Problem with pain med mal-absorption?

Hi everyone with pain!!

I got diagnosed with Fibromyalgia in 1991, my WLS surgery in 1992. I have noticed on other boards with RNY patients they are always in a fight with their pain doctors about their meds wearing off soon!

I have spinal stenosis, severe nerve impingement, and osteo arthritis in addition to the Fibro. My doctors ignore my Fibro but they do pay attention to my nerve problem and acknowledge that pain.

Currently I am prescribed Fentanyl patches and Lortab for breakthrough. She only wants me to take 2 pills per day for breakthrough, she increased the strength of the pills but took me down from 90 to 60. My doctor increased the strength of my Fent. patch but the 50 mcg were too big and I broke out in rashes and they kept falling off. I am back on one 25 mcg and one 12 mcg Fent. patch every 3 days and regular Vicodin three times a day. My fight with my doctor is that I need pain pill three times a day because they wear off so quick. She had given me Norco (double strength Vicodin) but only gave me two per day---I refilled them too soon and she refused to give me any breakthrough meds for a month. Now I am back to regular Vicodin and lay around a lot because without enough pain meds I just can't be super active like I want to.

Does anybody have access to any articles about mal-absorption of medications post RNY bypass surgery?

I want weaker pills but more dosing if I need it. She doesn't understand this and thinks by giving me stronger pills I can just does once or twice per day!

Thanks for any help/suggestions. And, I've tried LOTS of different pain regiments and this one is the best. I WISH we could take NSAIDS because they help a lot!!

My only suggestion would be to contact your WLS doc and see if he will contact you regular doc and explain the malabsorption issue. I have the same problem and I've not had RNY. I get by better with a smaller dose but more often because they never last long enough. I don't know who they tested to determine the length of effectiveness but it sure wasn't folks like us. Best of luck and maybe one of the others will have a better suggestion.

Thanks for the reply. That's what I am wanting is less strength, more dosing!! My doctor retired a year after my 2002 RNY surgery so I haven't had any doctor follow-up. I just found a new gastrointerologist who said she would be willing to help me with what she could. But, she said that they don't know a lot about the surgery after-effects and they are still learning. Here in San Diego they did a lot of surgeries and there are lots of us who no longer have access to their surgeons.

Replies like yours I can print out and bring to her. She is willing to try and research these issues.

Hi,
I had the RNY done almost 5 yrs ago and got Fibro about 2 yrs ago.  I have had to fight to the end to get what I wanted to make me comfy.  Well, I found the comfort in Fentanyl patches 25 mcg + Norco 1-4x a day for breakthru.  Then they bumped up my patch to 50 mcg and had me take the Norco 1-4 a day but lowered the quantity.  She said since they bumped up the patch they wanted to decrease the amount of breakthru meds. I was doing great, pain level 1-2.  Then...cold weather came.  I told them I was taking more than the lowered amount but not exceeding my 60 tablets.  It gets confusing, but they ended up having me taking my Norco 1-2 x a day. (not what I asked for) I keep the patch on by putting it on my chest just beside the breast bone and it stays on very well.  They want to always bump up the patch and lower the pills. I told them I want to be able to control the amount of pills I take, if I need half or a whole one I can take it.  The patch if it is too much, it is too much.  I also use my Ativan like that too.  If I only need 1/4, I use a 1/4 if I need a half or whole, I use it.  So I can control how I feel with the pills. If you got a strong patch though it would work better.  I tried to tell them I had wls and when they take 1 vitamin I need 2.  that is how I argue my demand for more, not for habit, but for the sake of not absorbing all of it.  I will write more later.  Hope this at least helps a little.  Kristy

Wow Kristy, you story sounds like ME!! 

I still think the surgery is worth all the extra hassels we have to go through, my days spent at the infusion center getting iron injections, etc.  I am thankful I got my surgery and I know if I just keep being pesky enough I will get the pain meds to the level I need them at. I appreciate you sharing your story.

 This is a pain for me too. I asked to be off the patch in October due to costs and it has been a pain ever since w/ them getting me regulated on w/ long acting pills. My dr left and I switched to another at PM office. I was on 2 breakthru (BT) meds and they didnt understand why the old dr did that. It worked, that's why. I break some in half so I can take more often on the BT meds. Many sites have wls patients with this problem. I will PM you an article. 
S

I'm having the same exact problem.  I had RNY in 2005, but just started having fibro symptoms a little over a year ago.   My rheumatologist has finally decided to refer me to a pain specialist because the Vicodin 3x a day just isnt getting it.  It does wear off within 2 hours!  I've never been to a pain management doctor before and dont really know what to expect.
You mentioned an article above, could you email that to me??  [email protected]
I would really like to read it, and possibly share it!
Anyone that can tell me what to expect would help alot too!

Patti

Instead of taking a pill every 12 hours... take a 1/2 a pill every 6 hours...  basically, when you would normally pop a pill because you hurt only take 1/2 and when it wears off take the other 1/2 that normally works for me.

I have found that I will only accept "hard" pain meds that I can break in half. I have explained to my doctors that "time released" capsules do not work with our bypass construction. And I agree---breaking the meds in half or more to make the dose last longer works pretty well.

Thanks for the support! 

I just noticed your post and have a similar situation with my skin with the fentanyl patches.  I found that the generic patches, there are different brands - I go to CVS and I get the MYLAN brand and they are the best. They are tiny.  I wear the 50 mcg patch - it is about   1 1/2 inches by 1 inch.  It has no goey stuff on it.  To avoid the rashes, I change it more often.  You can get your doctor to write you the script for every 48 hours instead of every 72 hours, getting 15 patches a month, instead of 10.  (I actually change them every 36 hours and get 20 but it is a large fight with the insurance company every 6 months and I don't think I will get it after this fall.)  I don't think every 48 hours is a problem.  The actual duragesic brand or other generic brands are 3 times the size and they are really goey.

For breakthrough pain, I take Percocet 7.5/325mg.  When the pain is bad, I take 2 at a time.  I always take 1 at bedtime and some days I don't take any and other days I take 2 during the day but I am given 60 for the month.  If I ask for 90, they will give them to.  For my surgery, I was given liquid morphine and dilaudid.  I have no problems with my pain management doctors because I rarely ask for anything extra, actually some months I say I don't even need any percocet because I still have left over.

As far as the malabsorbtion goes, we absorb regular pills fine. We can't absorb long acting pills like oxycontin - the 12 hour or 24 pills but the regular pain meds that last 4 - 6 hours are fine.  So, you won't get any help on that front.

I would try to go to a different pharmacy and ask if they have MYLAN brand patches or if they can get them for you.  Then you can go up to the 50mcg strength.  If you are on the higher strength, you won't need as much breakthrough medication.