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Chronic pain management after WLS


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#1 Linda in MN

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Posted 21 October 2010 - 01:26 AM

My new adventure following WLS has been 13 months of chronic pain. It is totally unrelated to the my surgery. I've suffered from one frozen shoulder and now the second one is developing the same pain. Both shoulders radiate pain into a neck with some long term issues from a car accident years ago. So that's my problem.

I'm wondering if any of you have advice about the special challenges of managing chronic pain following gastric bypass. I have ended up in pain management, partly because I can't take NSAIDS, which is common for frozen shoulder patients. Of course, I still may have ended up in pain management even if I could take them. I don't know but, it has certainly complicated my situation.

I'm reading on the medication sticky thread that I shouldn't take time-released medication. I was just about to ask my pain management doctor if I should switch to extended release because I've heard on my chronic pain forum that it is often done when the pain management goes on for a long time. I don't want to switch if my surgery will prevent them from working properly.

Also, how do pain meds affect me differently than people who haven't had a gastric bypass? I find that I get good relief for 2 hours and then I notice the pain cranking up again. I watch the clock for 2-3 more hours, trying to stretch out my doses to cover the day on my allowed doses. I find it mentally exhausting to constantly be monitoring and dealing with pain management while attending to all the other responsibilities I have in life, including caring for my disabled teenager.

This year with chronic pain has been a real eye-opener! I never knew how hard it is to deal with and get help for chronic pain. I'm so very thankful for the supportive pain clinic I found. (my first pain clinic was a nightmare!) I do have to drive three hours each way to this clinic. It seems it should not be so hard to find proper treatment for chronic pain. :(

(I've also done many months of PT, chiro care, etc for the problem. Pain management is only part of what I'm doing...)
Linda in MN
5' 9"
Highest/Start of Pre-op Diet/Day of Surgery/ Current/Goal
272 / 263 / 243 /
158 / 172
My real goal is to be free of diabetes!
Began my WLS journey with seminar 8/07
LAP RNY 10/07/08
:D

ONEDERLAND 1-16-09!!!

#2 Linda in MN

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  • Current Weight:158
  • Goal Weight:172
  • Body Mass Index (BMI):23.3
  • Surgery Date:10/07/08
  • Surgery Type:Gastric Bypass

Posted 21 October 2010 - 01:29 AM

Opps! I'm sorry I managed a double post! I don't know how to delete the thread.
Linda in MN
5' 9"
Highest/Start of Pre-op Diet/Day of Surgery/ Current/Goal
272 / 263 / 243 /
158 / 172
My real goal is to be free of diabetes!
Began my WLS journey with seminar 8/07
LAP RNY 10/07/08
:D

ONEDERLAND 1-16-09!!!

#3 cinwa

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Posted 21 October 2010 - 04:09 AM

I deleted the double post.

I'm sorry you're going through pain problems Linda - I know from old that it's miserable.

There is evidence that some bypass patients aren't getting the full benefits of medication post-op as they did before surgery.

I know from my own experiences that the pain meds I occasionally have to take for adhesion issues only give me a couple of hours of relief.

Unfortunately, getting most docs to even accept that is impossible - abuse of narcotics is on the rise but convincing them you're dependant on them - not addicted, can be difficult.

I was lucky to have a doc on the ball and he gave me a link to an article post back in 2006 by the American Journal of Health-System Pharmacy that states post-op, drug absorption can be an issue for some:

By bypassing major portions of the small intestine, Roux-en-Y bypass procedures drastically reduce the surface area for absorption. Villi and microvilli give the small intestine a much greater surface area than the large intestine.16 Thus, bypassing of the duodenum and jejenum represents a large loss of surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in patients who have undergone this procedure. Therefore, products with prolonged dissolution times, such as extended-release formulations, should be avoided in this population.


This is the link to the whole article - it's worth printing out a copy and taking it with you to the doc: Medication and nutrient administration considerations after bariatric surgery -- Miller and Smith 63 (19): 1852 -- American Journal of Health-System Pharmacy

If you're having an issue with a bad shoulder, I'd suggest you ask to try the pain patches. I've used them for arthritis in a knee and they were very effective.

9/24/07 - Lap. - RNY with umbilical hernia repair

10/27/08 - Open - removal of omental mass, gallbladder, appendix, adhesions

11/12/10 - Open - bilateral femoral hernia repair


"Many of life's failures are people who did not realize

how close they were to success when they gave up".

 

~*♥*~ Thomas Edison ~*♥*~

 


#4 Mamadebski

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Posted 21 October 2010 - 06:23 AM

Hi there,

I just wanted to write to you and tell you that I empathize with what you are living with. Prior to my surgery I had been searching for answers as to why I was in so much severe pain all of the time. It took me going to man, many doctors who all seemed to poo-poo the idea that it was real, saying it must be depression and/or anxiety. This frustrated me to no end. I kept searching and searching on the internet until I found a doctor who understood and diagnosed me with small fiber polyneuropathy. Since then I have been on a low dose of Morphine daily. I was afraid I would become addicted to it, so I have not increased it even though I could. The only time I went up on the dosage was right after surgery. the pain relief has actually allowed me to function better than I have in years. That being said, I'm not advocating for anyone to start up on Morphine - I just wanted to share my story with you. I've written a bit more on my blog about this, so feel free to read them. PM me if you want to chat more, OK?

