Josie115
05-19-2005, 07:43 AM
I have been on hydrocodone for a number of years.(back problems) Currently taking 4- 7.5/750 per day. I almost never take more..I had a total hysterectomy 2 years ago for cancer and had a terrible time trying to get pain controlled. The doctor was concerned about it and did want to make every effort to find the right amount/type of pain med...but still didn't work. I came home from the hospital with percocets that did nothing. I switched back to the vicodans finally..
Now, I fractured my shoulder in March skiing..(dumb move) and just had mri to find out what else was wrong..have lots going on in there..slap lesion, torn rotator cuffs and frozen shoulder. I will now need surgery. If anyone has ever experienced this type of should injury, you'll know how bad it is..(pain) It's really bad. I'm afraid that I will again be stuck without any pain control. For awhile, my doc had me on avinza hoping to get LA meds..they made me very nauesous and that didn't improve..tried for 3 months. The dosage wasn't enough either..but we kept increasing which just kept making me throw up. What does anyone think about the kind of pain meds to take care of this???
I'm ok right now with the pain..heat/ice, physical therapy, tens unit, but come time for surgery...HELP. What I'm taking isn't going to work.
Now, I fractured my shoulder in March skiing..(dumb move) and just had mri to find out what else was wrong..have lots going on in there..slap lesion, torn rotator cuffs and frozen shoulder. I will now need surgery. If anyone has ever experienced this type of should injury, you'll know how bad it is..(pain) It's really bad. I'm afraid that I will again be stuck without any pain control. For awhile, my doc had me on avinza hoping to get LA meds..they made me very nauesous and that didn't improve..tried for 3 months. The dosage wasn't enough either..but we kept increasing which just kept making me throw up. What does anyone think about the kind of pain meds to take care of this???
I'm ok right now with the pain..heat/ice, physical therapy, tens unit, but come time for surgery...HELP. What I'm taking isn't going to work.
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zandy
05-19-2005, 08:02 AM
You poor thing! Yes, I know just how painfully awful that type of pain is, because I too had a frozen shoulder along with a torn rotator cuff. I did not have the surgery as I'm type2 diabetic and the doctor didn't think I'd heal well (in his experience with diabetic's), and it took a long time to heal for everything (about 1 1/2yrs), and I still have some problems with my right shoulder occassionally. But I did want to tell you that in my opinion, I hope your doctor doesn't do the surgery until at least your frozen shoulder problem has resolved. BTW, a frozen shoulder normally takes about 18 months to heal, the healing goes in 3 stages, and each stage takes about 6mos. It's only what I've read and heard about. So please do check it out for yourself. On the other hand, I wish you the best of luck in whatever you decide.
On the subject of pain meds. I don't think you'll have any other choice but to use short acting narcotics (vicodin, percocet, etc.) for your pain. I believe, imo, that long acting narcotics might not help you. They work on different pain receptors. The one other thing that did help me was a cortisone shot in the shoulder. It helped to loosen the shoulder up alittle bit. Oh, and physical therapy? My doctor advised me not to have it as long as I had alot of pain, which I did for nearly 1yr. Actually, I did try P.T. for a short time (3 visits) but the pain was unbearable. And because of the frozen shoulder/torn rotator cuff combination, one could make the situation worse. Again, check with your own doc first. They all have differing opinions. Best of luck to you!
P.S. For your nausea, your doctor can prescribe nausea meds to help you (vistaril, phenergan,compazine, etc.)
On the subject of pain meds. I don't think you'll have any other choice but to use short acting narcotics (vicodin, percocet, etc.) for your pain. I believe, imo, that long acting narcotics might not help you. They work on different pain receptors. The one other thing that did help me was a cortisone shot in the shoulder. It helped to loosen the shoulder up alittle bit. Oh, and physical therapy? My doctor advised me not to have it as long as I had alot of pain, which I did for nearly 1yr. Actually, I did try P.T. for a short time (3 visits) but the pain was unbearable. And because of the frozen shoulder/torn rotator cuff combination, one could make the situation worse. Again, check with your own doc first. They all have differing opinions. Best of luck to you!
P.S. For your nausea, your doctor can prescribe nausea meds to help you (vistaril, phenergan,compazine, etc.)
Ivorygirl
05-19-2005, 09:05 AM
Prior to going in for your surgery, I would recommend that you sit down with your surgeon as well as your private physician and discuss this concern with both of them. Tell them of your concerns for pain management and what options there are for you to insure that you will be made as comfortable as possible postoperatively and prior to being discharged home since this has been a problem. Ask them to mark your chart for the anesthesiologist that you have some resistence to pain meds effectiveness and that you need this taken into consideration in your immediate postoperative time period (having your doctor mark you chart will avoid any questions as to the validity of your statements...for what patient would love to have more pain meds ;) ). Most hospitals have a pain management team which you should request on seeing prior to your surgery.....usually they see you the first morning after your surgery, however, in your case I would strongly recommend asking your doctor if you may meet with them sometime prior to your surgery. Just before you go into the OR for your surgery, the anesthesiologist will meet with you. Also discuss these concerns of yours with him. That way he will consider the meds he will give you just prior to the surgery being over that will make you as comfortable as possible....most of the time this is in the form of an epidural or morphine self administering pump (PCA) in which you press a button when in pain & morphine is delivered to you as needed. Most importantly, discuss with your surgeon your need for his support as your not being discharged home until you have tried the pain medication regimen that is planned to be used and that it's effectiveness is evaluated by a professional. I hope this helps alleviate your concerns........Ivorygirl:wave:
Shoreline
05-19-2005, 10:10 AM
Hi Jozey, Sounds like you have a monster surgery coming up. Docs d o usually stick to short acting meds imediately post op because it's easier to make a rapid adjustement rather than wait for a 24 hour pill to wear of before making a big change. They can combine meds like percocet and dilaudid or Hydro and dilaudid and pain can be managed post op after the intial stay in the hospital where you would likely have IV meds via "PCA" "patient controlled anesthesia" It can deliver a contninous dose and then you have the ability to give yourself small bolus doses by pressing a button every 5-15 minutes dependning on the settings. If your not comfortable in the hopital, it's best to have someone there to advocate for you. Somethat can stomp the halls, yell and demand to see the surgeon now to manage uncontrolled pain. You won't be in shape to do that yourself, It's too easy to simply close your door and say this is what the doc ordered, but an advocate can make a sceen untill the anesthesiologist or surgeon get there to adjust medds. I would never leave a loved one alone in a hospital untill I knew their pain was managed.
