What opioid drugs used to manage chronic pain in dysfunctional liver patients?

[mac009]

I was recently diagnosed with beginning stage, PSC, or Primary sclerosing coliangitis, and have chronic moderate pain issues (muscularskeletal) as well.  I don't want to take anything that will make my liver condition worse and wondered if methadone was safer or any other alternative.  I have researched a little it seems that methadone doesn't work like the others on hepatic function.  Any comments would be greatly appreciated.  Thanks!

[antman]

i was just on jury duty involving methadone. anyway i listened to 4 days of testimony regarding methadone from Dr.s and scientists. what i learned was that methadone works like any other opiate. it mtabolises in the liver. opiates are not paricularly hard on the liver. however, the biggest warning i left was this: with methadone start low and go slow. that is, start with a very low dose and adjust upwards if necessary. metadone has a very long half life and reaches it's highest blood stream levels in 2-5 days. those are the most dangerous days for the induction period. in addition, an impaired liver will extend that half life even more. as, your liver may not rid itself of the methadone as fast as a normal liver .also, it's very addictive. so, weigh the cons of addictions against the analgesic properties. but back to you question, no, it's not hard on your liver.

[Kalio1]

Sorry to hear of your troubles and pain. I was on a pain management program for a back injury prior to diagnosis and I was switched to Vicoprophen and told it was metabolised by the kidneys not the liver. It doesn't work as well as things I have used in the past but knocks the pain down to a manageable level. It doesn't affect me cognitively, a very important aspect for me. I take one every 6 hours. The pharmacy had to "order" it originally. The pharmacist referred to it as "liver friendly" however I know nothing of your particular liver disorder or what is acceptable pain wise.

Did your doctor make any recommendation? I'd speak to your pharmacist about it, they are expert in this area. Maybe he can discuss options with you.

Best of luck to you.

[gazebo1]

Sorry about the pain you are experiencing. Are you trying ursodiol?  It may help to lessen the pressure and pain.  I have posted before on opiate pain relievers since I suffer greatly from spinal stenosis and have had various doctors work with me for pain management.

In my case, taking all the Advil and Tylenol  really injured my liver along with the HCV the past 20 years.  SO...the docs have me on time released oxycontin with no APAP to hurt the liver.

The most common, vicodin, is a combination of codeine and thebaine along with APAP, or acetaminophen (Tylenol). The acetaminophen is what studies show injures the liver - not the hydrocodone or oxycodone.  Your doctor may suggest Norco, that is hydrocodone with low APAP. If you pain is chronic and never ending, the oxycontin is time released and has no APAP.

Any of these can lead to dependency and addiction if abused, of course.  Contrary to the mass media buzz about opiates, studies show that most people with chronic severe pain do not become addicted, but some certainly may - be very careful with these drugs.

Good luck,
G