# Pain Management and Pain Killers



## 15836 (Nov 13, 2006)

As some of you may know, my life has been living hell for the last 12 months (which is when my IBS began). I have finally broke down and am going to ask my GI doc for pain killers, becuase when I get an attack the pain is just too unbearable. My question is what is the best painkiller for unbearable abdominal pain (I don't care about side effects). Also, is it better to just try to get your GI to get them or is it better to go to a Pain Managment doc?ThanksRab


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## 14416 (Jun 21, 2005)

Neither of my GI's prescribed them for my IBS. They were totally against their use.I went to two different pain management doctors. The first one prescribed Duragesic (fentanyl patch) and Lyrica. Insurance changed so we went to another pain management physician who prescribed Avinza (12-24 version of Morphine).I was on Morphine for about 3 months. It helped with the diarrhea tremendously, but it made me much more sensitive to the pain, in my opinion. I was on the verge of Narcotic Bowel Syndrome - it's very hard to describe the way it made my intestines feel - it didn't address the cramping/stabbing pain in my intestines like it would have addressed the pain from a back injury. In my opinion, pain medications are tremendous for diarrhea relief, but don't do much, if anything, for IBS/intestinal pain.This was just my personal experience.It was much easier to have a pain management physician prescribe them than it was trying to convince my GI to give them to me.


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## overitnow (Nov 25, 2001)

I was at the lower end of the pain scale with my D, so this is not a personal testimonial; but LynnP--ex of this group--also uses the same supplement I do and this is her report, from an e-mail to another suffererFrom Provex CV--for Leslie 204 in the Products and Websites Forum)"Hi, A__, "Mark Sprague asked me to email you re my successes in using Provex CV. I have suffered from IBS D for 13 years now. Unlike Mark, however, the pain was so intense when I had attacks, I would literally turn white faced and have finger nail marks in the palms of my hands. If you've had children at all, equate that pain to labor pains and you'd be close."I have been on Provex for over a year now (started in Feb. 2003) and have to say, that I'm 75% better than I have been for many years. As Mark stated, I no longer have intense abdominal pain and while I'm not anywhere near as regular as a 10am freight train, I tend to only have one bowel movement a day, and sometimes two - way better than the four to five I was having daily. My MD was amazed that he was able to manipulate my abdomen without me feeling any discomfort."I used to eat Imodium like it was candy - up to 30 to 40 tablets a month - now I have two or so once every 10 days or so. I'm not so tired and I actually leave the house in the morning not wondering if I am going to have to stop and visit the gas station on my way to work. I can do morning meetings now and actually go out and enjoy myself in the evenings."This is not a pain med; but it seems to correct problems that lead to both pain and D. Other than a slight blood thinning from the ginko biloba, there haven't been any negative side effects that I have noticed.Mark


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## eric (Jul 8, 1999)

Narcotics for IBS is probably a bad idea."Narcotic. Narcotic analgesic drugs are usually not prescribed for continuous treatment because of possible development of physical dependency or addiction and unwanted side effects, such as drowsiness and interference with clear thinking. Furthermore, continuous narcotic use can actually increase pain sensitivity and also alter gut motility, leading to severe constipation. This is called the â€œnarcotic bowel syndromeâ€ (Annals of Internal Medicine, 1984;101:331â€"334). Keeping these cautions in mind, narcotic analgesic drugs are occasionally used to relieve intermittent attacks of more severe pain."http://www.grandtimes.com/Treatment_of_Irritable.htmlMost people with severe pain in IBS, have that pain quite often.Second this is something I think many don't think to much about or even know about. "continuous narcotic use can actually increase pain sensitivity"This is very important. Already there is increased pain sensivity in IBS, this is called viceral hypersensivity. The narcotics make the pain receptors in the gut more sensitive to pain and lower already lowered pain thresholds.So treating pain in IBS this way is extremely counterproductive. They know alot more about the generation of pain in IBS then they used to and there are ways to manage pain in IBS more effectively then in the past.You might also talk to people with or who had severe IBS pain, like myself and even morphine and other narcotics didn't help all that much, except basically to relax you and put a person to sleep.Some people with IBS and minor pain and d, might like them because they might help the d, but they might also be unaware that the pain gets worse over time. I have known people with narcotic bowel syndrome and IBS and they were really messed up with pain, its not a good thing.


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## 16229 (Jan 28, 2006)

The biggest worry there is the alteration of gut motility.As far as addiction/dependence, when someone can tell me why it's okay to be dependant on Xanax but not on oxycodone, then I might begin to try to understand the argument. The fact is they prescribe a lot of things that create dependence, cause drowsiness and interfere with clear thinking.That being said, they are not something that should be used daily or even several days of the week. You'd just be trading one problem for another. Acute attacks may be a different situation, but what given pain killers help vary drastically, and some it doesn't help much at all.From experience, the best thing to actually help you in the long term, if you have chronic pain, is a pain management therapist. We often make things much worse pain wise by a) overreacting







hyperventilating. These make the pain worse and the attacks longer.I'll admit I'm still sketchy on the whole narcotic bowel syndrome thing, and if it is true I don't really think, after talking with many doctors, that it is the top worry. At least it doesn't seem to be to them. But, really, anything more than occasional use for acute attacks is too much for IBS. Using them for the run of the mill stuff, probably isn't best.I still use painkillers, on occasion, but believe me when I say that pain management therapy has been a much better tool. It's helped me cope with the pain on a much more consistent basis. Also, my pain tolerance is so much higher than it used to be it's crazy to think about. Note, that with I, take the meds mainly to fall asleep. They do not fully relieve my pain. Just enough, hopefully, for me to sleep through it.


