Am I damaging my liver with pain meds?

[Lexy485]

In Nov. 2004, I had a spinal fusion with instrumentation to correct the 70 degree curve in my back (double curve and twisted like a spiral staircase). I am fused from T1 - L2, and I recently developed a stress fracture on my L5. The type of work that I do puts alot of stress on my back. I have always had pain in my thoracic spine, after the surgery the pain between my shoulder blades actually increased. This is due partially to the hardware that portrudes out in that area. After the surgery, I was taking about 6 norco 10/325 a day and maintained that dose for until recently. Over the past month I have taken about 8 a day due an increase in lower back pain. I am so worried about my liver and kidneys. But if I go without the pain meds, I can't function. I feel the hardware in my back, it's heavy, I feel like it actually gets caught on my muscles, nerves, ect. The thoracic pain coupled with the lower back pain is unmanageable at times. My main concern is my liver. I recently started taking milk thistle to help counteract any liver damage. My question is: Is taking 8 norco (10/325) a day damaging my liver? and does milk thistle actually help protect the liver?  

[Tuckamore]

Hi Again Lexy,

As I indicated in my last post and as you can see from the post above the subject of the long term usage of acetaminophen use is surrounded by a lot of controversy.

I have discussed this with several physicians including my own. They beleive that this small push to reduce the dosage recommendations are coming from one, not very comprehensive study. They believe it is an unfounded "scare" and that if ppl follow the recommended dose there is not a high risk. I am not a scientist and I have only my trusted resources to rely on for direction.

Certainly it is a fact that some ppl do suffer renal failure that appears to coincide with acetaminophen usage. The unknown all of this is the predisposition that these patients had to begin with to renal failure. What other factors played a role in the renal failure? How much acetaminophen was actually ingested and for how long?  What are the real percentage of the risk? Is it 2% or 40%? There is no consistent agreement.

It is also true that all medications come with risks of one form or another. It is frightening to know that cardiac arrest may occur from some of the most popular medications that are prescribed by physicians. We still take those medications because the benefits out weight the low risks. One must always weight the risks with the benefits.

We could argue the theories on this forum for weeks and still have no reliable scientific conclusion. There continues to be a huge controversy in the medical community. No one seems to agree on what dose is the right dose. If the medical professionals and scientists cannot agree it certainly leaves the general public confused and left to draw their own conclusions. As you can see in a statement that follows from a medical toxicologist.
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In June 09 the U.S. health advisers recommended to that FDA that the maximum dose of over-the-counter acetaminophen in medications should be lower.  However Dr. Michelle Ruha, a medical toxicologist at Banner Good Samaritan Poison Control Center in Phoenix stated, "Most of the problem is with the prescription pain medications that contain acetaminophen." Many people using drugs such as Vicodin or Percocet still don't feel relief from their pain and either abuse their prescription or supplement with an over-the-counter medication. "The patients we see coming to our hospital from liver failure have either intentionally overdosed or taken too many prescription pain medications with acetaminophen in them,"

There have been 150 clinical studies on the drug's safety if taken as recommended. Of course the manufacturer, McNeil Consumer Healthcare strongly disagrees with the health advisory recommendation to lower the recommended dosage.

In my opinion it comes down to what you and your physician decide is the best course of pain management for you, all factors considered. And that you take your medication as prescribed. Never take more than current recommendations.

I think it is unfortunate that hydrocodone does not come without the acetaminophen. I do beleive that in the future that may change due to the recently raised concerns.

Taking acetaminophen with a bit of food helps protect your stomach lining and slows the rate of absorption.

[nurseaudrea]

It sounds like you do need to see a doctor that specializes in pain management. There are better meds for your condition that will last a lot longer and it will also cut down in the frequency of taking the meds. There are extended release forms of meds without acet. in them. Usually when you know you have to be on pain meds for an extended period of time it is better to switch to those types of meds. I am sure others will respond and tell you the same thing. Like you, I had an anterior fusion in 98 and a posterior fusion with instrumentation in 2000. I had to have the hardware removed last May. The hardware definitely played a role in the amount of pain I was in. It has helped tremendously to have it taken out, but it did not take enough pain away to stop the meds. I have other issues because of the fusion that have made other levels in my spine worse. Levels above it have herniated causing nerve damage and pain, but I do not want anymore surgery and will just have to live with the pain. Thank you Lord that there is pain meds that help.

