what meds do you take for pain?

Please if you will, post what meds you take for pain that are working for you.

I am back on the Percocet but my body must be used to it and it just isn't working well anymore.

I can't keep getting shots but I am miserable.

Pain, very little sleep and high bp.

The percocet isn't lasting in my system the 8 hours like it used to.

Please help if you can, I need new ideas for something else to try.

Thanks everyone.

Cindy

Well, here are some options. Its all up to your doctor though. All I would say is "The Percocet isn't working anymore--what ideas do you have?". Only if they say there aren't options or I don't know would I ever name prescription names. It is very typical to build tolerance and doctors should except it. Percocet isn't really supposed to last 8 hours anyways. If sleep is the problem, sometimes a muscle relaxer or sleep med (or even Melatonin or Unisom after you ask your doctor) may be a good idea. Personally I don't like taking a pain med if really all I'm trying to do is sleep (kinda a waste)...but lots of folks think if the pain is preventing you from sleeping, then treat the pain.

Oxycodone (active ingredient in Percocet..ie. raise your dose...a likely step...unless you are on 5mg Percocet, then they can give you 10mg), Vicodin (unlikely as its typically weaker), Tramadol (non narcotic, but works for some), Morphine, Oxymorphone/Opana, Fentanyl, Methadone, and Hydromorphone/Dilaudid.

Personally, I do well on Methadone for long acting and either Oxycodone, Morphine, or Opana for breakthrough. Opana is brand only. There are a ton of formulations of some of these, such as Morphine. Some of those are brand only since they are new (under patent). Some doctors put you on the newer ones which they have formulated as hard to abuse, but they are more expensive and often don't work as well. The stuff without Tylenol is better for your liver too (pure narcotics aren't hard on it, but you lose a bit of effectiveness). I've tried everything but Fentanyl. Both Methadone and Fentanyl should only be prescribed as long acting (daily) type meds, so I'm not sure what you are looking for (an as needed med or something to take daily for pain management). Best wishes.

Thanks Kate for your suggestions.

I have daily pain and have been on an opiate of some sort for the last 13 years.

Thinking you are correct that I maybe should go back to a long acting med for now.

There are a couple that have worked for me in the past.

Of course I will explain my situation to the doctor and let him tell me what he thinks we should try and then give my opinion if asked.

He generally asks me if I have any reservations about what he is offering me.

Thank you so much for all your help.

I have been feeling so down lately and so sick that I haven't been accomplishing much at home and that even makes me feel worse.

It just makes me feel better that someone cares enough to try and help.

Cindy

Oh yeah if you have been on opiates for 13 years your tolerance probably way exceeds Percocet. You never want to over treat pain (aim for 100% relief), but under treating it isn't any good either. I've been told 50% is a reasonable goal, and most need a long acting opiate, short acting opiate, and any adjunct meds used for pain, already commonly prescribed for headache, such as a anti seizure or anti depressant med.

One of the few good things about pain management with narcotics is you know right away if its helping, and you typically go in monthly so you can have a discussion and make any changes quicker than many other meds. You also definitely need a long acting med if you take it daily so you don't get all those ups and downs due to the level in your system. The amount of Tylenol even in the low Tylenol Percocet is still enough to worry about for some folks too. No reason for someone to be taking Vicodin, Percocet, etc, daily with the Tylenol in it. Its usually the doctors scared of prescribing it without as it has a higher potential for abuse.

Are you seeing a pain specialist, neuro, primary care doctor, or someone else? I am planning a switch from my primary to a pain specialist...I've been looking for the last year and finally found someone willing to take me on as a patient and not drop my meds lol. If you aren't seeing a pain specialist, they are usually much more knowledgeable, but often there are more hoops to jump through such as trying injections first, signing a contract, pill counts, urine tests, etc. I don't care as long as I don't get treated like an addict (one place I went in particular was way creepy). My pain has been out of control for awhile now so its either tweak the meds and make it worth it, or come off of them. Best wishes.

Just got back from the doctor and all went well.

He changed me to the MS Contin and raised the dose a bit.

Also added Cardizem to the Cozaar I am already taking for bp.

My bp was, as he put it, sky high again today.

I asked the pharmacist if it was common for people to take more than one bp med and she said absolutely it is.

Hoping I will be able to get some sleep tonight as I haven't really slept well for a week.

