How is Chronic Angina Pain treated without using nacotics?

I am on 4 different medications for angina. If the angina gets out of control I have to go to ER get a nitro drip spend the night in ICU and then released for the next time. I am treated like a narcotic drug seeker. I have had an ER actually give me 0.5 mg of MS via IV after having severe angina for over an hour and then they are perplexed when it doesn't work. My PCP refused to write a prescription for narcotics for chronic angina pain and refused to refer me to a pain specialist. Where does that leave me as a patient living with chronic angina pain that is trying to have some relief? My last visit to ER and ICU for 12 hr visit was $10,000.00. Does anyone have a cardialogist or PCP that is willing to address your chronic angina pain? I have advanced Microvascular Cardiac Disease. I use Nitro Spray 0.4mg and I will use 8-15 sprays on a normal day where I have not had any real activity. Please need some feedback. I am having doctors tell me I am not having any real pain and more is less to treat me and the latest doctor said he was a minimalist. Meaning don't ask me for a prescription for pain just suck it up and pay me. By the way I'm an RN and never told my patients they just don't have pain.
Please respond. I need to show the responses to my latest PCP the minimalist.
Hugs,
VeeCee

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VeeCee,

There is an offline group of MVD women (very exclusive club!) who discuss some of the specifics. Pain management is a big topic...Some women have MDs who get it and treat it, some still struggle with hospitalizations or MDs who don't get it, some have pain management MDs that are worth their weight in gold. Being treated like a drug seeker seems to be a familiar refrain. One of the group is a former cardiac RN for many years (joanincarolina), but she's been offline a bit more lately. We also have a couple of other medical professionals.

If you want to message me privately, I can see what specific threads I can direct you to or send you. Some of this dialogue happens via email, sometimes on a closed, private FB page.

xoxoxo Mary

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VeeCee,
Hear you loud and clear. I'm in a similar situation...and a med professional as well..in the group Mary describes above.
Much of what you are describing sounds so familiar. My cardio DID send me to a pain management MD..and I am now on chronic opioid RX..to my personal dismay...but necessary at this point or I would be in the ER or inpatient everyday- also not a possibility and darn it I cannot take my NTG drip home with me !!! So know you are not alone..and feel free to message me privately as well.

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Do you take Ranexa? I take it for coronary artery spasms, but I've read it it used for microvascular problems also.

Doris

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I'd suggest you find a new PCP. And get a cardio doc on your team who will stand behind you.

8-15 sprays of Nitro is a lot on a daily basis. Have you tried NitroStat (0.4mg sub-ling tabs)? I found the spray didn’t always hit the mark.

I have chronic angina as well, for the last five years. I've been fortunate that all my cardiologists +believe+ me (even when stress tests and EKGs are negative). When I get to the ER, I get my cocktail of IV nitro and PRN morphine (bolus) without question. Many ER nurses recognize me and tease me that I know what the ER doc will order even before they’ve seen me.

My cardiologists understand I have chronic angina and have done everything possible to help me, including prescribing pain meds specifically for angina and pointing me toward a Spinal Cord Stimulator (implanted Oct. 31 – which HELPS for small angina attacks, pain level 3-4-5-6). I’m on so many pills already, and don’t like narcotics, so I opted for the SCS and still take NitroStat when needed.

I also carry a note from one of my cardio docs, alerting EMT personnel that if I’ve dialed 9-1-1, to take me to the ER immediately and without question – even if I don’t seem to be in “all that much” distress. I’ve had medics tell me point blank that I wasn’t having heart problems and I’ve had to FIGHT to get them to take me to the hospital – not great for one’s stress factor when one is having an angina attack!

One guy actually refused to transport me to the ER. Fortunately, his partner knew me from many previous trips, and stood up for me. The guy then drove about 15 miles farther than necessary and about 20 miles an hour, increasing a 10 minute trip to nearly a half hour! I complained to the EMT Chief, and that guy was removed from his job. Seems others had complained as well…

Bottom line: get medical personnel on your side, and FIGHT for yourself. Good luck!

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Hi VeeCee

I cannot say anything regarding how your medical profession works because here in England it is as everybody knows different but as patients, our problems are the same.

