To reiterate- it’s the cocktail of Tylenol/Advil that is apparently extremely effective for pain. Tylenol is still on the market…
Actually you have to be careful about Tylenol. I work in a hospital and we only allow a certain amount in 24 hours. Then you cannot get anymore for 24 hours. That includes pain meds like Norco that have Tylenol in it. Tramadol is given for chronic relief at times.
Just a couple points on pain meds (and not necessarily about opioid use)… Just useful stuff.
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Ibuprofen is a great anti-inflammatory and pain reliever–especially at higher doses. Depending on your type of “event” they can do the job. Relieves fever too.
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Acetaminophen (Tylenol) is a similar analgesic but doesn’t have the anti-inflammatory effect. It lowers fever and relieves pain but is not an anti-inflammatory. Since it doesn’t help inflammation using it for those specific conditions like arthritis isn’t recommended unless you can’t take other meds. It has a place on the formulary.
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Taking a combo of ibuprofen PLUS acetominophen acts even better for a lot of short term pain. The acetominophen makes the effect of ibuprofen last longer (through less liver metabolism for the ibuprofen). (Might be the best compromise between no NSAIDS (and bone healing) and pain relief–I’ve heard great reports from the past for dental patients).
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Acetaminophen can cause liver toxicity which is why you need to keep track of how much you’ve taken. It’s in a ton of cold medications (especially) and taking too much in a short time period can cause irreversible liver damage.
As to narcotic prescriptions…
It’s all a mess right now in my opinion.
- Narc prescriptions can’t have a refill. You’d have to go back to doc and he’d have to give you a new Rx (which is what we used to do). But…
- Docs are being tracked on how many scripts they write now. So one is better than two (and saves you too) Doc doesn’t want a record of writing too many scripts.
SO…your doc wants to give you what you MIGHT need without you needing to go back to him. He’s doing it for you and him…
He can’t write “narcotic” with one refill (if needed). Which would suit most (cause you wouldn’t need the refill).
“I had major foot surgery last week and 30 pills were written for my pain level. Every 6 hrs for pain. Big note in surgeon’s office that there is no refills of any pain meds. I currently have taken 4 pills and now using Tylenol. Seems like it is harder to get more pain meds at surgerions office which is a good thing.”
I’ll parse this out…
!) major foot surgery–You probably needed the pills especially in the beginning. Take them. Being in pain doesn’t help for much. Rehab can be non-existent if you hurt too much.
2) every 6 hours for pain–Better yet a patient should take pills initially and get pain to a tolerable level and then take partial half doses (or even quarter) to maintain a manageable pain level on a much shorter interval than six hours. (and it’s usually 4-6 hours as to how long the analgesic action lasts.). Six hours is max.
3)“taken 4 pills”–good! No need to be a hero and if Tylenol works, that’s great. Don’t take too many. Don’t expect everyone to have that result. You don’t get a medal for being stoic.
4) “harder to get more pain meds at surgerions office which is a good thing.”–I’ll disagree. I think the surgeon needs to be able to give a reasonable script to a patient knowing that can be more or less based on knowledge of the patient.
@gouf78 …Thanks for your thoughts. Trust me I am not being a hero. The pain meds make me dizzy, confused and very constipated and I even cut them in half. I am non weight bearing for 6 weeks so I have to sit and have my foot up. So not at rehab stage yet. I cannot take advil because my bones are healing.
I am not saying people don’t need pain pills. What I am saying is use what you think is acceptable to you and your body. I see many patients come out of surgery and I always advice them to stay ahead of the pain. Trust me if I was in severe pain I would be taking them. I just have a high tolerance to pain.
I do believe the doctor should see you first before calling in more pain meds unless you have a chronic condition. I have seen many people that are addicted to meds that come through the hospital looking for more meds after the doctor cut them off. If used sensible they can be used to control acute and chronic pain.
Sorry Nurse001 --Your scenario of surgery is generic on many levels so seemed a good “test case”.
Didn’t mean anything personal in any remarks I made. The “hero” was to the masses–not to you. I apologize. You’ve already figured this out for you.
Ask your doc about a combo of Advil and Tylenol–it seems to work great for many. Using even very small doses of a narcotic in combo works very well.