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## eric (Jul 8, 1999)

Narcotic bowel syndrome is very real and pretty common. Its also probably not something most people know about or really even care about when they are in severe pain and want it to go away. I have done a lot of research on pain and IBS, which has been very helpful to me personally.Serotonin when released from the gut is the neurotransmitter that sends singals up nerve fibers to the brain in regards to sensations. The brain then sends signals back to the gut.This is on pain in general worth reading.Mind-Body-Pain Connection: How Does It Work?http://www.webmd.com/content/article/1/1700_50465.htmalso drugs like vicodan "binds to the opiate receptors in the gut."Long term they can desensitize the gut receptors and make pain worse, this is called narcotic bowel syndrome.


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## eric (Jul 8, 1999)

Also FYI with a treatment that is safe and effective in the majority of IBSers, espeically pain and is a natural way to go with pain and symptoms."A Patient symposium for understanding IBS and other functional GI Disorders was held by the UNC Center for Functional GI & Motility Disorders on July 15, 2006."Olafur Palsson gave a very practical presentation on the clinical uses of hypnosis.70-80% benefit in studies for pain and IBShome hypnosis shows an improvement vs. standard medical care with no hypnosishttp://www.ibshypnosis.comThere are two hypnosis models:The Manchester Model (Peter Whorwell)The North Carolina Model (Palsson)http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/131102842Why Consider Hypnosis Treatment for IBS?by Olafur S. Palsson, Psy.D.Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients (click here for discussion of treatment options for IBS). However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. - The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects. - The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms. http://www.ibshypnosis.com/whyhypnosis.html


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## 15836 (Nov 13, 2006)

Thanks for all the replies. Yes, currently I take Hyoscyamine, but it only helps very minimally during attacks. I'm also on Sertraline and Nortriptyline. My GI won't give me any Narcotis for my attacks, but a few people mentioned that taking a narcotic (Vicodin or similar) seldomly, like when attacks occur maybe once or twice a month, that its not that bad for you. Does anyone agree?


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## eric (Jul 8, 1999)

Do you only get pain attacks once or twice a month?Most of the antispasmatic are not all that effective.My pain attacks you to be around four times a week sometimes twice a day, but they could also last the whole day as well or sometimes go away as fast as they came on.One thing is for sure, when I learned how to really relax when I was having an attack, which was not easy at first, helped greatly. If you get worked up during one it makes it a lot worse.The HT however did a huge number for me on pain and IBS, as well as other symptoms. Maybe I have a pain attack once every three months if that now and they are far less severe. Most of the time now I can relax my gut right before the attack begins and I am usally 95 percent of the time okay then.


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## 15836 (Nov 13, 2006)

Well, my stomach/intestines hurts everyday/24-7 (on a scale of 1-10, the pain is about a 5 every minute of every day). When I get attacks, the pain shoots to about a 9 (which is pretty unbearable). I get attacks about 2 times a month and they usually last about 2 days. Even though I've been to the ER several times, my GI doc still refuses to give me some narcotics for the pain. Thus, I have no choice but to see a pain management doc.


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## eric (Jul 8, 1999)

You know"hurts everyday/24-7"If that is really the case you might get a second opinion.Although IBS can cause a lot of pain, 24/7 is a red flag.Does it go away at night for the most part?You say it 24/7 though, but say you get them 2 times a month and they last for two days.IS it your always in pain then it get worse? My pain could go over ten off the scales. Do you have any idea or guess on how your IBS got started?


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## 23376 (Jul 31, 2006)

I too suffer on a constant basis. Mostly though it it is a dull ache that elevates into intense pain on occasion. My pain is generally constrained to my lower left side.I've been keeping a journal lately. I've been recording the foods and times I eat along with any symptoms and meds.A couple of things I have discovered so far is that fatty foods (red meat and chocolate in particular) cause me untold grief. Because I'm an alternating D & C my doc prescribed codeine to control the pain. While it does not elimate the pain, it makes it bearable.While IBS and it symptoms are unique to most individuals, hopefully sharing, can help.Jack


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## 16229 (Jan 28, 2006)

Funny, it was actually an ER doc that started prescribing them for me. He said he was sick of seeing me all the time.You probably need a pain management specialist, but the key is, to monitor symptoms well. As I said, the altered gut motility is probably the worst potential. It can complicate things, especially since you already have gut problems.


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## Screamer (Aug 16, 2005)

I'm another one who's in pain 24-7 and my doctor also told me to take codiene to slow down the bowel when I'm having bad D attacks (you can get it over the counter here though). My pain is about a 6 or 7 pretty much every day and then during attacks it's off the scale. I've yet to find much that helps and it's IBS, I've had every test my doctor could think of. Another thing with me is my pain is totally unrelated to what's going on with my bowels. I can be slightly C and have a good day or slightly D and have a good day and have a normal day and be in agony. Or any combination of these.