I have found that not all GTN sprays are equal, some are better than others. At present I have two different manufacturers, Coro-Nitro which is the better one and nitro-lingual which as little effect. When I just used the Nitro-lingual like you it was in excess of 10/12 shots per day but with the coro I know if I have to take 3 times then A&E here I come.

Last Sunday I had a dam good break through event so I know what it’s like, especially when your 80% sure that when you get to hospital some uneducated (in this area) is going to say something silly like ‘you keep pulling your inner chest muscles’.

The paramedics arrived at the tail end, my BP had dropped to 117/59 and they said that I had raised t waves (looking back at some older tracings I can see them raised (inverted) in V1and some ST elevation) as far as I know from reading this can indicate MI. By the time I got to A&E I was coming out of the event and my BP had returned to my norm (135/89) and I probably didn’t now have the raised T wave? I had no troponins and was set after 4 hours to go home, what happened next was unbelievable the Dr came in and said “all change! My registrar said to admit you” anyway next morning a consultant came to speak to me. He was old school and treated me as if I had ‘little woman’s disease’ he actually said this is a womans disease……but men do get it! He stopped Amlodopine (CCB) and put me on antidepressants which sent me zombiefied after 2 pills so I have stopped the happy little woman pills mainly because I am not depressed and my pains are real and when having them I go a dead persons colour. Also my heart beat quickens when I have them from about 85 up to about 120bpm.

You need to stick in there, under the NHS it is the luck of the draw who you see but from my understanding you can pick and choose?

At present (until it is changed again to find my best mix) I’m on:

Lansaprozol 30mg (my stomach objected to the other meds)
Perinderpril 2mg
Isosorbide Mononitrate 90mg (Imdur)
Nicorandil 2 x 10mg
Asprin 75mg
Simvastatin 20mg
GTN Spray as required

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You have to have your medical professionals to back you up with any and every thing. If you can't get thier support go find someone who does cuz they won't do anything good for you ever.

I have never been accused of being a drug seeker though after my triple bypass I think sometimes I sound like it...esp. when I told my PCP I heard they had Fentynal lollipops...those sound good!!! ROFL He just laughed and said I couldn't have them!!!! How wude!!!!

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Ladies, I have read your comments. I am wondering how do you tell it is angina, indigestion or asthma. I am having severe chest pains which normally wake me up in the morning. It fluctuates from once a month to two or three times a week. The last time I had these pains, the pressure discomfort continued for the next two days. I am wondering if I will have tomorrow. Please tell me what your angina pain feels like. I take Isosorbide Mono something, 60 mg twice a day plus nitro. I am still having chest pains. I have CAD. I need to learn what pain I am having and which dr to call. Thanks

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Hi Oldfogie ~ (that name is a hoot)!

If you have Isosorbide, etc, that is a long acting anginal drug, meant to stop angina. Sometimes, people with established heart disease also have small (micro) vessel disease, too, which can be a process to find the right medication combo.

If you are having these pains waking up in the AM, I suspect it might have to do with sleep apnea. I would go so far as to say, you should have a sleep study in a lab overnight, where they have you hooked up and can find out what is happening. Too many people don't make the connection between apnea, hypopnea (which is shallow breathing), and nocturnal /waking chest pain. Sleep disorders are linked to heart disease. Please as your cardiologist or internist or GP to have you sent to a sleep lab to check it out. There is another post here on the sight where this is discussed in great detail.

You could also have GI, reflux, etc, and docs are often quick to assume that is it. Mainly, this is cheaper to solve with a little pill and such. Sleep issues are serious.

All the best, Mary

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Old Fogie - - I agree with Mary about sleep troubles AND small vessel disease (which I have on top of CAD).

I also suggest you talk with your cardiologist about scheduling a stress test (non-invasive) and/or a cardiac cath (invasive). If you have CAD your arteries may be blocking more and more, and thus you are experiencing angina.

For me (and everyone is different:) angina is a) like an elephant is sitting on my sternum, between my breasts AND/OR b) like my heart is a water ballon and someone is squeezing it...

