Hysingla ER / Zohydro ER -- Extended Release Hydrocodone

Good morning all. I need some advice from the brain trust.

I had RNY in January of 2011.  Things are going well. I started at 350, got down to 230, and am currently at 250, where my body REALLY likes to stay. (Well, it would like to be bigger, but it certainly doesn't want to be any smaller.)

I've got a supra-scapular nerve impingement that is making my life hell. Right now, the only reasonable solution is opiates. My doc switches me from hydrocodone to oxycodone and back again in order to keep me from developing and maintaining an increasing tolerance to the medications, and while it has worked o****il recently, I'm starting to develop rebound headaches that are almost as debilitating as the shoulder pain. (This, they say, is a common side-effect of overuse of acetaminophen. Don't worry, though, I'm still way below levels that can damage my liver.)

Anyway, my pain management doc wants to put me on Hysingla. This is an extended release hydrocodone medication. He knows about my bypass, and assures me that this pill "dispenses" in part of the intestine that will be unaffected by my bypass.  I'm still dubious. If I try it, I'm stuck on it for a month. I'm afraid I'll take one, it will pass through too quickly, and I'll be in constant misery.

So, does anyone here have experience with Hysingla ER, or even Zohydro ER (another similar medication) or any other ER medications 5 years out from an RNY? Is it even worth trying, or should I refuse and just deal with my current level of pain or go up in dosage on my short acting opiates? (I mean, that's a decision my PM doc would make, not me, but that seems the only reasonable alternative, right now, to the ER medications.)

Hoping for some first hand knowledge, or even second hand knowledge. I know my WLS doc said "no extended release medications ever," but my PM doc says, "Yes I know you had RNY, but this will work fine."

Thanks,

Rev.

I don't know. I don't think anyone knows for sure. The only way to know is for you to try. 

The question is - how is you gut movement? Is it slow or fast? 

ER meds can be affected my food you take...too much fiber can block absorbtion... 

How about patches? The pain medication patch can deliver the meds outside of the gut... It works for some but not others. With patch - people still can take some oral pain meds for break through pain. 

I wondered about patches too, but I think that the smallest dose of any opiate that comes in a patch is higher than I currently need, so I don't want to bump up my dosage until and unless I have to. It's a good thought though; probably the best given the bypass, and it's one I'm trying to hold onto for later if I need it.

I did wonder if this is a standard thing, or if it varies from people to people.  I know, for instance, my surgeon told me he was able to do more of a bypass on me than he was on the average person. I also know that the DS folks get a much longer bypass (more is bypassed, I mean). I'm sure that has something to do with it to.

I may just give the ER med a try. I'm just about as concerned about the long term acetaminophen use (even though I'm under 2 grams a day) as I am the other stuff -- and the ER meds don't have acetaminophen.  Anything an opiate does to your body (ie., forcing the creation of more pain receptors, resulting in higher tolerances, constipation, etc.) is completely reversible; liver damage isn't.  For a lot of my pain, an ibuprofen would probably work a little better than the opiates do. But, again, opiate use side effects go away after you stop using them; stomach ulcers are the gift that keeps on giving.

I hadn't thought about fiber. I do try to eat high fiber foods. I may have to play around with my diet and meal timing if we go this route.

My gut movement seems pretty normal. I'm very regular, and since I'm 5 years out, it's a little hard to remember what it was like pre-surgery, but I'd say it's probably more or less the same now as it was then. The funny thing is that there are times I'll take a pain med pill and it will work in 20 minutes; sometimes it takes 45 minutes; and sometimes it never works at all. I figure that HAS to be my bypass at work, somehow. I don't know if the ER version would make the release more consistent or less.

Thanks for your reply; I appreciate it.

I deal with back pain - sciatica.  I had a surgery last year that show that I it was not the disc, but that I have none spurs. So really there is no much they can do.  

I do take pain pills as needed.   Lately I asked my doc to prescibe me stonger painkiller - hydrocodone with Tylenol. I cut the pill in 1/4 and take that. That really helps limit the tylenol. Plus I found out that taking smaller dosage more often works better for my pain then larger dosage ... I take the pils on empthy pouch, and typically I can feel it working withing 15-20 min,.. But the effects don't last long.  As if my body is processing that faster than normal.  

I tried Tylenol 2 or 3, but I think the codeine in it is slowing my HBR.  

What really helped me years ago for shoulder pain was accupuncture.  I either had rotator cuff damage or nerve impingement - and normal therapies: injections, physical therapy, heat, and ice, massage..etc did very little to take the pain away...the doc suggested surgery... 

Someone suggested accupuncture. I was very sceptical about that...but after one visit I booked another and another... In 6 months my shoulder was almost fixed... In a year the shoulder was healed...no residue pain, no mobility issues, full range of motion. That was 12 years ago. I still go for acupuncture app once every few weeks... Not for the shoulder - but for my back. More often when my scatica flares... Typically I get pain relief for 1-2 weeks after the procedure. 

But... Not every acupuncturist is the same. I found someone well trained in that - she uses needles, current, and heat.. To stimulate healing and reduce inflamation.  

When I tore my ankle (no bones broken) I did not even bother to seek medical help but went to her... Her treatments plus some exercise, ice and heat, and some wraping to stabilize the leg - and in 6 months things were back to 100% normal.  And I know I did a lot of damage to the ligament in the foot.. It was black and blue and swollen to more than double.   

Sometimes - we need to try other things... 

Thank you very much for your reply. It's interesting to see such similarities with my own experience. I appreciate your sharing.

There is a surgical procedure for that, no one should take pain meds for a long length of time, only a week or two, pain meds can really mess with your mental state, and Body, they are toxic and ruin lives. .  They are no cure.  If I had a doctor doing that to me, I would be finding a surgeon immediately. 

Thanks for your reply. I've had a surgery for it already, in addition to two other shoulder surgeries. The next surgical step is exploratory surgery since neither MRIs nor CT scans are showing where, exactly, the impingement is occurring. However, they're waiting to see if it will get any better on its own before cutting into me a third time. And I think that's a valid course of action since it could be scar tissue that's causing the problem right now.

I've got an orthopedic surgeon and a pain management surgeon managing my case, and I trust their judgment in my treatment and pain management plan as far as the actual injury itself goes. I do have concerns about taking ER medicine after bypass, which is why I posted here asking if anyone has actual experience with taking Hysingla ER or Zohydro ER.