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jeff1smith

Pain Meds interaction w/PD Meds

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Had back surgery last week. All went well with the exception, I found out I'm allergic to the Opioids that most pain Meds have in them. ( threw up some

great hospital food too , lol)

So after trying 3-4 different pain Meds, I was sent home with directions to use a combo of Advil and Tylenol and add a muscle relaxer. Well, as you 

are probably figuring out, that mixture isn't even close to making me comfortable at all. 

 

Do do you have a recommendation that I can help them with? Tylenol 3 ?

what I take currently:

I take carbo/lev 25-100 x2  6 times daily 

2 Amantadine daily 

2 Selegeline daily 

 

The sooner the better as you can imagine.

Thanks,

 

Jeff

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Hi

Hope all goes perfectly with the back surgery!  

When my husband had back surgery the strongest thing the doc recommended was Nabumetone (it does require a prescription).  It seemed to work well for him without complications; hard on the stomach if used too long.  Be careful with the muscle relaxers; that didn't work so well for him...cognitive issues which eventually cleared by stopping the med.  Again, good luck!  

 

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Jeff,

If you are allergic to the opioid used in most pain meds, which is hydrcodone, then you're allergy stems from codeine. Hydrocodone is just a ramped up version of codeine, so anything in that class will have the same effect.

The next best option would be a pain medication called Ultram  (generic name is tramadol). Ultram is an opiate, but is a very distant cousin to codeine. Now if you were to add a muscle relaxer, the main concern would be drowsiness. Also, Ultram just works on pain and not inflammation. That is why you should also take ibuprofen  (brand names are Motrin or Advil) to help with the swelling, inflammation,  and mould pain.

The main interaction is between Ultram and selegiline. The interaction is known a "Serotonin Syndrome" which can be serious but is very, very, rare. All of the Physicians,  MDS,  and Neurologist I have spoken with, none of them has ever had this happen to a patient.

I hope this helps and please keep me posted.

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Flyingfoxone, 

Thank you very much for your advice. Nabumatone  (brand name is Relafen) is a high powered class is medications known as NSAIDS  (Non Steroidal Anti-Inflammatory Drugs). The majority are by prescription only, but there are a few you can purchase over-the-counter. Such as Aspirin, Ibuprofen  (Motrin or Advil), and Naproxen (Aleve).

Acetaminophen  (Tylenol) is known as a non-aspirin pain reliever. The reason is because it can be used to relives fever and headache, but DOES NOT reduce inflammation. 

I hope this helps and please keep me updated. 

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2 hours ago, MComes RPH said:

Jeff,

If you are allergic to the opioid used in most pain meds, which is hydrcodone, then you're allergy stems from codeine. Hydrocodone is just a ramped up version of codeine, so anything in that class will have the same effect.

The next best option would be a pain medication called Ultram  (generic name is tramadol). Ultram is an opiate, but is a very distant cousin to codeine. Now if you were to add a muscle relaxer, the main concern would be drowsiness. Also, Ultram just works on pain and not inflammation. That is why you should also take ibuprofen  (brand names are Motrin or Advil) to help with the swelling, inflammation,  and mould pain.

The main interaction is between Ultram and selegiline. The interaction is known a "Serotonin Syndrome" which can be serious but is very, very, rare. All of the Physicians,  MDS,  and Neurologist I have spoken with, none of them has ever had this happen to a patient.

I hope this helps and please keep me posted.

Since there's a chance I could need surgery in the near term (either a recurrent hernia or some other complication from the prior hernia surgery), I have a related question.  I am allergic to most of the opioids I've tried in the past.  I got a rash from Percocet and Dilaudid.  I hallucinated after just 2-3 days on Viocodin. 

 

This is further complicated as I am heterozygous positive for Factor V Leiden.  As such the current protocol, at least for something like hernia surgery, is 1 week of daily injections of Lovenox.  That contraindicates all of the NSAID options I'm aware of.  Tylenol is not particularly effective as a pain reducer for me, and hasn't been since I was a small child.

 

My options for pain meds are running thin if I do have the surgery.  And last time I was (involuntarily, and due to a screw up by the surgeon) without any pain meds for many hours after the surgery and it was about as bad on pain as it gets.  Whether I'm just on the wrong end of that particular bell curve, or the surgery went wrong in some way I don't know about yet I don't know, but the assumption should be that I will need something effective at relieving pain for the first couple days after any surgery.