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## eric (Jul 8, 1999)

Its pretty well known that serotonin plays a crucial role in sending the signals from the gut to the brain in regards to sensations and discomfort and pain.Visceral Sensations and Brain-Gut MechanismsBy: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLAhttp://www.aboutibs.org/Publications/VisceralSensations.htmlAmy, the pain can come on from normal functioning even. "Abnormalities include hyperalgesia, in which patients report greater pain than healthy volunteers for a given noxious stimulus; allodynia, in which patients report pain from stimulus that is nonpainful in healthy volunteers; and altered pain referral patterns"This is worth watching and also talks about thishttp://www.ja-online.com/dukeibs/eval/exam.php


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## 18408 (Oct 11, 2006)

well for what it is worth i have a great deal of pain and by pain i mean out of 10 it is a 10 but i do have pain killers and try not to take them i am waiting on having my stomach open for a look round they done cams inside and all the ct scans ultra sounds and bloods they now think it may be scar tissue even throguh i have not had a op on me stomach you can get growths on the stomach , well i have had extra strong poain killers named pethidine but i was given a copy of mike mahoneys cd 100 to use i was thinking this can't work but i will try and i have had less pain in the last 2 weeks of starting the dics i am only on day 17 but it seems to be helpin i don't know how but it is so fingers crossedcheers


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## eric (Jul 8, 1999)

Steptoe, hypnotherapy can help the brain downregulate endorphines to the gut.It also works on the anterior cinculate cortex a problem seen in IBS and pain.However it also reduces stress and anxiety as a side effect. There are other reason though and some not fully understood yet.


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## eric (Jul 8, 1999)

PS I am glad they are helping you they have helped a lot of people here and elsewhere, including myself tremedously.


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## 15836 (Nov 13, 2006)

Eric wrote: You know"hurts everyday/24-7If that is really the case you might get a second opinion.Although IBS can cause a lot of pain, 24/7 is a red flag.Does it go away at night for the most part?You say it 24/7 though, but say you get them 2 times a month and they last for two days.IS it your always in pain then it get worse? My pain could go over ten off the scales. Do you have any idea or guess on how your IBS got started?Well, yes it hurts everyday -24/7 - Its more of a dull ache pain that never goes away. When it flares the pain shoots to a 10. Actually, I have already got a second opinion. I have taken every test in the book. And I live in NYC, where my 2 GI docs I see are some of the best in the world. They say they have tried everything and now I just need to take these meds and hope for the best. Although my docs have not prescribed any narcotics yet, I have taken Vicodin (from a friend) during an attack, and it has helped tremendously. BTW, the anti-spasmodics the doc gave don't do a damn thing....


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## eric (Jul 8, 1999)

Rab, do you go to the Mind Body Digestive center by any chance in NY?Mind-Body Digestive Center Research and Treatment The Mind-Body Digestive Center80 Central Park West New York, N.Y. 10023 Telephone 212 712 0494 Fax 212 787 0983 E-mail info###mindbodydigestive.com At the Mind-Body Center, we are a gastroenterologist and clinical psychologist interested in helping patients with functional bowel disorders. Our current focus is Irritable Bowel Syndrome.http://mindbodydigestive.com/They could be very helpful for you, especially with the pain.Also narcotic bowel syndrome doesn't happen right away. At first the narcotic helps and as the pain receptors become sensitized, it might take more pain pills for the same effect and each time you have an attack the pain gets worse and eventually narcotics don't work and your left in even more pain.So at first a person is going this is a good thing, but later it can become really bad. Worst then it is now.What have you tried so far, lets go down the list.


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## Flowby Jonas (Aug 14, 2006)

I don't know about the rest of you but I cannot tolerate any of those oral pain meds. I mean they make me PUKEand make my tummy flip out in an array of different painfull ways. Worse, I feel like garbage when I take them. I have not taken any of those since 1995. I have found for me there is one way to manage pain. Here in Oregon, medical marijuana is available to us with diagnosed IBS. I have lost 35 lbs over the last 5 months as well. For years I knew of the nausea stopping abilities for marijuana. I have found that for me it helps with the pain and the nausea I get. After an attack when you are sitting there in pain, dried out, and weak I lay down and smoke a little pot and rest.Now I don't recomend this to anyone but it works for me. I had been having 3-4 attacks a week for about 4 months till I started to eat carefully and drink my water. I have not had an attack for 12 days now, its kinda weird. I guess I have been self medicating for awhile now because for years I thought I was getting food poisoning. It took me years to realize it was something otherwise. I dont think the pot changed anything just made it easier to deal with it.As far as some of these pain and anit-depressant meds go I won't buy into them and the pharma-money companies out to do what ever they can to make a buck. About every day you hear something about a drug that the FDA is freaked out about or allows that is bad for us. There are many examples of this out there, oxicontin is just one.One thing I have discovered is I can't tell when I hungry anymore. Sometimes I feel pain and its because I am hungry. I was having so many attacks I stopped eating for 4 days or so cause I didn't want another attack. I started to wonder if IBS could lead to bulimia or anarexia.This is not a advocation for pot just my experience.Chris


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## 15836 (Nov 13, 2006)

Eric,I have not yet been to The Mind-Body Digestive Center. However I actually live right near there. I will check it out as soon as I get free time. Do you know if my Insurance (Cigna) will cover it? Also, do you go there? And how is the pain reduced without any medication?


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## BQ (May 22, 2000)

Rab,Here's Cigna's site:http://www.cigna.com/On the left side of the page you will see a tab for "Provider Directory".. Look up the Doc there to see if he accepts Cigna.BQ


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## 16229 (Jan 28, 2006)

rab, I don't know this particular one, persay, but they use a combination of therapies along with teaching coping techniques.Breathing exercises are stressed, as well as pain aversion (meaning, showing you how to ignore it so it does not bother you). That usually involves engrossing yourself in something else. For me, that's usually video games.They use things like massage/acupunture to help release bottled up pain and ease cramps.They also have a long set of things, cbt, to help you identify different situations, and getting your body to respond in a positive way to those situations. Some centers go all out, with different tests to show you the emotions etc. you feel, when, and why. Over time you train your body to react differently in these situations.Depending on the center, there are a range of other things they use.Note, these things work great for mild to moderate, sometimes even significant pain. Sometimes the long term treatment includes meds (depending on the center) and sometimes not. You should probably look up the center to see exactly what they do.As I said, this stuff is great. It still only works up to a point, though, that is why some still use the narcotics as temporary stopgaps for rough times. As it was explained to me last year when things were really bad. I needed a rest from the pain to deal with the pain. At that time, I was in too much pain to accomplish anything from the therapy. After two weeks on the narcotics (while still in therapy) they cycled me back off of them into the normal therapy again.


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## Lillett (Jun 4, 2006)

My PA prescribed me Nortriptyline. It is an antidepressant but has been shown to be effective for pain relief in IBS-D patients. I have had very little pain with it this first week however it does make me constipated. I am on a very low dose but I am finally getting some relief. We'll see.


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## eric (Jul 8, 1999)

Lillett They prescribe antidepressants because of the link in IBS to serotonin and because the gut uses serotonin to signal to the brain sensations.So its possible to modify.There is also a connection with relaxation techniques and serotonin. You can learn to use the brain for relief in pain and for IBS.Because all pain is processed in the brain and the brain then sends signals back to the gut, these processes can also be modified for releif. This is a learning process.A lot of doctors treat one symptoms, and that is good to treat the most bothersome symptoms first for releif, the mind body center treats the person as a whole person. This can make a significant impact on IBS, in fact its where a lot of IBS find relief in research.I live on the west coast so I don't go there, but have sent quite a few people there who have been pretty happy with their help.


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## eric (Jul 8, 1999)

Things to know aboutPain and Mood: Depression Hurtshttp://www.msnbc.msn.com/id/6038684/site/newsweek/ANGER AND CHRONIC PAINhttp://www.long-beach.med.va.gov/Our_Servi...ok/cpmp-15.htmlIrritable Bowel Syndrome and Depressionhttp://www.webmd.com/content/article/86/99285.htm"Visceral Sensations and Brain-Gut Mechanisms " "Visceral Sensations and Brain-Gut Mechanisms By: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLA http://www.aboutibs.org/Publications/VisceralSensations.htmlMind-Body-Pain Connection: How Does It Work? http://www.webmd.com/content/article/1/170...vent%20ArchivesStrategies for Coping with Chronic Painhttp://www.healthauthority.com/painmanagement.htm#StrategiesAre You A Gut Responder? http://www.aboutibs.org/Publications/gutResponder.html


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## Twocups424 (Mar 26, 2002)

All I know is.....I've tried antispasmotics,antidepressants, antiacid pills, calcium, watching my diet, not watching my diet,Donnatol, belladonna, Questran, Immodium, cortosteriods, codeine, ultram, etc. etc. The only combination that truly makes me the best is Questran everyday ( 2 scoops) 1-2 immodium, and a codeine pill everyday or maybe two at most of a low dose pill. NO DR. WILL PRESCRIBE THAT ON A REGULAR BASIS. I'M ALMOST READY TO DO IT ILLEGALLY TO LIVE A NORMAL LIFE. THE PAIN IS LIKE A TOOTHACHE IN MY BUTT!!!!!


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## eric (Jul 8, 1999)

The pain can be like a migrane in the gut.Two cups like you know drugs worked for me on pain, it wasn't until I used the gut directed hypnotherapy did my severe pain drastically improve. Meds are not the only answer.also"In this disorder, the digestive tract is especially sensitive to many stimuli. Stress, diet, drugs, hormones, or minor irritants may cause the digestive tract to contract abnormally, usually leading to diarrhea. Periods of constipation may occur between bouts of diarrhea. Irritable bowel syndrome affects women 3 times more often than men.The brain has enormous control over the digestive system. Stress, anxiety, depression, fear, and virtually any strong emotion can lead to diarrhea, constipation, and other changes in bowel function and can further worsen a flare-up (bout or attack) of irritable bowel syndrome.During a flare-up, the contractions of the digestive tract become stronger and more frequent, and the resulting rapid transit of food and stool through the large intestine often leads to diarrhea. Crampy pain seems to result from the strong contractions of the large intestine and increased sensitivity of the receptors in the large intestine that sense stretching and pressure. Flare-ups almost always occur when a person is awake; they rarely wake a person from sleep."http://ibsgroup.org/groupee/forums/a/tpc/f...m/592100662/p/2Is as important to treat this"The brain has enormous control over the digestive system. Stress, anxiety, depression, fear, and virtually any strong emotion can lead to diarrhea, constipation, and other changes in bowel function and can further worsen a flare-up (bout or attack) of irritable bowel syndrome."as it is the gut, they are both operational to generate the symtoms. For example mast cells have been implicated in IBS. These cells are embbed in the gut wall. A real or perceived threat, even the threat of an upcoming pain attack, will cause the the HPA axis or Hypothalamic-pituitary-adrenal axis the bodies stress system to send signals to those mast cells in the gut, which in turn do something called degradulation, basically inflame break open and releases histime onto the smooth muscle. The smooth muscle reacts to it as a toxin and this can contribute to pain in IBS.One of the many ways stress anxiety and even subtle emotions can aggravate and cause very real physical symptoms. Its not a its in your head thing, but how the brain and gut brain work together.also I put this on another thread and I totaslly here you want pain relief, the pain can be totally unbearable and directly effects one mental state for sure. Out of all my IBS symptoms, it was pain that made me the most suicidal.Pain in IBS is very real and can be off the charts.Narcotic bowel syndrome is very real and is pretty common.Most people don't really understand it well and want releif from pain, but by taking narcotics there are gradually causing more pain each time.Its important in IBS also to learn pain management and not just rely on narcotics or antidepressants. hear where people are coming from because you can read my previous posts on Pain and my own IBS and I totally understand how bad pain in IBS can be and not wanting to live with it, however the above things make pain worse long term in IBSers. *This doesn't happen right away either it happens slowly without the person being aware of it at first.*