Most important, since you recognize that you are having some sort of pain, is to SEE A DOCTOR. Since you have been diagnosed with CAD, if it were me, I'd call the cardiologist!

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Hi Mary,
I requested you as a friend and will send you an email. I was speaking to my brother today and he seems to think there might be some derogatory comments in my medical records about being a drug seeker. The only place I would even assume that comments to that nature would get in my medical records would be from an ER doctor at the local hospital in Moscow, Idaho. I am going to request all my medical records since my HA in April from that hospital to start with and if I found any MD has made those comments I will seek an attorney and request it expunged from my records. I have spent my entire life being responsible and doing the right thing. I will not tolerate anyone calling me a drug seeker or drug addict. Before my heart attack I was on one medication for hot flashes. I very, very rarely went to the hospital, ER or even PCP! I haven't even been sick for one year. I will not tolerate derogatory comments or charting in my medical chart from any MD or medical professional (in this case non-professional). As a professional RN I have been extreme careful what I have put in any patient chart being very aware that it could end up on a small building sized screen in the front of any US court room. Anyways, appreciate all answers to my discussion post. Everyone keep the faith. Our divine Lord and Savoir blessed me with SSDI after only 4 months so I have faith all things are possible with prayer and devotion.
Hugs to all,
VeeCee

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Maternalcaregiver,
So glad to have so many sisters from different Mothers! I will except you as friend and we can talk privately. No disrespect to all the wonderful members of this website. Inspire has supported me in a way that no one person could. I will have open discussions with anyone on this website as well. I am always looking to gain knowledge.
Last week I had Laryngitis and was noticing every time I stood up I was dizzy, light headed and really felt drained. I got to thinking about my symptoms and decided I needed a lot less Ranexa. So I cut the Ranexa (an anti anginal) from the 2000 mg a day to 1000 mg a day. I must tell you, it did not increase my angina symptoms at all and I have so much more energy and feel so much better. Since my cardiologist is in Seattle and I do not have an appt with a local cardiologist until January I decided to take some matters into my own hands. I believe once the initial trauma of heart attack and 2 subsequent stents has passed and now my body is starting to level out a little bit. This would mean less medication to control some of my symptoms. I have never been one to tolerate medications very well unless my body really needed them. This tendency runs in my family. I also pray to GOD daily that HE will help my body to make collateral microvessels in my heart to help me with the Advanced MVD. I plan on being around for a long time to raise my beautiful 9 yr old daughter and enjoy her life as an adult. We need to help ourselves as much as possible because it is very, very difficult to find an MD that will listen and actually get off their butt and do something aggressive and positive for their patients. Apparently, it is much easier to just treat us like drug seekers, tell us "Less is More" which is what I was just told yesterday and just blow off the patient. They still get paid for the office visit but don't have much charting to do or any follow up. Sorry guys I am just calling it like I see it and thank GOD as a practicing RN I NEVER short changed my patients like I have been as a patient.
Hugs,
VeeCee

