Signing out for a while

I mentioned that I was messed up with some nasty lower back pain — I got in to the doctor this morning, and oh boy, I got some good drugs. I’m going to be doping myself with cyclobenzaprine three times a day for a while, so I don’t expect to be particularly perky for a while.

The pain has been pretty bad. On my personal scale I’d give it a 9 (10, the worst I’ve ever felt, was a ruptured eardrum). To put it in perspective, though, my wife went through labor and delivery three times, so it might have been a 3 or 4 on that scale.

Somehow I’ll have to wade through the lethargy and get the grading done. Maybe this will improve the student’s grades.


  1. birgerjohansson says

    A non-addictive pain medicine that works well is something pharmaceutical science has been looking for a long time. There has been so many false dawns that I have almost given up hope.
    There is some stuff developed from cone snail toxin, but it only works for a minority of patients. Also, it can induce nausea.

  2. birgerjohansson says

    Step one: find a way to “vitrify” human tissue at low temperatures without growing ice crystals that rip apart membranes.
    Step two: freeze yourself to await better medical procedures.

    Step three: Profit!

  3. René says

    I most certainly sympathize with you here, PZ. I suffered from a herniated disk (at the L4-L5 level), three times. The pain was such that I just wanted to die. I still suffer from the aftereffects. I can only walk short distances and cannot stand long enough to do the dishes. I now have to get around in what we here call a scootmobile.

    Best wishes!

  4. Carl Andersson says

    @birgerjohansson That cone snail thing works great, only it has to be administered epiduraly, and the therapeutic window is pretty damn narrow, so er… it’s really only useful for a handful of inpatients and opiods works fine for most of those so…

    It works fine in THEORY!

    Cyclobenzaprine for lower backpain tho, evidence for that is kinda iffy, if it’s sporadic you should really hold out for some flavour of opiod. Chronic? sucks to be you and a pain specialist would be needed, and he’d also give you some NSAID’s + minimal opiods while trying to manage your pain expectations, ’cause it’s probably never going away.

    Because that’s the state of the art of chronic pain management these days, it sucks and I hope they manage to find some magic new drugs by the time I need them

  5. says

    A broken arm, you get a cast and a sling.

    A broken leg, you get crutches or use a wheelchair.

    Back pain is the worst, torturous and debilitating, and there’s nothing you can do about it except hope that treatment and rest work. I’ve had it, and empathize.

  6. says

    Been through that and they decided wrongly that it was a heart attack. The worst I’ve had was shingles in the mouth. Ut feels like every tooth on one side of your jaw has an abscess. I scored it at 11 after the oral anaesthetic and discovered the bliss of morphine for the first time.

  7. says

    A general recommendation not directed at anyone in particular: There are very few things I could say I swear by, but I swear by Classical Stretch. It’s been on PBS for years, so is available for free to many people in the US. (Miranda Esmonde-White is Canadian, but I don’t know about its availability there…)

  8. chrislawson says

    Hope you make a rapid recovery.

    Echoing what others have said before, it’s best to keep pain medications to a minimum. If you do need strong analgesia to get through a particularly bad episode, use it for the shortest time needed. Cyclobenzaprine is an antispasmodic closely related to the tricyclic antidepressants. It’s not known to be addictive but it does have its own set of side effects and you have to take care to minimise risk of heart arrhythmias and seizures, as well as some important drug interactions with other antimuscarinics and serotonergics.

    I’m not trying to give specific medical advice here, but it’s important to be aware that (as others have said above) the best current evidence is to keep analgesia to a minimum, use paracetamol (aka acetaminophen) first line, try topical heat, keep mobile, and it’s better to stand or lie down rather than sit. When you are able, start gentle stretching exercises, preferably in consultation with a physio or exercise physiologist first although there are many good online sources for basic exercises that should be safe if you follow their caveats.

  9. John Morales says

    Age-related decrepitude; pretty inevitable, for all of us. Alas!

    Take it easy.

  10. StevoR says

    Hope you feel better ASAP and wishing you the best. You are not a god or even Akhenaten and a professor not a Doctor but still hope this song helps.

  11. brightmoon says

    Best wishes for a speedy recovery. I was bedridden for about 5 years after my ex injured my back! He only tore some muscles but that hurt enough

  12. says

    Oh, dear. So sorry.
    I once graded a whole cohort of students while on Vicodin for sciatica. The next semester they all thanked me for being so generous with their grades!

  13. billroberts says

    I have had 2 lumbar spinal decompression surgeries. Both were very successful and helped relieve back and leg pain. Find a good neurosurgeon.

