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When talking about pain, it is important to understand that there are different types of pain, and that each type seems to respond to different kinds of treatment. If one fails to do so, then one is likely to end up confusing apples and oranges. The approach to pain has to be careful, systematic, and based on a very careful diagnosis by your physician or by the neurologist caring for you. The approach of "this worked for me" is likely to be misleading, because each person needs to be carefully evaluated by his physicians to try to establish the kind of pain that it is, and the anatomical structures involved in causing the pain. For example: In PWP, there is dystonic (muscular spasms) pain: this is most difficult to treat, and ultimately the best treatment is to adjust the antiparkinsonian drugs optimally if possible. Neurontin (or Lamictal, Tegretol, Topamax) are unlikely to help, since these drugs are best for pain from nerve damage: pinched nerves or neuropathies. Muscle relaxants like Zanaflex, Baclofen, Flexeril are sometimes helpful. Klonopin also has a good record in relaxing muscle types of pain. It may end up being a trial and error strategy; sometimes one nees to combine strategies. If all else fails, then chronic pure painkillers like Ultram or Oxycontin can be used, with the dangers already pointed out by Bob Fink In pain from arthritis of the knee or of the hip, which is common, or from bursitis, the best medicines seem to be the anti-inflammatory drugs like Vioxx, Relafen, Ibuprofen, and the like. In bursitis, LOCAL injections into the inflamed bursa of steroids can be extremely helpful. In arthritis (joint inflammation) some orthopedic surgeons or arthritis specialists also use direct injection of steroids into the joints, with success for several weeks, but then they have to be re-injected. Only If the arthritis is severe enough, then the best solution might be surgery. In pain from a pinched nerve or from neuropathy, the best drugs are Neurontin, Lamictal, Tegretol, Topiramte, and, believe it or not, the antidepressant drugs like amitriptyline, Celexa, Paxil, and others like them. In situations where a pinched nerve can be shown by appropriate imaging studies, surgical approach may be considered AFTER medical measures have not worked. Pain in a leg can also be caused by circulatory insufficiency. It is important to rule this out as the cause of pain. Only appropriate vascular evaluation, when indicated, can address this kind of pain, which may require surgery for relief. Narrowing of the spinal canal from arthritis can also cause leg pain. This type of pain sometimes responds to the anti-inflammatory drugs, taken chronically. Some pain specialists inject steroids into the spine - but this tends to be only a temporary measure. Often the most effective approach is surgery, provided appropriate imaging studies have confirmed the diagnosis. Of course, there are PWP who are so debilitated that surgical approaches are too dangerous. In those situations, chronic analgesics, like Ultram and Oxycontin are sometimes used, but only after careful consideration of all the other alternatives. IN PWP, pain in a leg can fall into any of these categories, and you really need the help, INDIVIDUALLY, of your GP, internist, and neurologist often working together, to sort things out carefully and effectively treat the pain. Jorge A. Romero, MD ----- Original Message ----- From: "Juanita Hibbert" <[log in to unmask]> To: <[log in to unmask]> Sent: Saturday, January 26, 2002 3:11 PM Subject: Re: ultram/pain > Agnes I am not the PWP. However I have had a total knee replacement. It > is the best thing I could have done for myself. > I had lived with knee pain,bone on bone, for yrs then got to the point > where I almost could not get around. The pain after surgery was minimal > compared to the pain prior. Whithin two wks I was no longer taking pain > meds, in 6 wks I was back to all normal activities. I used water > therapy for my PT to regain my mobility. > I do believe that being in the water for my PT was the reason for my > rapid, successful recovery. I am due to have my right knee replaced in > the near future. > It is well worth the short term discomfort. > Good luck. Hugs Juanita CG for George 75/71/64 > ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn