The general question: Does anyone have any links to sites that talk about the relative efficacy of the various narcotic pain relievers?
History of what prompts the question:
I had my gallbladder out last Monday. Morphine IV in the hospital (probably “overkill” but I guess they took advantage of the IV they left in place). made me drowsy, but didn’t produce a “buzz” in my head the way the pills did: Percocet (5/325 oxycodone/acetominophen) when I went home - 1-2 tablets up to some limit per day. Last day I needed that during the day was Wednesday; I used alternating Advil/Tylenol on Thursday (other reasons to switch back to Advil), plus some perc at bedtime Thursday. Haven’t touched the Perc since then, I’m back on OTC-strength Advil because of other issues. Tummy still hurts a bit but generally only if I move wrong.
A friend had nearly identical surgery on Friday (she also had a bite taken out of her pancreas). She was sent home with Vicodin 5/500 (hydrocodone/acetominophen). And it wasn’t doing the trick so the doctor gave her Ultram to alternate with it. As of today, she’s still in significant pain and needs both meds.
Anyway… as far as I can tell from google-fu, I was frankly given a more powerful pain med. Not just the narcotics schedule (mine’s level II, hers is III) but oxycodone is stronger. I plan on complimenting my doc on better pain management, for sure.
Is this the sort of information you are looking for: Linky
Basically it’s a pain management conversion scale, where you can figure out how to convert doses of one medicine to another. I believe the standard is your basic morphine, with all others being based on that as a unit of measure of potency.
note actually reading that article it doesn’t quite have all the medications on it, just the stronger narcotics. This is a bit easier to use and might work better: Narcotic Converter
Thanks, ToeJam - that’s very helpful! I played with the second site and found that indeed my friend was given less “pain relief” than I was (plus hers had a higher dose of acetominophen, so she had a lower total daily limit that she could take). I’m really annoyed at her doctor… worse surgery, poorer pain relief.
I know that there are these conversion tables, but as a nurse I can tell you that pain and pain relief can be very subjective. 50 mcg of Fentanyl is supposed to be comparable to 1mg of Dilaudid, but I can tell you that patients always get better pain relief from Dilaudid. Unfortuately, they also get more side effects, such as nausea and itching. My point being that scientists develop these conversion tables, but they don’t always perform true in real life situations.
even with the exact same drugs, 2 people will have different prior experiences of pain, different physiological responses to medication, and different amounts of pain from the “same” surgery. Each variable impacting the amount of pain each conciously percieves.
All else being equal, though, from what I read on those links, I was given stronger pain relief than she was.
I haven’t asked my friend how her pain experience was after her C-sections; I know mine was quite “good”… in that aside from the long-acting morphine in the epidural, I had precisely one narcotic pain pill (most likely Percocet), and that was in the first 12 hours. After that it was all NSAIDs. I would say the gallbladder surgery for me has been roughly comparable in pain, maybe a bit worse. I may simply tolerate major abdominal surgery better than average; if so, I’m certainly grateful!
Do American doctors have something against codeine?
I mean, it is constipating, but it’s a much nicer, cleaner, cheaper drug than Tramadol (Ultram), which always seems to send my elderly patients loopy.
We don’t use much oxycodone/hydrocodone here outside of palliative care.
I think both of your doctors were very generous with the pain relief!
I’ve done enough scripts for laparoscopic cholecystectomies to know our usual pain relief prescriptions off by heart- in the good old NHS you’ll get 30/500 Co-codamol (Codeine+paracetamol) in hospital- reducing to 8/500 at home, with Diclofenac 50mg three times a day for 7 days post-op.
Our C-section patients just get 8/500 Co-codamol and Diclofenac- personally I found it perfectly adequate in terms of pain relief, I know other women who have needed the higher dose 30/500 Co-codamol.
I would imagine that the use of Codeine is limited because it causes so many people GI distress. Codiene is probably the second most frequenly named medicine on pt’s allergy lists.
Well, when I had my lap chole I had a stone obstruction. They kept me in the hospital about 2 days and I used IV morphine till the morning I went home. Of course, I had a rock the size of my 5th distal phalanx stuck in there, so there’s that, but mileage varies.
I was on IV morphine while in the hospital as well. Less serious surgery than yours, I guess - at least nobody said I had anything stuck! (though they did have to do a cholangiogram as my liver numbers were evidently still elevated). The morphine was I think overkill. I got fentanyl while I was still in the immediate post-op area - I remember them asking my level of pain from 1-10 and I said 4. Heaven knows what they’d have done if I’d said 10!
Interesting on the codeine. I’ve heard of such allergies but didn’t realize they were that common.
I’ve had hydrocodone (Vicodin) and oxycodone (Percodan/percocet) for pain relief after dental work, but people “only” get codeine for lap-chole? Wow. Maybe docs think I’m a wuss (I’m not, really! I stunned my doc by telling her the gallbladder colic “wasn’t that bad” - had to say “yeah, it sucked but the itching!!!”… and I’ve had 2 kids with botched epidurals, and didn’t scream either time).
Well, any narcotic is constipating… I was quite shocked when I asked the nurse for Colace (docusate - stool softener) that evening in the hospital and the nurse said she’d have to phone the doctor for permission; on the maternity floor those were handed out like breath mints and I knew I’d need 'em! And thank heaven I did… things would have gotten ugly otherwise :p.
I got by after my c-section with just one strong painkiller and the rest of the time with NSAIDs (Naproxen, I think). However I had an extremely “good” experience as I said - urgent but more in the realm of “in the next couple of hours” vs “slash and grab NOW”, so the doctor was able to take her time and minimize the damage. I don’t think that regimen would have done for a more damaging surgery, so I’m not surprised you see women needing more.
Few patients here list codeine as an allergy, and 8/500 Co-codamol is available OTC as pain relief. I know evidence says it is no better than standard paracetamol (acetominophen), but most people would disagree- the mild opiate “buzz” seems to work wonders- plus the placebo effect of being on “extra strong” pain killers, I’m sure.
Maybe our reluctance to go with newer opiate preparations is because anyone prescribed codeine prearations is also precribed laxatives as a matter of routine, maybe because we don’t have direct to consumer drug marketing, maybe because drug reps here have less power to change prescribing patterns, maybe because our doctors just don’t like the idea of too many opiate drugs to choose from and go with what they’re used to, maybe because the black market in prescription narcotics in the USA is something we’d like to avoid here.
Certainly, I’d only opt for an oxy-something if codeine preparations were contra-indicated or had been tried and failed, because I go with what I know.
C-sections are funny- the only major abdominal surgery where you immediately get handed someone else to take care of, are guaranteed to be woken every 2 hours to feed and change said person, and where you don’t get the good drugs in case the baby gets too much from your milk!
(I’m not, really! I stunned my doc by telling her the gallbladder colic “wasn’t that bad” - had to say “yeah, it sucked but the itching!!!”… and I’ve had 2 kids with botched epidurals, and didn’t scream either time).