@gouf78 Thanks for your reply. This is why I love CC as people have many different opinions and it is always good to hear many sides 
“I do believe the doctor should see you first before calling in more pain meds unless you have a chronic condition.”
I do too. But the scrutiny on docs and their prescribing is keeping them from doing that.
It’s better now to give one script and say “no more refills” than to give a lesser amount and say “you may need more”.
Ironic because legit health care givers curtail good therapy in fear of their license and the less legit don’t care.
Article claims that drug companies pay physicians more when they make more opioid prescriptions:
CNN Exclusive: The more opioids doctors prescribe, the more money they make
https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html
But is this common generally for prescription drugs?
It is a really long article -so forgive my short attention span -but did it say what percentage of physicians consult or speak for opioid manufacturers? a drug company in general? I know drug companies hire physicians as speakers -but I didn’t think it was a large percentage of physicians who do it.
opioid problem from ER MD’s point of view
https://www.washingtonpost.com/outlook/some-patients-are-in-pain-some-just-want-drugs-how-do-i-tell-them-apart/2018/03/09/1c1b66d2-20b7-11e8-badd-7c9f29a55815_story.html?utm_term=.b8f7b9c96943
I don’t understand the point of the CNN article. There’s no surprise that a drug company would use someone who actually dispenses their drug as a speaker or consultant. If you did the same study with docs who prescribe a certain antibiotic you’d get the same result.
I just read an article by a vet who said he couldn’t get morphine drips for surgery on animals due to regulations. The alternative is quite inferior.
Makes me wonder if people who are so against needed pain relief for people would feel the same if it was their precious pet.
Sorry, I’ve been off of this topic for several days. I started seeing addiction patients at a colleague’s pain clinic. This colleague wants me to open the conversation about addiction so that his patients who may be abusing opioids would feel comfortable admitting it to me.
But one more story and then the point I wanted to make. I scheduled one of my patients to his clinic. She sat down and told me she would never see me at this clinic again and wanted to go back to my previous clinic. I asked, “why?” She told me that it was the clinic where she lied to get her oxycodone. Oxycodone tablets were the tablets she would crush and then smoke! Her addiction started after a car accident and then resulting femoral acetabular impingement. After months of opioids, doctors finally cut her off and she went into withdrawal. From that day, her career in the illicit drug world began…
This story is important due to the fact that there are many published research articles demonstrating a low rate of addiction to opioids, but they assume that the patients are being HONEST! During addiction, honesty is probably the second thing to go after self-control.
I believe that addiction to opioids are much easier than has been reported just from the fact that patients lie. However, because of the public sentiments, these patients have been too embarrassed to get help. I want society to move away from saying “addictive personality” “addictive tendencies or behaviors.” These descriptions have no clinical relevance. Producing dopamine already puts all of us at risk for addiction. Acknowledging that addiction is a normal consequence of exposure to powerful pharmaceutical drugs would bring these individuals to their doctors for help.
As for addiction risk, the length of opioids treatment also affects the potential for withdrawal. There are multiple articles demonstrating a 30 - 50% withdrawal rate for patients discharged from the ICU after 7 days of sedation. That’s huge!! So, the reports of addiction risks don’t match up to these ICU studies.
^^^^Okay, but surely it’s important to distinguish between dependence and addiction.
I understand what you are saying, but dependency is a very strong factor in opioid addiction. I would like to guess that nearly 100% of my patients have tried to quit on their own but couldn’t because of withdrawal. In a retrospective study, “Similarity and Difference in Drug Addiction Process Between Heroin- and Methamphetamine-Dependent Users”, a median of 5 doses separated first withdrawal symptoms and compulsivity to use. That’s too fine of a line. Of course, how many of these ICU patients go on to become addicted would be the next great study. Nevertheless, if I was an Intensivist, I would do everything reasonably possible to limit the days on opioids.
I work in the ICU and our Intensivists and pharmacists do monitor the narcotics pretty close. Once the patient is off the vent and drips they get weaned down pretty quickly. Hardly anyone goes home with a prescription for oral narcotics unless of course they are a surgical patient. We are not a trauma 1 hospital.
The military would be an interesting case study, both because they’re prescribed opioids at a higher rate than the general population and random drug testing provides an independent check of illicit opioid use.