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Post Info TOPIC: Fact sheet: Hep C and Painkillers


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RE: Fact sheet: Hep C and Painkillers
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Couple things her.....gator be prepared for a huge adjustment changing mattresses we went thru this and my advice to anyone that has back r hip pain to go ultra firm...plus feels good in the store but they literally swallow your body and when you want to change positions it's like a workout and it wakes you up...we traded at the 30 day mark for a firmer one and even that is not firm enough...so think about hanging on to the old one for a week or two as you may not realize how good the old sealy really still is.

 

Next I have had Facet injections but it was 20 yrs ago...I will tell you this it's not the most comfortable procedure to go thru but after and I mean right after when they have you wait in the waiting room for an hour before you can leave(at least that's what I had to do) you will feel amazing like sitting on a cloud...it's great that is because they finish each steroid injection with a long lasting lidocaine......that doesn't last long enough and you will feel like it didn't help but you will notice after a few weeks it's getting better and it continues to improve for months to come...this is the time to try and do spinal muscle strengthening exercises like press ups and leg raises ( see a PT for proper techniques) at least this was my experience.

 

Duane



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53yr M 1a acq 12/83 cirr pre tx MELD 17  tx nv diag 1/29/12  tx S/O 3/5/14  trans list.

EOT 5/28/14 UND 6/12/14 SVR 8/29/14 MELD 14 dx HCC 9/5/2014 tumor ablation 9/24/14

In the 10K lakes State It's not about us but those around us.



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I have occasional hip and lower back pain that I probably aggravate by working out or running. I have a script for Vicodin 5/325 mg. which I rarely take and only when back spasms make it difficult to walk. The low dose of acetaminophen in the Vicodin doesn't do much, but the synthetic codeine takes the edge off the pain. The consensus between my hepatologist and pcp is that low dose acetaminophen at 1500 mg./day or less is o.k. with compensated cirrhosis

On an entirely different avenue to deal with back pain, we are getting a new mattress with adjustable bases delivered today after 12 years with the old one. My wife was also complaining of back pain and realized our old Sealy had sagged (butt divots) in several places and it was time for a change. We tried out everything, memory foam, inflatables, etc., and agreed on an all latex foam mattress made locally. Maybe it will help with the insomnia issues as well.

I don't have the same degree of chronic pain problems that many of you have and have been looking at drug free alternatives for pain management when possible. There are stretching and yoga classes that I have been considering which I would have laughed at the idea a few years ago.

 



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Geno 1b, compensated cirrhotic, 54 yo, prior null responder. Pre tx VL approx 595,000, tx with Sovaldi/Olysio (no Riba) started 1/8/14. VL 40 @ 2 weeks, UND @ 4 weeks. Still UND @ EOT + 1 year.

Gator Man SVR12, Dragon 0, Final Score.



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This is a really good thread as many of us have different pain issues.  I have neuropathy and ongoing pain in my legs, really reduces the amount of sleep I get. Arthritic symptoms have noticeably worsened after eot.  In hands, knees, hips etc. I am reluctant to take naproxen every day which does seem to help a bit.  I'm prescribed gabapentin 3x daily but it doesn't seem to have much affect.  First question would be, which pain med has least impact upon the liver?  Docs here have become reluctant to write oxycodone,  in fact this has to come from a pain mgmt. doc.  What are others doing for pain mgmt.?

 



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1b  Int/Riba relapse @ 48 weeks.  Stop tx Peg Int/Riba 12 weeks ill. Relapse S/O 6/23/14 :(   Started Harvoni 11/12/14  EOT 4/28/15.  EOT+4 UND :)  SVR! 8/4/15  :)     Thankful for every morning.



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 My monthly appointment with my pain management specialist doctor was this morning. She wants me to try the nerve block approach and I suppose I'm going to have to try it. She prescribes me oxycodone 5mg now but I don't take them like I should. I returned 31 this morning which makes 93 returned in the past 4 months. She said it does no good toward me achieving quality of life if I won't take them. So I told her to don't prescribe any more oxycodone but rather Ibuprofen for the next one month, so she did. (200mg PRN) because I can't just ignore my hepatologist so I'll try his way for a month to see. If it does not work then I'll agree to her suggestion of starting with Lumbar Facet Joint Injections. She gave me a paper with a general description of that procedure HERE as well as an online address to a video description of it.  All that can be done via imaging has been done and I have multiple issues, including physical spinal damage from a motorcycle wreck, that can possibly be the source of my worst pain in my lower back. If we can reduce that particular pain then I can function with the rest okay. Once the location is pinpointed via LFJ injections etc, then further actions will be needed for long term. She gave me literature and information links to educate myself on further options then we will discuss those in a couple of weeks.

