Life after RNY - Pain Meds

I had Gastric Bypass 12/18/14. I have had several surgeries this summer.  They are Total Knee Replacement in June, Thumb CMC Arthroplasty with Tendon Transfer in July, yesterday Gallbladder surgery and on Wednesday I will be have the same hand surgery but on my right hand.

My question is about pain meds.  I am having a terrible time with pain meds. Most of them are not working for me. Could my Gastric Bypass be the cause? The meds either do not work or wear off very quickly.  I have tried, Norco, Tramadol, Tylenol 3, Percecet.  None of them have worked really well and I am getting worried with my hand surgery this coming week.  I had a nerve block in July for my left hand surgery and it didn't take.  They had to give me a local during the surgery and it wore off by 5pm.  I was in a world of hurt.

Today. I was thinking about pain meds and it dawned on me, my Gastric Bypass!  That is what could be causing all these pain meds not to work.  Am I thinking right? 

Those are some heavy-duty surgeries;  when I had my knee replacements I was given Hydrocodone.  That took care of the pain if I used 15 g of pills (that's three 5-gr) once when I got up, then again when I went to bed.  I only had to use the pills for three months, and was doing very spaced out usage in the last few weeks.  I was pretty paranoid about becoming addicted, so didn't want to over-use the meds.

I know what constant pain is like--I'm a wuss.  

You might find Lortab (liquid tylenol w/codeine) helps, too. 

I am also a  pain wuss.

There are a number of us who have found that pain meds don't have quite the same effect AND wear off more quickly than before RNY, but I was not able to find any medical/scientific study on the effect of RNY on opiate absorption.  I have run into several doctors who simply don't believe that it matters that much.

I found that taking Lortab liquid (Vicodin equivalent) worked much better than the Vicodin tablets, but when faced with requirements for something stronger (e.g., the hydrocodone after my TKRs), there either isn't a liquid equivalent OR the doctor isn't willing to prescribe it for some unknown/stupid reason.

When I had my knees replaced, both times the pain med schedule while in the hospital was every 4 hours (and the computer won't let them guge it to you even 15 minutes early!) but by the end of hour three I was in serious pain... and basically I just had to suffer.  When I got home, I would add a small additional amount of Tylenol or -- when it was really bad -- I would give in and take another dose at only 3.5 hours.

The RNY wouldn't affect the effectiveness of pain meds given by injection or IV, though. The only problem introduced by the RNY would be that we are not absorbing the full dose.

Some of us (and I am probably in this group myself) are more sensitive to pain or have a lower tolerance for it than others. Unfortunately, what I have found is that in the hospital post op or when in the ER with kidney stones, they are willing to give an additional amount of IV pain meds to make me reasonably comfortable but are not willing to deviate from the "standard" doses of oral pain meds once you are sent home.

Unfortunately, other than the Lortab and adding Tylenol (make sure you don't take more than 4000mg per day, though, including whatever is in the prescription meds!) I don't have any suggestions, but I do share your frustration. I just had an open surgery and practically has to beg to even GET pain meds beyond the first week, let alone get a dose that really helped.

Lora

I am glad to see, I am not the only one.  There has to be a reason this is not working as well.  If we have problems with absorption from vitamins, then it has to hold true for pain meds.

My Orthopedic Surgeon's office is running a new test on me to see what pain meds work for me and what won't.  There was an issue with the sample I gave them (mouth swab) and it had to be redone yesterday.  We are hoping to have an answer middle of next week.  However, as I was thinking about this later yesterday afternoon and the correlation between the pain meds and Gastric Bypass, it dawned on me that is what the problem is.  I am not immune to the meds, it is just the way my body is absorbing the meds or not absorbing.

I take plain oxycodone for pain. There is no tylenol in it so it's easier on the liver. I actually have a very low tolerance for pain meds now. I have to make sure I am in bed or I'm bobbling all over the place. When weaning off I will rotate tylenol with oxcodone. I am very grateful I do not have chronic pain

I hope you find meds that work for your next surgery.

Deb T.

I have such a high pain tolerance, I have been known to let medical problems go too long.  My recent bowel obstruction/hernia repair surgery had me avoiding pain meds altogether because they all listed constipation as a side effect...give me pain over that.  Here's the weird thing, though--yesterday, an aluminum cover seal on a four-ounce yogurt cut my finger like a knife.  The pain level bothers me as much as a surgery.  Consider yourself warned my Greek (yogurt) friends.  Ouch.

I thought I had high pain tolerance till I had my Total Knee Replacement and hand surgery.  Oh my gosh.  :-(  I was so wrong.  This was the most painful experience of my life.

I don't have a high pain tolerance, but I definitely agree that TKR hurts like hell.  It is such a deep, intense pain.  The only thing I have had that hurt more was a large kidney stone (and that sucker hurt so bad that I was literally in tears and couldn't even keep my eyes open)!

Lora

Before I had my knee replacement, I kept asking what it is like and no one would really answer me.  Ha! Now I know why!  I always that a Total Hip Replacement was the worst joint replacement.  Um, no.  That is easy.  It is the knee replacement that hurts and is the hardest to recover from.