Once pain wakes me up, it is hell trying to get back to sleep again and then it just wears on me and the headache just gets worse from there.

Yes I went to a pain management doctor about 5 years ago and after doing the trigger point injections with no success, he said all he could offer me was methadone which I did not want to take so that was that.

Methadone is one drug that just scares me.

Seems like it is hard to regulate and as I have heard very hard to get off of.

I just don't need that.

I sure hope your experience at the pain management doctor is a good one.

I think I am just a weird case. Not much of anything preventative has helped me one bit and alot of the long acting drugs I have tried either caused me terrible anxiety or didn't work well.

The fentanyl patch worked well for pain relief but I could not keep it from coming off.

Bought expensive large bandaids made by 3M that worked OK but it also irritated my skin alot and itched til I couldn't wait to take the darn thing off.

Anyway, thanks for all your help.

Let me know how your appointment goes.

Cindy

Just throwing this out there: do you think that your percocet could be causing you rebound headaches? I have no idea if they are, but I used to take A LOT of extra strength hydrocodone w/ my local neurologist and then started to see migraine specialists and they put me into a hospital to get me off of the narcotics b/c they said they were only doing me harm, i.e. rebound headaches. Oh, what I wouldn't give for some hydrocodone now when I get a bad migraine (and I get about 25-28 days of migraines per month). So, how do I treat them? I am taking preventatives (which obviously do little good, except to take the pain level down) and then I have found a tremendous drug cocktail accidentally that works well: robaxin and alprazolam (both probably spelled wrong). Otherwise for the bad ones, I give myself a shot of DHE.

I wish you the best of luck!

Hope the MS Contin works well for you. Likely you were started low with room to move up (they need to be safe), so don't be shocked if you get even less pain relief to start. Will you eventually get something for breakthrough as well? Typically you have something to take as needed, whether its a couple times a day or a couple times a week. There are definitely a lot more pain treatment options out there. Don't be afraid to seek out a different pain doctor if needed. Do you think your pain is increasing your bp? Wouldn't be surprised one bit. Make sure to keep an eye on it as they up your pain meds as when your pain does get under control, on two bp meds, you could actually get too low of bp.

Thought I'd chime in that Methadone works really well for me when I'm dosed high enough. Yes it can be hard to titrate down from, but you can be switched to something else if needed, take a few months, add in a med to help such as Clondine, etc. Don't know what you mean about hard to regulate. It gets a lot of press about overdoses. You and your doctor just need to know it has a long half life but a short effective pain relief time...it builds up in your system. It becomes a problem when an addict or uneducated patient doesn't get high from it (you can't as its synthetic) and takes more, or combines it with benzos.

Especially in the beginning it can cause extreme sedation though. I got used to it thankfully. The pros to it is its cheap, it doesn't cause euphoria, it has a long half life (I can take my doses unevenly and not go into withdrawal, and I don't get the highs and lows of the pain relief that happen with other opiates), and you are build tolerance slower. Some folks wouldn't consider it, but I would at least want to make an educated decision as many folks also do very well on it.

I only went to the narcotics once all my doctors were out of ideas for me...a last ditch treatment. I wouldn't care even if I was in rebound, as long as I am having lower pain. I have a 24/7 headache condition which is less likely to allow rebound, very unlikely to go away on its own, and with the Tylenol combo meds I think I'm at lower risk anyways. Narcotics definitely aren't a first or even 10th line treatment, but they can give some of us our lives back. Best wishes.

abp: Thanks for your post.

It doesn't appear that I am getting rebound headaches but who can be sure.

Believe me that I am a weird case.

Have tried everything preventative and I am not even kidding about that.

Have had DHE a couple of different times and it shot my bp up extremely high and make me violently ill with no reduction in pain so that isn't an option.

My doctor just said today (for about the 100th time) that the list of meds that we have tried for both prevention and pain is really extensive.

Tortoisegirl: You are probably correct about seeing another pain management doctor.

We only have one in close vicinity and I explained what they told me.

The nearest one would be 2 hours away and my husband owns a business and has a hard time getting away for anything.

I may just have to do it though.

As far as the Methadone goes, I know that everything you said is absolutely right.

Someday I may have to try it when I exhaust other options.

And I will if need be.

Hope you don't think I'm being stupid having fears about it.