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## eric (Jul 8, 1999)

This is something to practice. Not while having a pain attack, but when you learn it it can help relive the pain when you have an attack.From Michael Mahoney Mike suggests How to Relax Your Tummy Muscles ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Firstly you have identified that your stomach is not relaxing. However you knwo it can, becuase you have done it in the past. OK so just take a few mo's and study your breathing.. If your chest rises when you breathe in then you are taking big breaths, not deep breaths which you should be A deep breathe is when you chest stays still, and your tummy moves out. To get it as it as it should: First lie down. Put a book on your tummy, and breathe your breathe into your tummy and feel the book begining to rise. (Don't force your tummy muscles out - let the breath fill your tummy ) You will have to concentrate a little to start with. Do this with your eyes open. Once you are doing that comfortably, put the book on your chest. breathe into your tummy and keep the book still. Your tummy should move, not your chest. This happens quite naturally at night when we sleep - (assuming you don't have any breathing health problems) Do this with your eyes open too. When you have mastered that, put the book back onto your tummy, take gentle breaths and breathe into your tummy under the book again. This time with your eyes closed. Then after 6 successful deep breathes, open your eyes, put the book back on your chest, close your eyes and let the breathe go into the tummy again, chest remaining still. OK, When you can do this, do it without the book. You will notice a difference in the calming, and your stomach relaxing. To help think of each breathe having a relaxing colour, and the colour relaxes your stomach even more. Try this a few times a day and let me know how you go on. This is just gentle control of breathing patterns. So easy, we do it in our sleep anyway Mike author of the IBS Audio Program


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## eric (Jul 8, 1999)

Pain Managementhttp://www.healthauthority.com/painmanagement.htm#Strategies


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## Twocups424 (Mar 26, 2002)

Been there done that!!!! Didn't work. Been through cognative therapy. Always try to practice deep breathing and relaxing my pain away. Doesn't do a thing. I have excess bile in my intestines proven by a colonoscopy in the spring. Excess bile is quite caustic and is burning my guts!!!!! causing extreme cramping. The dr couldn't even finish my colonoscopy even with several drugs. I AM TAKING QUETRAN ETC AND NONE OF IT IS HELPING. WHAT THE HECK ARE DRUGS FOR IF NOT TO HELP YOU LIVE A NORMAL LIFE WHEN PAIN EXSISTS. Tell me the people who take antidepressants, etc. etc. aren't hooked on those just as much. I have a toothach in my butt and it hurts!!! You or anybody else wouldn't be expected to live with a throbbing tooth now would you??? You would want relief. Go try to think away a toothach.


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## eric (Jul 8, 1999)

Actually antidepressants are not addictive.However I hear you. Most of the advise here is for IBS pain management."Excess bile is quite caustic and is burning my guts!!!!! "Is this actually causing uclerations?I don't know anything really about excess bile like that or even what can be done about it. There has to be some doctor somewhere though that might be able to help you.I also actually have a toothache which needs a root canal right now and am waiting for insurance to kick in so yes at the moment I am using mind over matter, but yes I do want it fix as soon as possible. What have the doctors said about helping with the excess bile or are they helping you out to find some kind of treatment for you? Is this bile problem a specific condition like a problem with the liver? I do know I have had severe pain from the IBS most of my entire life. It has played on my mental state in the past greatly. Depression and emotions and pain are very connected. But that is IBS, not exceess bile causing the pain.


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## 23376 (Jul 31, 2006)

I recently visited a new GP who prescribed Celebrex as a pain management tool. Anybody out there have any experience with Celebrex. I have been taking codeine for some time now, but really want to get off the narcotics.Jack


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## Twocups424 (Mar 26, 2002)

Sorry Eric you and I are just not going to see eye to eye. I say yes excess bile is causing my pain. And you didn't read my post, when the dr did my colonscopy he did find excess bile right in there lining my colon. I am TAKING QUESTRAN, but it is not doing the whole trick. I totally disagree that all pain is mind over matter and it I think it away enough it goes. Again I repeat if you can't get pain pills when you need them most what were they created for. Its not like I haven't tried other avenues!!!!! Tried them all. I


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## eric (Jul 8, 1999)

