Herniated Disc Pain Relief
Dealing with the side effects
Painkillers do two things to do: dry you out (dehydrate) and constipate you. The first is relatively easy to deal with (drink more water); the latter is almost impossible to deal with.
Try stool softeners and laxatives, and maintain a very high fiber diet. Unfortunately, in my case, I did these things and still stayed "stopped up" most of the time. You can build up a dependency on stool softeners and laxatives, so don't use them for more than a week or so.
An enema might be necessary if you really need relief after a few days, but you can build up a dependency on them, too, so be careful.
A herniated disc is one of the most grueling pains to deal with, because it's truly unrelenting and sometimes insurmountable no matter what you do, even with the toughest painkillers available. I had an L5-S1 herniation a few years ago, and it took almost 5 months for me to get surgery (a discectomy) approved and scheduled; in the meantime I was up just about every night with pain, and daytime wasn't a whole lot better. This is my advice on how to deal with the pain, with respect to painkillers and other strategies.
Keep in mind that I'm not a doctor, and I'm simply relating my own experience. You should consult with your doctor about what sort of pain relief program to start.
During the course of my herniated disc experience, I tried just about every analgesic available. My general advice is:
- take painkillers before you start to feel intense pain--most narcotics work better at preventing an onslaught of pain than diminishing it once it's on full-strength
- never up your dose as a step - work up very, very gradually according to your needs. Keep in mind the painkillers do not completely eliminate the pain - they just bring it down to a manageable level.
- if you wake up in the middle of the night in pain, try walking around before taking a painkiller. I would grab a book, magazine, iPod or my laptop computer (I'm not joking!) pace back and forth for about 30-45 minutes before taking a painkiller. Then, the pain will have subsided enough to allow the painkiller to work.
- Distract, distract, distract. Try anything - everything - to get your mind off the pain. I guess this depends on your personal philosophy, but with a pain like sciatic pain from a herniated disc, I've found that concentrating on the pain does absolutely nothing except remind you you're feeling miserable! I became a big fan of comedies and engrossing scifi dramas.
Here are a few tips that worked for me:
- walk, walk, walk - even simple pacing usually helps reduce pain; try walking before taking painkillers if the pain is especially intense
- lie on a couch with your legs lifted up onto the armrest. This tends to feel better than lying down completely flat.
- avoid sitting on anything soft. Sit on completely rigid seats (like flat wood).
- stand as much as possible, and gently rock if your legs start to get tired. (Just ignore those that think you look like a crackhead!)
1. OTC painkillers
Advil (ibuprofen) or Aleve (naproxen sodium) do well if the pain is very mild. Note, you can not take these if you're gearing up for a spinal injection or surgery. You can try Tylenol (acetominophen) but I found it not to work too well on its own.
2. Vicodin (hydrocodone + acetominophen)
Vicodin is the next step up from the OTC painkillers. It lasts about 4 hours, and hits its peak of pain relief at the 1.5-2 hour point.
Keep in mind that it is a narcotic, like all those below, so you shouldn't drive a vehicle or make any important decisions while under vicodin.
Vicodin is composed of hydrocodone and acetominophen, and states the proportion of both ("5/325" means 5mg hydrocodone and 325 mg acetominophen). Acetominophen is toxic to the liver, so you should never exceed 4000 mg of it per day (or approximately 12 pills containing 325 mg each), but I would suggest keeping it below that.
Keep close track of how many pills you are taking per day. When you start getting to the 10-pill-per-day point, ask your doctor for something stronger.
Norco is effectively the next level up from Vicodin, with a higher relative dosage of hydrocodone vs acetominophen than Vicodin. For example, while Vicodin might be 10/660 (meaning 10mg hydrocodone and 660mg acetominophen), a comparable Norco dosage might be 10/325, or 10mg hydrocodone and only 325mg acetominophen. The lower acetominophen allows you to take a higher painkilling dosage of hydrocodone.
In terms of the way it makes you feel, it just feels like a stronger version of Vicodin. If Vicodin was working for you, but you have to step up your analgesic level, then Norco is the next obvious step.
4. Percocet (oxycodone)
A similar opioid narcotic to hydrocodone, but considerably stronger, oxycodone is also mixed with acetominophen to make Percocet (OxyContin is the time-release version without the acetominophen; because it doesn't have the acetominophen to prevent overdosing of oxycodone, OxyContin is highly addictive and my doctor said he almost never prescribes it anymore).
The dosages I took of Percocet were 5/325 and 10/325 before surgery. I was taking more than 12 pills of the 10/325 dosage on the day before surgery, so I would say this is the medicine of last resort. There is one more option - morphine - but I personally found it to not work as well. (A morphine IV drip would, probably, but the time-release pill, Kadian, did not)
My treatment history
If you want to read what I went through with respect to treatment (including cortisone injections and a discectomy), please read my hub on herniated disc treatment options.
What didn't work as well for me
These painkillers didn't work too well for me, but YMMV so you might want to ask your doctor about them if you're in a lot of pain. Apparently some of these modalities work wonderfully for people with certain pain patterns.
5. Kadian (time-release morphine)
This did not work well for me - I felt high but in pain - but is a popular painkiller for a badly herniated disc so it's apparently often prescribed.
I personally don't like the feeling of being high at all - I guess I'm a control freak over my brain function! - but I will say the high is not a particularly pleasurable one. Please don't take that as a challenge!
But if it ends up working for you, ask your doctor for a coupon card for this - I didn't even have to pay a copay for it, since I had $50 per month covered by Kadian.
6. Dilaudid (hydromorphone)
This painkiller is supposed to last longer than the typical 4-hour window of vicodin/norco/percocet, but I found it to, like Kadian, not work all that well for the pain. It's supposed to be especially effective for nerve pain, and was supposed to allow me to sleep through the night without waking up. Didn't do that for me.
7. Ultram (tramadol)
Ultram didn't work as well at managing pain, either. Ironically, it's supposed to help with neuralgia (nerve pain). I was given free samples by my doctor.