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Chronic ankle sprain

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I sprained my ankle five months ago. I sought medical treatment immediately via my primary care doctor and referred to an orthopedist. The orthopedist prescribed naproxen and after a couple months the swelling and pain never subsided. I then began 6 weeks of physical therapy and was prescribed tramadol for the pain and underwent cortisone shots. During this time it was determined that I had tendonitis on the anterior tendon and a tear on the posterior tendon. After physical therapy I regained my balance but my ankle was still swollen and painful. A MRI confirmed a partial tear in the posterior tendon. My orthopedist said surgery shouldn't be necessary and that my ankle will take several more months to heal on its own. He said that he won't prescribe any more tramadol because it just masks the pain and doesn't promote healing. I'm still in a great amount of pain from from the tendonitis and the sprain. He said that I would just have deal with the pain. I don't think he realizes how painful it is. Do you think I would be out of line if I asked for more tramadol? The naproxen and ibruprofen he said to take doesn't do anything for the pain. I don't want to come off as ungrateful but going on as is for several more months is going to unbearable. Thanks for your time.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Patient replied :

Hello,

Thank you for choosing DoctorSpring.

There are few issues we need to consider here.

Tramadol is a weak opioid medication. So you should be getting same or more pain relief with naproxen or Ibuprofen on comparison. The fact that you are NOT getting adequate relief and the sense of need for Tramadol suggests early opioid dependency.

This should be avoided and I believe that is the reason why your Doctor said he won't prescribe any more Tramadol. I am sure you do not want opioid dependence and an injured ankle.

It will not be as hard as you think. In less than a week you should feel better and even you will not need medications. (or at best occasion Ibuprofen). Such continuous pain is uncommon in ankle injury. In any I recommend you to comply with your Doctors recommendation and see for a couple of weeks. If pain persists Tramadol may requested at that stage.

*Total abolition of pain will put you at higher risk of accidental minor repetitive injuries to the ankle , which can delay healing. Pain after all is protective stimuli.

Hope this helps
Feel free to ask follow up questions
Thank you


Hello,

Thank you for choosing DoctorSpring.

There are few issues we need to consider here.

Tramadol is a weak opioid medication. So you should be getting same or more pain relief with naproxen or Ibuprofen on comparison. The fact that you are NOT getting adequate relief and the sense of need for Tramadol suggests early opioid dependency.

This should be avoided and I believe that is the reason why your Doctor said he won't prescribe any more Tramadol. I am sure you do not want opioid dependence and an injured ankle.

It will not be as hard as you think. In less than a week you should feel better and even you will not need medications. (or at best occasion Ibuprofen). Such continuous pain is uncommon in ankle injury. In any I recommend you to comply with your Doctors recommendation and see for a couple of weeks. If pain persists Tramadol may requested at that stage.

*Total abolition of pain will put you at higher risk of accidental minor repetitive injuries to the ankle , which can delay healing. Pain after all is protective stimuli.

Hope this helps
Feel free to ask follow up questions
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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