Pain management question- meds without Tylenol

Hi All,

I have a question and wonder if anyone else has any experience with this. Right now, Tylenol #3 (Tylenol with codeine) is one of the meds I use when the pain gets bad. I take up to four a day. Lately, I have noticed quite a lot of warnings about the Tylenol in these medications. I am in sort of a quandary here- the Tylenol 3 helps some, but I have also been on it for a good while. I am going to ask my dr if he can write for either plain codeine or if there is something else we can try. (I already have some elevated lived numbers from depakan.)

I am just not sure what to do anymore. I do not want to go back on long acting opiates- mainly morphine. (I was on it for several years and it helped, but I don't want to go back unless I have to.) Tylenol 3 helps, but not as much as I would like it to and I beginning to think it is time for a change. I would be fine with having a medication without Tylenol as an abortive. My neuro suggested going back on short acting Morphine, but my pain dr didn't want to do that just yet. This leaves me stuck in the middle.

I see the neuro for a follow-up on Monday. I will definitely talk to him again about the whole pain management thing. I guess I could also ask him if he would be willing to talk my pain dr or at least send the report- so everyone is on the same page.

I know it is time for some change in managing this pain. I fainted two weeks ago and badly sprained my ankle. My internist x-rayed it and prescribed some lortab- which has been helping more than the Tylenol 3 lately. I hope I don't sound like a drug seeker or anything. I am just tired of dealing with the constant pain and the tramadol/T3 combo isn't working and I am not sure what to do.

I suppose I could ask the neuro if it would be possible to try plain codeine or even the morphine and if he agrees, have him send a note or I could take a copy of the script to my pain dr. Does this sound reasonable? I think the only other option would be to try and get in with my pain dr in the next few weeks and see if there is anything we can do to keep the pain under better control.

Does this sound reasonable? Has anyone else dealt tiwht this?

Pain free days,
sconesail

Vicodin and Fentanyl are two good pain meds that do not contain Tylenol. Also you can get Percocet without Tylenol in it.

Fentanyl might be a good one for you long term, it comes in a patch so you can wear it and is much kinder to the liver because it bypasses your digestive system and liver.

Vicodin has to be watched carefully, its in pill form but you may build up a tolerance to it quickly and need more to decrease pain.

Lastly, Methadone is a very good pain medication, (however it is addictive) even though it was not created for that. My Mom had cancer and took Methadone pills and it allowed her to function without suffering so much before she passed. She did tell me she had a more difficult time concentrating while on that medication, she liked to read a lot and would "lose" where she was in the story of the book I was really glad her doctor was willing to let her take it, She was at a point where she couldn't walk anymore because one of the tumors was on her spine, within 3 days of taking Methadone she was walking and driving her car again. So it does have its good points, but needs monitoring.

I hope this has been helpful to you!
Trinity

Codeine isn't really available except in combination meds. You could ask your doctor for a trial on Fiorinal w/ Codeine. This includes 3 other medicines which can help w/ headache: Butalbital, aspirin, and caffeine. Although you may say 'aspirin doesn't help my headaches', in combination w/ the other ingredients it can help. I think you're wise to avoid Tylenol -- the day doesn't go by that they don't find some other health risk associated w/ Tylenol.

-Platy

Actually, the FDA got worried about that and had the manufacturers cut back on the tylenol http://www.fda.gov/drugs/drugsafety/ucm239821.htm

Basically all the meds that used to have 500mg of tylenol now have 325mg to try to avoid the issues you are worried about. But most of the tylenol meds have a form that either doesn't have any OTC med, or sub ibuprofen in the tylenol's place.

Hi All,

Thanks so much for all the advice and encouragement. I'm not sure what I would do without y'all!

I really appreciate the input. So many people just don't seem to understand the chronic pain stuff. I hope I don't sound like a drug seeker when I say this- but I KNOW it is time to tweak some of the pain medications. I am currently on long acting Ultram with tramadol 50mg for breakthrough as well as Tylenol #3. I also know that having to take the breakthrough meds-mainly Tylenol 3 and on a daily basis is not ideal for managing the pain.

