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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33897
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am currently on NORCO and went cold turkey of Fentinal 75

Customer Question

I am currently on NORCO and went cold turkey of Fentinal 75 in June trying to get of opiates.Have been self medicating with marijuana [had my own strain with high CBD,was tested in Cal.]since then. Now i'n not allowed. I have cronic back pain, all documented with MRIs.I've tryed everthing[ linadem,tens machine,physical therypy,ect. I am not a canidate for surgery[to risky] Dr will put me on almost any narcotic but shutters when I ask about MARINAL. Our health care in a small area is backward and not up to date if you know what i mean? Live in rural area. I need someone more open to new methods and willing to keep an open mind. MARINAL is a synergist and would help me take less and maybe get of opiates and us something much more safe and not addicting.marijuana] I have the MRIs and Dr readout' Since I had to quit self medicating [1wk] my pain level when for 5/6 to where im in unbearable pain to where I vomit yellow from pain, showering or anything easy is ubearable. I'm having NO qualit
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.


I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

Following should be integrated in your management;

1) Physical therapy and occupational therapy, plays an important role in functional restoration. The goal is to increase strength and flexibility gradually.

2) Recreational therapy; take part in pleasurable activities that help to decrease pain.

3) Vocational therapy; provide work capacities and targeted work hardening, and one may return to gainful employment.

4) Sympathetic blocks

5) Bier block (intravenous regional block)

6) Continuous epidural infusion

7) Spinal cord stimulator

8) Baclofen pump; Intrathecal infusion (Intrathecal bupivacaine infusion or Morphine pump are the other alternatives)

9) Sympathectomy; Surgical sympathectomy (Endoscopic cervicothoracic sympathectomy) or Chemical sympathectomy or Radiofrequency or cryoprobe lesioning should be considered.

10) Acupuncture

11) Relaxation techniques; associated with the above treatment.

12) Biofeedback training

You need to consult following specialists;

a) Pain management physician

b) MD in physical medicine and rehabilitation

The helpful herbs for chronic pain are;

1) Willow bark
Devil's Claw
St. John's wort
5) Valerian
8) Ginger extract

You can take Rhus Tox 30, 2 globules, three times a day as an homeopathy treatment.

Supplements and alternative integrative therapy protocols for pain relief are;

1) Evening primrose oil

2) Acetyl-l-carnitine

3) Alpha-lipoic acid

4) Benfotiamine (Milgamma), 100 mg, is a lipid-soluble vitamin B1 analogue

5) Vitamin E

6) Acupuncture

7) Yoga

8) Prolotherapy

Commonly used medications for chronic pain are;

1) amitriptyline (Elavil, Endep),

2) nortriptyline (Aventyl, Pamelor)

3) desipramine (Norpramin)

4) pregabalin (Lyrica)

5) phenytoin (Dilantin)

6) carbamazepine (Tegretol)

7) venlafaxine (Effexor)

8) duloxetine (Cymbalta)

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Following measures would be helpful for your back issue;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

3) Local analgesic gels or sprays / ointment

4) Hot fomentation

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

7) Lumbosacral corset or support or brace

8) If obese or over weight, reduce weight for long term benefit.

9) Epidural steroid shots

10) Surgery is usually last resort, when the above conservative measures fail. You can start the following exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

You can consult following specialists (apart from your GP);

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Customer: replied 1 year ago.
I have had therapy, epidurals,tens machine, mofhine, norco, fentenal. Im at my wits end. Drs would rather I have more narcotics than try MARINAL which is a Synergist which would increase the effect of to Norco and I could take less narcotics and evetually be rid of them for pain. I have ate and smoked maajiana with the norco and results we great. I have quit fentinal in June. Stopped "self medicatating 8days now and my pain level is 1-10 it's 20. Please help me find a open minded Dr how understands pain manigment. This injury is from2.1.07 / servere back issues I live south of Buffalo 80mi the closest decent health care
Expert:  Dr. Arun Phophalia replied 1 year ago.

I am very sorry about your pain. I can understand this can be excruciating and disabling pain as this is nerve pain. Majority of the pain management physicians nowadays have to go by the strict guidelines issued, as there had been abuse reported. But these guidelines have unnecessary harassed all the people in pain, who need it genuinely. You may consider contacting following doctors;

Anthony Leone MD

934 Cleveland DrBuffalo, NY 14225

(###) ###-####/p>

Spine & General Orthopedic Surgery.

Hens Pain Center

*****Ste 102Buffalo, NY 14221(###) ###-####/p>

Koritz, Hans R, MD

2949 Elmwood AveBuffalo, NY 14217

(###) ###-####/p>
Customer: replied 1 year ago.
Your answer was gernaric and basicly worthless as I have done most of our remedys. And you try to scam me to talk in person fo 45dollars more. Be real and answer me.
Expert:  Dr. Arun Phophalia replied 1 year ago.

I will opt out. This will open up the question for the other experts to answer. Hopefully some other expert on the site will provide you exactly what you want.

Wishing you all the very best in life.