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Avatar universal

Pain Killer Alternative

I have been asked by my boss to find a non-addictive pain killer(s) sufficient for severe chronic non-malignant pain.  

After reading through a few forums, especially helpful one from 2001 --http://www.medhelp.org/forums/addiction/messages/30733.html --

it appears that there are really no viable alternatives to narcotics for effective severe chronic pain control.  Ultram was discussed in the 2001 forum as the best alternative (which I know was a while ago ... many new medications may now be available).  NSAIDS were portrayed as leading to stomach problems.

I am not a doctor or nurse (nor expected to be), but my boss wanted some alternatives to present to the doctor this week.  

The background:  Her daughter has had two surgeries in the past two years, which have resulted in severe open wounds from the surgeries that have had a hard time healing (I don't really want to get hung up on why these wounds are not healing).  So Percocet and Vicoden have been presribed in pretty high strengths (I don't have those numbers to share).  The daughter is 21 years old.  She becomes mean on the Vicoden and doesn't like the Perocet, because she is also a student at college, and cannot function too well on the Percocet.  The mother is concerned that the daughter now has a physical dependence on the Vicoden (maybe Percocet too), as the daughter has been using both now for 1-1/2 years; the mother is unsure if actual addiction (emotional, taking the drug for a "high") has resulted; but physical dependence is pretty much a given now.  Other pain-management tools are being considered, as well as options to heal the open wound.  But for now, my question is strictly narrowed to:  are there any viable alternative(s) to narcotics for effective pain control for moderate to severe pain?  If not, what are better alternatives to the Vicoden and Percocet?  We know that we will have to deal with withdrawal issues, too.  Really appreciate your responses.  I have a great respect for the people in this forum, as I have spent the last 2 hours reading through various discussions.  Thanks!
50 Responses
271792 tn?1334983257
Hello! Glad to see you posted.

I suffer with chronic pain, as you will see many people in here do. I took pain meds for nine years and became addicted to them. I recently stopped. I have been prescribed a medication called "Naproxen" 500mg tablets, to be taken twice a day. It is non-narcotic. From what I have read, it takes several weeks to get into the system and begin to work. Since I just started it on Friday, I am not there yet. However, I am hopeful. I am also contacting a woman in my area who is a "nutritionalist". She uses herbal supplements and specific exercies for pain management. Again, I have not talked with her as of yet.

I don't know that I have been much help, but others will post and tell you what they are doing for pain relief.

Also, when, and if, addiction from the pain meds becomes an issue, please come back and post about that. You will find several treatment options as well.

Good Luck and keep posting.

Hugs....
Avatar universal
Thank you so much for taking the time to respond.  I have added Naproxen to my list of alternatives to be researched.  In the 2001 post discussing pain killer alternatives, Naproxen was discussed and dismissed by some who were concerned about stomach issues.  But again, that may just be a potential side effect (like all medications have side effects).  

Would you mind me asking what pain medications you were on?  I'm just wondering if Naproxen is sufficient for severe pain.  As stated, the daughter has an open wound.  From what I heard, someone who was a doctor (not the prescribing doctor) looked at the strength of the prescription and was awed by how high it was, but then also commented they had never performed the type of surgery that the daughter experienced (thus inferring the strength may be appropriate for the need).  The  wound is very deep and in a place that can tear open easily.  So the mother is caught in a catch 22 ... concerned about physical dependence and possible addiction but knowing that the daughter has to have something to deal with the very real pain she experiences.  
Avatar universal
I didn't mention that the daughter has been diagnosed with ADHD, and is under treatment for that as well.  The below states that some preparations of Naproxen are not recommended for use in patients with hypertension:  http://en.wikipedia.org/wiki/Naproxen

Naproxen – Also like other NSAIDs, naproxen can inhibit the excretion of sodium and lithium. Extreme care must be taken by those who use this drug along with lithium supplements. Naproxen is also not recommended for use with NSAIDs of the salicylate family (drugs may reduce each other's effects), nor with anticoagulants (may increase risk of bleeding). Certain preparations of naproxen are not recommended for use in patients with hypertension, as they contain sodium, potentially worsening the effects of hypertension, in the very small subset of people who exhibit sodium-sensitive hypertension.
Avatar universal
I believe Naproxen is an anti-inflamatory - that's how it helps with pain.  But I would double check this (i.e. google.)  :)

Every med is different.  Personally, I could not take Naproxen, it made me sick.  

And I know you didn't ask me this, but if you want any additional info, I tried Cymbalta, Neurontin (not very long tho,) Naproxen, Fleveril (muscle relaxant,) Aleve/Advil, and Norco - which is what I ultimately got addicted to.  And - btw - was the only thing that worked when the pain was SEVERE.
271792 tn?1334983257
Thank you for your post on Naproxen. As you mentioned, it have side effects, as most medications do.

