Dr. Mahmoud Ahmed Abdelrahman Abouibrahim
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have fibromyalgia and chronic pain in the lower back. I also have pain in legs. The pain is so severe that I cannot do anything. I can move only inside my house. I step out by using my wheelchair. I have been prescribed with several kinds of analgesics over the years. But nothing has helped me. Is there anything else? I have even tried seeing physiotherapists too. I had a relief from pain when I was given a large dose of Morphine. Currently, I am taking Apixaban, the blood thinner.
Hi,
Welcome to icliniq.com.
You have spinal cord compression due to untreated vertebral fracture which causes severe back pain and difficulty in moving your lower limbs. In such cases, MRI (magnetic resonance imaging) is the most diagnostic one, and a neurosurgical consultation is required. Surgery can be done to decompress the spinal cord. It can improve the pain and movement. In case, if the operation is not possible, stronger pain medication can be taken to control the pain. I recommend taking Tramadol 50 mg for every six hours along with Paracetamol. Also, take vitamin B complex tablets to improve your nerve conduction and pain. In pain management, we follow a ladder to achieve pain control. Please send me your X-ray for reviewing it. Please provide your reason for taking a blood thinner.
Patient's Query
Thank you doctor,
I am taking a blood thinner for having a pacemaker. I got atrial fibrillation before few years. I tried taking Tramadol. It made me upset, and I suffered from constipation. So I stopped taking it. I take vitamin B12 twelve weekly for pernicious anemia. I do not have a copy of my X-ray.
Hi,
Welcome back to icliniq.com.
I recommend you take tablet Co-codamol 30 by 500 mg (Codeine phosphate with Paracetamol) two tablets for every six hours. For constipation, use Senna 20 mg once daily before bedtime. Take all these medications under your GP approval. Please provide me your feedback.
Patient's Query
Thank you doctor,
I cannot take any medication with Codeine. It gives me terrible indigestion. Can I take Morphine along with my blood thinner? It helped me a lot.
Hi,
Welcome back to icliniq.com.
Oxycodone is a Morphine derivative, and it can be used. Take Oxycodone 15 mg tablet for every six hours after getting your GP (general practitioner) approval. The common side effect seen is constipation. Take Senna 20 mg tablet once daily before bedtime. It will be fine. Always take Paracetamol along with Oxycodone.
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Internal Medicine
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