AS far as taking #4 7.5 lortab or vicodin or whatever a day, that's not a huge dose that's gong to make you tolerant to all post op meds. taking 2 10mg norco would triple your present dose of hudrocodone. 2 10 mg percs would quadrouple your present dose, 4 mgs of dialudid would be 4 times your present dose. There is plenty of room with the short acting meds to make qdjustments and use something stronger and control the nausea.. But do discuss your fear and your mild tolerance to hydro with your docs..
By the way, Morphine is morphine, short acting morphine binds to the exact same receptors that Long acting does, It just doesn't have that kick where a big dose is released at once, it's just spread over time. The same goes with all LA and SA meds, Oxycdone is oxycodone, whether it's OxyContin or percocet, it still binds to the same repeptors, but different classes of opiates do bind to different receptors and even drugs in the same class, like the synthetics, "hydrocodone, Oxycdone, Hydromorphone, Oxymorphone" although they bind to the same group of receptors each group of receptors have several sub groups that one may bind to and not the other, so there are differnces even among the same class, like the difference between Oxycodne and hydrocodone.
Meds like hydro and morphine are two different classes and the side effects may be intolerable with one and not the other and they do bnd to sligtly different receptors.
Oxy and hydro are in the same class but you responded better to hydro. It's not uncommon to respond better to one med than the other and with the stronger hydro product Norco that only has 325mgs of tylenol in each 10 mg dose, you can take enough to manage pretty severe post op pain. Some docs are using LA meds after you leave the hospital although that's not what they are intended for and surgeons have no clue how to comfortably taper you off them. Just discuss your concerns and options with the surgeon and the anesthesiologist.
Good luck, Dave
AS far as taking #4 7.5 lortab or vicodin or whatever a day, that's not a huge dose that's gong to make you tolerant to all post op meds. taking 2 10mg norco would triple your present dose of hudrocodone. 2 10 mg percs would quadrouple your present dose, 4 mgs of dialudid would be 4 times your present dose. There is plenty of room with the short acting meds to make qdjustments and use something stronger and control the nausea.. But do discuss your fear and your mild tolerance to hydro with your docs..
By the way, Morphine is morphine, short acting morphine binds to the exact same receptors that Long acting does, It just doesn't have that kick where a big dose is released at once, it's just spread over time. The same goes with all LA and SA meds, Oxycdone is oxycodone, whether it's OxyContin or percocet, it still binds to the same repeptors, but different classes of opiates do bind to different receptors and even drugs in the same class, like the synthetics, "hydrocodone, Oxycdone, Hydromorphone, Oxymorphone" although they bind to the same group of receptors each group of receptors have several sub groups that one may bind to and not the other, so there are differnces even among the same class, like the difference between Oxycodne and hydrocodone.
Meds like hydro and morphine are two different classes and the side effects may be intolerable with one and not the other and they do bnd to sligtly different receptors.
Oxy and hydro are in the same class but you responded better to hydro. It's not uncommon to respond better to one med than the other and with the stronger hydro product Norco that only has 325mgs of tylenol in each 10 mg dose, you can take enough to manage pretty severe post op pain. Some docs are using LA meds after you leave the hospital although that's not what they are intended for and surgeons have no clue how to comfortably taper you off them. Just discuss your concerns and options with the surgeon and the anesthesiologist.
Good luck, Dave
Josie115
05-19-2005, 10:58 AM
Thank you all.. I've had plenty of experience with the PCA..mostly not working. I also have a problem with 1. waking up in the middle of surgery and 2. waking so quickly after. That problem happened with my hysterectomy surgery and they said that was the problem with the pain management issue. The rest of that story is..the crap they all dished out about "geeezz..you've had enough"..even though it was written in the chart why..no one really read the charts..the pain pump was broken (afterall) and they didn't have any more. The whole experience was terrible. I did sit down with the doc and the "A" man prior to surgery. Didn't do a bit of good. Having an advocate there would have helped..they didn't even come into my room for 8 hrs. one day..someone told me I should have call 911..lol, if I could have reached the phone I would have!
The shoulder issue is some concern..I fractured it in March..missed some PT due to a death in the family and a birth..the whole month was a mess..anyway, I believe that the doc thinks he will break up the scar tissue during surgery..in the meantime I am doing regular physical therapy to try to improve the "frozen" shoulder and build a bit of strength..
Dilaudid works for me.. maybe that will be one of our discussion items..morphine seems to do nothing..:( Thanks all...
The shoulder issue is some concern..I fractured it in March..missed some PT due to a death in the family and a birth..the whole month was a mess..anyway, I believe that the doc thinks he will break up the scar tissue during surgery..in the meantime I am doing regular physical therapy to try to improve the "frozen" shoulder and build a bit of strength..
Dilaudid works for me.. maybe that will be one of our discussion items..morphine seems to do nothing..:( Thanks all...