Pain meds for Gastric bypass patients

Posted by aprilarlady @aprilarlady, Mar 24, 2017

Good Morning. I am a gastric bypass patient 13 years out from surgery and maintaining my 150 lb weight loss. I have chronic daily pain from arthritis, degenerative disc disease, cervical herniated disc(s), torn meniscus, labral tear in my hip and recurring tendonitis in various places. I take Hydrocodone/Apap 10mg/325 4 times daily for pain since as gastric bypass patients we are not supposed to take NSAIDS. I get very little relief from this. It is in pill form. Does anyone else that is a weight loss surgery patient have this issue and find that it is due to malabsorption and/or anyone taking pain meds in liquid form get better relief?

@laurie1l

I'm new to this site. Does anyone ever get an answer from The Mayo Clinic ? Isn't that what we're looking for ? → Professional answers fro Doctors….

Jump to this post

@laurie1l

Hello and welcome to Mayo Connect.

This site is people to Connect and discuss with others.. and they do not have to be Mayo Clinic patients… medical conditions that we have in common. We try to help each other handle our situations. Sharing experiences we can gain knowledge and ideas on what to ask our care teams (personal care physicians and specialty physicians, NPs and PAs that participate in our care).

Everyone is different. Some medications work for one person and not another. Others can suggest things you never thought of to handle your pain or how to handle a doctor or test, etc. Sometimes other's input makes us realize we need to be seeing a different doctor. .. a specialist maybe.

There are no Mayo doctors monitoring this site that I know about. You can call and make an appointment or look through the pages Amanda has posted.

Ask a question and we will do our best to direct you to answers.

ZeeGee

REPLY
@laurie1l

Did you ever get a reply on this ?

Jump to this post

yes, generally speaking, thanks

REPLY

I had gastric bypass in 2012 and had lost around 150lbs before my surgery and then I lost 250lb after surgery. I started at almost 600lbs. The lowest weight I got down to was 157lbs, and just looked horrible. But right now I am struggling with my weight. I have probably gained at least 50lbs in the last couple years. I have arthritis, fibromyalgia, ankylosing spondylitis, and scoliosis. I take oxycodone (30mg for the day, I also take gabapentin 300mg/3x daily, and I also am on a fentanyl patch (25mcgms for 72hrs). when I began using the fentanyl patch, I started with a patch that was 150mcgrms. So, I have worked my way down from 150 to 25. No, my meds do not take away my pain. Some days are worse than others. I have real problems with my pain and weather. Every time the barometric pressure changes, my pain feels "it". My pain is worse in the cold, rainy weather, and I live in Oregon. If your pain meds are not working, maybe you should talk to your doctor about changing your meds or adding another med to the one's you already take. I hope this helps a little bit. If you have anymore questions or want someone to talk to, send me a message.

REPLY
@gailb

@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

Jump to this post

Are you still using both of these? I am dealing with DDD and chronic pain.

REPLY

If you do your research, there are plenty of reputable vendors. You want to make sure it is lab tested and the labs are available to the consumer for viewing.

Also, it is not legal in all areas of the countty.

REPLY
@sandytoes14

@aprilarlady your previous post has recently come to my attention. Are you still having troubles with absorbing pain medication due to RNY?

Jump to this post

I have been. I had rny 6/11/2018, then a revision 8/2018 due to complications. I've had nothing but trouble with my recovery, but I've noticed most medications have less or no effect on me at all. I have insomnia, chronic pain, depression and anxiety to name a few. I've tried baclofen, tramadol, trazodone, gabapentin, tizanidine, robaxin, etc. I can barely tell that is taken anything. Insomnia meds don't make me sleepy, I've tried about a dozen different ones. What gives?!

