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View Full Version : Pain killers, muscle relaxers, how to choose what you need?



Mojo's Mom
04-15-2012, 12:18 AM
Okay, so I have Hydrocodone, Robaxin, and Valium. What I have been doing is taking two hydrocodones (mine are the 10/325 strength) first thing in the morning, then just one four hours later, when everything is starting to hurt badly again, then another one four hours later, then a final dose of two after another four hours, then at bedtime I take a Robaxin. The Valium I am not using at all.

How do you decide which to use, pain reliever or muscle relaxer? I want to get off all this stuff ASAP but I sure can't yet...I tried backing off on a midday dose of hydrocodone and it didn't go well. The hydrocodone doesn't seem to sedate me, but when I was taking the muscle relaxers three times a day I could hardly stay awake, although that could just have been exhaustion from the surgery, too.


Curious what has worked for others. Thanks in advance.

Karen Ocker
04-15-2012, 12:01 PM
Since we are all genetically a little different in how we metabolize meds we can only share experiences not advice. That is the prescribing practitioner's job.

Having taken courses in pain management myself, as part of my field of practice-now recently retired- one thing stressed was that valium and other benzodiazepenes like xanax have very little place in surgical pain relief. Narcotics do not work at all for nerve pain but some antiseizure meds do-like gabapentin and Lyrica.
There is a place for other modalities like TENS, pain patches, NSAIDs, ice and antidepressants. This is because pain uses several different nerve pathways. Different approaches alone and in combination are used.
I had a very extensive revision 9 years ago at age 60. Another forum caused "Flatbackers' suggested I use a pain management doc--which actually never occurred to me at the time. He fine-tuned my pain meds and we used: Dilaudid(at night only) Fentanyl patches, Tylenol, ice packs, gabapentin, Sam-E, Alpha-stim (TENS) and he gradually tapered me off the narcotics with an antidepressant(Paxil).
We were in touch by e-mail and had weekly visits. I was off all narcotics by 3 months and gabapentin and Paxil by 6 months. I was able to use Aleve and Tylenol, off and on, until about 18 months post op.
I am now pain free and recently sent him a thank you e-mail.
I add I tried to reduce the fentanyl patches too quickly without clearing it with him and I went into withdrawal. Paxil helped that and I only needed that for 2 1/2 months.
I did my best to exercise and improve fitness before and after surgery.

jrnyc
04-15-2012, 12:05 PM
is there a reason your doctor did not give you oxycontin..??? i ask because it doesnt seem
as if your pain is well controlled....????
it has no aspirin or tylenol type product in it...
i have hydrocodone 10/325, but also have oxy 30 mg...i take the hydrocodone
after oxy has worn off...i do not take more than one oxy in 24 hours, so i use
the hydrocodone to fill in when needed....
i have not had surgery...yet...but have a pain management doc in NYC who is treating me...
i do need fusion T3-sacrum, with osteotomies and lamenectomies recommeded...

jess

rohrer01
04-15-2012, 04:23 PM
I was told that Valium and Klonopin are the only two benzodiazepines that actually work to reduce muscle spasms and have been prescribed Klonopin as it works better and lasts longer. I also take baclofen for relief of muscle spasm. I have not had surgery, but have been on different pain regiments during the last 15 years or so. When pain is bad, they usually give me something LONG lasting like oxycontin or fentanyl patches. That keeps you from having the highs and lows that cause 'addiction'. This does NOT mean that you can just stop taking these meds as you WILL go through withdrawal symptoms if not done properly (personal experience). The muscle relaxers over time will make you less and less sleepy as your body becomes used to them, the same as the narcotics. Baclofen is one muscle relaxant that is not supposed to lose its efficacy, even though after a couple of weeks on it you do seem to get used to it in the sense of it not making you tired (again personal experience). I would call your doctor and ask him/her how they want you using these meds to have the best effect. Sometimes they prescribe the same thing to everyone, but the same thing doesn't always work for everyone. I agree with Jess, it sounds like you would benefit from something longer lasting (just my opinion) until your pain is under better control. I hope you get it figured out.

I personally can't use any antidepressant because of a heart problem and gabapentin (Neurontin) didn't work for me. That's not to say that things like that wouldn't help you.

Rohrer01

Mojo's Mom
04-15-2012, 06:09 PM
Karen Ocker, thank you for your long and well considered response. I wish like Hell, mainly for my husband who lives with chronic pain syndrome, that there was a pain management facility of the caliber yours clearly was. Sadly, the only game in town here is a joke and I wouldn't set foot in their doors for money. They do write scripts, and are no pill mill, but there is little effort made to individualize treatment.