  14. chesapeake says

    I’ve been on opioids, very successfully, for 22 years for LBP. Early on I tried everything including cyclobenzprine, which did nothing. Below is the entry for that drug from Public Citizen’s WORST PILLS BEST PILLS, an excellent subscription resource for drug info. I tried everything from this drug to steroid injections, to opioids, and physical therapy . Only the last two worked. I am now on a pretty good dose of oxycodone and low dose fentanyl patch with excellent results. There has also been no problem with addiction(physical dependence is different) and no desire to abuse these drugs. Life would be agony without them.

    Seems to me that cyclobezaprine (Flexeril) is useless . Worst pills says “DO NO USE”. I agree with that. I go to a pain specialist who tried several things with me but Flexaril was not one of them. That was earlier by a family practice doctor. Another worthless drug for pain is gabapentin though heavily and illegally marketed by the manufacturer for pain.heavily fined.
    Oddly, the BEST medication for my back pain, which is caused by damage from heavy lifting, to the ligaments and tendons around the PSIS, bilaterally, is AMBIEN. It knocks the pain out almost completely, and allows me to sleep without oxy at night. I take it in divided doses, at 1am and then again at 6-8. I sleep til 1-2pm.

  15. chesapeake says

    Cyclobenzaprine has not been shown to be any more effective than painkillers or anti-inflammatory drugs such as aspirin for relieving the pain of local muscle spasm.[2]

    A systematic analysis of clinical trials in which cyclobenzaprine was used to manage low back pain found that the drug was more effective than a placebo. However, the authors of the analysis commented: “Studies comparing the relative value of acetaminophen, nonsteroidal anti-inflammatory drugs, and cyclobenzaprine individually and in combination for the treatment of back pain are needed.”[3]

    Cyclobenzaprine must not be used with the family of antidepressants known as monoamine oxidase (MAO) inhibitors or within 14 days after stopping an MAO inhibitor. Seizure resulting from a high fever and deaths have occurred in patients receiving cyclobenzaprine (or structurally similar tricyclic antidepressants) and MAO inhibitor drugs.

  16. chesapeake says

    -__I have been a subscriber to WORST PILLS BEST PILLS (about $20 yr) and find it to be an excellent resource . My wife and I have found it often a better resource than our doctors, who don’t always rely on the science.

  17. magistramarla says

    I’ve had two back surgeries and I’ve never completely recovered. I have to wear a back brace daily and use forearm crutches to get around. I can only drive about 1/2 mile to the grocery store and PT due to numb feet and leg spasms.
    The first surgery failed completely because the surgeon put three pins in my back that were too large and could not fuse.
    I had to find a scoliosis surgeon who works with kids, who could do a revision surgery and use small pins that are usually used in kids. My bones are that small and light.
    The sad thing is that I originally didn’t have any back pain. I was seeking relief from the above mentioned neuropathy and leg spasms. The surgeon blamed it all on a probably non-existent back problem. It’s more likely a neurological problem caused by my autoimmune disease, Sjogren’s.
    On top of all of this, I’m extremely allergic to any opioid. Even eating a salad with poppy seeds will cause my tongue and throat to swell and close off my breathing.
    I was on cyclobenzaprine and gabapentin for years. I weaned off of both during the pandemic, since they weren’t really helping and I was tired of living in a fog. I had to also stop using NSAIDs because they were chewing up my stomach.
    I’m now only using CBD cream for the pain and numbness. I live in a state where cannibus is legal, but alas, it makes me nauseous.
    Pain management doctors are worthless. I’ve had two tell me that if I can’t take opioids, they can’t help me.
    I hope that PZ recovers without surgery. I wouldn’t wish this kind of chronic pain on anyone.

  18. chesapeake says

    31 magistramarla says they were on cyclobenzprine and gabapentin for years and they weren’t really helping. See what I wrote above. I want to emphasize this, that the studies show they don’t help.this was my experience. I’m a little shocked to see the number of regulars with serious pain issues. Lots of good advice. Maybe some will work for PZ. it took me some time get a routine that worked but things are finally in good shape and have been for about 10 years-I’m 81. For some opioids are safe and effective. For others not. Good luck.PZ. I gone you don’t have to go through the agonies some of us have. Early on I was suicidal for a short while. Now life is very good.

  19. chesapeake says

    PZ, you said “ — I got in to the doctor this morning, and oh boy, I got some good drugs…”. What are these good drugs. The only one you mentioned was cyclobenzaprine. Does that seem to help? Any other drugs? Hope you are doing well.