 

If I do wind up needing surgery what are my best options?  Some kind of antihistamine to go with an opioid?  Is there an NSAID that is not also a blood thinner?  Can high doses of blood thinning NSAID's moot the need for the Lovenox?

 

Currently only taking Rytary for PD meds.

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Last year I had two surgeries to repair my  lumbar spine.  Out of fear of addiction to opioids, I discontinued the use of prescription pain medicine the second week post surgery.  I used a combination of ice packs, meditation and turmeric 1000mg.  This combination was extremely effective in managing my pain.  I wish you good luck.

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Stump,

I have copied your questions so I can answer each one for you.

 

Since there's a chance I could need surgery in the near term (either a recurrent hernia or some other complication from the prior hernia surgery), I have a related question.  I am allergic to most of the opioids I've tried in the past.  I got a rash from Percocet and Dilaudid.  I hallucinated after just 2-3 days on Viocodin. 

ANSWER: The rash is definitely an allergy to the Percocet and Dilaudid. The hallucinations you experienced while on Vicodin are more of an adverse effect as opposed to an allergy, and are usually dose related. Usually lowering the strength of the medication will usually avoid this from happening. 

 

This is further complicated as I am heterozygous positive for Factor V Leiden.  As such the current protocol, at least for something like hernia surgery, is 1 week of daily injections of Lovenox.  That contraindicates all of the NSAID options I'm aware of.  Tylenol is not particularly effective as a pain reducer for me, and hasn't been since I was a small child.

ANSWER: As far as you having the Factor V, the usual protocol is to use Lovonex. Sorry to be the bearer of bad news.

 

My options for pain meds are running thin if I do have the surgery.  And last time I was (involuntarily, and due to a screw up by the surgeon) without any pain meds for many hours after the surgery and it was about as bad on pain as it gets.  Whether I'm just on the wrong end of that particular bell curve, or the surgery went wrong in some way I don't know about yet I don't know, but the assumption should be that I will need something effective at relieving pain for the first couple days after any surgery.

ANSWER: Now there are a class of Medications called COX2 inhibitors (one example is Celebrex. I have seen these used for pain because they have very little effect on thinning the blood. But depending on how severe the Factor V is, it would be completely your Dr.s decision as to use it or not.

 

If I do wind up needing surgery what are my best options?  Some kind of antihistamine to go with an opioid?  Is there an NSAID that is not also a blood thinner?  Can high doses of blood thinning NSAID's moot the need for the Lovenox?

You can take an antihistamine,  like Benadryl, which may cause drowsiness, but the dose to overcome an allergic reaction to medications would have to be so high, and it probably won't even work due to the different histamine receptors we have.

As far as the question "Can NSAIDS moot the need for Lovonox," the answer is, unfortunately "No."

Every hospital now has opioid prescribing guidelines they must adhere to. So I think you will see a different type of medication therapy than what you had in the past.

I hope this helps and please keep me posted. 

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Thank you for that extremely thorough response.  Can't say I love the answers, but that's not your fault, and I'd far rather get the complete truth than anything else.

 

As it turns out, I'm going to avoid surgery for the time being.  The issue was not a hernia after all.  However, as part of the investigation they did a pelvic CT scan, and that revealed a high likelihood of another hernia on the opposite side of the first one developing at some point.  So, it may be necessary to have surgery for that, but there's no telling if that's weeks or decades away.  I'll hope for decades.

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Stump,

I'm glad I could help and if you have anymore question,  you know where to find me.

Good luck.

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Mark...

I tried the tramadol......vivid dreams and hallucinations. Back to Advil and Tylenol.

 

Thanks for the advice. 

 

A quick note note for anyone having surgery, you gotta write out your dosages and verbally tell your nursing team. They don’t get what

we take , when and why.  Bring your own meds, seems hospital pharmacies don’t stock them.

 

 

      Jeff 007  “shaken, not stirred “

 

 

 

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Jeff,

I'm sorry to hear that. I guess we knew our backs were against the wall and this was our "Hail Mary."

As far as directions for your meds in the hospital. Bring in your bottles so that the staff can write them down. My hospital experience have gone pretty much the same way. The nurses are expected to deliver meds 4 times a day. As we know, Parkinson's does not work like that and it is very difficult to get the staff to change their habits. When it comes to taking your meds on time, I have either expressed to the neurologist on staff, or I have been told to bring mine from home.

I hope this helps and please keep me posted.

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