Jess, I am afraid I gave the wrong impression about how well my pain is controlled. I think I am doing very well, but my back muscles were cut and they as well as the ones doing the work in their place are under a lot of strain. When they get tired of standing and walking, they hurt. Lying down for a bit is the best relief, but I simply do need some narcotic pain killer for now. Oxycodone would be tremendous overkill in my view. I feel I have plenty of pain relieving tools at my disposal.

I was given instructions on how to take what I have, but I know from experience that, as Karen noted, individual responses vary widely. I am making my own choices about how to use the meds i have based on what seems to work out. My nerve pain is either resolved or not in evidence at this time, so I do not need Lyrica or any of the related drugs. Most of my pain at this point is surrounding the surgical site, which may be simple pain due to having been cut into. Some of my pain is definitely due to muscle spasms as my body tries to compensate, as well as the back pain I already had from my magnificently serpentine spine.

I took nothing for pain prior to surgery, not because my pain was controlled, but because my arm has to be seriously twisted to get me to take anything in the way of a drug. I have watched the toll narcotics, Lyrica, antidepressants and benzodiazepines have taken on my husband over the last ten years and I have no desire to down that road. I knew I would need narcotics for a short time after this surgery, but my goal is to get clear of them as fast as possible.

I just wanted to see what had worked for others. I thought I remembered reading that some people found Valium the most effective for muscle spasms, but perhaps not. I know we all respond differently. I am not using Valium and do not want to...benzos scare the crap out of me. But the others scare me only a little less.

Anyway, I went 11 quite comfortable hours including 7 hours asleep on nothing but the residual from two hydrocodones taken at nine pm, 1000mg of extended release Tylenol and one Robaxen all taken at about midnight.

I just sometimes wonder if I should be Robaxen instead of hydrocodone, and I am not entirely sure. But I do feel my pain is adequately controlled. This was back surgery, but not on the scale of most here or even close.

Thanks to all, again. I guess only I can sort it all out. My husband says I am trying to cut back too quickly and he may be right, so for now I am sticking to two hydrocodones first thing in the morning and two about 12 hours later, with singles at 4to 5 hour intervals during the day. So six total for the day, and one Robaxen with 1000mg Tylenol at bedtime. Not pain free but tolerable.

Confusedmom
04-15-2012, 10:24 PM
Okay, I was fused T4-S1, so the meds are heavier, but I have some of the same concerns. It seems after talking to other Lenke patients, the typical combo includes: oxicontin and Norco (Hydrocodone + Tylenol) for pain, Valium and/or Flexiral for muscle spasms and Senna Plus for constipation. I was told to fill all scripts and take everything. I think Dr Lenke wants your pain minimized so you can get walking more, etc. Anyhow, I'm a month out now and trying to wean, also. I quit Flexeril altogether--don't know that it was doing anything for me. I cut the oxicontin down to 1 20-mg in the morning, and I've got the Norco to every 5 hours, 6 at night. I am still taking 2 Norcos each time, but they refilled at a lower dose, 5 mg instead of 7. My next goals will be to get to 6 hours between and then sub plain Tylenol for the Norco. (Apparently 325 is a regular strength Tylenol.) I am taking Valium every 6 hours. At the end of that time I start to feel like someone is kicking me with a big boot in the middle of my back. So, I do think that is a muscle spasm and that the Valium is helping control those. I am very concerned about withdrawal when I go off of it, but right now I need it. I hope to be off in the next month because I need to be able to drive my kids places! When I do go off, I will probably transition to an antidepressant, Lexapro, to help with withdrawal symptoms. I have taken it before for anxiety and I tolerate it well. Hope hearing individual experiences helps some. I know it helps me.

Thanks,
Evelyn

jrnyc
04-15-2012, 11:21 PM
well, i am glad your pain is well controlled, as it didnt seem that way with your previous post...

oxycontin, by the way, is not the same medication as oxycodone...
and...i have botox shots for my muscle spasms, so i do not take any muscle relaxers...
i feel about muscle relaxers a little like you feel about pain meds...

best of luck in your recovery....
jess

Mojo's Mom
04-16-2012, 05:33 PM
Jess, I meant to type OxyContin. I understand the difference...my husband uses OxyContin for baseline and Vicodin for breakthrough. I don't feel my pain requires the strength of either long or short release oxy.

Evelyn thanks for sharing what has worked for you...I knew I remembered at least somebody who found better muscle spasm relief from Valium than the traditional muscle relaxers.

My surgical team also wants me to use everything as prescribed, I am sure for the same reasons. But it is hard to keep me slowed down(that will be a whole different story when I get to a long instrumented fusion, I do understand) and I prefer to plug along on the least meds necessary to keep me off the bed. Among other things, I don't want to mask the pain so much that I overdo, which is easy for me.

