I recommend going to rxlist and or the PDR and checking them out. In particular, look at the dosages and drug interaction information for all of them.
The oxycodone and the hydrocodone are traditional opiates. Opiates are “idiosyncratic”, meaning patients show wide variation in response. On average, most people will find the oxycodone is “stronger” than the hydrocodone, and Ultracet weakest of all (the least effective for analgesia.)
Ultracet is a newer formulation of Ultram (tramadol) with added apap (aka acetaminophen or Tylenol) Watch out for seizures with this one if you have susceptibility, and go through the medication combinations to avoid, using the PDR, rxlist, or the insert; in particular, do not mix Ultram with SSRI anti-depressants. Tramadol has some opiate activity, but it’s pretty weak. Its pain relief mechanism appears to work primarily through mechanisms that are unknown, but speculated to be similar to anti-depressants. People who have been on it for a long time have had opiate-type withdrawal symptoms, so be warned. A lot of confusion surrounds this drug for some reason; I’ve heard some doctors say “it’s just like Advil” (no, it’s not), I’ve heard others say “it’s just an anti-inflammatory” (wrong again). It does have some weak opiate binding action. Some people find it does little or nothing to relieve pain; others find it quite helpful.
Hydrocodone is prescribed in strengths ranging from 2.5 mg up to 15 mg (although 10 mg. is the highest strength available in some parts of the U.S.). For severe pain, 7.5 mg to 10 mg. is more commonly prescribed, but people do vary in their response.
After you read up on these medications, remember two things in particular from your reading:
- Do NOT drink ANY alcohol within at least 24 hours while you are taking any of these medications. The reason is not so much the sedative interaction of the opiates with the alcohol, but the effect of combining apap with alcohol on your liver. Bad stuff. Don’t do it.
- Be very careful how much apap you take. According to my trusty PDR, never take more than 4,000 mg apap within 24 hours, and never more than 1,000 mg at one time. And that’s with NO alcohol, no liver problems, no other concurrent liver-unfriendly meds. If any of those apply, get thee to a doctor, and insist on apap-free pain meds, such as low-dose oral morphine, oxycontin, and so on. Just 'cause Tylenol is all over the place doesn’t mean it’s a particularly safe drug. It’s astonishingly easy to do some real liver damage to yourself with that one.
Too bad your surgeon has such a cavalier attitude towards pain management. There’s plenty of studies from the past few years indicating patients with good post-op pain management heal much faster and better than those that are left to suffer and suck it up. In several very large scale studies, addiction doesn’t seem to be much of a risk in patients given opiates for post-op pain; something like 0.003%. To be clear on the tininess of the number, divide 1% into 35 little pieces, then just one of those pieces. So unless someone’s got prior history of addiction, they’re not likely to develop a problem post-op. The doses you’re on are relatively low, so adding fiber and roughage (lettuce, prunes, bran, cucumbers are some examples) to your diet should keep constipation at bay. Hopefully, everything will heal up quickly and nicely, and you won’t be in pain much longer. If you have problems, get a second opinion and/or a pain management specialist.
To improve your pain relief, combine the hot baths, heating pads, comfy pillows, etc. with the pills. Some people get a lot of help with pressure/temperature sensitive memory foam pads or pillows (Tempur-pedic, Carpenter Co., etc.) Try one in the store before buying, since they’re so darn expensive.
Re your pill pricing: In these cases, the price has nothing to do with the analgesic properties of the pills. It has everything to do with marketing budgets, research and development costs, what the drug company thinks the market will bear, etc.
I am not a doctor; this is not medical advice but a sharing of public information that is readily available. I simply cannot/will not answer questions like “mix and match” or recommend specific dosages; no doctor (or any intelligent person) would, without a complete history/exam, and the appropriate licensings and “doctor/patient” relationship. Hopefully, the information here and the sources suggested will at least ensure you avoid liver damage from an apap overdose.
You might also try consulting with one of your doctors about adding an anti-inflammatory to your pain-control regimen. There are many to choose from: newer generation COX-2 inhibitors like Vioxx, and old stand-bys like Advil, Naprosyn, etc. (Pay attention to the dosages on these as well; 17,000 people die every year from these meds; GI damage, kidney or liver damage. Just because it’s OTC doesn’t mean you shouldn’t be careful.) If there is collateral nerve damage, (often characterized by “electric” or “burning” pain) many patients have done well with medications like Neurontin,which are helpful for neuropathic pain. Opiates are not always the best drug to control a particular pain. It depends on the patient, and it depends on the type of pain.
Note to kambuckta: Twenty of the oxycodone all at once could mean a permanent holiday from reality–more likely from liver damage due to all that apap. It would be unsafe for an opiate naive patient to take that much oxycodone at once, but long-term chronic pain patients and some cancer patients take daily doses much larger than that, and do just fine.