Tell me which painkillers to take... any docs out there?

[Ben10WasTheSpawnNowWeLoveLego]

History

Major surgery 6 weeks ago to remove 1st rib behind collar bone and to remove anteriour scalene muscle in rib. Surgery to relieve pain from neck all the way along to my hand caused by artery and nerves being compressed for 1 year previously (Thoracic Outlet Syndrome). I then had to have further major surgery to deal with haemothorax (1st surgeon punctured the lining of the lung and massive amount of blood collected in the lung).

It will be a long recovery due to the number of nerves and muscles involved and the length of time of the compression. Apparently the lung will be stuck to the chest wall for at least a year (which will cause pain) and the chest drains will have caused damage to the nerves in the

I have gabapentin for the nerve pain (900mg), paracetemol 1g 4 x day if needed, dihydrocodeine 30mg 3 x day if needed, naproxen (NSAID) 250mg 3 per day if needed. I even have Oxycontin 10mg on hand if needed.

I really need to know which order to take the tablets apart from the gabapentin when I have pain. I want to minimise any damage the tablets might cause me. I'm thinking paracetemol, then naproxen, then DHC? I am not regularly taking any of them at the moment as pain has reduced but starting proper physio next week so my pain will def increase.

I'd be wary of taking both DHC and Oxycontin at the same time as they are both opioids i.e. based on opium. Gabapentum I've not heard of, sorry. Naproxen is basically Feminax Ultra. If the pain is severe I would go with a combination of DHC (or Oxycontin), Paracetamol and Naproxen. A Pharmacist told me that Co-Codamol and Ibuprofen was safe to take, and the fact that I'm still here 20 years later proves that, so what I've just typed would seem to be safe yet effective. Now watch someone who knows what they're talking about shoot me down.

To add, the Codeine may "back you up" a bit.

Not a doc but a senior nurse, will I do?!! I would consider taking both the naproxen and paracetamol regularly as they work differently (and differently to gabapentin) and can complement each other. The anti-inflammatory properties of the naproxen will be helpful once physio starts! Taking regular paracetamol can make the other analgesics more effective too. They are also likely to cause you less side effects, although you need to be careful with stomach irritation/reflux type symptoms with naproxen.

Then you can add the dihydrocodeine in if needed and as a 'last resort' the oxycodone. I assume you have oxycodone/oxynorm not oxycontin as oxycontin is a long acting formula that needs to be taken 12 hourly regularly. It's no good as an 'as required'.

Thank you both - senior nurses very welcome. I have been trying to wean myself off medication in some misguided effort as I have never really taken any before all of this. Right so back on the paracetamol and naproxen with the dhc as back up. It is actually oxycontin that I was prescribed on discharge having had oxycondone in hospital as I can't tolerate morphine. I just want to sleep past 4 am. Everything wears off every night at 4 - grr

I know all about the backing up situation! The iron supplement for anaemia post surgery certainly isn't helping my cause. Good old lactulose to the rescue

Ah well, with regards to waking at 4am, if the naproxen/paracetamol/gabapentin doesn't work within a few days and the pain is worse at night than during the day you could think about taking the oxycontin at 9pm ish as it's slow release so might last you through the night. In an ideal world you'd also take it at 9am so you have a pretty constant level of pain relief throughout the day also. You might then be able to stop the paracetamol!
It's a case of trial an error to see what works best for you, but give each combination a few days and make sure you take them regularly rather than just when you have pain.

THank you Madamy. I will start taking things more regularly and see how I get on. I fall asleep so early at the moment so probably part of the problem is that I have to take the tablets too early at night to get all the way through. Maybe I'll have to get DH to wake me to take them!

I just don't want to get addicted to any of the narcotic type tablets - not that I have an addictive personality. The oxycontin completely floored me tbh so I'd like to stay away if possible as the pain is nowhere near as bad as it was when I was taking them (post thoracic surgery).

Just wanted to say thank you.

A Gabapentin/Naproxen cocktail three times a day is doing just the treat and I set my alarm to make sure that I take them at 10pm. I am so much more comfortable.
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