[jwcj]

Dear Lexy,
I subscribe to the New England Journal of Medicine, and not long ago they posted new recomendations about taking acetaminophen.
They now are using guidlines that do not recomend taking more than 2000mg of acetaminophen a day.
That's cutting their prvious recomendations in half, so because of their newly made changes I would check with my doctor.
I too use meds that have a lot of acetaminophen in them, and I have my blood work done twice a year just to be safe.
Believe it or not the opiuts in our meds are not near as damaging as the acetaminophen is to our livers. Go figure.

[Lexy485]

I take my pain meds on an empty stomach frequently, but I do drink plenty of water. Does the risk of liver damage increase if you take them on an empty stomach? I will make sure and eat before I take my meds. I'm so glad I found this forum. Thank you so much.

[Lexy485]

Thank you so much for your comments. Everyday is a challenge in one way or the other, I thought over time I would feel better, and I feel worse, and I'm having more problems. I'm afraid to complain, because I think I should count my blessings, I'm afraid I'll get worse if I complain.  I feel so alone in what I'm going through. I can't talk to just anyone about my pain management concerns. I'm glad I found this forum. I worry about how the meds are affecting my liver/kidneys everyday (just adds to the pain). I've only taken the 2 extra pills (almost daily) for about 2 months, it seems like the 6 a day are not lasting through the evening hours, I can't sleep through the night sometimes. I work, I can't concentrate at work with no sleep. The type of work I do, aggrivates my condition too. The first time I told my doc's nurse that I needed a refill a little early, she lectured me and said I was going to get liver toxicity if I continued to take that much for even one more day. Would you recommend finding a doctor specialized in pain management? Thanks for your feedback, you don't know how much I appreciate it.  

[concerned621]

I just read something last night in Prevention magazine. Females don't process acetaminophen like males do. Acetaminophen is in many more things than we know and it's more common for females to have adverse side effects and death from over doses of it.  Please do what Tuck is doing and have your enzymes checked especially if you are a female. It's hard to tell by our usernames but I assumed Lexy, you are a female.

I was taking it after a surgery in 2006 and had a seizure, the paramedics and ER stated it was from high doses of acetaminophen and that I should not take it in the future.  

Take care.

[Tuckamore]

Hi Lexy,

Welcome to the Pain Mangement Forum. I am glad that you took the time to post. I understand your concern and am sorry that your pain has increased. I take the same medication that you are prescribed, also since 2004. I take between 1,600 and 1,950mg per day of acetaminophen. On a rare day I will take 2,600mg.

My physician checks my enzymes every 6-9 months. They have always been with in limits of normal. She says that if I drink plenty of fluids and don't take my meds on an empty stomach there should be no serious concerns.

It is recommended that you not exceed 4,000 mg's of acetaminophen in a 24 hour periods. Recently there has been some concern raised by certain scientists that that recommendation should be lower to as much as 2,500 per day. There is much controversy surrounding the recent suggestions.

By my calculations you are taking 2,600mg of acetaminophen per day. In my opinion, concerning but not alarming. It is important to make sure that you are not added to that amount in any other form. For example many cold relievers, sleep aids and the like also contain acetaminophen. I avoid those medications. I never take anything with acetaminophen other than the pain medication.

So drink plenty of fluids to help your liver and kidneys cleanse your system, unless contraindicated. Discuss this with your prescribing physician. And before you take any herbal supplement always consult with your physician. Mine does not approve of most of them.  

Please keep in touch and let us know how you are doing. I will be interested to hear your updates. Please feel free to respond to other posts. We all learn from one another. And best of luck to you.

Peace,
Tuck

[concerned621]

You should be having regular blood work to check your liver enzymes.  If not ask your MD about blood work.
Milk Thistle does protect the liver and kidneys. It stimulates the production of new liver cells.  
I would not just rely on this.  Any time we are on long term medication for pain we should have our blood work checked.  I'm not a doctor but I do have regular blood work to ensure my liver and kidneys are not being affected.  
I'm sorry for your pain and wish you the best.