REPLY
@shelton13

I have been. I had rny 6/11/2018, then a revision 8/2018 due to complications. I've had nothing but trouble with my recovery, but I've noticed most medications have less or no effect on me at all. I have insomnia, chronic pain, depression and anxiety to name a few. I've tried baclofen, tramadol, trazodone, gabapentin, tizanidine, robaxin, etc. I can barely tell that is taken anything. Insomnia meds don't make me sleepy, I've tried about a dozen different ones. What gives?!

Jump to this post

Hi @shelton13, welcome to Mayo Clinic Connect. Sorry to hear that recovery from gastric bypass surgery has been complicated, including insomnia, chronic pain, depression and anxiety. I'm bringing @sandytoes14 @grandmar @dandi @fourof5zs and @ken82 back into this discussion to offer their experiences and thoughts.

Shelton, What kind of gastric bypass surgery did you have? Have you ever considered a pain rehabilitation program or sought help from a pain management specialist?

REPLY
@colleenyoung

Hi @shelton13, welcome to Mayo Clinic Connect. Sorry to hear that recovery from gastric bypass surgery has been complicated, including insomnia, chronic pain, depression and anxiety. I'm bringing @sandytoes14 @grandmar @dandi @fourof5zs and @ken82 back into this discussion to offer their experiences and thoughts.

Shelton, What kind of gastric bypass surgery did you have? Have you ever considered a pain rehabilitation program or sought help from a pain management specialist?

Jump to this post

Hi @shelton13
I was sleeved October 2016.
I am sorry you have had so many issues with your surgery.
I'd like to address the depression and anxiety you are experiencing. I assume that you had neither of these before the surgery. It is not unusual to develop depression after surgery. You entire body was put into a state of shock. You many things to deal with even when WLS goes as expected. For many of us, food means comfort and our source of comfort is gone. As for anxiety, many people actually feel uncomfortable in their new body. Some people do not like being noticed as they change, especially if they are in a relationship. It almost feels like cheating. If you were very heavy before the WLS, people looked for a different reason. If you've lost a lot, people are looking at you in a much different way. This can be difficult.
As for medications. People who have had by-pass (especially), medication does NOT work the same way. Because of the surgery and the changes to our stomachs (regardless of the kind of surgery), we do not absorb things like before. This is especially true for by-pass surgery. Therefore, if you are taking anything that is time released, that will NOT work. Ask your doctor for a regular released version. If he/she says they don't make it, check with the pharmacist. Often one version is more often used than the other and the doctor does not know it. I had the same issue. As for the other meds, your doctor might have to adjust the dosage.
If you have lost a lot of weight, you might not have noticed that you have more energy than before. If you are not doing anything to use up some of this energy, it might be difficult for you to sleep. Exercise might be useful. Exercise might also help with the pain. You might want to stay away from some of the heavy duty drugs and try something like melatonin. Also, try not watching TV or working on your computer for 1/2 an hour before bedtime. Try reading at that time. Make sure your room is cool and dark with not light at all. If all else fails, try seeing a sleep doctor to make sure nothing else is involved.
At this point, I don't know why you would have pain. I do know that some people have pain for a month or so after surgery. For me, believe it or not, it was the area where they removed the excess stomach portion they removed.
You did not mention if you have been keeping in contact with the surgeon who did your surgery. If you have and you are not getting the answers or help you need, I would research out another WLS surgeon and get another opinion.
Hope you find answers soon!
Best of luck and keep us up to date with what is going on….
Ronnie

REPLY
@colleenyoung

Hi @shelton13, welcome to Mayo Clinic Connect. Sorry to hear that recovery from gastric bypass surgery has been complicated, including insomnia, chronic pain, depression and anxiety. I'm bringing @sandytoes14 @grandmar @dandi @fourof5zs and @ken82 back into this discussion to offer their experiences and thoughts.

Shelton, What kind of gastric bypass surgery did you have? Have you ever considered a pain rehabilitation program or sought help from a pain management specialist?

Jump to this post

I had RNY and yes I'm currently seeing a pain management specialist and pain management psy. I've had a few injections for the pain but no relief yet.

