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Very scared about pain management/tolerance Very scared about pain management/tolerance

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Unread 04-22-2010, 06:24 PM
Very scared about pain management/tolerance

I'm scheduled to have a vaginal lap-assisted hysterectomy on the 26th and I'm really struggling. I'm doing most of it on my own which maybe isn't helping things (live alone, no SO, no real family support) but I'm very scared and about to cancel.

I really think it's the right thing, I'm 28 and have severe endometriosis and anemia from all the bleeding...I have had to take two disability leaves from work because I was an insurance risk from all the blood loss and low blood pressure.

However, I've also had major pain problems and because the anemia is so bad (hemoglobin only 7.7 WITH weekly iron injections) they had to switch me to narcotics to manage the pain because if I take even two advil it makes everything so much worse. Of course, the problem with this is that I've developed a tolerance. I've always had a bit of a tolerance for narcotics and the doctors have never known why...I remember being given my first percocet with a procedure for endo when I was 17...I was given two with one ativan and was still fully conscious and alert and that freaked the doctors out as I had never taken meds like that before.

Now I'm at the point where I could take three percocets and barely feel a controls the pain but only just barely and they don't knock me out or give me side effects. I've been using them for about a year on and off...trying to make sure it's on and off so I don't get hooked as well. Unfortunately for the last two months or so I've needed them almost daily and now I'm very worried I will suffer tremendously after my surgery.

I'm only 120lbs and so generally doctors seem to assume meds will knock me right out and don't dose me high enough. I have talked to the surgeon and the pre-admit team so I'm hoping it will be ok, informed I will likely have a PCA when I wake up from the surgery and that *should* take care of the pain but I just can't stop worrying. I haven't been able to sleep or eat for almost two days now because I'm so worried about it.

I have a friend who is a nurse and she said I should speak up if I'm in a lot of pain and push for an extra day in hospital if I don't think oral meds will be able to cut it so that I don't end up being sent home in agony. The only other thing I can compare it to was my last laproscopy (sp?) at which point they sent me home with 10mg oxycontin and percocet for breakthrough pain. That was a year ago and mostly did the trick though the first 24 hours were pretty bad.

Are they pretty good at controlling this pain? I just worry if a lap caused that much pain I'm going to be screaming in agony and if that's the case, I'd almost rather continue to battle the anemia. I realize that probably makes me a huge wuss...but I just don't know what else to do at this point...
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Unread 04-22-2010, 06:33 PM
Re: Very scared about pain management/tolerance

I second the speak up. And keep speaking up until you are satisfied. (also a nurse.)

Don't cancel. You need this. Good luck.
Unread 04-22-2010, 06:40 PM
Re: Very scared about pain management/tolerance

Originally Posted by WKShadow View Post
I second the speak up. And keep speaking up until you are satisfied. (also a nurse.)

Don't cancel. You need this. Good luck.
Thank you, I need people telling me not to cancel because no one in my life is going to do it...and it would be so easy to just back down. I've gotten mildly sick and I swear, it's like I don't even care about taking care of myself because if I'm sick they will cancel...I'm just too scared and nothing seems to be helping.

I will keep speaking up, but is it possible that they won't be able to control the pain? I watched my Mom die from pancreatic cancel and while she was lucky, others on the floor you could tell weren't having their pain controlled. I realize that's a completely different thing but I think it's where my fear comes from. There doesn't seem to be a reason to make someone suffer anymore...but I worry they won't dose me high enough because they will think I'm a drug addict or something
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Unread 04-22-2010, 06:47 PM
Re: Very scared about pain management/tolerance

If it helps, my TVH had pretty minimal pain and I was off narcs after 24 hrs; the daVinci lap I had for BSO was more painful, so at least for me, the vag part was the easy part. So maybe you'll find its "no worse" (not to diminish your pain) than what you've had in the past. On the PCA---if you speak up they can increase your dose and frequency of meds, so don't be shy about asking them to. Also ask the Dr to lift the limit, so you aren't topped off. And do tell them what worked in the past. And tell the anesthesiologist about your tolerance. I was in minimal pain and I'm not brave so I hope you will have that experience too. Good luck with your surgery.
Unread 04-22-2010, 07:33 PM
Re: Very scared about pain management/tolerance

I don't know much about pain meds but I can tell you that I had a LAVH and did not think it was that bad. The nurses even commented that I only hit the pain med button 2 times after the surgery. I don't think I even hit it, probably a family member "trying" to help. The worst part was getting out of bed otherwise not bad. Of course we are all different. Maybe the pain you have now will be worse than the surgery. As far as the really need to speak to your doc in detail about all of this and make sure that he has written orders in place to accomodate you. Don't give up! It sounds like you need some desperate relief. Have faith in yourself. We are here for you. Best wishes!
Unread 04-23-2010, 06:40 AM
Re: Very scared about pain management/tolerance

I'm worried about pain management too. My surgery is going to be abdominal though. The last time I had surgery (abdominal to remove one ovary), the pain was so bad that I literally screamed as soon as I woke up in the operating room. They immediately gave me morpheine through an IV pump that sort of helped, but it did not do much for me pain-wise. I went through a whole bag of it that evening, and they had to give me a new one. I must have pushed that button over a million times!! Days later, I was on Tylenol 3's and Naproxen, which helped a little, but my tolerance for pain is really low.

Have you asked your doctor about getting a spinal epidural? The same doctor who performed my last surgery is also doing my hysterectomy. She knows how much pain I was in last time, and booked me for spinal anesthesia, with the general. From what I've been reading on this site, a spinal gives you longer lasting pain relief. I hope this is true.

Hang in there and let us know how it goes. Sending you best wishes for your upcoming surgery.

Unread 04-23-2010, 08:23 AM
Re: Very scared about pain management/tolerance

I had LAVH and came home 6 hours later. I didn't need the pain meds and hopefully that will be true for you.
Unread 04-23-2010, 04:20 PM
Re: Very scared about pain management/tolerance


I also have the issue of taking pain medication and having somewhat of a tolerance to them. So I can understand your apprehension.

Here's something to consider, though: you don't really know how you're going to feel when you wake up or while you're in the hospital. So instead of focusing on this (which you can't control anyway ) try futurizing the situation. In other words, instead of fretting about how much it may hurt (when it may not hurt that much), say to yourself, "Just think, in a week I'll be home from the hospital!" I know it sounds corny, but it worked for me.

As for being able to control pain, I must say that I was in a good deal of pain when I first woke up from my surgery. I used the PCA device, but didn't really like it, as I'd push the button, then doze off, then wake up with everything worn off. Not good for me. However, I had a hip-top hip abdominal incision. In your case, a lap-assisted vaginal hysterectomy, there will be no incision, and in general, most do not have quite as much discomfort. Now, this doesn't mean you won't have pain -- but you can hope that yours will be somewhat less at least.

I did much better when they transitioned me to oral medication, and they staged (or staggered) the doses so nothing was ever "worn off" in my system. Something every 2-1/2 to 3 hours.... one dose would be ibuprofen, the next dose would be hydrocodone. That was much better pain control for me at least. I continued that regimen for several weeks after I got home, as I required pain meds for some time during my recovery.

You might also ask if they could use Toradol in the hospital. This is a non-narcotic, anti-inflammatory medication, and when I've had it, it was put in my IV. It was wonderful addition to the pain control arsenol!

One final note: I've long forgotten the pain I was in when I woke from surgery, except I remember it happening. In the long run, the surgery was the best treatment for what was happening at the time. The nurses did a great job getting that pain under control for me.

Many for a successful surgery and speedy recovery.

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