OA Pain study - Lidoderm patches

[maxfactor]

I've just left a message for my PM doc regarding these patches. I'm so anxious to try them. It seems that nothing helps my quad pain for any length of time and this is constant. I'll gladly report back if/when I get them. I don't see him again until 8/30 so I asked if he would prescribe without seeing me. Hope so! Thanks everyone. If this can take me from a constant 6-7 out of 10 down to even a 5 I'll take it!! I guess all of us who live in chronic pain will take anything we can get and still be able to function.

Jane

[maxfactor]

I left a message with my PM doc about this and got a call within the hour that they called in a prescription. I picked them up ($178.00 retail but for me $10.00) and used a full patch on each quad. Within 20 minutes I felt a difference. This will be a HUGE life savor to me. My quads really hurt in the resting position and I think these patches are going to alleviate quite a bit of the pain. Thank you so much for the suggestion. If this is all in my head, I don't care. It doesn't help the joint pain, but the muscles (what's left anyway) in the quads it certainly helps. I'll update as I get further into using them regularly. I only just got them on Saturday.

Jane

[Heather M.]

Jane,

I'm glad the patches are helping.  I think you probably have a lot of soft tissue problems, so the lidoderm should help.  And it really may help with the arthritis, too.  It's NOT a placebo affect (i.e. in your head), trust me!  The lidocaine in the patches actually calms down the nerves and makes them stop sending pain messages to the brain.  So they should work on just about any kind of pain, the trick is finding the right place to put the patch.

I have never used a half patch in one whole area, I cut my patches into 6 pieces and use three small squares stuck to various places around my knee--the base of the quads, the insertion point of the IT band, and then either over my lateral release site or down the medial joint line, whichever hurts more.  So I make one patch last two days.  You may want to see if strategically placing smaller pieces of the patch gives you comparable relief, or cutting 1/2 into smaller pieces and putting it around the knee?  Or you can just say "If it ain't broke, don't fix it, Heather!"  If the patches are only $10, that is wonderful.  

Let us know how it goes as you experiment.  And believe me when I say there is a lot of clinical evidence that these things work on nerve pains.  Now your problems are mechanical in nature, but the pain caused by these mechanical problems stimulates the nerves.  After a while, the nerves get irritated, and it takes less stimulus to make them start going haywire.  It's like crazy escalation, and the lidoderm helps soothe the nerves and hopefully reset the pain-sending process.  It's kind of like if you pinch yourself once, it hurts a little.  No big deal.  But if you continue to pinch yourself repeatedly in the exact same area, pretty soon just brushing a feather over the area would send the same sharp pain stimulus as a good pinch.  This is because the nerves are irritated.  So the patches help calm this irritation.  

Good luck.

Heather

[maxfactor]

My prescription does say "1 patch every 12 hours." I wish I could wear them all day. I really notice a difference.  I'm going to try the cutting them up thing. It's sometimes hard to pinpoint a certain area, so I think spreading them around is probably a good idea. I'm going to talk to my doc about break through pain. I wonder if I should ask him to dump the Norco and let me try the perc's? How long to the Perc's last? My 8hr pill lasts only 4 so I wonder if a perc will get through. Or is all of it wishful thinking? I've taken 6 or 7 Tylanal in between and could certainly take more. Doc keeps saying I'll really screw up my liver/kidneys. I'm not quite sure how to "mix it up." Ideas? My MS Contin (time-released morphine) is 60 mlg. Can that be raised or should I try something else? My PM doc is pretty good with me. I think he'll listen if ask for something else.
Jane

[maxfactor]

I cut up the patch into 3 different pieces. All was well until they started falling off. Anyway, they do work but I had wearing them 12 hrs on and 12hrs off. I want to wear them all the time!. I'm really feeling the loss here at work today. I can't wait to get home and put them on. If I wore them during the day, I think I'd suffer more at home after work. At work I can usually keep busy and have my mind on something else. At home, if I'm watching TV all I ever think about is the pain. If there's anyone out there who hasn't tried these for pain management, I would strongly recommend these patches. My thanks to Heather. These are helping me cope a lot better.

Jane

[Heather M.]

Jane,

You may want to buy a box of the little foil packets of alcohol swabs usually used to clean the skin before an injection.  You can clean the area you will be putting the Lidoderm on, then wipe with a wet washcloth, let it dry, then apply the patch.  It won't stick well if your leg is dirty (like if you've been gardening or sweating in sticky, humid weather!), if you have lotion on, or if the leg is wet/damp.  I try not to put any lotion on the spots I'll be using the patch on later.

It's funny, I use my patches during the day, especially if I have to be on my feet or be active.  (I wore them during the last visit to my PM doctor, which involved 4.5 hours of driving during the day.)  At night, I can elevate and use my e-stim, so I'm less likely to use the Lidoderm.  Different strokes, eh?

Heather

[Alyce]

I have used the Lidoderm patches for almost 9 months, and they are a tremendous relief.  I tried taking the neurontin, but couldn't tolerate it.  It is also available in a topical form.  However, it must be mixed by a compounding pharmacy.  It also works very well.

Warmly,
Alyce

[maxfactor]

What's an e-stim? I'm going to ask my PM doc about the TENS unit when I see him in August, if I can last that long. I'm having a lot of breakthrough pain after about 4hrs. And while the meds don't take away the pain completely, I should be able to tolerate my pain throughout the day. I'm going to ask him to nix the Norco and give me something else. I do put lotion on every morning, so I'll bet that's why the patches were falling off. If I can get something to help me during the evening, I'll definitely wear these patches at work. I usually wear slacks, so no one will even see them. I live in Bakersfield, CA. It's 100 degree days most of the summer. No humidity though, but still hot. I work in air conditioning all day. I rarely leave the office.  Thank you again for the advice. This site has been trememdous for my physche. Just knowing I'm not alone in this does something for my state of mind. Not that I'd wish any pain on anyone, but it does help to know I'm not alone. I don't know what's in store for me surgery wise, but I'll be finding out within the next month or so.