First of all Twocups I am trying to help out here, I am not the enemy in anyway and you seem to be very angry and directing it at me. I am not causing your pain I am trying to figure it out from your posts. If I didn't read your post why above this post did I ask these questions?"Is this bile problem a specific condition like a problem with the liver?"Is this actually causing uclerations?This isn't an IBS problem! Its some other problem. IBS methods for pain are going to be different, then some other conditions and specific pain they can cause.I really don't think you read what I wrote there. Nor did I say this"I totally disagree that all pain is mind over matter and it I think it away enough it goes."Mind over matter helps some pain and that is a fact."US experts say they have strong scientific proof that mind over matter works for relieving pain. ""Positive thinking was as powerful as a shot of morphine for relieving pain and reduced activity in parts of the brain that process pain information."http://news.bbc.co.uk/2/hi/health/4215078.stm Pain is very real and all pain is processed in the brain. I have spent a good part of the last five years studying it very closely.But back to your problem, why do you have excess bile in the colon, its not normal and some doctor must have some kind of explanation to you about why that is happening. IT isn't IBS.


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## aljay (Oct 29, 2005)

Has anyone tried acupuncture for IBS pain. If so did you have any success?.


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## eric (Jul 8, 1999)

In clinical studies accupunture has not shown to be all the benefical for IBS.However gut directed Hypnotherapy has shown to be effective for pain and symptoms. Satistically it is one of the most effective treatments for IBS.http://www.aboutibs.org/Publications/hypnosis.htmlhttp://www.aboutibs.org/Publications/HypnosisPalsson.htmlhttp://www.ibshypnosis.com/index.htmlWhy Consider Hypnosis Treatment for IBS?by Olafur S. Palsson, Psy.D.Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients (click here for discussion of treatment options for IBS). However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. - The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects. - The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms. http://www.ibshypnosis.com/whyhypnosis.html70-80% benefit in studies for pain and IBShttp://ibsgroup.org/groupee/forums/a/tpc/f...261/m/131102842You also don't have to be stuck by the needles and it can last up to five years.


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## eric (Jul 8, 1999)

Acupuncture treatment in irritable bowel syndrome.Schneider A, Enck P, Streitberger K, Weiland C, Bagheri S, Witte S, Friederich HC, Herzog W, Zipfel S. Department of General Practice and Health Services Research, University Medical Hospital, University of Heidelberg, Vossstrasse 2, 69120 Heidelberg, Germany. antonius.schneider###med.uni-heidelberg.deBACKGROUND AND AIMS: Despite occasional positive reports on the efficacy of acupuncture (AC) on functions of the gastrointestinal tract, there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome (IBS). PATIENTS AND METHODS: Forty three patients with IBS according to the Rome II criteria were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the so-called "Streitberger needle". Treatment duration was 10 sessions with an average of two AC sessions per week. The primary end point was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36), compared with baseline assessments. QOL measurements were repeated three months after treatment. RESULTS: Both the AC and SAC groups improved significantly in global QOL, as assessed by the FDDQL, at the end of treatment (p = 0.022), with no differences between the groups. SF-36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F = 6.746, p = 0.003) in a stepwise regression model. CONCLUSIONS: Acupuncture in IBS is primarily a placebo response. Based on the small differences found between the AC and SAC groups, a study including 566 patients would be necessary to prove the efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients.PMID: 16150852


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## aljay (Oct 29, 2005)

Thanks for that Eric. It confirms my own thoughts on the matter but I would be willing to give it a go if I thought there was any chance that acupuncture could help.Pat.


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## eric (Jul 8, 1999)

