Pain Medication absorption after RNY

I had RNY about 4 1/2 years ago but currently I am going through a couple of major surgeries........and now I've hurt my back somehow (probably pinched nerve).

1.  Has anyone had sciatica issues?  What kinds of medication did you use? 

2.  Do you think that typical pain meds like Norco, Oxycodone, VIcoden, etc. don't absorb normally?  I feel like Tylenol is a waste of time....

Any thoughts?

Jen

I have had several issue with severe pain since my RNY 5 years ago, and I initially found (e.g., when I had my hernia repair done and my initial PS at 18 months out) that Vicodin seemed to be not quite as strong as pre-op (but close), BUT that the duration of the pain relief was much shorter.  Now, after taking it for almost 18 months for intermittent severe pain (that they had trouble finding the source of) AND occasionally taking it for pain in my knee that needs replaced), I have developed some tolerance for it so it takes more to get the same pain relief and a dose still only lasts 3 hours max instead of 4-6.  I end up taking half a dose initially and then taking the other dose 3 hours later when the prescription is a particular dose every 6 hours.

I have not had any trouble with IV or injection pain meds not being as strong or lasting the expected amount of time, so it is definitely an absorption issue.  I am not exactly sure what the issue is, though. I have looked and looked for some medical study or journal article to give to my PCP about the issue (he prescribes the pain meds for my knee) and haven't found anything.

Tylenol was a waste of time and money before surgery AND after.  I bought a small bottle after surgery 5 years ago and still have half a bottle left.

Lora

I have had very similar experiences to what Lora described. Pre-op, I was a complete wimp when it came to narcotics. I mean, I was OUT on the smallest dose of vicodin. Since RNY surgery, I have noticed EXACTLY the same thing Lora described. Hydrocodone and oxycodone taken orally hit very quickly and wear off very quickly AND I build a tolerance to them within a matter of days with regular dosing. As yet, there do not appear to be any scientific studies investigating the pharmokinetics (absorption rate/efficiency) of any opioid drugs in bypass patients. However, several other drugs have been looked at and were shown to absorb at different rates and amounts than in normal gastric systems. In general, the drugs investigated seem to absorb faster and be metabolized faster (meaning the effects don't last as long) in our systems than in normal folks. But, the AMOUNT absorbed from a single dose is sometimes dramatically less and sometimes even doubled.

Lately, I have been using a new non-opioid drug, Nucynta, which works like Tramodol and I have found it to be very helpful.

I have a back issue that developed at 2 yrs postop (in April it will be 3 yrs for me since RNY surgery) from no injury or trauma (I have a group of nerves impinged in my lower back and right hip area near L5 and S1) and have tried many different medications to help me deal with the horrible constant pain from it (sometimes like Sciatica shooting pain down the back and side of my right leg).  I'm no slouch when it comes to pain, in fact I have a pretty high tolerance to pain (I have had twins and triplets as well as many major abdominal surgeries) but this pain brings me to tears sometimes.  I currently take Tramadol and Gabapentin but still have pain issues.  No amount of narcotic pain medication gets rid of this type of pain and I recently moved and have a second appointment with my new primary care dr. this week.  

My new job is very physical and my body is still getting used to it a month later.  I've had muscle soreness (pretty much everywhere LOL) and have been taking hot baths at night to help with that.  Tylenol never worked for me either preop or post-op for anything so I don't even bother with it anymore.