It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Panlor SS

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 08-12-2006, 08:53 PM   #1
    averimomma
    Junior Member
    (female)
     
    averimomma's Avatar
     
    Join Date: Aug 2006
    Location: missouri, USA
    Posts: 26
    averimomma HB User
    Panlor SS

    My plastic surgeon just put me on Panlor SS. I have been on Loratab (10 codiene/ 500 tylenol. The tablets I am on now are only 32mg. They do not seem to work all that well and the caffeine in it seems to make me jittery! I like the loratab but it was just not working to break my pain! Can someone help me understand what they think and what works better. I guess I have been on the loratab too long with this terrible surgery and in a lot of pain and the Panlor does not help at all. I can not even feel the effects of the codiene in it. PLEASE HELP!

     
    Sponsors Lightbulb
       
    Old 08-13-2006, 03:24 AM   #2
    Shoreline
    Senior Veteran
    (male)
     
    Join Date: Jun 2003
    Posts: 3,519
    Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
    Re: Panlor SS

    Hi AviMomma, DHC isn't comonly used in the US, so it's hard to find any consistant data on it' s stength compared to other pain meds. The only consistancy I found was that it was twice as strong as regular codeine and weaker than hydrocodne, but your are taking more mgs of DHC to compensate for some of the difference in strength.

    I don't know what type of surgery you had but normally after surgery, they decrease the strength of meds untill you are completely off the medication. It would be unusual to start increasing the strength or dose of meds 2 or 3 months post op without a reason such as infection, reinjury or return of the original problem. Part of the healing process is redcution in pain even with extremely invasive surgeries like TKR's, hip replacement, spinal fusion etc.

    If you can tell us more about the type of surgery you had there may be a better way to treat the specific type of pain your having. If they had to cut nerves as part of the surgery, you may respond better to meds they use to treat nerve pain. Normally the first line in nerve pain is the antidepressant elivill. This just comes to mind because my mother had a radical mastectecomy last year and the nerve pain didn't respond well to opiates and it did respond well to elevill. Rarely is the goal of surgery to keep someone on pain meds indefinitely and unfortunately the surgeon decides when it's time to discontinue or step down the strength of medication.

    Post surgical pain is acute pain that should deminish as time passes. Chronic pain is very different but few patients simply increase the strength of pain meds untill they are satisfied without first trying other methods to relieve their pain that doesn't create physical dependence on pain meds.

    Doctors don't like to admit their surgery failed and when a patient requires more and more meds post op it's not uncommon for surgeons to look for other causes for the need for medication rather than their surgery failing. It's easier on their EGO to suggest the patient has a drug problem than to admit their surgery failed.

    Normally a patient has surgery, pain is controlled well in the hospital, you come home with something like percocet for the first couple weeks and then step down to one of the hydrocodone products like lortab and then slowly decrease the dose and availability of that pain med as you heal.

    The goal of a hip replacement or a Knee replacement or back surgery is to correct the problem and relieve the pain, not corect the problem and slowly increase the dose of pain meds to the point of physcial dependnece and tolerance. If you still have pain 6 or more months post op then the pain is considered chronic and they start looking for ways to manage the pain that surgery didn't relieve. Opiate pain meds aren't the first line in manageing chronic pain.

    Basically DHC is weaker than lortab 10 but finding out why your having more pain now than you were 1 month post op is the bigger question you may need to consult with other docs to find an answer. Your surgeon is likely going to say give it time, continue PT and staying dependent on opiates to manage you pain is a pretty hefty price to pay when the goal of surgery was to relieve your pain. Based on the meds prescribed, I would guess he's stepping you down in strength in hopes of discontinuing pain meds which is normal protocol for all surgery. Surgeons fix things, they don't manage chronic pain indefinitely with pain meds simply because we had surgery.

    There are pain management docs that may be willing to step in and try some alternative therapies before deciding the only way you can have any quality fo life is to remain dependnet on opiates.

    Good luck, Dave

    Last edited by Shoreline; 08-13-2006 at 05:22 AM.

