Advice for those here with chronic pain

I have severe osteoarthritis of my right hip. I went to a cardiologist yesterday and she looked at my meds and asked why i wasn't combining Tylenol with the Ibuprofen i was taking. She added 1 gram of Tylenol 4times a day to the the 800mg of ibuprofen 3 times a day that i was taking. It makes a huge difference, i was able to take the dogs for a long walk in the woods for the first time in a year. I just with either the ER,rheumatologist, orthopedic surgeon, GP or Pain clinic had mentioned this to me.

I have suffered (and continue to suffer) chronic back pain from failed surgery for decades.

Tylenol, NSAIDS and Narcotics all greatly benefit each other (they have more than an additive effect). There are some things to be cautious of:

1) 4G of Tylenol on a regular basis is a bit scary to me. Be sure your liver is healthy, don't dare drink and be very cautious you don't get extra acetaminophen from other over-the-shelf drugs.
2) At the same time, Ibuprofen and other NSAIDs can cause kidney issues ... so be careful with that as well (I actually saw my kidney tests go to danger zones before I saw a doctor for the pain).
3) Narcotics, of course, have their share of dangers too, but are surprisingly safe for your internal organs unless you abuse them. Some people don't tolerate them well, though.

I was prescribed Percocet at one point as a break-through pain (I have morphine daily), but didn't want to take that much acetaminophen so I got that changed to just oxycodone.

Great to hear your doing better, though!

JTM, thank you for posting this. I didn't know that the combination could be more effective than either alone.

I've avoided the opiates because of the sleep apnea — that and they tend to make me really nauseous ( i learned what projectile vomiting really means). Doctor indicated that as long as you don't go over 4 g they don't see liver damage - but that was really good advice about the alcohol - i have a sister in law on the liver transplant list because of taking tylenol like tic tacs.

Re narcotics and OSA ... I don't buy it. If you have OSA and leave it UNTREATED, then yes, narcotics be bad. But if it is treated it should not be making things worse.

Narcotics tend to suppress the rate and depth of breathing, but as the patient becomes tolerant some of that is restored. If you have a patent airway you will breathe.

I would like to amend that just a bit though: I don't suffer CAs. That could be an entirely different ball of wax.

As for regular ole OSA, my AHI averages 0.5 now ... and I'm on a fairly strong dose.

Very sorry to hear about your sister in law. There's a scary place to be! For me, it was actually the kidney scare that motivated me and my doctor to use narcotics. All of that was BEFORE my OSA diagnosis, so for quite some time I was treated with narcotics while experiencing OSA. I can see a link between that time (when my wife told me the snoring got worse) and the narcotic use, which is why I feel it is a risk for the untreated ... of course the untreated aren't here reading this!

I had to give up on the Ibuprofen, tylenol etc because of the risk to my organs. The doc put me on relatively low dose narcotics and luckily they made no difference to the sleep apnea.

I'd like to add a word of caution when using NSAIDS - I am in kidney failure (stage 3) because of combined NSAIDS, Tylenol & narcotics. If I had just allowed my PM dr to use the level of narcotics HE thought appropriate for me instead of my wanted to listen to my rheumy & ortho drs who liked for me to use high levels of NSAIDS and try to avoid narcotics as much as possible. I don't think the level of Tylenol (4g) sounds at all harmful, but I'm just speaking up as a FYI so you can be aware of what can happen.

In my experience many drs stirring the kettle so to speak, can be a bad thing. Although I'm sure your cardio dr meant well & it sounds safe, a good pain mgmt dr can help guide the other drs & keep things like liver failure & kidney failure from happening. My PM didn't get involved until after my disaster even though he had sent letters to my rheumy & ortho drs. In fact it was a letter from him that had my rheumy do additional bloodwork that defined my problem. They then sent me to a nephrologist (kidney dr) who went NUTS about the level of NSAIDS I was on. After the whole mess got defined I was put on a narcotic pain patch (different from another type of pain patch I had been on that also was dispensing NSAIDS into my system). Now narcotics are addictive and when I was put on the patch, I understood that it was for life, but I at that point I didn't have a lot of choices for pain management. I have severe RA, and severe osteoarthritis in most all my joints, along with some other pain causing issues as well. I've had both knees replaced, still need to have hips, ankles and 1 shoulder replaced. I am having these surgeries in stages. Since I was diagnosed with lymphoma that kind of stalled those surgeries for a short time, but I plan on 1st ankle for the fall. Anyway, I just wanted to share an overview of what happened to me when my drs each had their own point of view about pain caused from different problems & how to treat pain.

