializes in the lowerbody. He's considered the 'best' guy in town. He has had PF twice, and has enough of an interest to have his own PF video.

I am also interested in trying the nightsplint. I've held off... looks so uncomfortable. But http://www.footsmart.com has a 'passive night splint' that looks pretty comfortable. It looks far less complicated and more comfortable. Have you seen it? Do you give nightsplints to your patients? Do I have anything to lose in trying a nightsplint?

Beverly

Re: Dr.Thanks. Will ask for nerve block shot and exploring nightsplint.

Dr. Zuckerman on 8/31/00 at 17:01 (026834)

I have only used night splint in very few cases. My understanding is that they are for first step pain in the morning and only this condition. The nite splint was researched by Dr. Wolper a foot and ankle orthopedic surgeon in my area. He use it for first step am pain.
The problem I found was sleeping with it very uncomfortable. and if you have to get up at nite for kids. bathroom etc.