Hang in there.

Deb
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#5 Linda in MN

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  • Hospital:Cuyuna Range Medical Center, Crosby, MN
  • Height (ft-in):5-09
  • Start Weight:272
  • Current Weight:158
  • Goal Weight:172
  • Body Mass Index (BMI):23.3
  • Surgery Date:10/07/08
  • Surgery Type:Gastric Bypass

Posted 21 October 2010 - 07:19 AM

I deleted the double post.

I'm sorry you're going through pain problems Linda - I know from old that it's miserable.

There is evidence that some bypass patients aren't getting the full benefits of medication post-op as they did before surgery.

I know from my own experiences that the pain meds I occasionally have to take for adhesion issues only give me a couple of hours of relief.

Unfortunately, getting most docs to even accept that is impossible - abuse of narcotics is on the rise but convincing them you're dependant on them - not addicted, can be difficult.

I was lucky to have a doc on the ball and he gave me a link to an article post back in 2006 by the American Journal of Health-System Pharmacy that states post-op, drug absorption can be an issue for some:



This is the link to the whole article - it's worth printing out a copy and taking it with you to the doc: Medication and nutrient administration considerations after bariatric surgery -- Miller and Smith 63 (19): 1852 -- American Journal of Health-System Pharmacy

If you're having an issue with a bad shoulder, I'd suggest you ask to try the pain patches. I've used them for arthritis in a knee and they were very effective.


Thank you for your reply! (and deleting my double post) :D

I will give that article to my doctor. It will be helpful to his treatment of me and possibly other patients.

When you say pain patches, what drug do they deliver? I have some lidoderm patches from my first failed attempt at a pain clinic. They also wanted me off narcotics, the ONLY thing that has effectively treated my pain and onto Lyrica or Nuerontin which put EIGHT pounds on me in four weeks! They did not care at all about my medical history and the great lengths I had gone to to loss weight and control my diabetes. It was an awful experience. Now I have an awesome pain management clinic. They treat me with dignity and as an individual. Whew! Chronic pain is difficult enough without being treated badly by a pain clinic that is supposed to help you. I have to share this one thing about that first pain clinic. The very first words out of the mouth of the nurse practitioner when he walked into the exam room were "I had the same condition as you and I NEVER needed prescription medication". Good for him. I'll bet he never delivered an 8 1/2 pound human being without a single pain med like I did but, that had nothing to do with my case.....but, I digress!

Thanks for your help.
Linda in MN
5' 9"
Highest/Start of Pre-op Diet/Day of Surgery/ Current/Goal
272 / 263 / 243 /
158 / 172
My real goal is to be free of diabetes!
Began my WLS journey with seminar 8/07
LAP RNY 10/07/08
:D

ONEDERLAND 1-16-09!!!

#6 Linda in MN

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  • Height (ft-in):5-09
  • Start Weight:272
  • Current Weight:158
  • Goal Weight:172
  • Body Mass Index (BMI):23.3
  • Surgery Date:10/07/08
  • Surgery Type:Gastric Bypass

Posted 21 October 2010 - 07:27 AM

Hi there,

I just wanted to write to you and tell you that I empathize with what you are living with. Prior to my surgery I had been searching for answers as to why I was in so much severe pain all of the time. It took me going to man, many doctors who all seemed to poo-poo the idea that it was real, saying it must be depression and/or anxiety. This frustrated me to no end. I kept searching and searching on the internet until I found a doctor who understood and diagnosed me with small fiber polyneuropathy. Since then I have been on a low dose of Morphine daily. I was afraid I would become addicted to it, so I have not increased it even though I could. The only time I went up on the dosage was right after surgery. the pain relief has actually allowed me to function better than I have in years. That being said, I'm not advocating for anyone to start up on Morphine - I just wanted to share my story with you. I've written a bit more on my blog about this, so feel free to read them. PM me if you want to chat more, OK?

Hang in there.

Deb


Thanks for sharing your story, Deb. It is very hard to find effective treatment for chronic pain. This last year has been eye opening for me. I don't think there is anything wrong with using what works, under careful doctor supervision. My pain clinic is very strict in his rules and monitor you for other drug use. They guard against abuse as much as they can. I actually feel for them because I'm sure it is not an easy field of medicine to practice. I'm sure they do deal with abusers. At my first pain clinic, I felt they treated me automatically like I was one. Just coming to them with pain seem to make me guilty. :mad: At my present clinic, I'm treated kindly and with compassion. I am very aware that I must comply with all the rules that are for my benefit. I take them very seriously because without their management of my pain, I would be at the point of despair!
Linda in MN
5' 9"
Highest/Start of Pre-op Diet/Day of Surgery/ Current/Goal
272 / 263 / 243 /
158 / 172
My real goal is to be free of diabetes!
Began my WLS journey with seminar 8/07
LAP RNY 10/07/08
:D

ONEDERLAND 1-16-09!!!

