chronic pain management after gastric bypass

i've been away for a while...i had RNY almost 16 months ago...i've lost 115 lbs in that amount of time, though i lost most of that in the first 9 months...my weight loss has been at a crawl since then because i have been off my feet for most of that time...I'm not complaining, I've been in & out of the hospital several times & just had my 3rd foot surgery (still have one more before i can become active again, can't wait to get back to the gym)...my question is regarding pain management...at 360 lbs before surgery, i had uncontrolled diabetes for years, & had developed peripheral neuropathy...I've been taking opiates for pain relief for almost 5 years now...my problem is that I'm just not getting good relief since my surgery from oral pain meds...they just don't last as long as they are supposed to...i can usually get about 4 hours relief from a dose that should be lasting 6 or 8 hours...I'm assuming that this has something to do with malabsorption of the medicine, as i've been told these meds break down in the small intestine, but I'm really not sure...has anyone had problems managing chronic pain since their gastric bypass...i had this surgery in order to improve my life, but I'm actually disabled due to this neuropathy, & not being able to get a handle on this pain is just making me miserable...I'm just wondering if i need to seek help from a different pain doctor, if there are doctors better educated on medicine management after WLS, or if i should try a different type of meds (transdermal patches instead of oral pills)...if anyone has had any experience with this, i would appreciate any insight...

Sorry I cannot relate, but I will be praying for you. Talk to your doctor again. Good luck and keep me posted.

My pain is different from yours, so I am not sure if the chronic pain treatments are comparable.  I am only 3 weeks out too...keep that in mind.

I have Fibromyalgia and since surgery it has been out of control.  My doctor finally relented and prescribed narcotics but I received NO relief from them what so ever (I think I was getting more relief from plain Tylenol).  So back to the doctor I went after a few days and explained my problem and my thoughts (like you my main concern was the malabsorbtion properties of my "new" digestive track)...after consulting several other physicians and contacting my surgeon (apparently she didn't believe me), she prescribed a liquid narcotics (like I had immediately following surgery) and a patch.  The liquid narcotics I can take every 4-6 hours OR I can take one patch ever 12 hrs.  The patch works better but makes me loopy, so I took the narcotics while at work (no loopyness from them) and take the patch when I get home to help my body relax.  After a few days my pain became more manageable and I've not taken the patch once the pain came down.  I still use the liquid.

So the moral to my long story is, if the pills aren't working you may want to ask your doctor about a different delivery method.

I have rheumatoid arthritis and I have to take enbrel shots every week. I have to miss 4 shots, 2 before and 2 after surgery because my shots lower my immune system. I have to not take them so I can heal better. I am so scared that not only will I have to deal with the pain from surgery but I will have to deal with a flare up with my rheumatoid arthritis. I'm hoping and praying that it will not be too bad.

I just switched from ibuprofen to Tramadol to prepare for surgery and after surgery. Tramadol is non-narcotic but acts like one I guess. It has been working well for me. I take 3 a day (50mg each) but I believe you can take as much as 8 a day. They have an extended release version as well, but you don't want that. I only mention it so that you tell your doc you don't want that one. My surgeon has told me that Celebrex (yes it's an NSAID) is okay because it's a "second generation NSAID" but since he was out of the office when my PCP tried to call, my PCP would not prescribe it to me so Tramadol was the next in line. I have chronic knee, hip, and other joint pain that I was taking between 1600 and 2400mg daily of ibuprofen. The Tramadol is about 90 - 95% as effective FOR ME as the ibuprofen. My hip needs to be replaced and nothing has taken that pain away 100%.

I just mentioned it as another option. You may want to ask your surgeon about Celebrex as well. I've been googling it and it seems some surgeons are okay with it and some are not. The nurse in my surgeon's office that had RNY has been taking it for quite a few years with no issues [so far].

I hope you find something. I know how you feel.

Have you ever tried Neurontin or Lyrica for neuropic pain?

Hey Jillie Bean,  I use Neurontin and Norco in combination and it helps so much.  Neurontin is a wonderful medication. 

I completely sympathize with you! My pain management doctor doesn't seem to understand my meds don't last for 8 hours any longer. It is frustrating because then you get labeled as a "drug seeker".  I have a hard time with the pills as well, but the liquid seems to last a bit longer for me...maybe you can give liquid a try? I am on liquid lortab. When the pain management doctor said I should be able to swallow pills now and tried to switch me, I had to fight him. I really do not know why it matters which form I take it in anyway, it's the same medicine! Sometimes you have to fight!! Good luck :)

I had some complications a month out from my RNY, had a fistula repair. It was like having a RNY two months in a row.

I am 50 years old and though I don't and never did have diabetes I do have a touch of arthritis and the pain from that is a constant aggravation. I would say talk to your Primary Care Doctor, your endocrine doctor and your wls doctors and have them either recommend a pain management specialist or formulate a program to help you as best as is possible. Since you are a bypass patient you need to stay as far away from NSAID's as possible, but you may have to take on in the end. Keep in mind that may also cause problems.

Good luck and God Speed to you.

 

 

My surgeon has me on liquid pain meds because he said I would absorb them better than pills. The patch might be a good idea, too.

Pam