I'm leary about taking any drug for the first time because I have had such bad reactions to some.

For instance when I take phenergan, reglan, compazine, ativan (there are a few more on my list I just can't remember them all right now) I get this horrible reaction where I can't sit or stand still and get that awful creepy crawly feeling.

Last time a nurse accidentally gave me phenergan I was in the ER an hour later.

I know they had to think I was crazy.

They kept asking me to quit pacing but I absolutely could not.

Also when the nurse was trying to take my vitals, I wouldn't let her keep the bp cuff on because it was like my arm was super sensitive to it as it pumped up and I couldn't stand it.

Anyway, there was a young intern there who gave me Cogentin and Xanax and within 30 minutes it was gone.

That's why I don't like taking anything new.

The only anti nauseant I can take is Vistaril.

Once when I was having a day surgery(about 15 years ago) they put in an IV and sat me in a chair to wait.

The longer I sat there the more thoughts came into my head that I would not survive the surgery til it got so bad, I took the IV out, got dressed and left.

The nurse called me when I got home and asked what happened.

When I told her she said it was an adverse reaction to the Ringer's solution and to please come back.

They gave me straight saline the second time, so I can't even handle Ringer's solution.

Told you I am weird!

Anyway, thank you so much for taking the time to try and help me.

I can't tell you both how much that means to me.

Cindy

I have never thought about having a reaction to the saline ringer but every time that I get an I.V. I have an anxiety attack like no other. Never thought that would cause it but as soon as they start it I have a horrible one.

I'm not new to this forum I was around on the old one just didn't remember my name or password so I made a new one tonight!

I take Zomig 5 mg--1/2 dosages at a time and Maxalt 10mg for migraines, along with Ibuprofen 800mg for migraines and for body pain. I try not to take too much of the Ibuprofens, though, because it can cause stomach bleeding and that scares me!

I'm a hard one to treat for pain because I can't take any thing in the narcotic family, like Codeine, Morphine, Fioricet, etc, because they make the pain worse and make me jumpy, anxious and even feel crazy. So, my options are pretty limited.

JennPayne,

I'll bet the Ringer's is causing your anxiety attack.

After I had that happen to me, I never let them give me anything but straight saline and it has never happened again.

I remember the nurse telling me that anxiety attacks caused by Ringer's is a common problem.

chelle,

That must be a challenge not being able to take so many pain drugs.

Hope what you are able to take is helping you.

Thanks for your posts.

Cindy

PS I am doing great with the MsContin. No more extreme ups and downs and good pain control so far.

For migraine pain the one thing, that always works for me is Imitrex (Sumatriptan).
For body pain paracetamol with caffeine OTC type painkiller.
I also use Ibuprophen gel 10% strenth with muscular pain, which helps especially when my neck/shouler region hurts.

The both kind of pain often come together, but not always.
At the moment my body pain is bad, but my head has been fine for some time.

I also have problems with quite high BP, especially when I have M. I often wondered if it is caused by Sumatriptan.

For migraines I use Nubain (Nalbuphin) injections and/or Sumatriptain (Imitrex) injections. For menstrual cramps, body aches, etc, I use either Alleve or Advil.

I used to use Percoset, but I had rebounds from that. The migraine would get better for awhile, then roar back worse than it was in the first place.

Mini: Triptans raise my bp so quickly and so high that I have terrible vomiting very shortly after taking them so they are out of the question for me. They also make my heart race.

Brenda: I often get Nubain when I go to the ER and it usually does a good job reducing the pain. Now that I am on the morphine though, I won't be able to take it anymore. It is not compatable with morphine.

Thank you both for your posts.

Cindy

Yeah, I think it's a synthetic form of morphine. My doctor gave it to me because he said it has less addiction problems than a lot of the other opiates.

I have taken effexor and topomax for years. When I get a migraine I usually try Migranal or DHE injection. Triptans tend to rebound. If the migraine will not break, I will try a round of prednisone and stadol for pain. The last resort is nerve injections. I had my sub occipital nerve frozen. It was a successful procedure for over a year.

My daughter had an occipital nerve stimulator implant. After at least 10-12 weekly hospitalizations for iv DHE and every possible treatment. The stimulater was our "hail Mary". Although my daughter's headaches did not go away completely, they did go from a daily "8/9" to a "2/3" pain level. If you are ever in the Houston area, Dr. Diana Lebron at Texas Children's hospital is a board certified headache specialist. Dr. Lebron is the best headache doc I have ever met in my life. I wish she treated adults.

