Discussions that mention tylenol

Pain Management board


Dave,

I really don't know where you get this information about opioids destroying the internal organs, I would love to see it as it contradicts every study that has ever been done.

These are, by and large, very safe drugs. There are a few synthetics like Demerol, and Darvon which have some toxic metabolites you have to worry about in prolonged use, and no sensible doctor would use Demerol long term for that reason. Drugs like Oxycodone, Hydrocodone, Codeine, Morphine, Diacetylmorphine, Fentanyl even Hydromorphone (Dilaudid) -- can be used for years and years on end without creating organ toxicities, nor do they cause decline in cognitive abilities when used appropriately long term.

Where people run into problems with opioids & organ toxicity is when using compounded opioid medicines like Tylenol #2 #3 #4, Vicodin, Percocet..etc These contain tylenol listed as APAP on the bottle, and it is the tylenol in them which cases liver & kidney problems - not the opioid. Other compounded opioids contain aspirin, caffeine, and ibuprofen - and again, the problems come from the added drugs: aspirin and ibuprofen carry a risk of GI problems, kidney toxicity, and liver problems with extended use.

Dilaudid in particular is very safe, it has no active metabolites which makes it useful even in cases of renal failure.

Many people have a misconception that those in pain who use opioid pain killers are going to be complete incapacitated and laying in bed all day drooling out of one side of their mouth oblivious to the world around them. This just isn't reality. If you titrate these against pain you end up with a more functional person, less incapacitated from relief of the pain. I take morphine every day, and the difference between taking it and being undermedicated is exactly this: Without it I'm laying in bed most of the day incapacitated ...though not drooling. With the morphine I'm up and able to do most things that people without pain completely take for granted. Instead of being cognitively impaired, I'm finding it far easier to do higher math and other complex task now that the pain is lifted.

While it is true you could take enough of most of these substances to create an incapacitated state, that isn't the aim of pain management. The one case where this is true is called "terminal sedation" which is reserved for end of life care to make their exit from the world less painful.

A lot of people have a misconception that only cancer is painful or worthy of these kinds of medicines. Most chronic pain is non-malignent. The vast majority of opioid prescriptions are written for non-malignent pain. Most of the conditions it is written for are not terminal, or at least not going to progress fast enough to kill you any time soon. These are people with decades of life left, and those are decades that will be lost to be pain if it isn't treated. Physicians wouldn't use these drugs long term if they were going to shorten lifespan. Suicide is very substantially elevated in the chronic pain population, and it is a telling indicator of the severity & seriousness of chronic pain that people would choose to end their life rather than continue to suffer at those pain levels.