I just want to make sure I am making the best use of what I have on hand. I guess the only way to be sure is to experiment a bit.

twistedRN
04-16-2012, 07:53 PM
Hi Everyone,
I am at the opposite end of the spectrum, will be 3 wks postop tomorrow (fused T3-sacrum with pelvic fixation). For the first week I was on the hospital regimen as far as meds go. Second week in the local area I was on 2 hydrocodone (5/325) every 4 hrs as needed for pain as well as gabapentin and baclofen every 8. Between week 2 and this week they have had me wean down to HALF a hydrocodone tab every 4 hrs (up to 1 if needed) and my gabapentin has gone to once daily. Essentially that means 2.5 mg of hydrocodone every 4 hrs. I am not wimpy when it comes to pain and this usually seems to work ok for me but it has been rough today - to the point where it definitely limits extensive walking etc. In the hospital, once my pain was under control, I would have said my pain never went above a 2-3. But my pain at home here now is always between a 2-6. Seems it was pain relief in the hospital, but not at home? I certainly understand limiting narcotic use and am trying to work within their protocol...

Confusedmom
04-16-2012, 09:26 PM
TwistedRN, that sounds brutal to me, but everyone is different. You will probably experience fewer wihdrawal symptoms than I will.

Mojo's, I agree totally with wanting to be out of bed. Too much to do. But I am still at the point I am more likely to be out of bed WITH the pain meds. Without (like when I'm getting to the end of a dose), I've gotta be flat on my back. I hoped to be weaned by one month. Ha! Now I'm hoping for two....

Cheers all,
Evelyn

jrnyc
04-16-2012, 09:48 PM
is it better to limit meds and walk less...
or take what the surgeon recommends and get more walking in for exercise....?
3 weeks sounds very early in terms of being able to keep up with recommended activities...
that is just my perspective, as someone who worked in drug and alcohol rehabs...
you all have medical, not recreational, reasons for needing your meds...
most pain management doctors are quick to evaluate their patients, and first thing they usually
look at is where/why the pain is coming from....
major surgery is a top reason for meds to not be discontinued, or even weaned off, too quickly...

jess

Mojo's Mom
04-17-2012, 11:40 AM
TwistedRN, I am stunned that you are on so little for pain! I am not quite two weeks out from a much more minor procedure and have been taking way more Hydrocodone than you. What you are taking in just week three is a very tiny amount that I am surprised does much of anything at all.

My hydros are the 10/325s, and I have been taking two first thing in the morning, one 4.5 hours later, one 4.5 hours later and then two 4.5 hours after that. I've been taking the muscle relaxer only at night, but today I am trying a switch for the second med dose of the day: one muscle relaxer and one 500 mg 4 hour Tylenol. I want to see if it makes me more sleepy, and also if the muscle relaxer works better for the pain, which seems to me to be mostly spasms.

What I've been told is that they want me to take enough meds to be able to stay active. They are very concerned with staying active, although not overdoing (when I said I was doing laundry, grocery shopping, cooking, etc. they were not too pleased). I think when you hurt too much to do anything but lie down, that's when your pain is not being managed.

That's what the phone is for. Twisted, I really think you ought to call them. They may have a plan, but if it doesn't work for you, they need to change it.

twistedRN
04-17-2012, 12:56 PM
Hi Everyone,
Thanks for all the great advice! I think that last night was particularly bad for pain (evenings are the worst anyway) and I should probably refrain from logging on at that time! At my 4 pm med dose today I plan to take a full norco tab to see if that will help my evenings be a bit lower on the pain threshold. I feel like, if that part of my day gets a bit more under control, I will be ok. Thanks for all your concern and great advice, though, and I certainly will call the doc if there is no improvement.

Mojo's Mom
04-17-2012, 05:51 PM
Hi Everyone,
Thanks for all the great advice! I think that last night was particularly bad for pain (evenings are the worst anyway) and I should probably refrain from logging on at that time! At my 4 pm med dose today I plan to take a full norco tab to see if that will help my evenings be a bit lower on the pain threshold. I feel like, if that part of my day gets a bit more under control, I will be ok. Thanks for all your concern and great advice, though, and I certainly will call the doc if there is no improvement.

Twisted I am in awe of you...we are all so different! I am highly motivated to get off the Norco yet even with a smaller surgery by far I wonder if I can even come close to cutting back the way you have.

Today I tried a change that seemed to help. After the two morning Norcos, at the four hour interval I took a Robaxin and a 500mg Tylenol. It seemed to work out better, and I did not notice drowsiness from the Robaxin, and it was a mental boost to "skip" a dose of Norcos and be ok. I did take a single Norcos after another 4 hour interval and was able to walk comfortably for fifteen minutes this evening. That was not possible last evening. I think the muscle relaxers are going to be more important for me than the narcotics.