What pain meds work well for Gastric bypass patients?

@aprilarlady, I had RnY gastric bypass surgery 7/8/14, with a weight loss of 85 pounds currently. Because of this I too am unable to take NSAIDS. I started taking Hydrocodone/acetaminophen 5/325 mg over a year ago to relieve my pain from herniated disks at L5-S1 and L4, as well as a compression fracture at C7 and stenosis, degenerative disk disease, and arthritis. The Hydrocodone did not work for me. Last summer, I began seeing a pain doctor who took me off the Hydrocodone and put me on Tramadol/acetaminophen 30/325 (as I remember). That was working great, still with pain, but tolerable.

Then I injured my back additionally through traveling and lugging my suitcases back and forth weekly between my home and a job site. I had sudden acute pain that ended p with me in a wheelchair after several days of trying massage, chiropractic and acupuncture (my first time ever). I then had an MRI that showed the problems I described at the beginning of this post. My pain doctor added Baclofen 10 mg and changed my Tramadol to 50 mg without the acetaminophen. He said I could add acetaminophen for breakthrough pain as needed. This has been working great for me. I had outpatient spinal surgery on my L5-S1 on 12/22/16. I have had complete relief from the pain on my left side since then. But the pain on my right side continued. My pain doctor added Gabapentin to my medications. 300 mg twice a day.

My spine surgeon put me on Physical Therapy in late February, with both our goals to improve my core muscles and avoid surgery on my L4, which is completely out of alignment with my spine. The PT seemed to be working until my 4th session, after which I was in excruciating pain the following day and for several days after. Then suddenly it felt much better. I waited 2 weeks before I had another PT session and after that very gentle session, again I had excruciating pain and ended up in bed for 5 days only walking to the bathroom, icing and changing position about every 30 to 45 minutes. That was 2 weeks ago and I am still in pain. My pain doctor then tried Hydrocodone again when I requested it. But when I had used it previously, I took it with the Tramadol and I had good pain relief. He told me I should never take the 2 medications together. On only the Hydrocodone I had very little relief and after 3 days, I began noticing withdrawal symptoms from stopping the Tramadol suddenly. I stopped taking the Hydrocodone and went back to the Tramadol.

I am doing ok currently, but my pain level is a constant 7. I can't do much exercise like walking around more than half a block (yesterday), which was very hard to do. This morning I am very tired from my activities yesterday. I had bought tickets, 2 months ago, to take my granddaughter to see "An American in Paris," live at the Pantages Theater in Hollywood. I was determined to go if at all possible. She drove and was helpful for me in walking. But I'm paying for my fun today. I'm also participating in a medical research study for Alzheimers at the University of California at Irvine. Today I am having a PET scan as part of the study. Thankfully, they are sending a cab to pick me up and bring me back. It will be another active day for me.

So, I can recommend Tramadol and Baclofen as having been very helpful for my pain. I would not take Gabapentin, and i have asked my doctor to withdraw me from it. I wish you luck in your search for pain relief. If you have any questions, please feel free to contact me. Gail B

I am so frustrated. Does anybody here deal with chronic pain and had Gastric Bypass? I am struggling with Tramadol not staying with me as long as the dosage says it should. Like there is a malabsorption issue perhaps. Is there anyone with this issue and is there clinical evidence of it? I am in pain and my PCP thinks it should be 1 pill every six hours. I can't go that low of a dose and that far apart.

@annek1965
I am not sure I can help. To repair a paraesophageal (sliding hiatal) hernia I had nissen fundoplication in 2001 that failed; a bad repair of it in 2007; I had it taken down at the Mayo Clinic in 2013 and lost most of the fundus and hernia repaired. The hernia repair failed. In 2014 I had the gastric bypass at the Mayo Clinic to fix the hernia. I had complication of my esophagus shortening and it pulled a loop of my intestines along with my stomach into my chest. It also caused a small leak that eventually stopped on its on. I had 3 weeks in the hospital and too weak to have more surgery. I was on feeding tube and blenderized diet . I leveled off and got stronger. About six months later two more loops of intestines came into my chest and pushed my left lung against my ribcage partially collapsing my lung. I had to have open thoracic surgery to repair it all. I lost a bit more of my stomach. I did have enough to divide and make the pouch about large egg size. I had to stay on the feeding tube for about five or six months longer.

I have a lot of pain from arthritis and still pain from where they cut me open for the surgery in 2015. Cracked ribs, cut muscles and I have a torn labrum in my shoulder.. probably not from the surgery, but aggravated by the surgery.