REPLY
@grandmar

Hi @shelton13
I was sleeved October 2016.
I am sorry you have had so many issues with your surgery.
I'd like to address the depression and anxiety you are experiencing. I assume that you had neither of these before the surgery. It is not unusual to develop depression after surgery. You entire body was put into a state of shock. You many things to deal with even when WLS goes as expected. For many of us, food means comfort and our source of comfort is gone. As for anxiety, many people actually feel uncomfortable in their new body. Some people do not like being noticed as they change, especially if they are in a relationship. It almost feels like cheating. If you were very heavy before the WLS, people looked for a different reason. If you've lost a lot, people are looking at you in a much different way. This can be difficult.
As for medications. People who have had by-pass (especially), medication does NOT work the same way. Because of the surgery and the changes to our stomachs (regardless of the kind of surgery), we do not absorb things like before. This is especially true for by-pass surgery. Therefore, if you are taking anything that is time released, that will NOT work. Ask your doctor for a regular released version. If he/she says they don't make it, check with the pharmacist. Often one version is more often used than the other and the doctor does not know it. I had the same issue. As for the other meds, your doctor might have to adjust the dosage.
If you have lost a lot of weight, you might not have noticed that you have more energy than before. If you are not doing anything to use up some of this energy, it might be difficult for you to sleep. Exercise might be useful. Exercise might also help with the pain. You might want to stay away from some of the heavy duty drugs and try something like melatonin. Also, try not watching TV or working on your computer for 1/2 an hour before bedtime. Try reading at that time. Make sure your room is cool and dark with not light at all. If all else fails, try seeing a sleep doctor to make sure nothing else is involved.
At this point, I don't know why you would have pain. I do know that some people have pain for a month or so after surgery. For me, believe it or not, it was the area where they removed the excess stomach portion they removed.
You did not mention if you have been keeping in contact with the surgeon who did your surgery. If you have and you are not getting the answers or help you need, I would research out another WLS surgeon and get another opinion.
Hope you find answers soon!
Best of luck and keep us up to date with what is going on….
Ronnie

Jump to this post

The pain is not related to the surgery. I have back issues and fibromyalgia. I had the depression and anxiety prior to surgery but it's worse now. I am still in contact with my surgeon and he's doing everything he can to help. I will be speaking to my pharmacist about the medication but I do make sure I'm not prescribed delayed release meds. Thanks for the advice.

REPLY
@shelton13

I had RNY and yes I'm currently seeing a pain management specialist and pain management psy. I've had a few injections for the pain but no relief yet.

Jump to this post

@shelton13

I am glad to hear you are going through pain management. What type of pain are you having?

My RNY was not for weight loss. It was because of a large paraesophageal (sliding hiatal) hernia. More of my story if you wish to read at my blog.. no ads: https://zarogasnook.blogspot.com/2015/08/a-long-time-passing.html

My last surgery was open, so I still have a lot of pain from it. I also have achalasia. I thought I might wind up in the ER last night with it.. but finally all is well. It put me off the charts with pain last night… I could not swallow food nor water so taking pain meds not an option. I also have Barrett's esophagus.

@grandmar Did a great job talking about pain meds. When our stomachs go through change it effects the way they work. I lost a few small sections of my stomach during my surgeries. Pain medication was not much of a problem until the last surgery.. the open one. Liquid Tylenol and arthritic rubs took care of most of the pain along with moist heating pad and ice packs. The moist heat helped the most. I have microwavable heating pads much like physical therapist use. I have to be careful and not burn myself. Microwaves have gotten more powerful and it takes about half the time now to heat it to appropriate temp for me.

