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Pain Medications suggestions? I have massive amount of Pain
Dec 18, 2009

I have been HIV + for 10 years now, and I have had AIDS since November 2006. I am currently on a salvage regime, due to I am resistant to most of the HART drugs. My pheno type and geno type test shows the only medication that im sensitive to is Fusion Injection, which Im taking ( very painful) im partially sensitive to instentress, travuda, intellence and norvir. But my main question is my level of pain... I have severe hiv related nerve damage and I feel and damaged my back. I have 3 herniated bulge discs in my lower back and I have a 12mmlegament tear in my right hip, I need several operations to fix this but, my Spinal/Ortho surgeon and my Infectious Desease specialist are hesitant to authorize such a surgery, since my CD4 counts has been less than 20 for over 3 years with a latest pcr viral load of more than 6 million, Yes six Million. Ive been hospitalized more than 6 times this year alone, with pcp infections of the lungs, fungal thrust infections that spread to my bones, and menigitas, but Im in hospice care now. But I have daily severe Pain. on a scale of 1 to 10, I can never get below an 8. It takes me an hour to walk from my bed to the bathroom, because all the muscles in my body hurts including my joints, in addition to my severe backpain... ive tried all the narcotics medications. I was taking 200mg MS CONTIN PO Q12HR and Dilaudid Tablet PO 16MG Q4Hr and that allowed me to more a little more, but that failed. Im now on 100mcg fentanyl patch and Dilaudid -5 Oral Solution 20 mg q4hr prn. This is helping much at all. I tried and failed Oxycontin 160mg. I tried and failed the MS CONTIN 200MG. the only thing that Ive tried in the past that help alot and bringing my pain level down to a 6 is the Actiq Fentanly lolipop 1200mcg q4hr. Actiq helped alot. I took it for about 3 months until medicare decided it was too expensive (11k a month) and they stop approving to pay for it. When Im hospitalized, the only thing that helps is IV dilaudid 8mg IV q3hr. My most recent visit they gave me a PCA self controlled pump where I can push the button every 15 minutes and self administer pain meds.. that helped greatly... Maximum dose was Dilaudid IV 1mg per 15 mins. for a total of 4mg per hour and 8mg ever 2 hour. Keep in mind that when im sleep, im not getting medications , so its hard for me to sleep sometimes, because I wake up in pain. My main question is, what other medications or regimes would you suggest for me? I am on Hospice, at my own home, but I have a RN come visit me daily. to be honest being in so much pain, makes life not fun... at all... it takes away my drive to fight for a cure... Please give me any advice you have. Is there any drugs, That I havent tried? Im currently seeing a pain specialist at Loma Linda Univerty Hospital dept of Pain Mgmt. My doctor is the Medical Director. Dr. Reynolds MD

Response from Dr. Henry

You have explained your difficult situation very well. Morphine infusion, spinal morphine or stimulation, methadone, use of adjunctive agents like marijuana or lorazpam, gabapentin types of medications, tricyclic antidepressants, acupuncture--there may be something that might help some but difficult to say (often a trial and error process even in the best of circumstances) without full evaluation/examination. KH

I have the rash associated with viramune and I am worried. Should I be?
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