Is this typical for migraineurs to see pain doctors? I have tried so many preventative medications and triptians and I always end up in the ER where they have to use narcotics. I have a very limited amount of Fiorcet with codeine that simply does not even touch the pain does not even bring it down 1 in the pain scale but my GP does not seem to care. I cannot continue on visiting the ER every 1-3 weeks when the pain gets to a 7 or 8 I need to knock it out before it gets that bad. I cannot take NSAIDs. I know in today's environment pain doctors come with a lot of hassle and drawbacks but I am at the point where I am willing to try anything. Has this been successful for a lot of you and if so how did you find a pain doctor and did they know much about migraines? I imagine this is something I will somehow have to find a referral for and that could take months in itself. Any tips or advice would be much appreciated.

Its more unusual to see a pain specialist for headache / migraine, but once they are chronic and not responding to standard treatments, some of us have found that to be the best option. Even if you aren't going there for narcotics, they may have some new ideas (good ones will do a variety of injections/blocks as well as various adjunct meds, which are called preventatives in the headache world). I have ended up on daily narcotics but also have short acting ones for pain spikes / migraines.

Check if your insurance actually requires a referral. If so, ask your primary doctor if they think you would benefit from seeing a pain specialist. If not, you could either ask your doctor, or seek one out yourself (I looked online for pain clinics / doctors in my area which ad good reviews).

I'm going to be honest and say that these places can be hit or miss, especially for certain locations (ex. Florida and Kentucky). Especially for me since I was wanting to find someone who would continue my meds and consider doing more for me. The first few places recommended a treatment plan which was to get my narcotic dose down, not get my pain under better control. Pain doctors in general aren't going to know much about headaches / migraines. I got lucky and found one that got a lot of referrals from my previous neuro, who had a lot of tough daily headache cases.

If you are having episodes which require the ER on any regular basis, its time you find a doctor who can prescribe you something to manage at least most of these at home. If you have an idea of what works for you already, even better (as you can suggest it if that comes up in conversation). You may want to try some headache specialists (neuros) first. Although they are generally anti narcotics, some aren't, especially in limited amounts such as you are mentioning (once every 1-3 weeks).

Also, there are other abortive options your GP may not be familiar with. In short, this isn't typical, but for me at least, it was a very good choice to see a pain specialist. Sounds like you don't have a headache specialist (neuro who specializes in headache / migraines) though? That is a more typical first step from a GP. Shocked your GP hasn't referred you out (unless they have and you came back).

If you ended up going the pain doctor route, depending on the treatment regime, it might not be that much hassle. Same with a headache specialist. Definitely worth it if your pain is under better control. A headache specialist may also be able to get you on a preventative (or better combo) to reduce the frequency and/or severity. Best wishes.

Cindy

I'm new to this site and its interesting to read everyones posts. My story is so similar to many here. I've had similar reactions to the drugs u mentioned except phenergan turns my arm where my IV is into a big red hive. My allergy lists is long and highly sensitive to a page full of preventatives. DHE sent me into SVT and AFib, felt horrible, I work with a cardiologist and now I understand what chest pain and atrial fib feels like!! Or a heart attack!!

I only take Amerge 2.5 mg for my really bad migraines, currently I'm getting about 2 really really bad ones a week, sometimes it helps I have never been given narcotics or seen pain management, luckily I have a great Doc and good insurance and where she works the have like a "hospital" setting there where they can administer IV infussions and pain meds so the patient doesnt have to go to ER or hospital, so I go to her and I'm there for a few a hours for IV narcotics, fluids and magnesium. The mag seems to help.

Also are you checking your BP daily? As you are on 2 bp meds. I'm sure they told u to monitor ur bp and they dont want it below a certain number especially if you are taking narcotics at home.

Angela

I definitely agree that a headache specialist is the best option. The next best option is to find a pain specialist. If you live close to a large metropolitan area, some pain specialists are neurologists and/or have a one year headache specific Fellowship. So it's worth it to ask. There are some online nonprofit headache sites that will recommend doctors to members.