     
    Old 08-13-2006, 08:25 AM   #3
    averimomma
    Junior Member
    (female)
     
    averimomma's Avatar
     
    Join Date: Aug 2006
    Location: missouri, USA
    Posts: 26
    averimomma HB User
    Re: Panlor SS

    Well....I had an elective breast reduction and I ended up popping a stitch...I put my story under cosmetic surgery and this message board under stories....well everything went well until a few weeks later when I popped stitches and my pain began increasing and pain meds were being taken more and more and it just wasnt helping.....June 15 was my surgery and as of today... I have a hole about the size of a quarter that my fatty tissue has came out of and is pushing out about almost half an inch. Lots of pressure and pain especially when I bend over. It will not even try to scab and I dont think it will! It continues to seep and bleed. It gets really nasty at times and I have to constantly keep gauze and neosporin on it. I ended up in the ER for it and they said there is no way that this should be still like this and I needed to go and see my dr. they put me on antibiotics. the next day I went to my dr (plastic surgeon) and he was mad that they put me on antibiotics and said that I did not have an infection and that I didnt need to be on them but once you start them it is only safe to finish the complete doses! I went in there this week and asked to maybe get the fatty tissue pushed back up in there and throw a few stitches in there. I dont want to and I am having HIGH anxitey about it. The week of the 20th I am going to have it done in his office but I had the option to do it at the hospital but it is the same as before....SURGERY!!! Just to put in a few stitches that he said when it is said and done it will only take like 30 minutes after he cleans it up and stitches it. I do not want to have surgery again......IT REALLY SUCKS! I am allergic to morphine, darvocet, percocet and PCN. I thought I was going to die after surgery. Exactly 15 minutes after surgery I was wide awake in recovery and remember everything and I was in a lot of pain. They said that they could not really manage my pain after surgery in my IV due to me being allergic to morphine. I wanted it even though I tear my lips off just because I hurt so bad. I feel like this is a horrible nightmare. Yeah my back feels better but this should be healed by now. My husband is extremely ****** at me for all of this and was going off in the dr office a few days ago. My husband says that my chest looks like a butchers block.

     
    Old 08-14-2006, 05:56 AM   #4
    Shoreline
    Senior Veteran
    (male)
     
    Join Date: Jun 2003
    Posts: 3,519
    Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
    Re: Panlor SS

    Hi AV Momma, Sorry to hear about the popped stich. I know in my moms case , She had the original RM done a year ago and just has her 3rd reconstriction to cover the sunken and scared area which turned out quite nice. The only thing remaining is the Tatto. y mom was also surprised by the amount ofpain and pain from dying nerves that had been severed. The biggest problemis the way docs make surhery sound, They do hundredsds a year, it's no big deal, these thinks happen, but it's not their body. The last surgery aside from cosmetic they removed some necrotic fatty tissue that had lost it's blood supply. Surgery 2 months ago with an infection and still neeeding pain meds insn't that unusual, but if your doc makes it sound like it's as simople as out patient surgery, pain is minimal etc etc etc, everything a doc could say to minimize the minimize the experience and yet a year later she's till having a giant X covered and dead tissue being remobved isn't minimal surgery. There are other meds for pain they can use, they jst have to be more creative and although a plastic surgeon may be creative when it comes to reconstructuion, they aren't too empethietic or creatice when it comes to pain conntrol. It sounds like your have allegies to the keto synthetic and allergies to the naturl opioids like morphine, but you do have 2 other disticnt and different classes of opiates that may help and a bunch of meds to use tomanage nerve pain and meds to improve the effectiveness of pain medds. You didn't mention the class of synthetcis that include the fentanyls and demerol or the class that includes methadone or Levo-Dromoran, which are both much more potent than morphine other than demerol.

    Meds like alevill and lamyctyl can also be good adjuncive meds and you might want to consult with an infectious disease doc. Once you start having complications you have to stop worrying about how your surgeon will feel or if he may be insulted if you want second opinion and different docs brought onto the case. A special consult with anesthesiology to discuss anelgesic options and the ID doc to discuss healing the infection. The plastic surgeon did his thing and got paid , more often than not things do go smooth but when things don't some docs simply don't know how to deal with the follow up problems.

    Plastic surgeons don't normally deal with long prolonged recoveries unless working on major recoctruction or burns. When they are dealing with major issues like this , anesthesiology is managing pain control, not the surgeon who''s knowledge of pain medication and post op pain control was limited to one semester during medical school where anyone that went to med school before 96 and the oXycontin revolution was tought opiates are bad, depeddnecy and addiction isn't any different and dealing with a failed or complicated suregery is better than having to deal with an addiction the docs seems to be overly concerned about.

    Your 2 months post op with a major infection, controlling the infection and controlling the pain are the two things your doc should be doing but neither fall undeer the specialty of plastic or cosmtic surgery.

    I've had 3 failed back surgeries and fusions that didn't take where the hardware eventually starts breaking because it's not designed to hold things together indefintely witout bone growth from the fusion starting to take over the load bearing. No fusion and the hardware does it all untill it starts snapping.