#7 cinwa

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Posted 21 October 2010 - 08:53 AM

I had Fentanyl patches.

9/24/07 - Lap. - RNY with umbilical hernia repair

10/27/08 - Open - removal of omental mass, gallbladder, appendix, adhesions

11/12/10 - Open - bilateral femoral hernia repair


"Many of life's failures are people who did not realize

how close they were to success when they gave up".

 

~*♥*~ Thomas Edison ~*♥*~

 


#8 Linda in MN

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  • Current Weight:158
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  • Body Mass Index (BMI):23.3
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  • Surgery Type:Gastric Bypass

Posted 21 October 2010 - 09:11 AM

I had Fentanyl patches.


Is that the only med that comes in patches? I mentioned this idea a while back to a nurse friend and he said, "Oh, no! Fentanyl is for like stage four cancer patients!"
Linda in MN
5' 9"
Highest/Start of Pre-op Diet/Day of Surgery/ Current/Goal
272 / 263 / 243 /
158 / 172
My real goal is to be free of diabetes!
Began my WLS journey with seminar 8/07
LAP RNY 10/07/08
:D

ONEDERLAND 1-16-09!!!

#9 goatwoodward

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Posted 21 October 2010 - 10:20 AM

When I broke my wrist last year, I told the doctor that vicodin does nothing for me & percocet puts me to sleep immediately. He put me on a drug for cancer patients (dilaudin or dilaudid or something), but on a very, very low dose (2 mg). Maybe fentanyl is similar?

#10 SweetSouthern

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Posted 21 October 2010 - 11:07 AM

I have a broken pars interarticularis in my back which is the small bone between the L5 and sacrum that keeps the discs from rubbing each other. I fell a year before my GBS and did this and broke my tailbone. I was on desperate need of help. I was put on Vicodin for a year by my orthopedic surgeon and then I was referred to the pain management dept in his practice. My pain management dr says that narcotics have no role in chronic pain so he will not prescribe anything heavier than Darvocet N 100 or Ultracet. I tried the Ultracet and it does nothing for me. I have now been on Darvocet for 4 yrs. I am at the maximum dose daily, which scares me because of the acetaminophen content, but I cannot function without it. I still hurt daily, but at least I can walk and do my house work and things I like doing occasionally. It has made a huge difference in my life and is very frustrating at times to deal with chronic pain. I hurt every day, but I am managing to deal with it. I get injections in my lower back every few months. I just got one a few days ago. It helps some also. It is a steroid. He has also given me Flector patches to try, which is a topical anti-inflammatory so it will not cross the GI tract. I have not tried them yet, but will when I start my period next month, which is the worst pain for me. I developed "SEVERE" right leg pain from the hip to the knee every month when I start my period and my pain management dr says it's due to hormonal change and it relaxes my SI joint and causes the pain to run down my leg. It's almost unbearable, so hopefully this will help. Oh, I also take Flexeril every night, a muscle relaxer. I hope you find some relief with your pain. It's horrible to hurt and nothing be done about it. I have a wonderful dr too and I am so happy he will not give out hard narcotics for pain management. I don't want to be addicted, even if I need the drug for pain control. I would stay away from Dilaudid, Percocet, Fentanyl, and drugs of that nature. They should only be used for short-term use. They can be very bad for you in the long run as far as addiction. You also build up a tolerance for them and eventually need more and more and then when you REALLY need something for pain control, as if you need surgery or some type of trauma, it really is harder to control your pain level because the harder drugs will not work as effectively on you as they would someone that has not been taking a heavier narcotic. Good luck with your pain control.......You have others out there that know how you feel.

Edited by SweetSouthern, 21 October 2010 - 11:09 AM.

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#11 cinwa

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Posted 21 October 2010 - 12:38 PM

Is that the only med that comes in patches? I mentioned this idea a while back to a nurse friend and he said, "Oh, no! Fentanyl is for like stage four cancer patients!"


The only other one I know of is Lidoderm. Lidoderm contains a topical anesthetic (lidocaine) and it is unrelated to Fentanyl.

My pain was severe so the doc opted for Fentanyl.

A prescriptive strength cream might be something to talk to your doc about.

9/24/07 - Lap. - RNY with umbilical hernia repair

10/27/08 - Open - removal of omental mass, gallbladder, appendix, adhesions

11/12/10 - Open - bilateral femoral hernia repair


"Many of life's failures are people who did not realize

how close they were to success when they gave up".

 

~*♥*~ Thomas Edison ~*♥*~