New study suggests that ibuprofen with acetaminophen may be effective in some emergency room situations without the addiction risk of opioids.
This is interesting. My daughter had to have two ribs removed, one in December and the other this past July, and after each procedure, she definitely did require oxycodone for a few days. But her surgeon told her that she should switch to the ibuprofen/acetaminophen combo as soon as possible. He had her alternating Advil and Tylenol every two hours around the clock until she had healed enough not to need anything. She said it worked remarkably well.
The added benefit was that she wasn’t as loopy, and was able to drive a lot sooner.
I’m in the middle (going on 3 weeks) of dental trismus (lockjaw due to trauma of jaw muscle from Novocain) right now. I’m on 2000 mg of Tylenol 4x/day; 800 mg of ibuprofen
4x day alternating every 3-4 hours - my second round of dexamethasone (steroid,) plus 5mg of Valium ( used as muscle relaxant) 2x day, moist heat, massage and jaw opening exercises, 4x/day - plus PT twice a week. I’ve had to create a spread sheet to keep it all straight:
Getting better slowly but still cannot eat anything that needs to be chewed at all.
I’m one week out from serious eye surgery. Only pain meds I was told to take was alternating acetaminophen and ibuprofen every 3 hrs. It worked just fine. Perhaps the only difficult part was setting a timer for every 3 hrs and having to endure interrupted sleep.
My D was on a lot of opioids after breaking her spine last summer. She was so worried about addiction she took less than she really needed and was in more pain than she was letting on. She’s primarily been on Tylenol since about two weeks after her surgery. She’s still having pain that Tylenol isn’t addressing well enough some days. Tried Aleve on the recommendation of her doctor but it didn’t help.
We were told she couldn’t take ibuprofen for several months after her surgery because of bleeding risk, but maybe that’s not the case. She did need a blood transfusion, so maybe that’s part of it.
I will have her bring this combo up with her doctor.
I’m hoping for speedy healing for all of the previous posters. @88jm19 I had major eye surgery two years ago but was just told to take Tylenol, which kind of worked, but not quite enough.
I attended a legal seminar that had a session on opioids and an expert spoke to us. He is an MD and strongly advocated the use of the combo of Tylenol/Advil for almost all pain situations. His position was that unless the pain was so severe that the patient can’t eat or talk, opioids are not necessary. A big problem is that maybe about 3 doses would be fine, but 30 pills are prescribed. I’ve known many people who have taken responsible and low doses and still had trouble weaning off.
I would much rather do the ibuprofen/acetaminophen protocol than take RX pain meds myself. That being said, I do think we need some discretion for physicians (regulated of course). We don’t want to push people to heroin.
Have seen RX pain meds nearly destroy a person (who came back thankfully) and know another person who is convinced they can’t live without them due to a chronic condition.
(ETA: In fairness the article was addressing emergency room policies and I do tend to agree with it).
I believe that it might work for soft tissue procedures, too. I have a study with N=1, the same subject undergoing two surgical procedures. Did not need any heavy duty drugs, the two OTC ones did the trick. I stopped them as soon as possible, too, because I wanted to enjoy a glass of adult antioxidant beverage once in a while. 
Funny, I had to stay in the hospital overnight after the more recent procedure, and the nurse asked me if I needed anything to stop the pain in the bud before my epidural was supposed to wear off. I asked for Advil, and the staff had to scramble to get a doc to sign the order because apparently the surgeon only ordered the heavy duty painkillers thinking the otc stuff would be too early to take several hours after the procedure.
For me and some other people tylenol / acetaminophen does nothing, and taking too much is of course dangerous. Asprin / ibuprofen / naproxen can’t be taken in quantity by people on blood thinners (such as they give people after heart attacks). Given the addiction risk of opioids I think that we need another fourth class of pain relievers.
However, ibuprofen for sprains and some fractures is certainly something that makes sense in a lot of cases, and was my “go to” drug for sprains until that blood thinner thing got in the way (fortunately I haven’t had a sprain since).
I found no difference in pain relief when I switched from oxycodone to ibuprofen and acetaminophen. Whether I was truly past a very bad pain that required the oxy, I don’t know. The other two worked just fine for me.
re Aleve: Doesn’t work for me at all, but my sister who has no luck with ibuprofen swears by it.
I’m kind of uncomfortable with too much of any of it. Wasn’t Tylenol the #1 over the counter drug that sent people to the hospital? I think people start popping that stuff like candy, and it can wreak havoc on your liver.
My husband had a major surgery and only a few of the oxycodone pills afterwards, because we were freaked out about addiction, and just couldn’t stay ahead of the pain with the other pills, so he suffered. But he didn’t get addicted.
Too much acetaminophen can cause liver damage. But note that some opioids are mixed with acetaminophen (e.g. Vicodin contains hydrocodone and acetaminophen, while Percocet contains oxycodone and acetaminophen), and some over the counter drugs that contain other things contain acetaminophen (see http://www.knowyourdose.org/common-medicines/ ), so the risk of acetaminophen overdose may be increased due to taking drugs (including some opioids) where it is a included but is not the main ingredient or selling point (i.e. people may take too much acetaminophen due to not realizing that some of the drugs they are taking contain it).
@emilybee That’s a lot of Tylenol! I think the max dose in 24 hours is 4000mg.
I think the key to pain relief is the MIX of ibuprofen and acetaminophen.
@juniebug, they say even close to 4000 mg per day can be toxic for the liver, for some people. I hope they’re keeping their eye on it and running blood tests.
But maybe she meant 2000mg total per day, not per dose, 4X per day.
The problem here is that many people can’t take NSAIDs.
There’s no good answer to pain. I just hope we’re not withholding opioids from people who actually need them.
I often get headaches (not migraine) that occasionally cannot be alleviated by ibuprofen. My doctor prescribed a muscle relaxant that did nothing. I have had Tramadol and Vicodin, for post-ops, but those both make me nauseous and the Tramadol at least did nothing for my headache. My sister is a nurse practitioner and recommended the Tylenol/Advil combo about a year ago, and it has been the best option so far. Keeping note of times and dosage are a must though, which can be difficult if you are suffering.
^^^ This. I have severe acid reflux. Even baby aspirin has triggered vomiting. Sigh. Today, I scheduled my total knee replacement surgery for January, and I’m scared to death! Surgeon requires a full strength aspirin daily for blood thinning for several weeks post op. My primary doc has suggested I try taking it ahead of time with a dose of Zantac in addition to my regular dose of omeprazole to see if I can tolerate it. Fingers crossed.
@juniebug, I hope you figure this out. My husband surgeon didn’t have him take any aspirin before or after a major knee surgery…which could have been the reason for DVT.
I hope they give doctors a tremendous amount of leeway here, and I’m concerned that they won’t. Some people experience pain much more strongly than others, and some medicine works on some people but not others. When my sister had her hip replaced, they gave her too little painkillers and she was crying hysterically in pain for days on end. The doctor wouldn’t do anything until the physical therapist said she couldn’t do her job unless the patient had pain relief. It was awful. On another note, I once pulled a muscle in my back and had both oxy and muscle relaxants. I used only the muscle relaxants after the 1st dose because that’s what worked for me. Doctors need flexibility to do what works for the patient, and the patient needs flexibility to change doctors if that relationship isn’t working. But of course that keeps the possibility of abuse open.