Finally got an MRI and my poor little foot has four torn ligaments, a partially-torn tendon, fluid in the joint and osteochondritis dessicans (dead area of bone on top of the foot). It aches constantly, often escalating to pain that makes me whimper, etc. I have a meeting with a specialist for a third opinion in four weeks to discuss invasive vs. non-invasive methods.
This isn’t asking for medical advice, just your humble opinion about what I might ask my doctor about
I’ve been taking Vicodin for about four months; it keeps me functional and able to work and sleep, but its effectiveness is wearing off and I worry about the big doses of acetaminophen it contains.
Is there another drug for moderate to low-severe pain you have used? I desperately am avoiding oxycontin and other scary stuff; is there anything that is a painkiller and an anti-swelling drug? Anything Vicodin-like that doesn’t have all the liver-killing APAP?
Have you tried Vicoprofen? It is another hydrocodone combination medication, but is mixed with 200mg of ibuprofen instead of acetaminophen. I try to avoid APAP myself due to my alcohol intake, and when a doctor is writing me a script for an opiate pain medication this is what I normally suggest. Vicoprofen has a generic, it is 7.5mg hydrocodone/ 200mg ibuprofen. It normally has the same SIG as regular Vicodin/Lortab has.
If you are looking for something that is not an opiate, try Tramadol, it works on the Mu opiate receptors and has some activity on the serotonin receptors. It is probably the strongest of the pain medications that is not classified as an opiate or NSAID.
I took indomethacin for my CPPD which presents in my feet. I found it worked well in combination with the colchicine, but I am not sure if it would work for you. Reduced the inflamation quite well.
Thank you, all, for the suggestions. I printed them out for my chat with the Doc today. I’m not sure a nerve block is a good idea; would it mean that I wouldn’t be able to pinpoint where the pain is for the third-opinion surgeon?
I certainly wish that Vicodin came wthout the APAP or 'Profen, as it is quite effective and I could take a non-swelling agent without worrying that my liver was going to burst.
Hydrocodone when not mixed is a C-II in the US, and no one actually distributes it. As for Ibuprofen, it doesn’t actually affect the liver, the major side effects with Ibuprofen (and other NSAIDs) is GI upset, Ulcers, etc.
What strength Vicodin are you currently taking? If you are looking for an opiate pain medication that is not mixed, there are various formulations of oxycodone that doesn’t have APAP or Ibuprofen.
Tramadol is an opioid, with the same potential for addiction as other opioids- it is not risk free by any means, and is classed in my BNF (British National Formulary, the British doctors’ drug bible) as an opioid, right after Pethidine and Pentazocine. Personally, I don’t like prescribing it- it tends to make older patients loopy and younger patients dependent.
Ask your doctor about anti-inflammatories, steroid or local anaesthetic injections.
Ask if you can have your analgesia split into its constituent parts -i.e. acetominophen and oxycodone (or codeine, or morphine) prescribed separately rather than as Vicodin. If your pain is not adequately controlled by the max daily dose of Vicodin this should be happening anyway.
Ask about physio, orthotics, splints or bandaging.
Ask about referral to a pain specialist, not just foot docs.
Ask about adjunctive pain meds.
Ask about support groups for people with chronic pain.
Ask about where to get help and advice on adaptations you may need to your home and workplace.
Ibuprofen and the other NSAIDs also carry the risk of bleeding issues (I was ordered off them for 1 week before several medical procedures this year, and for 2 weeks after the colonoscopy… oddly I was allowed to start them just a couple of days after the gallbladder).
Anyway - I popped in to suggest looking at NSAIDs. If Ibuprofen or Aleve don’t do the job, there are prescription-only NSAIDs - I have found that diclofenac (Voltaren and others) works wonderfully on my knee and shoulder. Better in fact than the Percocet I took immediately after the gallbladder surgery.
But either way - if the OP has been in pain for this long, it sounds like non-drug intervention is the way to go (surgery, casting, orthotics or whatever) - those ligaments etc. need to HEAL, not just have their pain suppressed.
In fact the Tylenol/narcotics are doing just that: suppressing the pain, but doing nothing to help them heal. I’d hazard a guess that they may have actually prevented healing by making activity more possible, therefore further aggravating the injuries. Something with anti-inflammatory effects might actually promote healing a bit for some injuries, though in the OP’s there’d be the same “suppress pain, allow injury to be aggravated” situation.
I’m not sure if this is what you’re looking for, everyone is recommending drugs you take by mouth. Have you tried supplementing your medication with medicated cremes? My Dad had a back operation years ago that left him with chronic foot pain and walking with a cane. He rubs Sports Creme on his feet everyday, he says it helps. I use Aspercream when I have aching muscles and it helps with the pain.