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Hello Nan1948,
I wish my problems were as easy as getting a new PCP. After 8 months of being sick I am now on the search for PCP # 5. The last time I went to my local ER in Moscow, Idaho the ER doctor hid until his shift ended and NEVER saw me. They had 2 other patients in the ER at the time. One had a migrane and the other had a UTI. The nurses left me alone in a room for over 50 minutes. My Mom and Husband were with me to witness this nightmare. My Mom was sternly asking the nurses if there were any doctors working in the hospital. After being in an angina attack for 50 minutes the next ER doc came in and said What is your pain level?, about a 3? I said no actually it is about a 9 and I was bawling at the time. He chuckled and said "9, really?" I was given 0.5mg of MS as usual for this particular ER. I was finally sent to ICU for observation and it wasn't until I had been there over 10 hours still have major angina that the ICU nurse decided to call the doctor on call to get an order to increase the MS from 0.5mg Q hr to 2.0 mg q hour. Never had a nitro drip at that ICU even after 4 separate trips to that hospital for severe exacerbation of angina. I had a truly wonder PCP at the time as you can tell. They would never call my cardiologist from Seattle because they were afraid they might look stupid and incompetent. I will never return to that hospital, by the way. My latest trip to the ER was in Pullman, Washington and it was the first time I was ever given a nitro drip. I was in heaven. I will never go to another hospital for angina. The last PCP I saw refused to give me a referral to a pain specialist and said I did not have pain and did not need Percocet anymore. My first prescription for Percocet, in my life, was written on 10/18/2012. I have only had 2 prescriptions for Percocet one was for 10 pills and the other for 60. But I am a huge drug seeker and need to be cut off completely, immediately. For some strange reason that same doctor had charted in her notes that I had been taking Percocet since 2011. I had no idea where in the hell she got that from! I think she just made it up. I suggested a tens unit to this same PCP and she said I don't need it. Had to fire her, the next PCP was in the same clinic. I drove a round trip of 3 hrs to spend 10 minutes with this PCP who had NO OTHER PATIENTS in the waiting room and this was an initial appt to establish care. The first thing he asked me was what can I refill for you and are you here to get PERCOCET?! I told him no, I had plenty of percocet and no I was not there to get any refills I was there to attempt to establish care with the PCP who would listen to me and become a team with a cardiologist to provide care for me. I was not there drug seeking. This PCP also told me that Percocet does not dilate blood vessels so it should not even work for angina. What he didn't realize is that HE was the doctor who prescribed the drug to me the morning that he was the hospitalist when I was in his hospital for observation after having an angina attack. What an idiot. This is the type of stuff I have be dealing with. This PCP told me well that is good because I am a minimalist and less is more. I thought OH GREAT, ANOTHER Doctor who isn't listening and has not even reviewed my chart! I wish my luck with the hospitals was even remotely as good as yours has been. I will keep looking for a better PCP but in rural Idaho it is not near as easy as living in a big city. Thanks for your comments and input. I really appreciate you sharing your experiences.
Hugs,
VeeCee

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Hello Notwell,
I have done a lot of research on MVD (Microvascular Disease) and it has been around for a long time but, has not really been researched until the last 10 years. There are many, many MD's that are not educated AT ALL in MVD and just figure if there is no major occlusions of any major coronary arteries then there is NO WAY a patient can present with major angina pain. If the angina gets out of control and it can lead to cell death. If enough of your cardiac cells die it can affect the electrical system of the heart which could lead to a dangerous arrhythmia. A dangerous arrhythmia could lead to cardiac arrest. This would explain why anyone with major angina will seek emergency care. There is also a huge anxiety component related to this pain. I believe it is a normal fight or flight response of the sympathetic system. I really do not know why an MD cannot google the issue if they are in the ER and a patient presents with an issue the MD is not familiar with. As an RN I have run across issues I was not familiar with and I would seek the assistance of other RN's or an MD if necessary. But I am a common sense kinda nurse and person. I am currently on
120 mg Imdur every day
500 mg of Ranexa 2 x a day
81 mg Enteric Coated Aspirin 2x a day
25 mg Metoprolol (Beta Blocker) 2x a day
2000mg Omega 3 Fish Oil 2x a day
Once a day multivitamin
400mg Vitamin E (D Alpha) once a day
250 mg Magnesium once a day (this is for vasospasms) It really helps.
75 mg Plavix once a day in PM for first year post stent
10 mg Crestor once every evening
0.2 mg Transdermal Nitro patch wear for 16-20 hrs off for a minimum of 4 hours every day
0.4 mg nitro spray or tabs PRN (as needed) if taken once every 5 minutes for total of 3 without relief call ambulance
5 mg Ramipril one time a day
60 mg cymbalta one a day
1000 IU Vitamin D3 one a day
100 mg Colace 2x a day
40 mg of Protonix first thing in am one hour before any other medications on empty stomach
50mg Tramadol 1-2 tabs up to three times a day as needed for nerve pain (I have nerve pain right lateral thigh post femoral stent) I do not take tramadol every day but it does work for the nerve pain
1-2 tab 7.5/325 mg one time a day for angina as needed. I do not take Percocet everyday but have taken up to 4 in one day (because I am presumed to be a drug addict) Ha Ha
2 mg Lorazepam (Ativan) one pill 2 x a day as needed for anxiety. I usually take one at bedtime and I can sleep all night and not be waken up by angina.
2 liters oxygen via nasal cannula as needed
CPAP with at least 1 liter oxygen every night
The oxygen can really help with angina and with low energy. If I get emotionally upset I have a hard time breathing the oxygen really helps.
As you can see I take a Plethora of medication but I am only 8 months out of a Heart Attack and less than 6 months out of my 2nd stent. Over time I will be tapering off of some of these medications. I am a type A personality so I think that might explain why I need so much Ativan. I have been calmer since getting disability money as we are now able to keep our home and there was a real possibility we were going to lose our home. This fact by itself created an enormous amount of stress. I only am in bed at night unless I am in the hospital. I have not been to ER since the end of October. My goal is to stay the hell out of the hospital but I know with this disease process that is not feasible. Thanks for sharing your journey.
Hugs,
VeeCee