I know they are scaling back the Tylenol in many medications like Tylenol 3 and such, and as I don't want to go back on long acting opiates, I thought it might make sense to go with plain codeine if possible. When I sprained my ankle a few weeks ago, my GP prescribed lortab, which really helped the head- but my pain doctor doesn't prescribe it at all. I may ask the neuro about it tomorrow and see if he has any ideas at all.

I have pretty much run the gamut on long acting pain meds over the years. The only one that really helped at all was Morphine. I don't want to go back on the long acting version because way too many people blamed the fainting on the pain meds. Also, I have done ok without it. I know I will probably have to go back to that eventually, but I'm trying to hold off as long as possible.

I feel kind of stuck right now. My neurologist has suggested going with short acting morphine as an abortive and I would be ok with that. When I spoke to my pain dr about it, I think he said that it might be ok substituting that for Tylenol #3, but I have forgotten what he said about ultram and Morphine. So we ended up sticking with the ultram/t3 combination at the time.

I see my neuro tomorrow morning. Right now, the best plan of action might be to ask him what to do or if it is possible to be on the long acting ultram with morphine, plain codeine, or something else for the really bad ones. If he has any ideas, I can always ask him to send the report to the pain dr or something so that all the bases are covered. If he doesn't want to deal with the pain part of things, maybe it is time to see if I could get in with the pain dr and ask him about this.

Right now, I just feel really frustrated. I'm also a little scared due to the pain which isn't helping. I hate feeling like this- scared, in pain, and slightly desperate. I'm really scared and the only thing that I can think of to do is take a little bit of zanaflex and distract myself with something.

Thanks for all of your help.

Pain free days,
sconesail

Scone, I hope you are able to find something to replace the T3. Everyone is so different, its hard to say what will help someone else. I will tell you what works for me. I have several other issues besides migraine. I have digestive problems from years of untreated Celiac disease, so no anti-inflammatories except occasional Aleve.

Also, I have chronic Lyme which has caused long term nerve, muscle and joint pain. So, for the daily pain, I take 1/2 of a Percocet with an arthritis strength Tylenol at noon when I rest and at bedtime. I have been doing this for many years without changes in my liver enzymes. For migraines and other head pain, I start with Amerge and a whole percocet, often with phenergan.

I have used dilaudid, demoral,and morphine as rescue meds for bad ones (a few times/month), always with phenergan. I switched to Fentnyl lozenges 2 years ago, and it has been a success. Much fewer trips to ER and a lot less medication hangover the next day.

My insurance will not pay for this and it is quite expensive. But it comes out to a lot less than my co-pays for ER and a lot less stressful. I did have to go thru a lot of hoops, as did my Dr. and my pharmacy to get this, but I'm so glad I did. I do keep trying other treatments, but this is what I use now.
Hugs,
Cindy

Hi All,

Thanks for all the replies.

I asked my neuro he said to talk to my pain dr. I did, however, ask if they would send a report to him- just so we are all on the same page- and he said that wouldn't be a problem and that it made sense. So that is good. I did get a toradol shot while I was there and that has helped a good bit. He mentioned rebound from Ultram and tylonol, but it has never been a hige issue for me.

I may call and see if I can get in with the pain dr soon. I will ask about possibly switching the Tylenol 3 for short acting morphine and keeping the ultram. If that is a possibility, it is worth a try.

I may also ask the neuro about possibly having injectable toradol on hand for bad ones. It never did much before- but wilh the botox and the stimulator, it seems to help.

Basically, it comes down to keeping things the same until I see the pain dr. I will do another round of Botox in six weeks. I am hoping to get in with the pain dr in the next few weeks. I will call tomorrow.

Pain free days,
sconesail

You might want to talk to your docs about a pain medication called Nucynta and Nucynta extended release. It is brand name, but is a moderate pain medication that is designed to treat the pain but not to give you a buzz. As well it's designed to augment pain medication addiction.

It's worked well for post-surgical pain for my shoulder, and for migraines.