I have recently changed my meds - I now take Trileptal. I was reluctant to try Botox, because it did not help my older daughter's headaches, but I am happy to say I am headache free for the first time in years. I have been diagnosed with occipital and trigeminal neuralgia. The nerve pain was becoming unbearable.

Have any of you taken butterbur? I will post the NIH study.

Angela0611 - I am not a doctor nor have a medical background, but I have been on a long medical journey when my daughter was diagnosed with POTS/dysautonomia and then both of us were diagnosed were ehlers danlos hypermobility (EDS), a connective tissue genetic disease. Although it was a relief to discover the answers to the weird things about our bodies - headaches, fainting, flushing, bp issues, insomnia, dizziness, etc there is not a cure. Many people with dysautonomia and/or EDS also have migraines. Some like you have severe allergies to prescription meds and have been diagnosed with mast cell disease. From what I understand, most people with mast cell improve significantly with proper treatment. (you don't have to have EDS or dysautonomia to have mast cell). Your doctor may have already suggested it, but I just wanted to let you know, because treatment (H1 and H2 blockers I think??) can improve migraines.

Good luck!

I take Tizanidine, a muscle relaxer, at bedtime each night because if I don't my muscles are so tight the next day that my shoulders alone will make my inevitable migraine worse; Zonisamide, an anti-seizure med, as a preventive nightly. Relpax and hyrdrocodone as needed. Percogesic (OTC) when I feel particularly optimistic. I also take meds to help me sleep because if I don't my migraine will be even worse and last longer.

In regard to migraneurs seeing pain specialists it seems to just become the last resort after you have suffered for a long while and you come to the realization that there probably isn't going to be an aha moment when some wonderful doctor says "Aha! I know exactly what is wrong with you! We'll do this and you'll be fine!" Most neurologists don't want to prescribe pain medications. My GP wanted me to go to a pain clinic since they knew more about pain meds than she does. My neurologists has headache training and is willing to provide pain meds along with the nerve block injections and the Relpax. The one pain clinic that I went to that would treat headaches (and there was only one in a 100 mile radius) required a pain medicine contract (no problem), a monthly visit (no problem) and a random urine sample (no problem). The problem was that the urine sample was billed at $500.00. Our insurance paid their part and we still had to pay $270. This pain doctor gave up on me and offered me a methadone prescription. One of the drawbacks of that, according to my GP, was that no other reputable pain clinic would in future accept me as a patient once it was in the system that I had taken it. I passed.

I am in the process of going off all meds in preparation for an appointment at Jefferson Hospital's headache center. I can only do this because I am currently unemployed, living with my parents, and 100% in control of my life.

When I do get a migraine I take Treximet (sumatriptan + naproxen sodium). I warn that this triptan has given me rebound problems and since I have been taking it others no longer work (maxalt & zomig). I also use tigerbalm for immediate relief.

I took Topamax for 3 years, but then I experienced 6 months of almost-daily headaches and concluded that this wasn't doing enough & went off of it. Doctors always say, "BUT it can always get worse", when I talk about ending medicines. Well nothing can ever be worse than those 6 months, so I'm prepared.

I most recently started Tizanidine because I had incredible daily shoulder pain as well, but, similar to Topamax, I could no longer tell if it was doing anything, so I stopped just a few days ago.
[I also went off birth control, it's too soon to tell how it will affect migraines.]

Once I went to the hospital & got a morphine injection for a terrible rebound headache. It did nothing except sedate me. I could still feel the pain throbbing dully which was very annoying, and the headache returned full-force when it wore off.

As someone previously stated, I also have had adverse reactions to Compazine & Reglan. I find that they aren't effective when taken alone, and when I do take them in combo with other meds (something my neuro encouraged), I become jittery, uncomfortable, and hypersensitive.

So, I'm still searching for a good solution so I can move on with my life, and hopefully not get into another daily pain situation.
Sending warm wishes to everyone!
Mel

3K9sMum: Your GP is mid-informed about methadone. It is commonly used in pain management. If the patient has documented chronic pain, a reputable pain clinic shouldn't think twice about accepting them. If they had history of going to a methadone clinic for addiction, then yes that statement would be correct. There is a big difference between going to a methadone clinic (daily) and getting a methadone prescription (monthly, from a pharmacy).

I actually take it and its been the only thing I've found to consistently help my pain. Its less common to be used as a first line long acting opiate, but it was also chosen for me as a first med. I ended up trying most of the other ones and coming back to it as my pain couldn't be stabilized on even higher doses of other meds.

