7 doctors weighed in:

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?

7 doctors weighed in
Dr. Paul Grin
Pain Management
4 doctors agree

In brief: 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.

In brief: 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.
Dr. Paul Grin
Dr. Paul Grin
Thank
2 comments
Dr. Robert Lowe
If you still have joint swelling, you may get some additional pain relief if your are able to optimize your RA immunomodulatory therapy(increase dose or frequency or switch to another med). If you have generalized pain "all over" you may also have fibromyalgia that will benefit from improved sleep hygiene, light daily exercise, physical therapy, and counseling. I hope you can get to feeling better
Dr. Paul Grin
Great advice, Dr. Robert M. Lowe! Thank you.
Dr. Karen Sibert
Anesthesiology
1 doctor agrees

In brief: 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!

In brief: 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!
Dr. Karen Sibert
Dr. Karen Sibert
Thank
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