Best pain medication for person with PBC and osteoarthritis

My doctors have determined I have Primary Biliary Cirroses (PBC). I have significant amounts of osteoarthritis in my knees. They have taken me off all aspirn and tylenol products.  I take TENORMIN twice a day, ZOCAR once a day, 5 capsils of ANTIGOL four times a day, NEXIUM twice a day, DARVON one capsil four times a day for the arthritis.     I was told by an RN that ULTRAM/TRAMADOL would be a better pain (arthritis) medication in my case than DARVON.  Would you please give me your opinion on which medication (Darvon or Ultram) you would suggest?   I would add that the DARVON is not taking much of the pain away but I understand it is less hard on my liver than aspirn and or tylenol products are.  My liver shows I have cirroses. If you believe Ultram is best please tell me why.  Thank you.  This is my second correspondance with you.   Woodworker

[Kevin Pho, MD]

All pain medications affect the liver to some degree.  Looking at the Drug Information Handbook, Ultram (tramadol) has liver failure as a side effect, occuring in <1% of cases.

Darvon has a side effect of increasing the liver enzymes, with a frequency that is non-defined.  

There are no head-to-head studies comparing the liver effects of these two medications that I am aware of.  

As for other pain medication considerations, Vioxx and Celebrex (both COX-2 inhibitors) has a hepatitis rate of <2%.

To my knowledge, there are no pain medications that are 100% safe for the liver.  Discussion of all the above medications should be done with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[lychick]

Has Oxycontin been considered? It has no Tylenol and is a long acting med. It comes in 10 mg. (which is released over a 12 hour period).This is the lowest dose so you are only getting 0.83 mg an hour. I know this drug gets a bad rap but it is a wonderful drug for chronic pain. I go to a pain clinic and I am familiar with Oxycontin because I work with Hospice patients on a daily basis.

[woodworker]

I have talked to two pharmacists respecting the use of Darvon or Ultram/Tramadol.  One encouraged the continued use of Darvon; the other Ultram; both thought that there is not much difference in their affect on the liver, especially one thought Ultram would do away with more of the pain.  Both considered Oxicotton (sp) to be harder on liver than either Darvon or Ultram.  Would like further comment on the latter problem: which is less hard on the liver.

[purple4me]

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