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I too have M.V.D. After my Heart Attack we moved from my small hometown (Where I knew everyone) to Florida.. It was suppose to be for stress reduction and to enjoy better health... Um NO ... Since the hospital did not know me the first thing they did was drug test me when I had chest pain and ask me WHY I had a MI at 47.. I said um I have Heart Disease and M.V.D. I asked for something for the panic attack I was having and something for the pain. They hooked me up to Nitro.. labeled me a drug seeker and that is now a permanent on my record! They did a Heart Cath after I failed the stress test and spasms in several arteries were caught... So I now had another diagnosis :) I feel your frustration truly I do. What I have finally found as helpful is taking a Calcium channel Blocker at night along with a sub-lingual Nitro ... It really seems to calm things down!

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Hi oldfogie,
Are you currently being medically treated for asthma or GERD? My angina feels different at different times. Sometimes it is like someone is taking a sword and shoving it in my chest and the pain comes out the back under one of my scapula's. Other times it feels like someone has a belt around my chest and they just keep tightening the belt. My last ER visit it felt like my heart was having contractions like labor contractions and the pain came in waves and when my heart was really contracting I would arch my entire back in pain. I was getting 5 mg of morphine at a time and a nitro drip started to stop the pain. That ER visit starting with a pain like someone punched me really hard in the right lung in front and almost knocked the air out of me. I was in Wal-Mart at the time was on my oxygen and the Nitro tabs DID NOTHING. I took Tramadol NO HELP, luckily I was only 5 minutes from a hospital. Sometimes the angina pain starts in my back like someone is stabbing me with a knife and when it gets worse the pain will expand to the other side of my back. Always torso area. I do not have COPD or asthma so I do not know what that feels like. A lot of times my angina is a stabbing pain either behind my sternum or just right of my sternum. Once in a while it is a sharp stabbing pain at the apex of my heart. Once in awhile my angina will burn and feel like stabbing pain right behind my sternum. MD's act like I am crazy when I describe so many different types of angina pain but that is what I really experience. Sometimes if it gets bad it will send a numbing pain down my left arm and my left hand will go numb. I hope this helps.
Hugs,
VeeCee

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VeeCee When I was on the Nitro Patch it felt like someone was stabbing me with a knife. As soon as I quit it the stabbing went away. Sometimes our medications can cause us symptoms.. I still have Angina but not that stabbing any longer.

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My angina gets worse when I remove my nitro patch after 16-20 hrs. I have more stabbing pains AFTER I remove my patch for the day. In my case, the patch is NOT causing the angina. Thanks for the input.
Hugs,
VeeCee

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Hello VeeCee - I was told by my cardiologist a couple years ago that research reports significant success using something called "TENS neuromodulation" to treat the debilitating chest pain of angina.

To address my own severe symptoms of coronary microvascular disease, my cardiologist prescribed both the small portable TENS unit I now wear every day clipped onto my belt, its tiny electrodes attached over my heart - PLUS he also referred me to the pain specialist at our regional Pain Clinic (a lovely man who coincidentally has done a 2-year fellowship in Sweden studying MVD!)