My urine screen this morning showed no trace of oxycodone and she said she gets frustrated with my non-compliance, but that she does understand that the reason I am hesitant to take these pills is that I take so many other pills that I am obsessed with trying to trim which ones I can when possible. The toxic HIV meds are the worst on my liver but I have no choice whether to take them or not. The same basically applies to everything I take now other than vitamin and emphysema meds. I've already trimmed a bunch of meds completely off (with Dr's approval). My current meds are:


  (1) - Xifaxan (rifaximin) 550mg tab - 2x daily [HCV-hepatic encephalopathy]
  (2) - Lactulose Solution USP 45ml - 4x daily + PRN [HCV-hepatic encephalopathy]
  (3) - Lasix (furosemide) 40mg - once daily [HCV-cirrhotic ascites]
  (4) - Aldactone (spironolactone) 50mg - once daily [HCV-cirrhotic ascites]
  (5) - Prezista (darunavir) - 800mg - once daily [HIV]
  (6) - Intelence (etravirine)100mg tab - 2 tabs/2x daily [HIV]
  (7) - Viread (tenofovir) 300mg tab - once daily [HIV]
  (8) - Sovaldi (Sofosbuvir) 400mg tab - once daily [HCV]
  (9) - Ribasphere (Ribavirin) 600mg AM/400mg PM [HCV]
  (10) - Oxycodone 5mg tab - PRN [pain]
  (11) - Baclofen 10mg tab - 3x daily [muscle spasms and cramps]
  (12) - Valtrex (valacyclovir) 500mg - once daily [HSV-2]
  (13) - Ventolin HFA (albuterol sulfate) - PRN [COPD]
  (14) - Centrum Silver mens 50+ - once daily [vitamin]

Anyway, I drove over 200 miles today, had a horrible day, am dead tired and my back hurts pretty bad so I've got to get some rest, and yes, I intend to take my pain med tonight for sure . I'll get started on finding out the specifics of all this tomorrow and I'll post whatever pertinent  info I find out at that time.

Thanks for the replies and help guys! smile



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60 yo, geno 1a, Dx 1994 HCV-HIV co-inf, Dx 2013 decompensated cirrhosis
Tx #1 - 24wks Sov+Riba /SOT 7-24-2014/UND@EOT/DETECTED@EOT+16 wks
Tx #2 - 24wks Harvoni /SOT 7-25-2015/UND@EOT,+12,+24,+52 = SVR

Mike

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I know I've posted about this before but I also take pain meds daily for comfort and quality of life, I am prescribed oxycodone IR 5 mg and at this point I'm usually taking 2 in the morning and two in the evening it has not had any impact on renal or liver function and is by far the easiest on the liver because it is short acting meaning it doesn't stack like an extended release meds and contains neither ibuprofen or acetaminophen,  I'm long past the phase where it has much of the buzzy feeling and it seems to have a longer term analgesic effect when used regularly, all my doctors are completely fine with this approach and they have even said if you need to take it more often do so.I do not think I would be able to continue to work full time even in an office job without this regimen. 

If your doctors won't prescribe it ask to do a controlled substance contract with them, this is as much a quality of life issue as it is a pain issue and it truly has made a huge difference in my tx of ESLD 

If you cant get what you need from your current doc get a referral to a palliative care dr. They specialize in these things.

 



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53yr M 1a acq 12/83 cirr pre tx MELD 17  tx nv diag 1/29/12  tx S/O 3/5/14  trans list.

EOT 5/28/14 UND 6/12/14 SVR 8/29/14 MELD 14 dx HCC 9/5/2014 tumor ablation 9/24/14

In the 10K lakes State It's not about us but those around us.