I don't know if its appropriate in your case, but I wouldn't automatically deny it based on the comment your GP made. I don't think that just because you were offered methadone means your doctor "gave up on you". In fact, it could have been a good thing, as they were recognizing that you may benefit from a daily long acting pain med. Methadone has been known to be more likely to be helpful for chronic headache than some of the other opiates, plus tolerance develops more slowly. Also, its unlikely to cause the patient to feel "high", although sedation is common, especially at first.

The only reason it has a bad reputation is because it is also used in addiction and there is a documented higher incidence of overdose. Lots of misinformation out there on methadone. Some folks try to abuse it and overdose. It has a long half life. So if someone was trying to get high from it, they would take more, and it builds up in the system. If taken as prescribed from a doctor who has education in how to prescribe it (start low and increase slow), its no more dangerous than any other opiate.

Sounds like your need a pain specialist who better involves you in the process and explains things better. Plus, although expensive drug screens are common (mine is billed as $900 and my doctor does them 3-4 times a year), often the doctor works something out with the lab that the patient doesn't get billed for anything the insurance doesn't cover.

They also may only send them out to the lab for the first test, and if they have a problem with a quick dip stick test in the office after that (so the high expense is possibly a one-time thing). Nothing wrong with asking what their UA policies are, stating you are concerned with the cost.

A good pain specialist can be very tough to find, as too many are anti opiate nowadays (some even say on the phone they don't prescribe narcotics). At least they are more available than 20 years ago...back then you only got opiates after surgery, and only Vicodin or 5mg Percocet. It wasn't until recently they are using opiates on non-cancer chronic pain. You want someone who uses a combo of treatments, and isn't afraid to use opiates if they are warranted. Finding someone that has some headache patients is a plus. You might ask your neuro if there is a clinic they refer to. You are correct that not all clinics will take headache patients. Best wishes.

Hi Kate,

I agree with all that you said. The only problem is that I am in a backwater of Alabama. I was having to travel quite a distance to the one pain clinic that I found that would deal with headaches. The doctor did literally say, "Well, that's all I know to do. All I can offer is a prescription for Methadone. You will have to come here each month and pick it up." Etc. etc. We had already tried the Butrans patch, Fiorinal (again), Vicodin, Hydromorphone pills, (no Fentanyl, I'm allergic) and many more.

My mother, and sometimes father, drive me everywhere for my doctor's appointments since I never know how I will end up. You know, with a demerol (did I spell that right?) shot, or a blinding headache.

Around here unfortunately if I had a prescription for methadone there would be an instant prejudice if I were ever to go to the ER for a migraine or to the "doc in a box" that we have for not quite ER cases but they will give pain shots for migraines. It is sad but it is the way it is. I would have been willing to try it and I did consider it for quite a while before I passed on it. I may eventually end up taking it. The only pain medicine that actually works for me it hydrocodone.

Strangely enough oxycodone, hydromorphone, fentanyl, etc. do nothing for me. The only thing that works for pain for me (and it was the same with my endometriosis) is hydrocodone 10/325 or 10/whatever. The higher class drugs do nothing for me. Ultram has never done anything. I have yet to find anything. It is weird but true.

Anyway, my neurologist does the nerve blocks in my head, gives me Rx's for the Relpax and the hydrocodone which I try to take as sparingly as possible. It also seems to take a while for me to build up a tolerance to it (the hydrocodone). An interesting thing that doc told me though - take a Tagamet with a 40 mg Relpax and that doubles the effect making it equivalent to an 80 mg which is what they tested overseas but not here. Has anyone else been told that? The Tagamet actually upsets my stomach so I don't usually do it but it does seem to make the Relpax work better.

Another thing about the Methadone at the time. We had had a neighbor get wind of my hydrocodone Rx and she broke in and stole a large quantity but we were unable to prove that it was her. Getting a Methadone Rx would have been inviting trouble from her. We have since moved so that argument is now moot...

I made my GP sound like an idiot but she isn't. She's just aware of how things are here and the surrounding areas. Now I've made Alabama sound bad. Oh well.

Would you please look at the thread I created about being new here, introducing myself and considering ECT? I'm asking for opinions and info if anyone has any. Thank you!