Can you not get stronger painkillers?

Also remember the critical thing with pain relief: take it preventatively. Once the pain starts to peak, it is too late for the drugs to work effectively, AND you need higher doses.

But if you take them in advance, lesser amounts will actually reduce and event prevent pain, far more effectively.

(This is weird, I know, because I am the kind of person who always figured taking painkillers as "a last resort" was the best thing to do. Apparently however it isn't).

The chemo effect is simple to understand. Most chemo agents screw up cells that are trying to divide. This includes the cancer cells, which is good. The normal cells that divide the most in their course of business are blood-forming cells in marrow (especially white cells) and lining cells of GI tract. Down the list are hair follicle cells. The art of chemo is giving the maximal amount that the normal cells can tolerate in order to nail the bad guys.

A lot of bone pain suggests cancer cells getting knocked off. The body responds to them as to any dead tissue with an inflamatory response. Inflammation is ususually associated with pain. It that's the case, there will be one round of pain as the cancer is bombed out. Maybe less severe pain with later rounds to take care of surviving cancer.

The low white count is a bad thing, directly because of the risk of infection and indirectly because the docs have to wait for the next round of chemo. But it suggests they whacked you with a stiff dose, which is good.

I never follow this advice, but don't give in to Anglo-Saxon male stoicism. Chronic pain, especially bone pain, can be very demoralizing. People have finite reserves, and you want to ration them to last a few months.

Well, I don’t know about your specific narcotics, but from experience – a) a drug that works well on one person may work quite differently on someone else, and there have got to be other options out there if your current meds are proving inadequate; b) narcotics can depress respiration, so assuming you are still fond of respiring, the max dosages are what they are for a very good reason.

Hopefully your doc isn’t a complete idiot like my first one was, and is willing to consider other pain relief options.

Well, I have no advice to offer. Endocet is already pretty potent, so perhaps it is a matter of taking them pre-emptively as SD suggested.

Otherwise, DVDs to pass the time. Requests?

Christ Jesus, why the fuck do you even need nerves in your bloody bones? What's the point? Half-erect simians galumphing around the Serengeti needed a pain response to help them learn to avoid chemotherapy?

Intelligent design, my ass.

As far as I know, the pain is from a covering on the bones, not in them - somewhat illusionary, but frankly my head has been clearer.

Do need to speak with the Dr, this is getting quite unpleasant.

Don't just "speak," it's perfectly OK to bitch your head off, in my book. Be as bloody-minded as you like and exert some control. People consistently under-report pain anyway and doctors have a strong tendency to under-treat what pain is reported.

At the very least you ought to be able to switch off and try different things to see what is most effective for you. Taking a grand tour of synthetic narcotics might even be an entertaining experiment!

Muscle pain is apparently a rare-ish side effect (usually accompanied by flu-like symptoms) following large doses of D.

Have come across recommendations for dose readjustment if myalgia occurs, but am not a doctor obviously.

it could be much worse. you could have to go through this whole ordeal in america.

oh... wait...

Anonymous's point is correct, and I was trying to avoid pedantic mode in stating it. There are nerve endings in the bone marrow, which seems to me one of several design flaws in the human frame. I've done perhaps a hundred bone marrow aspirations, in which one inserts a sturdy needle through the solid outer part of the bone and into the marrow cavity. Then a syringe is put on the needle and some marrow sucked out. It's straightforward to put local anesthetic into the skin, underlying tissue and membrane covering the bone. The procedure is painless until the tip of the needle is in the marrow cavity. When the marrow is withdrawn, there's an instant of sharp, excruciating pain. But only an instant. I always warned patients about it, with the proviso that that it would be brief and only happen once. But the anatomy makes no sense. Why should the nervous system need to know about problems in the marrow cavity? I mean, if you get a fracture there's plenty of independent evidence, no?

I would rather undergo torture than sound New Agy, but there is a meditation technique for pain. You sit in a quiet place for half an hour or so and try to notice everything about it, like the exact localization, quality and ebb and flow. A possible rationale is that pain circuits in the CNS go to two places. One is specialized for body part, to collect everything happening in e.g. your left hand, includng pain, temperature, touch and position. The other pathway is more diffuse and goes to areas for emotional tone. That mediates the feeling of "suffering", or "the miseries". The theory is that paying attention to the pain in a certain detached way dampens the second pathway.

