Pain Control/Narcotics

When I started coming off of my oxy, I did stretch it out longer and longer because I ALREADY knew that I needed to do this and not come off of it super fast because of my first c-section. I also knew that I missed the feeling of the pain meds more than I should so when I had a 2nd c-section, I had a very different approach. I told every single person responsible for my pain control about my experience the first time around and that I needed their support in different ways.

• I told my doctors not to prescribe more than necessary. I could always ask for more. 
• I told the nurses at the hospital that I didn't just automatically want them to give me my meds every 6 hours like clockwork. I wanted them to ask and see and sometimes come back closer to 7 hours. 
• I told my husband that when I got home, I needed him to help me watch the times and help me stretch out the pills including cutting them in half the last day or 2 to get as many days of pain relief as possible with as little actual pain medication as possible. 
• I asked the pharmacist to hold the 2nd prescription until/if I needed it. The hospital called in a second script which I found out after it was filled but I think was due to the first c-section coming home with zero pain meds and having trouble with a script that took a few hours after I left the hospital with my husband at the pharmacy and me calling my doctor and the hospital to get pain meds prescribed.
  • Hugely important side note here... a provider OR a patient can request that certain scheduled substances be partially filled. This is NOT for all medications.  https://www.ecfr.gov/current/title-21/chapter-II/part-1306/subject-group-ECFR8588b52940237ef/section-1306.13#
  • For example: Your doctor prescribes you 12 Oxycodone post-surgery. You don't think you will need that much. You can ask your pharmacist to fill as much or as little of that script as you want and then fill the rest as needed (within a certain window of time). So you can ask them to fill 4 now and then go back in a day or 2 to fill 4 more or all 8 OR just never fill any more of the script and not need to have any extra in your house that you won't use.

I've never had a drug or alcohol addiction problem but in the last 10 years, EVERY time I have needed to use narcotics, I've always been reminded about how easily I could see someone having a problem and I feel so much sympathy for people who have had addiction problems that have taken over their lives. 

I've also learned that I'm weird about pain and sometimes my pain tolerance is high and other cases it's VERY low. I fractured my elbow and ruptured a ligament doing Brazilian Jiu Jitsu and walked out of the gym laughing and making jokes while tears were streaming down my face. Then I went home and just used ice and ibuprofen and didn't realize it was more serious until it had been going on for weeks and at that point when they did the scans, there was no point in a cast and I didn't truly need a major surgery for the ligament. Now as my body was in labor... WAAAAAAAAY high pain. Bubbles up in my shoulder area from c-section surgery were miserable and worse and less controlled than the actual area of my body that was sliced open and stitched back together. You get the picture.

Fast forward to the lung biopsy. Apparently, the ONLY pain med they usually give you after the lung biopsy is generally IV tylenol. This was not ok. I could not take more than a shallow breath because the pain was so bad. I ended up getting dilaudid (which made me feel like crap at the time but ironically not nearly as bad after the c-sections or after lung surgery) and I was worried about when I got home so they prescribed me 12 low dose hydrocodone. I used 2 that afternoon/evening and the pain dropped off so by the next day I didn't even need tylenol or ibuprofen.

Moving forward to surgery. On surgery day I had been avoiding the Dilaudid because it had made me feel so badly after the biopsy. Obviously I did eventually use it because I couldn't control my pain without it and it didn't actually make me feel like crap. So when I went to leave and the doctor mentioned calling in a pain script, I told him about the extra hydrocodone I had at home and suggested he take that into account and prescribe me less medication because I can lean on that hydrocodone as needed. So when I came home I had 12 Oxy (5mg) and 10 leftover hydrocodone (5)/Acetaminophen(325). The goal was not to need the hydrocodone.

I had a really hard conversation with myself first and I still go back and forth about what meds I NEED right now to stay at a decent pain level and to keep moving. It's a little scary wondering if you still NEED the narcotics or if you just still WANT them. Even if you don't feel a high from them, you get that immediate pain relief (when it is strong enough to kick the pain) and just feel a little better. So as pissed as I was about being in so much pain at the hospital, I get that with everyone's pain being different, it's so incredibly hard for doctors to determine just the right amount of pain medication for their patients. I think open and clear communication and periodic conversations and talking to the patient about how and when to taper and when to ask for more and providing clear expectations about normal and appropriate pain levels is important.

I'm basing what I NEED on what is keeping me moving but it's removing all of my pain. Last night I used a hydrocodone. Today, all I've taken so far as 1000mg of Tylenol and it's 2 in the afternoon. Do I want the hydrocodone? Yes. Do I NEED the hydrocodone? No. My pain could be worse tonight and maybe I will need the hydrocodone to help me sleep in the middle of the night if the Tylenol just doesn't cut it. FYI - no more than 4000mg of Tylenol in a day and the Acetominophen has 325 per pill so I'm minimizing and cutting back on my Tylenol as well because using 2000-3000 tylenol a day for an extended period of time is also not great.

Pain management is very important and so is restricting opiod use BUT, finding the right balance for the patient is the most important.