I was taking Vicoden, Percocet and Oxycotin toward the end. I hade surgery, every therapy you can think of, epidural injections, steroid injections, and accupuncture. Some of these treatments worked for a realtively short period of time. The pain meds worked earlier on, but after years of use they stopped working as my tolerance built.

I also take "Soma", which is a muscle relaxer. Also non-narcotic. I wish I could be of more help, unfortunately, it has only been a short time that I am seeking non-narcotic alternative medications, so I am not well versed. There is a young lady who frequents this forum "FLaddict". She would be a good person to speak with. She is very helpful and does a lot of research. Keep an eye out for her.

Again, thank you. Hope you find the help you are looking for.
256169 tn?1191688915
With the type of injuries you describe she should feel NO shame nor any guilt, nor should her mother worry more about a "possible" problem with pills than the pain her daughter is now suffering......There are NO OTC meds that can really help the pain from such open wounds.  Good luck.

To get the details straight, you mean your boss has asked you to research alternatives for her/his daughter.....I have never heard of anyone getting "mean" on Vicoden, but ....I don't know everything.  Perhaps the daughter does have a physical dependance but that is not necesarily evil...She darn sure needs something for her pain......Perhaps your boss is a bit judgemental, based on incomplete information and predjudices.

Your boss perhaps needs to open her mind to the possibilities that these meds are "helping" and not necessarily hurting the daughter....She may be physically addicted but not necessarily psychologically.....Ask your boss, if the daughter is taking more than the prescribed dosage.....It would be hard to do this with your boss, but it might help if the boss "lightened up" on the guilt and shame thing and concentrated on helping the daughter with the pain......
256169 tn?1191688915
Personally I have found Naproxen to be quite worthless and VERY hard on the stomach.....After reading the ADHD thing of course care has to be taken with how whatever pain med chosen interacts with that medication.....I can't overemphasize how important it is to deal with the daughter's "pain"...It's good to be concerned about possible addiction, but your boss does not need to let predjudices against meds rule the decision.......Again, does the daughter take more than the prescribed dosage, more often than prescribed, or not......

Maybe a duragesic patch of some kind might work... I hear good things from folks about these things.
256169 tn?1191688915
Sometimes, Diabetes stops wounds from healing quickly, but hopefully they have already checked for that.... I would certainly think after 2 surgeries that those tests have been done.  I have a bruise on my hip that's been there for 12 months, as a Type II diabetic.
Avatar universal
Thank you for your post.  No one feels any shame nor guilt.  There may be some possibility of abuse.  Also, other people have commented on the personality change the daughter has when on Vicoden, not just the mother ... in fact, the daughter has also commented on it.  From almost a decade of working with my boss, slideshow, I can assure you she is not judgemental and loves her daughter so very much.  I am not a young woman and a mother myself, and can tell you, there is absolutely no question of the mother's love and commitment.  I have oftentimes been amazed by how much this mother DOES for and LOVES her daughter.  It is out of love that she is looking for other alternatives.  But no one feels shame or guilt ... that's not even part of this.

In my research and taking the time to read through this forum, it is out of the respect I have for the people here that I posted my question.  

My question is simple and may have no answer ... is there a better (i.e. less addictive) pain killer for severe pain than Vicoden and Percocet?  It seems that if there is, it would fall into the categories of NSAID or Opiate Agonists (e.g., Ultram, which is not yet a controlled substance.  I know Vicoden is an Opiate Agonist ... but there may be some others in this drug class that are as effective but less addictive).

Again, thank you for taking the time to post.
Avatar universal
The daughter is being taken to one of the best hospitals in the world and is receiving the best medical care for her condition.  I don't want to reveal too much.  It is a rare condition that has had complications.  They are scheduled to go to the Pain Management Clinic at this hospital where alternative approaches to pain will be explored.  That whole piece of this is outside the scope of what I've been asked to do ... that is why I'm not focusing on that.  The mother has that handled.  I'm just focusing on the prescription piece of this.  But, certainly, slideshow, there is a lot of other things going in with healing the wound and a comprehensive approach to pain management.  
214255 tn?1205639236
I have been taking pain meds for 4 5 yrs just to get high and well i'm off now, but I do know that when on some like vic's perks or oxy certian things would set me off little things that would have never if I was sober and I would have a major attitude so it is very possible that it can make her moody...Not sure what exactly, but my b/f would call it oxitude as in attitude....As for alternatives i'm not the one to know anything, but i'm sure someone will....Good luck!
Avatar universal
Thank you.  Yes, there is no question that the daughter gets an attitude when on Vicoden.  Even the daughter has acknowledged that.  appreciate the post.
214255 tn?1205639236
I see you wrote ultram was not an addictive, but I think it is look up tramadol I think that is the generic name for ultram and I have seen post on here for tramadol addiction.
Avatar universal
Yes, Ultram is addictive.  The question is, is it less addictive than Vicoden or Percocet?  The jury is mixed on that point.  Ultram is an Opioid Agonist (the same drug class as Vicoden), but some literature and testimonies suggest that it less addictive.