Since 2001, the U.K. National Refractory Angina Group has in fact recommended TENS therapy for angina (here's the link to the journal article to show to your physician: "Neuromodulation For Chronic Refractory Angina" - http://bmb.oxfordjournals.org/content/59/1/269.full ):

"Neuromodulation owes its origins to Melzack and Wall’s gate theory of pain that predicted that stimulation of vibratory afferent nerves would reduce or 'gate' the transmission of pain traffic relaying through the spinal cord at the same point.

"Transcutaneous electrical nerve stimulation (TENS) was specifically designed to make use of this predicted effect and was used to treat a variety of pain conditions before it was shown to be effective in angina.

"Neuromodulation should be offered as part of a multidisciplinary angina management program based on the current guidelines."

That last sentence is important - it begs the question of why in Britain TENS therapy is considered part of standard angina treatment protocol - yet U.S. docs still seem uninformed or unwilling to prescribe this non-drug, non-invasive, cost-effective pain management tool that actually works for most cardiac patients?

Why is my cardiologist a big fan of this pain therapy, while most women here tell me their cardiologists know nothing about it?

I now see my wonderful pain specialist regularly for follow-up monitoring; he also has Plan B and Plan C in place in case my current TENS therapy ever stops managing my chest pain symptoms as effectively as it has for the couple years. Pain clinics are focused on only one thing: PAIN. My clinic also offers a holistic whole-person approach, including free sessions like Health Recovery Tai Chi, Yoga, Meditation, group support, etc. It's quite remarkable!

Meanwhile, my use of nitro has reduced significantly thanks to this little black box I wear on my hip every day, all day long. More on this at: http://myheartsisters.org/2010/08/26/tens-for-chest-pain/

Anybody who is suffering intractable pain as you seem to be needs to be referred immediately to a pain clinic. Being treated in the E.R. with nitro drips is NOT sound pain management, as you know.

Good luck to you!

XOXO

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Hi Vee Cee, and Merry Christmas!
I'm so sorry to hear of your ongoing problems getting adequate pain relief from your docs. As you know from our talks, my own microvascular angina has been best treated by opioid pain relievers, a valium-like med (oxazepam) and nitro -- that is, until very recently. On December 14th, I had an SCS (spinal cord stimulator) implanted. It has been stellar at getting to my angina (as well as my chronic back pain). This device is allowing me to cut back on the opioids and start to live a more lucid and normal life.

I realize, too, that my luck with pain meds and the SCS has had to do with my 20 year association with the Swedish Pain Clinic in Seattle. I've "proved" myself to them over and over as NOT being a drug seeker or addict. Their word goes far around this medical community. That I've been with them so long speaks volumes to recalcitrant ER docs, family medicine, and cardiology.
I dare say, too, that my practiced calm around those docs seems to get me farther than flying off the handle, although some docs don't think I'm having pain unless I fly off the handle. Go figure....

I'm not sure what a person, like yourself, in a smaller city/town, can do about alternatives to bad medicine, other than to move or to commute to a bigger city.

You are a smart, experienced professional RN in real life, but to the docs, you're a noisy patient. Being in that boat myself, I can really appreciate the awful medical experiences you've had. I hope that you hit upon the right doc at the right time. I'm pleased to see that you've gotten a lot of really fine responses here on Inspire. Perhaps one of our heartsisters will have some good suggestions?

Meanwhile, congratulations on the SSDI!!!! Finally!!! That four months must have seemed like four years. Once it comes through, you can rest a bit. I hope that you and your wonderful family can have a quiet and peaceful holiday.

LOVE,
Melissa

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I would take and I do L-Arginine 500 mg and L-Carnitine twice a day, it cured mine, I tossed all the other stuff away. It works, three people won the Nobel Prize in Medicine in 1998, and doctors cannot make any money on it so they ignore it, also take 10 mg of Astaxanthin with a little fat food. How is your salt intake? Your body needs salt, I had angina once because my body had no salt. I prepare my own foods without salt, no processed food. Your system needs some salt, do not want to use American salt; however I use Himalayan salt it is good for you. I also use the spray on magnesium 125ml by http://www.activationproducts.com/ I do not believe the pill form is that effective, at least it was not for me.

Wam regards and Merry Christmas

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