The HT is way more likely to really help and is a lot easier and very relaxing.You should read thishttp://ibsgroup.org/groupee/forums/a/tpc/f...0261/m/10210344also in regards to pain and IBS and another condition called Chronic ABDOMINAL PAIN SYNDROME another functional disorder that has a lot of similarities to IBS. The messenger for sensations coming from the gut is the neurotransmitter serotonin, which is important in IBS. But some varied infoWHAT IS FUNCTIONAL ABDOMINAL PAIN SYNDROME?People with functional abdominal pain syndrome (FAPS) feel pain in the belly. The pain can be frequent or constant and may not be related to eating or to having a bowel movement. The pain can be so strong that it becomes the main focus of their life. It can affect or get in the way of daily activities. People with irritable bowel syndrome (IBS) may also have abdominal pain, but it is usually related to bowel problems such as diarrhea and/or constipation. To make a diagnosis of functional abdominal pain syndrome, your doctor must first make sure there is no other cause for your symptoms, and that there are no abnormal x-rays or laboratory findings to explain the pain. How is Pain Experienced?Doctors now know that many areas of the brain recognize the sensation of abdominal pain. Nerve signals travel from the abdomen to various areas of the brain. One area records the location of pain and how strong it is. The signals connect to other areas of the brain that involve memories or emotions. This means that the memory or emotion centers of the brain can affect the feeling of pain.What Factors Contribute to Functional Abdominal Pain Syndrome?Pain can appear seemingly without cause, or after a series of painful abdominal conditions, or after a distressing event. During times of added stress, symptoms can worsen.Repeated injury can cause nerves in the abdomen to become overly sensitive. For instance, after several abdominal surgeries, later abdominal pain may be experienced as more painful than before. Even normal bowel activity may feel painful.The amount of support a person receives from family, friends, and other sources can affect how a person responds to pain. Being anxious can make the pain feel worse. If a person has a bad experience with pain, the fear of having the pain again can actually make it worse the next time. How is Functional Abdominal Pain Syndrome Treated? The aim of treatment is to make the pain more tolerable rather than totally get rid of the pain, which usually is not possible. An effective treatment plan can improve how the person functions on a day-to-day basis. The brain not only affects how pain is sensed, but it is also able to block pain. When nerve signals travel up from the abdomen to the brain, some of them go through a kind of â€œgate.â€ Other signals are carried down from the brain to this gate. The signals from the brain can block some of the pain signals from the abdomen by â€œclosingâ€ the gate. Because the brain so strongly controls the sensation of pain, it can actually be used to relieve symptoms of functional abdominal pain syndrome. Different treatment methods that do not involve taking a medication may reduce how the emotional and memory centers of the brain control pain. These methods can also stimulate the brain so that it sends signals to â€œcloseâ€ the pain-control gate (Table 1). Medications may also be used to treat functional abdominal pain syndrome. For constant or severe pain, a doctor might prescribe certain types of antidepressants called tricyclics that help control pain sensation. At low doses, these drugs do not act as antidepressants but instead they act as pain relievers for treatment of functional abdominal pain syndrome and other painful conditions. The medicines help stimulate the brain to increase the signals that reduce pain. They sometimes take several weeks to work. WHAT IS FUNCTIONAL ABDOMINAL PAIN SYNDROME?People with functional abdominal pain syndrome (FAPS) feel pain in the belly. The pain can be frequent or constant and may not be related to eating or to having a bowel movement. The pain can be so strong that it becomes the main focus of their life. It can affect or get in the way of daily activities. People with irritable bowel syndrome (IBS) may also have abdominal pain, but it is usually related to bowel problems such as diarrhea and/or constipation. To make a diagnosis of functional abdominal pain syndrome, your doctor must first make sure there is no other cause for your symptoms, and that there are no abnormal x-rays or laboratory findings to explain the pain. How is Pain Experienced?Doctors now know that many areas of the brain recognize the sensation of abdominal pain. Nerve signals travel from the abdomen to various areas of the brain. One area records the location of pain and how strong it is. The signals connect to other areas of the brain that involve memories or emotions. This means that the memory or emotion centers of the brain can affect the feeling of pain.What Factors Contribute to Functional Abdominal Pain Syndrome?Pain can appear seemingly without cause, or after a series of painful abdominal conditions, or after a distressing event. During times of added stress, symptoms can worsen.Repeated injury can cause nerves in the abdomen to become overly sensitive. For instance, after several abdominal surgeries, later abdominal pain may be experienced as more painful than before. Even normal bowel activity may feel painful.The amount of support a person receives from family, friends, and other sources can affect how a person responds to pain. Being anxious can make the pain feel worse. If a person has a bad experience with pain, the fear of having the pain again can actually make it worse the next time. How is Functional Abdominal Pain Syndrome Treated? The aim of treatment is to make the pain more tolerable rather than totally get rid of the pain, which usually is not possible. An effective treatment plan can improve how the person functions on a day-to-day basis. The brain not only affects how pain is sensed, but it is also able to block pain. When nerve signals travel up from the abdomen to the brain, some of them go through a kind of â€œgate.â€ Other signals are carried down from the brain to this gate. The signals from the brain can block some of the pain signals from the abdomen by â€œclosingâ€ the gate. Because the brain so strongly controls the sensation of pain, it can actually be used to relieve symptoms of functional abdominal pain syndrome. Different treatment methods that do not involve taking a medication may reduce how the emotional and memory centers of the brain control pain. These methods can also stimulate the brain so that it sends signals to â€œcloseâ€ the pain-control gate (Table 1). Medications may also be used to treat functional abdominal pain syndrome. For constant or severe pain, a doctor might prescribe certain types of antidepressants called tricyclics that help control pain sensation. At low doses, these drugs do not act as antidepressants but instead they act as pain relievers for treatment of functional abdominal pain syndrome and other painful conditions. The medicines help stimulate the brain to increase the signals that reduce pain. They sometimes take several weeks to work. http://www.acg.gi.org/patients/gihealth/functional.aspIt is strongly speculated that the HT helps downregulate signals from the brain to the gut, might possibly help close the gate and also release endorphines back to the gut. also"Previous research found that hypnotherapy affects an area of the brain that processes emotional response to painful stimuli and that it can also reduce levels of gastric acid produced by the stomach."Visceral Sensations and Brain-Gut MechanismsBy: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLAhttp://www.aboutibs.org/Publications/VisceralSensations.htmlThere is newer information on IBS and a chemical called CRF as well as a connection to the gut and mast cells that contribute to the pain and are activated by chronic stressors, both physical and mental. There is also importantly the serotonin issues and that is also in part a treatment option in both medicines and stress reduction.I have a ton more information on this subject.


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## eric (Jul 8, 1999)

I should post this because its important research they have been doing now for a couple years. They insert a ballon into the rectum and apply pressure, while studying the brain."Neuroimaging has provided evidence of physiological differences between normal individuals and those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed in the brain.[14,15] Initial data from positron emission tomography (PET) scans demonstrated increased activation of the anterior cingulate cortex (ACC) among normal individuals, compared to IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thought to be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in the ACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared to normal individuals."





















They have also seemed to have known for a while now that pain gate seems to be lost and all visceral information is being sent when it shouldn't be.