"Ultram is prescribed to control moderate to moderately severe pain.  Used as an intermediary step between over-the-counter pain relievers such as Tylenol or ibuprofen and narcotic pain killers.  While technically is a narcotic or opioid pain medication, it is different from typical narcotics in that patients do not build up a tolerance with extended usage and there is a very low incidence of addiction. With other narcotics there is a general tendency to escalate the dosage of the medicine with time and a chance of addiction. The narcotic effect of Ultram is not as strong as the narcotic agents in other common pain medications, such as Vicodin (hydrocodone) and Oxycontin and Percocet (Oxycodone)."  http://www.spine-health.com/topics/conserv/overview/med/med042.html


I have read through the post, http://www.medhelp.org/posts/show/44446, which discusses this specifically.  

Thanks, for the guidance.
Avatar universal
When I'm done researching this, would anyone be interested in the final report?  I'm not a doctor, but I could offer some 8 hours worth of digging into this.  Maybe it would be worth something to someone, even if just providing a start in the walk of considering alternative pain relievers.  If no one is interested, that's okay ... just thought since I was doing this, I'd offer.

Look forward to your comments ... I know from reading through these posts, there are some people who have some really deep knowledge into this subject.  http://www.medhelp.org/forums/addiction/messages/30733.html
271792 tn?1334983257
I would be most interested in a final report, and I thank you for that offer.
I hope you found some help here today. Please post when you can.

Take care and GOD Bless!
256169 tn?1191688915
Thank you for taking the time to answer.   Often folks have that predjudice against people that use pain meds for pain....I just wanted to be that line of defense if the daughter needed.  It sounds like the arent has it covered.....I did not mean to be rough, only to have that avenue considered......Thank you for responding so nicely.....Good luck....

I would however consider a duragesic patch of some kind.  I hear that there are some out there that handle pain nicely with less addictive properties.........Tell boss to ask the doc.
Avatar universal
From reading what is going on with your boss' daughter, I'm shocked that they have not addressed the problem and are treating symptoms for over 1.5 years.  An opening in the skin, the largest organ of the body, especailly an organ of elimination and protection from germs/organisms/etc., is a serious medical condition.  She should go to another doctor, such as a dermatologist, to address the original problem.  After that, it would be possible to address any dependency or addiction issues.  It's interesting that your boss is passing this onto you to research.  hmmmmm...  Best of luck to all involved and I would love to read how it comes out. Warmest wishes for healing.  G.
228686 tn?1211558307
Have you considered acupuncture? It does work. I'd look into it.

Regardless, she does have an addiction to deal with. But who can tell with the physical problems what she should or shouldn't take? You're right, there really aren't alternatives when it comes to pain relief.
Generally you have to choose between being in pain and being an addict.
Avatar universal
There are some innovative postoperative pain control techniques - depending on where on her body the wound is located they range from epidurl pain control to putting the narcotic directly into the operative are thru a small pump.
Wha't is crucial is not to try to cure her addiction or worry about withdrawal's until after the surgery.You simply won't be able to cure the addiction until she's well into her post op phase.  What type of surgery is she having and how long has she been using?
256169 tn?1191688915
Again, DURAGESIC PATCH is at least worth a bit of research.   I know some foks that truly suffer that do like this option.....
Avatar universal
Just thought I would add something to this debate. Here in England all hangun ownership is completely outlawed yet gun crime (especially black on black gun crime has never been higher). I myself held a hangun licence about 10-12 years ago (just for target shooting you weren't allowed to carry them outside) but after the Dunblane massacre in 1996 were a guy killed 16 primary school kids and their teacher (with a LEGALLY held gun) the government banned all hangun possession. I think the government felt they had to do something after the massacre but it meant people like me couldn't shhot for target practice (sport if you like) but as a result, guns havr never been easier to get a hold of and gun crime never higher. Go Figure.
God bless all,
Graeme
Avatar universal
Oops sorry, I meant to post this under the "Thoughts on legitimate oc and recent crackdowns" thread. I'll move it.
Graeme
256169 tn?1191688915
Your points are "well taken"..  I agree that not all folks should have guns but some are responsible enough....At least as responsible as some police officers that I have met..The hard part is weeding through the administrative **** to decide who may own one.  My particular life experience "required" the use of a handgun...I am not so proud of it, but I am not so ashamed either.  I know if a terrorist opened up with an AK in a crowd that I am in, part of the crowd has at least a fighting chance.....
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