During this time of all these surgeries my vitamin d did not register at all. They tried me on high dose of vitamin d but my body would not tolerate it. It made me hurt like the flu. So I take a chewable mult-vitamin that has vitamin d. They do have a vitamin d that dissolves in mouth, but it was hard to find in low dose. I wanted to go slowly up on dose. My vitamin d started to go up and I decided to add a gel pill to it.. forget how much it is. Now 5 years later I am absorbing it. I am towards the lower end of the normal range. I was absorbing calcium, but magnesium was low, but started absorbing it. Vitamin b12 was low and I do monthly injections of it. It is in lower normal range.

I have a swallowing problem. I have spasms at back of my throat and at the sphincter above my stomach. My food basically drops from the back of my throat to just above my stomach.. . sometimes food or medications can stack in my esophagus if the sphincter does not open to my stomach. I take oxycodone for pain because hydrocodone did nothing but give me headaches and nausea. I believe it is the only one that comes in a liquid. I am allergic to tramadol. I chew the oxycodone, but sometimes it is as much as an hour before I start feeling the effects of it: a slight headache.. which goes away after a short time.. and weird head feeling which also goes away after a short time. I take 5 mg of oxycodone as needed. Most days I take one pill every 6-8 hours. Some days it might be every 4 hours. Sometimes it might be a half dose or a 1 1/2 dose. Sometimes the pain is really bad and I add Tylenol or at night half of a 5 mg valium tablet. The Tylenol isn't chewable.. I could get liquid, but I don't take it very often.

I don't really know if the lack of absorption is from missing parts of my stomach, the gastric bypass or the swallowing problem. I have barrett's esophagus to add to all this. Il do know that with time absorption seems to have gotten better for me. Care had to be taken though. If i do not feel the effects of the pain pill I have to be careful.. too many pills hitting at one time could be dangerous. I don't drive much, but a big does of pain pills hitting me while driving would not be good. Blood pressure or diabetic medications could be life threatening too.. so far I don't take any of those.

I seem to be one of the weirder cases at the Mayo Clinic in Jacksonville. Not really an honor I want. 😒

ZeeGee

I am so sorry for the awful pain you must be going through

Oh, no I haven’t heard of esketamine therapy. What does it treat? How does it work?
Yes, I’ve had 14 electroconvulsive shock treatments - did nothing except badly damage my memory. I’ve had pharmacogenomic testing and genetic testing. I carry 21 genes for bipolar and I have some crazy genes for my enzyme metabolizers, which make up about only 2% of the population that has mutations or carries 2 copies of the wrong genes. For example, most chronic pain medication like hydrocodone oxycodone and morphine codeine and tramadol have no effect on my pain whatsoever. But what medicines are supposed to work Arkansas Medicaid will Not pay for, so I’m looking at anywhere from $400-$1000 a month. There’s NO way. And did I mention I fell a couple of years ago and broke both my wrists and ruptured both thumb tendons - 7 screws and steel plate in my right wrist-broke it in 3 places - had to have metal removed, carpal tunnel release and thumb repaired = 3 surgeries. Haven’t gotten to my left thumb yet. They both ache and hurt every day all the way up to my elbows. So I constantly use biofreeze and wrist braces when I can to no avail. This on top of chronic pain, fatigue and fibromyalgia. I feel hopeless and I’m only 45......if Mayo won’t at least try to help me, what else can I do?

Oh, no I haven’t heard of esketamine therapy. What does it treat? How does it work?
Yes, I’ve had 14 electroconvulsive shock treatments - did nothing except badly damage my memory. I’ve had pharmacogenomic testing and genetic testing. I carry 21 genes for bipolar and I have some crazy genes for my enzyme metabolizers, which make up about only 2% of the population that has mutations or carries 2 copies of the wrong genes. For example, most chronic pain medication like hydrocodone oxycodone and morphine codeine and tramadol have no effect on my pain whatsoever. But what medicines are supposed to work Arkansas Medicaid will Not pay for, so I’m looking at anywhere from $400-$1000 a month. There’s NO way. And did I mention I fell a couple of years ago and broke both my wrists and ruptured both thumb tendons - 7 screws and steel plate in my right wrist-broke it in 3 places - had to have metal removed, carpal tunnel release and thumb repaired = 3 surgeries. Haven’t gotten to my left thumb yet. They both ache and hurt every day all the way up to my elbows. So I constantly use biofreeze and wrist braces when I can to no avail. This on top of chronic pain, fatigue and fibromyalgia. I feel hopeless and I’m only 45......if Mayo won’t at least try to help me, what else can I do?

@kypaint75 ,
Yes esketamine is the FDA approved form of the drug that comes in spray form. It is approved by most insurances.
Have you tried trans-cranial magnetic stimulation? Or electro-convulsive therapy? Sounds like you are resistant to all the pharmaceuticals that you have been given.

@kypaint75 ,
Yes esketamine is the FDA approved form of the drug that comes in spray form. It is approved by most insurances.
Have you tried trans-cranial magnetic stimulation? Or electro-convulsive therapy? Sounds like you are resistant to all the pharmaceuticals that you have been given.