Oral medications… time release as mentioned do not work well for most who have had any kind of abdominal surgery involving the stomach. Before all my surgeries I tried Tramadol.. I think I had an allergy to it or it was the one that made me depressed .. I am too lazy to look at my med list right now to know for sure. I took Lyrica for awhile. I would wake up at night gasping for breath. I discontinued.. it wasn't helping with the nerve pain anyway. I also took Zanflex for awhile. It did not help either.. tried Flexeril… didn't help. For sleep I tried sleep Melatonin, no sleep and a headache, Ambient.. no sleep, it made me restless. I do take a half of a 5mg Valium tablet to help with sleep sometimes. Best sleep I get is on the sofa in a room between 66°-68°… cold enough I need a blanket. The back of the sofa keeps me from rolling too far onto my back. I will sleep with one or two pillows under my head.. depends on how well I am breathing with allergies or if Achalasia is occurring… placed in a wedge way and not stack directly on top of first pillow. I use another standard size pillow that is old and thin and place between my knees. That one helps back pain and keeps my leg from putting too much pressure on the knee I had surgery on. I have a travel size pillow I place on my left hip. My left shoulder and ribs took a beating in the open surgery on that side… that is the side that was cut.

For pain I take Oxycodone 5mg. Not something they want me to take because ???? sorry I don't remember. But so far it is all that works for me. I take living life over excruciating pain and sitting around. When the med kicks in I have a very mild headache for 30-45 minutes. I endure pain when I have to drive… safer for all if I skip a dose or two. Right now my back is not doing so well, so the oxycodone is at 4-5 pills within 24 hours. I am seeing my pain specialist and it seems to be sacral dysfunction. It is better after an injection.. which rarely they do work. In 2017 he gave me an injection in my ribcage that blocked a nerve. I can sit back in a chair now. We have had a lot of low weather fronts come through and with those my arthritis acts up. I use a version of Aspercreme. They now sell Voltran over the counter and it helps some people. I am allergic to it. When my back isn't hurting so bad I will only take two Oxycodone in a day.

With any medication.. prescription or over the counter.. try and either get liquid or chewable or crushable. They will work better. You may have to try different medications to see what works best for you. Even before my surgeries at the Mayo Clinic I was low on Vitamin D. It helps all of the other vitamins absorb. At one time my Vitamin D did not even register. I tried the high dose of Vitamin D, but they made my body hurt like the flu. I take a chewable multi-vitamin daily. Flintstone or store brand. I don't like gummies.. not particularly fond of the flavors of any chewable vitamin. After a couple of years on just those my Vitamin D went up to 22. I added a 400 iu gel pill and I now have my Vitamin D up to 31. I tried increasing it up another 400 iu last week, but my muscles started aching again. They do make some Vitamin D that melts on or under .. forget which way. I may look into them again. I am also on a monthly B12 injection.

You might want to have a vitamin blood panel done to see what you are low on. You can then adjust your diet to include more and or take appropriate vitamins. Having them balanced can cut your pain down.

Be aware that you are more susceptible to pancreatitis and learn the symptoms. I have been blessed not to have it.

I did not mean to be so long.. chalk it up to not much sleep the last few nights. 🥱

ZeeGee

REPLY
@shelton13

The pain is not related to the surgery. I have back issues and fibromyalgia. I had the depression and anxiety prior to surgery but it's worse now. I am still in contact with my surgeon and he's doing everything he can to help. I will be speaking to my pharmacist about the medication but I do make sure I'm not prescribed delayed release meds. Thanks for the advice.

Jump to this post

Sounds very similar to me. I had Fibro pain for decades. I've had 2 spinal surgies for back pain that was unrelenting. Sadly, I waited too long for surgery. I have nerve damage that impacts my balance and how I walk.
I also have been taking anxiety meds for years.
So, here is what I have done…
1. I went for pain management for years. I did find a doctor who helped with injections. After they stopped working, I decided I had enough and researched out a FANTASTIC neurosurgeon. He did 2 spine surgeries in 6 months. He is a blessing.
3. Found a great therapist and my psychiatrist played with my anxiety meds.
4. Had ALL my meds and supplements checked for side effects.
Hope this helps!

REPLY
Please sign in or register to post a reply.