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## eric (Jul 8, 1999)

FYIStudy shows link between IBS and painhttp://www.channelnewsasia.com/stories/hea.../239806/1/.html


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## eric (Jul 8, 1999)

This is brand new"Patients treated with opioids often develop constipation due to delayed colonic transit and reduced gastrointestinal tract secretions. New findings from Coates and colleagues[9] showed that the serotonin (5-hydroxytryptamine [HT]) signaling system may also play a role in opioid-induced constipation, *which represents a pharmacologically induced functional disorder*. Serotonin is secreted from enterochromaffin cells, and is an important activator of reflexes in the bowel. Rectal mucosal biopsies from patients with opioid-induced constipation (n = 14; 50% women) were compared with those from healthy controls (n = 14; 50% women). Enterochromaffin cells were identified by immunohistochemistry, serotonin content was identified by enzyme-linked immunosorbent assay, and levels of the selective-serotonin reuptake transporter (SERT) were measured by mRNA levels. The authors found that SERT levels were significantly lower in patients with opioid-induced constipation compared with controls (P < .05), whereas there was no difference in serotonin levels and enterochromaffin cell numbers between the 2 groups. Although the mechanism of opiate-associated changes in SERT levels was not addressed, this study suggests that agents that stimulate the serotonin pathway may prove useful in opioid-induced constipation."http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/316101372That would be a drug like zelnorm.There is a lot of evidence on serotonin and IBS.


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## Albion (Feb 14, 2001)

I wouldn't take opioids for pain from IBS for the reasons others have mentioned, namely, the most common opioids (morphine, codeine, hydrocodone) are extremely constipating, and would probably worsen cramping that would ordinarily be relieved upon a BM.Narcotic bowel syndrome is very real, although it is entirely reversible once the opioids are discontinued. Clonidine (Catapres) 0.1mg has been used to facilitate withdrawal from opioids due to NBS.I take morphine (in opium tincture) for IBS-D, but this controls the diarrhea only; it has no effect on any pain caused by cramping. Fortunately, I do not experience cramping very often, but if I did, I would probably discontinue the morphine.Opiates would not seem to be a great choice to relieve the type of pain you are describing -- they make make the pain worse in the short and long-term. Generally, MDs (especially in ERs) would be extremely hesitant to prescribe opiates when a patient presents with intestinal cramping, since an impaction may be present, and any opioid would make matters worse.


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## Rick (never give up) (Oct 7, 2005)

I would like to suggest something that has worked for me, although I know it may not work for everyone.My major symptom has always been the pain, it's usually gone in the morning upon rising, but as soon as I wake up it slowly shows up. And it present all day long, with its ups and downs of course. Some days the pain is mild, other it's very strong.For this the only thing that gives me some relief so far are the enteric coated peppermint oil capsules, although I suspect (still doing some reseach on that) they may alter my gut motility. But when my gut is angry, one pill usually get's me going.Hope this helps.


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## Princefan (Nov 14, 2009)

HelloI am new to the Ibs forum. I have suffered all my life with bowel probems I am 53. My last colonoscopy was normal. For the past 6 years, my Dr has had me on narcotic therapy. I take a Tylenol 4 with each meal. This allows my digestive tract to slow down and allows me to work, eat out ect without having to worry about cramps and D within 30 minutes of a meal. It has not, however, helped me with the spasms that wake me up at night on occasion. These attacks last several hours and end only after a bm. I have nearly passed out, broken into sweats and thought I was dying during the attack. I have often thanked my Dr for the codiene because it allows me to control when I need to have a bm. After reading these posts about narcotic bowel syndrome, I am a little concerned. I know this medication is addictive, but I figured since it helped me live a more normal life, I would always be on them anyway. I have taken Xanax every night for 10 yrs too. Why have medication for ppl to use to help them, then worry about it being addictive if it's working for them?Anyway, I'm very unsure now if I'm doing the right thing by letting my dr use narcotic therapy for my bowels. Why would he give it to me if it wasn't safe?


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## BQ (May 22, 2000)

Best to ask your Dr about this and discuss your soncerns with him/her. There are alternatives to try (eg: Calcium Carbonate, bile salt binders, antispasmodics, etc ) if you would like to slow things down or firm up BM's. But talk to your Dr first about your concerns and see what they say.


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## Kathleen M. (Nov 16, 1999)

The thing is NBS isn't something that will happen to every patient. No side effect is universal. I also don't know if there is as much awareness of that problem among physicians as there should be.I would watch out for any indication your abdominal pain starts being a lot worse. Especially since that tends to compound the physical addiction where you take higher doses or take the pills more often to get the same effect.Every treatment has risks and benefits. Sometimes the risk is worth it if the patient can regain control of their life and isn't chained to a toilet all day every day.However because of the risks of narcotics doctors usually see if other things, like Imodium which has a similar mechanism of action, but doesn't have the addiction risk, will work before progressing to narcotics to control diarrhea.


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## stephanie11905 (May 8, 2009)

Luckily I do not have unbearable pain from IBS but I do from hemmies.... Sometimes they keep me up all night which makes me usless throughout the day. My general doctor gave hydrocodone. I used to take them regularly but was unaware of one side effect. I was so grateful for a full night sleep that I failed to do research and discover that it causes constipation. I ended up with pretty severe constipation. That in turn messed up my IBS severly to the point of losing 20 lbs from not being able to eat anything.. I understand about pain. When you have it you want it gone just becareful of the side effects of any pain killers you get. I now rarely take them but when I do I make sure I have extra fiber and take stool softner too. It seems to be working well.


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