    Your definitely still in the acute phase , not the Chronic pain phase so managing this kind of pain is actually simpler than trying to manage pain they can't find an answer too or are dumfounded why you still have pain, Obviously all you need to do is show the incision scar and the open wound, the visusal is worth more than anything you can describe or rate the pain as.

    There are still meds to try and adjunct meds to try. Using antidepressants for nerve pain or anti siezure meds for nerve pain are very common and don't imply the pain is in your head, so try to be open to the idea that something like elevill may bring some relief even if it's just a little in addition to the pain meds.

    As far as time line goes, It's not unuaual to start to taper down 8 or more weeks post op but in the case of infection, treating your pain now isn't going to turn you into an addict . Some docs will go 4 weeks with meds, some 8 and some 16 weeks post op, It just depends on the docs comfort level prescribing opiates.Your alergies complicate things but don't make it impossible if you dealing with a doc that manages pain allt he time. Some of the best chronic pain docs are also the docs that manage post op pain , The anesthesia dept should be able to do more than try something as uncomon and as harsh on the tummy as DHC.

    If your not getting relief and the surgeon doesn't know what to do, there isn't alot of point in keepin a surgeon around that doesn't know what to do when things don't go perfectly smooth. IT does sound like the wound infetion is also beyond the docs capabilities and that's what infectious disease docs are specifically trained for. Hopefuly as the infection heal the amount of pain your ecperiencing will also deminsih, but you stil have o get through the rehab and wall walking and wilprobably need pain eds longer than this docs averge RM that they describe as everyday surgery for them. It may be everyday for them but not for each patient.

    Unfortunately we stil have lots of opiate phobic docs still practicing and they will continue to practice the methods and ideals they learned when the POV of the benefits of opiates wwere very diferent than it is now. You do have options and finding a doc to manage what the surgeon can;'t in't an insult, if anything perhaps the doc should take some continuing edcation on pain management if they happened to sleep through or squeek by the one semester of training they actualy get.

    There are options but if the surgeon isn't familiar with what's available it's not going to be offered, that's why it may be best to say thank you but I do't feel were making the progres managing the infection or pain that we should and get the consults with other specialties that can help.

    You havne't done anything wrong so you shouldn't feel bad about telling the doc DHC isn't even coming close to managing the pain. Aside from meds there are also procedures that may bring relief, like innercostal nerve blocks that wrap around to the front that will dampen some of the pain, other meds and adjunct meds eve though you have alergies, so try to hang in there. Don't worry about what this doc thinks if they bring up dependence or addiction, right ow thepain is acute, the problem is obviously clear, so you have nothing to feel bad about. Although itmay bve tough to get a surgeon to admit they don't have a 100% sucess rate, it doesn't mean they are somhow managing to carry odds of succes that are vitually impossible for any doc to claim 100% success in all patients.

    I am sorry your still having problems and very sorry docs can be mso misleading regarding the ease of surgery and recovery, it's very easy on them so whats the problem.

    Hang in there and keep doing the trial anderro thing untill you find what works and you back on the road to healing. Asking for pain medecine when you have giant open wound , doesn't make you a drug seeker and any doc suffestion you are neesds to experience the same wound and procedure themself.

    Hang in there, Dave

     
    Old 08-15-2006, 04:33 AM   #5
    beebers
    Junior Member
    (male)
     
    beebers's Avatar
     
    Join Date: Feb 2006
    Location: johnson city tn usa
    Posts: 19
    beebers HB User
    Re: Panlor SS

    dihydrocodiene is the same strength as regular codiene. the addition of caffiene is believed to increase or potientiate the regular codiene.

    i recently had asked the same question and then found the answer myself in wiklepiedia (sp) and then confirmed it in another opiod comparrsion chart.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    Migrane help without triptans? LilyMac Headaches & Migraines 3 06-15-2009 11:15 AM
    ?butalbital/apap/caffeine? HelpMeHoldOn Headaches & Migraines 3 08-19-2006 07:16 PM
    I'm planning on filing a malpractice lawsuit kim32 Pain Management 13 04-12-2005 03:50 PM
    Ultram question legaldiva007 Arthritis 14 12-05-2004 06:51 AM
    Panlor SS JKIII Pain Management 3 08-14-2003 11:41 AM
    Pain Mgmt? Puleeze! oakleygirl Back Problems 31 05-21-2003 06:56 AM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 02:42 AM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!