The narcotics have made no difference to my OSA treatment. Actually I'm on a lower pressure, after getting an APAP machine my pressure went from straight CPAP at 19 to an avg 13.5 (range 12-20) on APAP.

I hope your situation works out without any further serious problems, but you might want to ask your drs for bloodwork that checks liver & kidney function frequently. If I'd had more bloodwork, perhaps I wouldn't have stage 3 kidney failure.

Jen

I don't know if this is useful for the conditions discussed, but I've used Glucosamine-Chondroitin for lower back pain going on fifteen years now. The problem was from an old back injury and pain due to vigorous exercise, plus onset arthritis. I've found it very effective for reducing lower back pain, shoulder and finger joints etc. I have thankfully suffered no side effects. It's like aspirin, in that it doesn't fix the problem but relieves the pain and makes it bearable. I like the stuff. Note: it takes a week or two to kick in before it's effective. Also, plunk down for the quality stuff, there is a difference IMO.

In the long term, chronic high dose of Tylenol, ibuprophen, and opiates is bad news. Your kidneys, liver, GI tract will all suffer.

I was there with pretty severe chronic osteoarthritic pain so be that it was getting impossible to walk across a room WITH NSAIDs AND Tylenol. I know what you're going through.

My pain is now GONE. Not just better. GONE. No drugs.

I eliminated grains, sugar, starches from my diet.

I know it sounds woo. I didn't even do it for the pain. But one morning I woke up and realized there was no pain. This was after YEARS of suffering. I couldn't believe it and kept waiting for the pain to return. It hasn't (except when I cheat with wheat, especially).

Doctors will never prescribe this dietary approach. They are hammers, and their nails are drugs. When you're a hammer. . .
I have to tell you how awesome it is for ME to hold the key to stopping the pain. I wish I'd known about it 10 years earlier. All the suffering I could have avoided (pain only barely controlled, damage to my esophagus, sleepless nights, inactivity and weight gain).

You can try it anytime you want. It doesn't cost anything, and most people know in a matter of days if its helpful or not (and either people for whom it's not helpful don't say much, or it works for most). If it doesn't work, Tylenol, ibuprophen, opiates will still be there. All you have to lose is your pain.

Janknitz wrote:In the long term, chronic high dose of Tylenol, ibuprophen, and opiates is bad news. Your kidneys, liver, GI tract will all suffer.

I was there with pretty severe chronic osteoarthritic pain so be that it was getting impossible to walk across a room WITH NSAIDs AND Tylenol. I know what you're going through.

My pain is now GONE. Not just better. GONE. No drugs.

I eliminated grains, sugar, starches from my diet.

I know it sounds woo. I didn't even do it for the pain. But one morning I woke up and realized there was no pain. This was after YEARS of suffering. I couldn't believe it and kept waiting for the pain to return. It hasn't (except when I cheat with wheat, especially).

Doctors will never prescribe this dietary approach. They are hammers, and their nails are drugs. When you're a hammer. . .
I have to tell you how awesome it is for ME to hold the key to stopping the pain. I wish I'd known about it 10 years earlier. All the suffering I could have avoided (pain only barely controlled, damage to my esophagus, sleepless nights, inactivity and weight gain).

You can try it anytime you want. It doesn't cost anything, and most people know in a matter of days if its helpful or not (and either people for whom it's not helpful don't say much, or it works for most). If it doesn't work, Tylenol, ibuprophen, opiates will still be there. All you have to lose is your pain.

I wish it was that easy. It certainly didn't do anything for me. I tried exteme low carb (which would mean no suger, starch, grains), and in fact lost 60 lbs doing it, but the pain situation didn't change. I've seen my MRI ... there is a LOT of scar tissue entwined with the nerves....

I have not been able to find any scientific evidence that long term opiate use is harmful unless the patient either abuses it or is unfortunate enough to acquire another disease that make opiate use incompatible.

johnthomasmacdonald wrote: She added 1 gram of Tylenol 4times a day to the the 800mg of ibuprofen 3 times a day that i was taking.

John, What did she say about any danger of stomach lining deterioration from ibuprofen?

I have to take a gram of acetaminophen in the middle of the night for pain. At one point I was taking 800 mg of ibuprofen but the sleep doc scared me off with a stern warning about stomach bleeding.

I really need to be taking acetaminophen and ibuprofen in the middle of the night to get appropriate relief.