Jane

[dm]

I know this might be a stupid question, as I've not used the lidoderm, but am interested in them.

If you're using small squares, can you rotate sites and have longer coverage? Like this, say you put 3 1 inch squares on your leg in the "primary" pain relief sites. These have to be removed in 12 hours. What about putting on 3 more squares, in other "secondary" sites, and leaving them for 12 hours too?

Then you're not wearing a patch on any skin area for more than 12 hours, but are shifting where applied to extend the relief. I know it's an odd question, but if you get relief from putting the patch in one spot near a nerve, once the time there is up, could you use another piece of patch somewhere else up the line, affecting the same nerve, but in a different area?

Like I said, I've not worn these, but the thought occurred to me, so I thought I'd throw it out there and see what you all think.

[californianative]

I tried my husband's TENS unit on my knee, tried it every way I could think of and personally, it did nothing for my pain, felt wierd, but nothing which was a shock to my husband who gets total pain relief with it on his back. Guess it depends on the injury.

[Heather M.]

You can't wear the patch on the same part of the body because the medicine is absorbed into your bloodstream.  So you can overdose.  You also can't use more than 3 patches at a time, for the same reason.  

The patch kind of works like the TENS unit in that its goal is shutting down the constant, non-emergency pain messages.  If I leave my TENS on for too long, it actually becomes irritating to my knee.  

Anyway, it's my understanding that moving the patch a few inches away would continue to provide medication that would be absorbed into the system.  And you don't want too much to be in your body at once.

I think you also increase your chances of a skin reaction to the adhesive if you use it too often.

Next time I see my doctor I'll ask her why you can't wear the lidoderm all the time.  I just know that I've been advised by everyone from the pharmacist to my doctor to my PT to follow the 12 hours on, 12 off regimen.

Heather

[Heather M.]

Here's a link to the web page for Lidoderm.  Remember that it's original purpose was to calm the nerve pain that can come from shingles.  It's just being explored for OA and other painful conditions, so all the product literature refers to shingles and neuropathic pain related to this condition.

http://www.lidoderm.com/

Here's what they say about wearing the patch for longer than 12 hours:

Excessive dosing by applying the LidodermŽ patch to larger areas or for longer than the recommended wearing time could result in increased absorption of lidocaine into the bloodstream which could lead to serious adverse reactions. When the LidodermŽ patch is used along with other products containing local anesthetic agents, the amount absorbed from all formulations must be considered. Make sure to use the LidodermŽ patch exactly as directed by a physician.

[Heather M.]

Californianative:

You might want to take the TENS unit into your PT and ask him/her to show you where to put the electrodes.  Since they are positively and negatively charged, it really does make a difference where you put them around the knee.  Usually, you want to put a positive and negative one around the site of your pain and/or the location of the irritated nerve.  That way the charge travels through the area more effectively.  I can't really describe how it works, I just know that if I don't place the electrodes just right, I don't get the right relief.  Also, my TENS unit has two programs:  one is constant pulsing, which is supposed to be the pain program.  The other is to build muscle strength, so it contracts for 15 seconds, relaxes for 10, contracts for 15 and so forth.  This runs on 15 minute cycles.  I found that I actually get better pain relief by using the strengthening program on very weak strength.  I would need to set my TENS at 75 or 80 out of 100 to contract the muscle hard enough to strengthen it.  But if I set the TENS at 35-40 on the strengthening setting, I find I get very good pain relief.  It turns off every 15 minutes and I have to reset it, but I like this setting better.  I never would have thought to do this if my PT hadn't told me that many people get more effective relief this way.  I find the actual pain management setting with its constant pulsing can irritate my knee after a while and I turn it off.  I could leave the low strengthening setting on all day long--it feels great.  

So if your husband's unit has two settings, you may want to try the other.  If it only has pulsing, ask your PT to use a TENS unit on strength-building setting, but put the number down low, and see if you get some relief.  Most PT's will loan you the small portable unit for 24 hours to see if it's helpful.  If you like it, the doctor can write a prescription.

Heather

[Alyce]

I use the entire patch over my knee, and place the white part of McConnell tape over the top.  My pain is primarily in the lower right quadrant, and it seems to adhere well.

When I don't wear the patch, for pool therapy, my knee feels like a jammed finger.  

Because I still need the patches, my OS feels as though the microfracture failed.  I had grade IV chondromalacia with a 13mm by 9mm lesion on the under side of my patella.  She found this when she was reattaching my LR.

Considering that I have not seen my OS since November (she's 3000 miles away), I was surprised at her conclusion.

I believe if I am getting such releif from a Lidoderm patch it's gotta be tendonitis, soft tissue etc.

If I use any of the cardio equipment, I get that deep bone pain, that the patches don't touch.  I just take extra tylenol.

Absolutely could not live without these patches.

Warmly,
Alyce

[Heather M.]

Alyce,

You hit the nail on the head with the description of how pool therapy makes my knee feel!  I always used to say when I got out it felt like I had a sandbag strapped to my knee, and it felt worse than it's been after waking up from some of my surgeries!  I actually had to stop the pool therapy because I have bone on bone contact in my knee and the aquatherapy was irritating things and making my knee blow up like a balloon.  I actually felt pretty good in the water for a little bit...so good that I'd go WAY past the point I should have stopped and push the knee too hard.

I'm glad that Lidoderm works for you.  It's a real lifesaver for me on days when I need to travel and have to have a clear head.

Heather