pain management question- pain meds and tylenol

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pain management question- pain meds and tylenol

Post  sailingmuffin on Sat Feb 15, 2014 10:16 am

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,

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Join date : 2009-12-05

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Re: pain management question- pain meds and tylenol

Post  Mini on Sat Feb 15, 2014 3:12 pm

The  reason there are warnings about Tylenol is because our body poorly tolerates any overdose,  and there was some publicity about the danger of trying to commit suicide using Tylenol for the purpose because it is  it is extremely difficult to save a person, because their liver gets damaged.

On the other hand Tylenol is  a very safe medication to take, with few s/e,  if taken in doses as prescribed by your doctor,  and if you always  keep to that dose.
It is certainly much safer, then codeine which has quite a few s/e and as an opiate can also result in dependency, and therefore the need to increase the dose over time etc.

It might be best to have a talk with you pain doctor
 before you make any decision to see what s/he says and what are pros and cons of each of these options.

It is certainly a good idea to make a change from time to time, and perhaps to try a different combination of medications.
My good neuro told me once that if something is no longer working after 3 months it is most unlikely to change. Sometimes small tweaking of ingredients is enough, sometimes more major change can be beneficial. Sometime a break from our routine is good, only to go back to what worked once well in the past.
Time to rethink the situation.
I hope you find a solution that suits you soon.

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Re: pain management question- pain meds and tylenol

Post  tortoisegirl on Sun Feb 16, 2014 12:46 pm

Taking four of the Tylenol #3 would be 4*300mg=1,200mg of Tylenol, which is still well under the limit for folks without any compromised function. I think the lowest maximum recommendation I've ever seen is 2,000mg/day. Relatively recently the official limit was 4,000mg, then they reduced it to X. Especially if someone didn't take that much every day, it typically wouldn't be considered to be a concern.

However, you say you have some elevated liver numbers from Depakan. You should specifically discuss that with your doctor to see if the Tylenol would be contra-indicated. Not sure if that equates to you actually having compromised liver function or not.

Also, it seems that this treatment combo is not working well for you. There is a difference between some relief and significant relief with a medication; the goal should be to get significant relief. It seems like a good time to try a short acting opiate for as needed use which doesn't have Tylenol.

These include codeine, morphine, oxycodone, oxymorphone (Opana), hydromorphone (Dilaudid), Tapentadol (Nucynta), or hydrocodone (the main ingredient in Vicodin; you can get this in short acting form from a compounding pharmacy, or long acting form from any pharmacy).

This could be a good step between where you are now and deciding to go back to daily long acting opiates. You're actually lucky you are getting any relief with this weak of a medication with your opiate history and age, as its common to build tolerance.

Of these, morphine and oxycodone will be the easiest to find in a pharmacy and the cheapest (generic), and the most commonly prescribed. Oxycodone is likely to last the longest. The plain codeine might be tough to find a pharmacy which stocks it, as the combination products like Tylenol #3 or cough syrups are much more common.

Also, I think they may only have an extended release type available that is plain codeine? They do make codeine with aspirin or ibuprofen, although I'm not sure those are any better of an option.

Its also Schedule II when not combined with Tylenol or other analgesics or above certain doses, which has more restrictions (same class as morphine, oxycodone, etc). So, as it seems it isn't working that well, I think its worth it to try something else.

Also, codeine has a very low bio availability, so in higher doses, you are going to get a lot more side effects (like constipation) then you would with an equivalent dose of another medication. Even morphine has low bio availability compared to the newer synthetic medications, but better than codeine. I hope you find a good pain relief combo soon.

I would discuss your goals with your pain management doctor; if you current treatment plan isn't working, and he doesn't want you go to on short acting morphine, what would be suggest to meet your goals? Discussing specific goals for pain relief before the actual medications and doses can be helpful.

I think its reasonable also to have your neuro send any suggestions in a note to your pain doctor in addition to discussing it with your pain doctor. However, I would avoid getting any pain scripts from your neuro unless you have some plan worked out for that. Most of the time pain doctors have you sign a contract to only get scripts from them. Even without something like that in writing that you signed, its not a good idea, even to get the script and not fill it yet. Best wishes.


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Re: pain management question- pain meds and tylenol

Post  ZomigMan on Mon Mar 24, 2014 10:53 pm

I avoid Tylenol myself. It is hard on the liver with any dose, and my father took a lot of it and died of liver cancer at an early age. With an ankle sprain, why not take an NSAID like Aleve? I took them for my severe back pain and they worked a lot better that Tylenol. They also work to reduce inflammation, which Tylenol does not do. Opiates of any kind give me migraines, so I avoid them.

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