Are there any precautions? Do you need to be sure to eat and drink with the ibuprofen? This is impractical in the middle of the night.

Thanks.

I eliminated grains, sugar, starches from my diet.

What do you mean by starches?

My experience, YMMV. Sometime back, a year or so, I was combining ibuprophen and Tylenol at bedtime. The combination worked better than either alone, and allowed me to sleep through the night with few disturbances. However, after a month or so, I began to have stomach problems. I thought I had gallstones from the location and nature of the pain. After consulting with my doctor and some tests, it was determined that I did not have gall stones, but I did have a slightly enlarged liver and a small ulcer. By this time, I had stopped taking the ibuprophen and Tylenol. After a 30 day treatment of Pepsid, the ulcer was gone, the pain stopped and my liver returned to normal. Were the ulcer and enlarged liver due to the meds? I don't know for sure, but it would be my guess. I haven't had any more trouble since I stopped taking them. On the other hand, my sleep disturbances returned.

Janknitz wrote:In the long term, chronic high dose of Tylenol, ibuprophen, and opiates is bad news. Your kidneys, liver, GI tract will all suffer.

I was there with pretty severe chronic osteoarthritic pain so be that it was getting impossible to walk across a room WITH NSAIDs AND Tylenol. I know what you're going through.

My pain is now GONE. Not just better. GONE. No drugs.

I eliminated grains, sugar, starches from my diet.

I know it sounds woo. I didn't even do it for the pain. But one morning I woke up and realized there was no pain. This was after YEARS of suffering. I couldn't believe it and kept waiting for the pain to return. It hasn't (except when I cheat with wheat, especially).

Doctors will never prescribe this dietary approach. They are hammers, and their nails are drugs. When you're a hammer. . .
I have to tell you how awesome it is for ME to hold the key to stopping the pain. I wish I'd known about it 10 years earlier. All the suffering I could have avoided (pain only barely controlled, damage to my esophagus, sleepless nights, inactivity and weight gain).

You can try it anytime you want. It doesn't cost anything, and most people know in a matter of days if its helpful or not (and either people for whom it's not helpful don't say much, or it works for most). If it doesn't work, Tylenol, ibuprophen, opiates will still be there. All you have to lose is your pain.

Hi Jan, I've been a vegan for over 30 years and a low-fat vegan for probably 20 years and also around that time i gave up all sugars except what comes in fruits and what comes in Silk or Costco Soy milk - but no added sugar, honey, agave, molasses, maple syrup. About a year ago I read the book "wheat belly" and gave up all wheat products. I can't say any of it made any difference in my health or in how i feel. After reading the book i was hoping that giving up wheat might help with my arthritis pain, the sleep apnea or my swollen legs/feet. So far i can't say i've noticed much difference. I also didn't lose any weight but i wasn't overweight to start with. But in general, i think you are giving good advice and I think people should at least give it a try

VVV wrote:

johnthomasmacdonald wrote: She added 1 gram of Tylenol 4times a day to the the 800mg of ibuprofen 3 times a day that i was taking.

John, What did she say about any danger of stomach lining deterioration from ibuprofen?

I have to take a gram of acetaminophen in the middle of the night for pain. At one point I was taking 800 mg of ibuprofen but the sleep doc scared me off with a stern warning about stomach bleeding.

I really need to be taking acetaminophen and ibuprofen in the middle of the night to get appropriate relief.

Are there any precautions? Do you need to be sure to eat and drink with the ibuprofen? This is impractical in the middle of the night.

Thanks.

HI V, She said to make sure that i took them with food with/before taking both. It took me awhile to find the actual prescription she wrote but here it is: " ibuprofen 800mg 3X/day alternating With Tylenol 1000mg 2-3X day (less than 4g/ day) ". I have to tell you that i'm often bad about just taking them with nothing or with just a cup of coffee ( funny, my grandmother couldn't swallow the tiniest pill while i could swallow a golf ball - no problem). In the middle of the night could you take them with a protein/energy bar that you keep by the bed - a few bites should be adequate . If i have to stay in this long term, I plan to get regular ( every 6 months at most) liver and kidney function tests (even if i have to pay for them myself - are you aware that there are lots of labs now where you can go for whatever testing you want without a prescription ( depending on state law - for example jersey doesn't allow it but PA does and it is only a half hour drive for me - Here's one but if you do a google search for online lab tests you'll find plenty - http://www.privatemdlabs.com/