Tig


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Hi Mike,

I'm dealing with all the things you mentioned, arthritis, spondylosis, neuropathic pain, and ongoing cervical/lumbar disc disease and the associated failures that accompany it. I've got more instrumentation in my cervical spine than you find on most jumbo jets! I have been a pain management patient for 12 years, and have taken it all. I briefly discussed placing an implanted nerve device in my cervical spine but there's always an issue with space or effectiveness that prevents the actual procedure. Have they discussed that with you? It's a drug free option if it works. I worried about the impact all these drugs would have on my liver but there comes a time that you go the path of least resistance. Sometimes that path is a trade-off. You may never find a choice that is right for every problem you're dealing with, but the one that is best for YOU the person. One that is both effective and least harsh on you physically. There comes a time when "perfect" isn't an option. 

I don't think there are too many anti inflammatory drugs out there, that aren't hard, on either your kidneys or liver. I'm taking Naproxen 375mg twice a day right now along with two opioids and I'm far from the place I'd like to be, but am satisfied that I'm balancing what's good for me and bad for my body. It's not perfect but it works and allows me to keep walking and talking without a grimace on my face... Most of the time!

Tig



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Tig

66 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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My hepatologist wants me to start taking Ibuprofen for pain relief from osteoarthritis, severe spondylosis and peripheral neuropathy. I've been doing so and enough of it (usually 600-800mg per day) makes my pain manageable and I'm okay with it. But yesterday I checked for interactions online and found a major warning with it when combined with one of my HIV Rx's Viread (tenofovir) which can cause renal cell carcinoma kidney cancer. I'm already at risk for these type cancers due to long term HIV infection. Also my last MRI 7-7-14 showed a suspicious lesion in my liver which will likely prove to be early stage hepatic carcinoma when my next MRI is done 10-1-14.

 So do I really want to take this Ibuprofen? I've spent the past year getting my pain management Dr to get me away from pain relievers that are harmful to my liver. Now it's my kidneys I'm worried about. My pain management Dr keeps suggesting nerve block surgery, but I have pain from multiple issues and I just am scared of that and see it as being a potential disaster that I'm not ready to deal with right now.

Now the article linked here tells me the safest option for hepatitis C infected patients is Paracetamol. That's acetaminophen, what I just spent a year trying to get away from via hydracodone / acetaminophen, reduced to hydrocodone / low dose acetaminophen (norco), reduced to oxycodone (no acetaminophen), reduced to ibuprofen.

With decompensated cirrhosis I'll need a liver transplant, which surviving will be a long shot if even being approved considering my slim chances for long term survival due to poor health from 20+ years of poorly managed HIV infection / Tx's. Then add hepatic carcinoma which will possibly be in the mix after October 1st, then add the possibility of kidneys that have been trashed by renal cell carcinoma, meaning a double transplant = I don't stand a chance.

 I don't want to disagree with my hepatologist but I do intend to explore any option that is possibly a better choice than ibuprofen in my case.

 So what's my best option? Going back to acetaminophen and just finish trashing my current liver. It's got to come out anyway and it seems like a wiser decision to trash it rather than increase the abuse on my poor, already abused kidneys.

 

 



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60 yo, geno 1a, Dx 1994 HCV-HIV co-inf, Dx 2013 decompensated cirrhosis
Tx #1 - 24wks Sov+Riba /SOT 7-24-2014/UND@EOT/DETECTED@EOT+16 wks
Tx #2 - 24wks Harvoni /SOT 7-25-2015/UND@EOT,+12,+24,+52 = SVR

Mike

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Thanks cinnamon girl for the link!

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Geno 1A, since 1981. SOT 1/2013   TX stopped 11/2013 in week 45/48 due to Myositis & Interstitial Lung Disease. Completed 94% of Peg-Inter dbl TX, UND since week 4.  SVR 4/2014!  Still SVR after 4+ yrs!

"Day by day, step by step, breath by breath"



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Thanks Jill, I've been wondering if it's O.K. for me to occasionally take ibuprofen, as Tylenol(Paracetamol) has little noticeable effect.    I have a scheduled appointment with my gastro NP in September; of course I'll wait for 'official' approval before risking use of ibuprofen.

 



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Be strong when you are weak, brave when you are scared, and humble when you are victorious.
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A useful fact sheet for anyone with Hep C who is wondering which painkiller is best to use.  It`s always advisable to speak to your doctor or medical provider if painkillers are needed on a regular basis.

http://www.hep.org.au/documents/factsheets/PainkillersLiver2010.pdf

 

 



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 

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