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Implications of Long Term Drug Regime
My wife has protruding discs in her vertebrae which result in chronic severe pain in her legs to the extent that she is unable to sleep for most nights. The solution is surgical but this being Canada, that is at least a year off. The physician has prescribed -
Tylenol 3 - to be taken 4X / day
Naproxen 250mg - to be taken 2X / day
on an ongoing indefinite basis. So with the prospect of being on this regime for at least a year or so, the following questions arise -
can the kidneys / liver safely handle this regime for a year?
does tolerance to the codeine kick in after a few months, minimizing its potency?
can the severe constipation that results from the opiod be handled with a fibre rich diet alone or are laxatives required?
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IMO if it helps it's worth it. I would be careful with the Tylenol tho. I don't see where you said that she would be on codeine. Consult a pharmacist and/or urologist.
No way to get the surgery elsewhere?
I'll probably be on Pregabalin until I die, but it is what it is. Things would be miserable without it.
The only legal recommendation would be to ask an unbiased professional. With that said, is the pain relief working if so she is fortunate. With any medication used long term there are side effects. The trade off is quality of life which usually wins. Narcotics stop the peristaltic action of the large intestine which can cause severe and chronic constipation with extended use. Therefore, sometimes extra fiber can exacerbate that situation. Homeostasis does occur with narcotics, higher doses being needed for the same relief.
Thanks so much to both of you for your responses. I wrote that one of her meds was Tylenol 3 - that's got 30mg codeine. This is Canada, so no, unless you go to a private clinic - no surgery. Of course, they do get around to you in a year or two or three even but that's hardly timely intervention. In the quest for an effective analgesic, we have already gone through Duloxtetine (the drowsiness side effect made that impossible to continue) and Gabapentin (no side effects but no analgesic effect either). Just prior to the current proposed regime that I have mentioned above, the latest combo was
Acetaminophen - 500
Naproxen - 250
and sad to say, like Gabapentin, no side effects nor analgesic effect. So we'll see what
Tylenol 3 - to be taken 4X / day
Naproxen 250mg - to be taken 2X / day
happens with the above.
"Therefore, sometimes extra fiber can exacerbate that situation". I can't understand why extra fibre would make things worse - that's kind of counter-intuitive. As for the homeostasis (that's nice word for tolerance), any idea as to how long that takes to manifest?
Have you considered trying Pregabalin in place of GabaPentin?
No. The doc wrote a Rx for GabaPentin and that was that. At the time, we never heard of GabaPentin let alone Pregabalin. They sound like they’re from the same family so is there a difference? Another question that I had, I don’t think has been addressed fully yet in this thread. Are the kidneys / liver capable of handling chronic dosing with Tylenol 3 / Naproxen without significant damage?
I also have a herniated disc, nerve pain and have burning pain in my lower back and left leg constantly. Also in Canada, but not a candidate for surgery. I’ve been to the pain clinic a dozen times with no success finding the nerves that are trapped, done physio, IMS, massage and still do meditation and I find distraction with something very absorbing to help. I’m on Pregabalin for the pain and it works pretty well, but had a few side effects for the first couple of months and Tramacet for breakthrough pain. All narcotics are constipating. Senna is the best solution as it’s not the fibre that’s missing but the bowel is not moving the way it should. Senna speeds it up. If she has nerve pain radiating from her spine, Tramacet is a much better drug. It has been shown to work well for nerve pain. Just some suggestions to ask the Doctor about.
If your wife’s kidneys are functioning well and she stays within the prescribed dosages she should be fine. She could ask for lab work every 3 months to monitor her function.
You didn’t mention the age of your spouse. In a young healthy person with no signs of liver dysfunction, 4 grams per 24 hours is generally considered safe. In an elderly person or a regular alcohol user, this is decreased to 3 grams. Occasional bloodwork looking at liver function tests is certainly worth considering.
With naproxen, one must worry about the stomach, and the possibility of ulcer. Signs of belly upset, heartburn, or vomiting should be reported to her physician. In the US acid reducing agents such as Pepcid or omeprazole are over the counter and can be bought without a prescription. It would be nice to know what her doctor thought of adding one of the medications to prevent an ulcer from forming, again, especially if she is elderly.
Also, is she taking the naproxen and the Tylenol simultaneously? She may get improved relief by staggering them.
Hope that is helpful! All the best
GabaPentin and PreGabalin are both related to the amino acid GABA gamma-aminobutyric acid as you might surmise since they both have GABA in their name. GabaPentin was useless for me, but PreGabalin is in wonder drug category.
RE: Naproxen.
from
https://www.google.com/search?q=naproxen+kidneys+side+effects&rlz=1C1_____en-USUS1028US1028&oq=naproxen+kidneys&aqs=chrome.2.69i57j0i512l2j0i22i30l5.13767j1j15&sourceid=chrome&ie=UTF-8
"Yes, naproxen, a non-steroidal anti-inflammatory drug (NSAID), can potentially damage your kidneys, especially with prolonged or high-dose use. Naproxen can lead to acute kidney injury (AKI) or worsening of chronic kidney disease (CKD). "
https://www.google.com/search?q=tylenol+3+and+kidneys&rlz=1C1_____en-USUS1028US1028&oq=Tylenol+3++and+kidneys&aqs=chrome.0.0i455i512j0i22i30i455l3j0i390i512i650l4.12789j1j15&sourceid=chrome&ie=UTF-8
Lyrica aka PreGabalin and your kidneys
https://www.google.com/search?q=lyrica+and+your+kidneys&rlz=1C1_____en-USUS1028US1028&oq=lyrica+and+kidneys&aqs=chrome.1.69i57j0i22i30i395j0i390i395i512i650l5j0i395i546i649.13624j1j15&sourceid=chrome&ie=UTF-8
I absolutely agree about the efficacy of PreGabalin. I had major thoracic surgery for severe pain and numbness from my right buttocks down to my right foot. That back surgery worked wonders almost totally eliminating the pain and numbness. That lasted about 10 months and then the numbness came back with a vengeance (no pain though- thank you, thank you, thank you!) Pain management then suggested PreGabalin, and on the second day of its use the numbness was reduced 50% in both intensity and duration, and no noticeable side effects! It also greatly elevated my mood, which had suffered because of dealing with too many unexpected and serious medical issues in a few short years (been healthy all my life so I am kind of a baby when I get sick). Perhaps it doesn't work that well for everyone, but for those that it does it is a blessing!