But opiates act on that pathway preferentially, removing "suffering" more than the mere physical sensation. Morphine is the classic drug for a heart attack. If you ask a patient with an MI if they are in pain after a slug of morphine, they do on careful questioning feel the pain. But they describe their state as being detached, or seeing the world as if from behind a glass wall. For serious pain, I would demand opiates over any feely-touchy stuff. But faux de mieux it might be worth looking into.

Oh, opiates are definitely your friend on certain occasions. I will never forget the feeling of blissful relief as the morphine drip started to kick in after 4 days of having leg bones in various fragments, with no relief of any use. Hated the detached feeling and not being able to control my own thought processes, but it sure beat the alternative.

(BTW this is from a strict drug avoider. I spent the bulk of the several months my leg bones remained in entirely non-healed fragments with no pain drugs at all. And my doc said the same as SD, by the way, re: taking drugs in anticipation of the pain returning, rather than trying to be tough and hold out until you can hardly bear it.)

P.S. Besides, really, do you actually need any more character?

Hmmm, my medition that just worked was running through bank annual reports on a conference call. Oddly took away the pain once I got going.

I will note that having had morphine, it doesn't seem to have much effect on me.

I can't imagine, in any case, need to know about marrow cavity and am sure anything that might come to mind is far too icky to contemplate.

And finally, no, I don't believe I need more character, but the world keeps supplying me with it.

Ah yes, another book arrived. I may have a library. Somehow, although normally I would be irritated and hostile about these books and dvd gifs, they are strangly something.

Now, narcotics.

I never follow this advice, but don't give in to Anglo-Saxon male stoicism. Chronic pain, especially bone pain, can be very demoralizing. People have finite reserves, and you want to ration them to last a few months.

Don't just "speak," it's perfectly OK to bitch your head off, in my book.

At the very least you ought to be able to switch off and try different things to see what is most effective for you. Taking a grand tour of synthetic narcotics might even be an entertaining experiment!

Yup. I've done the stiff-upper-lip-ignore-the-pain thing and in retrospect it was monumentally stupid of me. Tell the doctor that the only sensation you want to feel is the gentle warm lapping of a metaphoric sea on the shoals of the quiet idyllic beach of your mind and you're willing to experiment around until you can get as close as humanly possible to that.

I will note that having had morphine, it doesn't seem to have much effect on me.

Same here. I seem to be resistant to some/all opiates - some folks just are and unfortunately you might be. For example I've never gotten the slightest buzz off a single vicodin ( they work somewhat, but I get nothing pleasurable out of them ), have been entirely lucid and unbleary two minutes after an endoscopy ( when they'd predicted I'd be loopy for ~1/2 hour ) and didn't even notice it the first time I got shot up with morphine ( they had to double the dosage ).

So it probably pays to experiment around if it's an option.

Well. Now I know fair bit about bone innervation in mice femurs, thanks to Ovid/Medline. Getting my bloody money's worth from that database.

Apparently the periosteum (bone covering) is extremely nerve-dense. Same with the marrow, but pain originates primarily from the periosteum. Reasons for dense innervation have not been conclusively proven (theories relate to nerves regulating release of blood cells into the wider circulatory system), but they have noticed that nearby cells flipping out (for whatever reason) often excite nerves in the periosteum and cause terrible pain. The pain mechanism isn't well-understood, but opiates don't seem to work very well.

There's more, but it's mostly hiding the fact that they don't really know what's going on. Ah, science.

normally I would be irritated and hostile about these books and dvd gifs, they are strangly something.

Ha. Something.

I don't believe I need more character, but the world keeps supplying me with it.

Excellent! Oscar Wilde couldn't have put it better. This really ought to be in Bartlett's.

Somehow, although normally I would be irritated and hostile about these books and dvd gifs, they are strangly something.

The feeling is mutual, I'm sure.

"thanks to Ovid/Medline. Getting my bloody money's worth from that database."

Use Pubmed, pretty much the same coverage and free.

Not coverage, access. I get fulltext access to nearly all journals through my Ovid account (this is the not-free part, abstracts & citations are always free) and the search engine is much better than Pubmed (filters, topic suggestions, etc). Very useful if your search term is turning up 26k results at a time.

It is not something I subscribed to on purpose, but I am paying for the service.

Hmmm, my medition that just worked was running through bank annual reports on a conference call. Oddly took away the pain once I got going.

Hmmm. Sounds like financial reports have addiction potential. Who knew?