I am on orencia, (abatacept) 20mg methotrexate, 75mg fentanyl patch, 200mg celebrex, 250mg tramadol, 75 lyrica my pain is still severe? where can i go from here?

Sympathetic Blockade: Some continuous neuropathic pains are also maintained by the sympathetic nervous system and are designated as sympathetically maintained pain (smp). Sympathetic blockade can be accomplished using either regional anesthesia (e.g. Stellate ganglion block) or systemic intravenous infusion with phentolamine. Rec.: see an interventional pain management specialist.

Cause of pain?: First, make sure the cause of your pain has been properly worked up and diagnosed. Treating the source of pain is the only way to eliminate it. If you have chronic pain and have exhausted other treatment options, see a physician anesthesiologist who specializes in chronic pain mgmt. You may be a candidate for an implanted pump, regional blocks, or other modalities. Good luck!