Hi,
There are several painkillers that she hasn't tried, although I should point out that it might take a while for things to work or to get the right dose. Painkillers need to be taken at the right point for them to work effectively - if I take my breakthrough pain meds too late, they do nothing - so if you are already in a fair bit of pain, it won't work straight away, whatever it is. Also, it isn't advised to medicate to the level where you have no pain, if you have chronic pain, so she's looking at a good reduction in pain to a manageable level rather than a cure, so it's good to be realistic, but that is probably stating the obvious, for which I apologise!
Between her GP and pain clinic they should be able to find something that suits her - you didn't mention morphine either as MST or Oramorph, oxycontin, fentanyl or buprenorpheine, which are the more commonly used strong opiates. I get very sick on pretty much everything, so I have to take anti-nausea/anti-emetic drugs with my pain medication, something worth considering if that's the main side effect and it gives some benefit (most people on opiates also tend to need something to combat the constipation as well). These are stronger than cocodamol or tramadol so are not normally prescribed unless cocodamol/tramadol doesn't provide enough relief, in which case, BuTrans patches (buprenorpheine) are often the next step as these come in quite low doses so don't give such a big jump. I didn't notice any NSAIDs in the list either - ibruprofen, voltarol etc, either as tablets or as a cream. Has she tried those? They're not suitable for everyone so it may be she can't have them.
I have very sensitive skin and react to all sorts of things and I tolerated patches for quite some time - I found that different brands affected my skin differently but between the pharmacist and the pain clinic, we could work out which brand name patches would probably cause least problems and went from there. I just had to make sure my prescriptions were made out very carefully for a particular brand rather than the generic form.
TENS helps me a lot, as do heat packs, especially for neck pain, and when things are swollen, cold treatments. Some people find deep heat/deep cold gels help. For most people, it will always be a combination of several things: several treatments, a mixture of medication and the physio exercises on top, plus some psychological techniques, each adding in some relief, to get the overall management. Massage may help - her physio can advise on this.
As for the Buddhist thing - that sounds like Mindfulness, which is a technique that can help reduce stress reactions and in turn help control your response to the pain. It's very effective and is recommended by lots of pain clinics and is used extensively with cancer patients. My pain clinic doesn't have any courses on it but does rate it and I can't find a course or session I can get to near me, so don't rule things out!
Quite frankly, I'd do anything to get my pain to go down (or away!) and find that people often overlook the basics, such as rest, paracetamol etc, which are needed in conjunction with the other things. For instance, I am on a large daily dose of opiates (currently oxycontin), plus cox-2's as I can't have NSAIDs, paracetamol then acts as a helper drug and helps the aching feelings, then I have something for neuropathic pain and antidepressants (often used for chronic pain), then stomach protectors, anti-emetics, anti-histamines and laxatives to control the side effects of the pain killers, plus liquid oxynorm for breakthrough pain, then daily stretches, physio exercises and massages, heat packs, biofreeze gel, splints and resting splints, my beloved TENS machine, then distraction techniques, meditation and hypnotherapy, and plenty of rest, and hydro sessions in warm water each week. Lots of different things but each plays it's role and each helps, else it wouldn't be there, but mainly, although some of the above might give someone helpful ideas, I mean to illustrate that long term pain is complex and each person will have their own combination and it's rarely one straightforward drug.
I should point out as well that you need to get the electrodes placed right for TENS to be properly effective (don't worry - it's not complicated or especially precise) which a physio can normally advise you on.
I am not sure though from your post whether your PA has a chronic pain problem that is more permanent or something that although will be classed as chronic as it has been there a while, is from a one-off injury or some such thing that will eventually be fully treated, so apologies if some of it is not relevant. I hope K finds something that works for her soon :-)
gg
