ultracet and sleeping

[PeCeDe]

had a lower back injury a couple of weeks ago, after xrays it shows a newly formed wedge to one of the lower vertebrae, Doctor prescribed Ultracet amongst other drugs. this is an extremely painful condition and I cannot walk without the ultracet. As I've already read this is an unpredictable drug. during the day I appear to be able to function almost normally for about 7 hours on just 1 tab but at bedtime i take one and it lasts only a couple hours before waking me with pain. Is this normal and should I look at the e r version for nighttime relief? The Doctor says this could last upwards of 3 months. It also appears 2, 37.5 ultracet have no better or longer relief. Oh for good old Tylenol 3, oh well.

[Sheryl]

Tylenol with codeine is in fact available here but might not do any better for you, and many Thai doctors are reluctant to prescribe it.

 

It is not unusual for pain control to be more difficult at night - for one thing, during the day your mind has distractions, and for another, in the case of back pain it is quite likely that something about the position you are lying in -  or just the lack of movement -- aggravates the problem. You may want to experiment with use of a back board or different sleep positions.

 

Immediate release tramadol peaks in about 2 hours so it may be worth trying an extended release formulation.

 

As there is likely to be considerable inflammation contributing to your pain it might also be worth trying the addition of an NSAID (Naproxen, diclofenac, ibuprofen etc) provided you have no contraindications to it.  People tend to assume that narcotics/synthetic narcotics are always better pain relievers than NSAIDs but this is actually not the case if the pain is inflammatory in nature, since the NSAIDs will actually reduce the inflammation.  Tramadol and NSAIDs can be taken together, just be mindful of the need to take NSAIDs on a full stomach.

 

Studies have shown tramadol + NSAID to be more effective than tramadol + paracetmol

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140236/

 

 

[PeCeDe]

Thanks Sheryl, I've tried a few different sleeping positions, fetal seems to be best for me, have problems with the stronger NSAIDS like Naproxen due to stomach upset, the Doctor prescribed Myonal and Lyrica which seems to be ok. I can tolerate the lower doses of Aspirin e.g. 81mg. I will try the extended release Ultracet.

[PeCeDe]

Does anyone know where I can purchase Ultram ER or equivalent, I'm in Bangna and Mega Bangna would be nice, failing that how about downtown somewhere close to Asok BTS?

Second question, is it possible to get a decent nights sleep sitting upright?

[Sheryl]

Ultram ER not available here. You will only be able to get plain tramadol in extebnded release form, not tram + paracetemol (hardly a problem, if you think the para adds anything just take it separately)

 

The only brand of  ER tramadol here  I know if is:

 

Tramal Retard

 

Made by Sanofi so imported and expensive.  I am nto sure where you will find it, best I can advise is to ask around at very large pharmacies.

 

BTW I have the same problem you do re NSAIDs, and a history of gastritis,  but am able to tolerate the selective COX-2 inhibitors e.g. Arcoxia, Celebrex.

 

There are some concerns regarding safety of long term use of this class of NSAID (increased risk of cardiovascular  events) but you might want to consider it for short term use if you do nto have any known cardiac risk factors.

 

Another option you might want to consider is to see a specialist in pain management, you will usually get much better pain management that way. Would of course need to bring along your records documenting the back injury. There are some good ones at Bangkok Hospital (Bangkok branch) and Bumrungrad. There is in fact much more that can be done than tramadol - other meds, possible nerve block etc.

[PeCeDe]

Thanks Sheryl, I finally found a sleeping position good for me, which goes a long way to easing my concerns since a few days without sleep can be dismaying and disorienting to say the least.

 

I'm also managing to keep my Ultracet consumption down to between 5 or 6 a day, I don't think my body likes the stuff at all, for a couple of days I took 8 which resulted in huge headaches and the onset of cold sweats. I cannot understand how people can deliberately abuse this medicine but for me personally I will welcome the day I don't need it. I also of course do know the difference between a bodies addiction and a mental addiction.

 

I will keep the Pain Management scenario for future reference should things change drastically. I'm not made of money so I really can't afford a large hospital bill every week.

 

Once again thanks Sheryl you've been a big help.