Let’s Talk About Pain Medication
I get asked a lot of questions about pain meds:
“What medications were you prescribed after surgery?”
“How long did you take pain meds post-op?”
“Is it okay that I’m still taking pain medication at __ weeks?”
First, let me emphasize that I’m NOT a doctor, a medical professional, or any type of expert on this subject. Decisions about medications are very complex and unique to the individual, and they should be made with your doctor. But with that said, I’m happy to share my own experience, as well as a bit of what I’ve picked up from talking to other spinal fusion patients over the years. My intention is not to serve as a reference point or for comparison – it is simply to share the perspective of someone who has been through it.
I want to start with my pre-surgery pain management, because I think the medications we take before surgery can impact our physicians’ decisions about our post-op meds. For instance, if you are on high doses of opioids before your surgery, you may have developed some tolerance, which means that you may require higher doses or stronger narcotics to properly manage your post-op pain. (This is conjecture, not fact.)
In the months leading up to my surgery, I primarily used ibuprofen for pain relief. I took 800 mg 2-3 times a day to manage both pain and inflammation. It worked pretty well, but it wreaked havoc on my stomach (an issue which I’m still dealing with today).
My doctor prescribed hydrocodone, but I only took it once or twice. It made me feel sleepy and sort of woozy, but it didn’t do much to relieve the pain in my hip and back.
Immediately After Surgery
During my 2-day hospital stay, I was given Tylenol and morphine for pain control. I didn’t have a morphine pump in the hospital, but I know other people who did. I was discharged from the hospital with two prescriptions: Robaxin (methocarbamol) and Percocet (oxycodone + acetaminophen). Robaxin is a muscle relaxant and is not a narcotic. Percocet is combination of an opioid (a narcotic) and acetaminophen (Tylenol).
I was prescribed one Percocet every 4 hours. Unfortunately, it seemed to wear off quickly, which left me in significant pain for an hour or two while I waited for my next dose. I tried to stick it out, but after my first few days at home I called my doctor in tears and asked for his help. He said that I couldn’t increase the frequency of my Percocet because it would exceed the maximum daily dosage of acetaminophen. (The FDA warns that exceeding this limit can put patients at risk of severe liver damage and/or allergic reaction.) Instead, he gave me a new prescription for oxycodone with no acetaminophen, which gave me a little more flexibility with my dosing schedule.
People kept telling me to “stay ahead of the pain,” a phrase I’d never heard before. Essentially, this means to take your medication on a schedule (as prescribed). In other words, don’t wait until you feel pain to take it, because the medication doesn’t work instantly, and you’ll first have to wait for it to take effect, which means more pain for you while you wait.
I took this advice to heart, and for the first 2-3 weeks of my recovery, I stuck to a medication schedule. I kept a little notebook next to my bed, where I wrote down each dose. I even set my alarm so that I could take my meds in the middle of the night.
I believe I began weaning myself off of the opioids after about two weeks. At first I started spacing out my doses, supplementing with Tylenol as needed. Next, I stopped taking pain meds in the morning and early afternoon but still used them in the evening and at bedtime (although no longer on a schedule). Eventually I was only taking oxycodone before bed, and this continued until maybe about 6-8 weeks post-op. I continued taking Robaxin regularly during this time and in the following months.
I didn’t have a hard time stopping my pain meds, primarily because I didn’t find them especially helpful in managing my pain. They made me feel sleepy and sort of numb everywhere, but they didn’t do much to relieve the residual surgical and nerve pain. Personally, I found Robaxin to be much more helpful in managing my pain and discomfort.
I believe I’d quit taking oxycodone altogether by the time my kids went back to school in mid-August, so about 2½ months after my surgery. By that point my pain was pretty manageable with just Robaxin and Tylenol, with the exception of an occasional rough day, in which case I’d take pain medication before bed.
The First Year and Beyond
After the initial recovery period, I managed my pain almost exclusively with Robaxin, Tylenol, and/or NSAIDs. On the rare occasion that I needed something stronger, I took one of the pills that I had left over from surgery. I still had some pain, but it was relatively mild. After those first few weeks, I focused less on managing my pain and more on getting back to normal; that meant coping with things like stiffness, swelling, and mobility issues – things that opioids didn’t really address.
At 3 years post-op, I do still occasionally take Robaxin and/or Tylenol for back pain. I had to stop taking NSAIDs because of stomach issues, which is unfortunate because they worked best.
Final Thoughts About Managing Your Post-Op Pain
Stay ahead of the pain. When you get home from the hospital, take your pain medication as prescribed by your doctor, and stick to a schedule. Write it down, use an app, or set an alarm. Don’t try to keep track of it in your head because, well, you’re on pain medication. Your brain may not be at its sharpest at that moment.
Don’t suffer needlessly. Let’s be honest – you’ll probably be in a decent amount of pain after your surgery, and you may still feel pain even after taking your medication. Some pain is expected. But in my opinion, unnecessary pain doesn’t serve any purpose. It may be harmful to your body, and it’s certainly harmful to your spirit. Now is not the time to be “brave” or “tough.” If your doctor prescribes something to help with pain, and if your medical history allows it, take the medication.
It’s okay if your pain meds make you want to sleep all day. I mean, where exactly do you have to be anyway? Your job after your spinal fusion is to heal, and your body needs sleep in order to do this properly. Bonus: on top of making you drowsy, pain medication may also help you position yourself comfortably enough to get a few hours of sleep.
Don’t be afraid to call your doctor. If something doesn’t feel right, call your surgeon. Sometimes a minor tweak to a medication regimen can make a big difference. Also, follow your doctor’s instructions about weaning yourself off pain medication. If you feel like you can’t do it on your own, there’s absolutely nothing wrong with asking your doctor for help!
Use non-drug methods to manage your pain. While opioids will help relieve some of your pain, they’re not a viable long-term solution. Non-drug methods will be important when it comes time to wean off pain meds, and even more so once you begin transitioning back to your normal routine. For me, these methods included TENS therapy and ice/heat. For other people, they might be meditation, massage, essential oils, etc. As long as it’s okay with your doctor, do what works for you.