Legal Pain Medication

[dsmandell]

I have seen many posts from people interested in getting pain medication without seeing a doctor. That's not my question.

I am wondering how doctors in Thailand determine when to prescribe pain medication, as I am recovering from a recent surgery and still endure severe pain. It is no longer a constant pain, but the prescribed 500mg Tylenol tablets don't make a dent, nor does combining ibuprofen with the Tylenol. I don't know what else I need to do to convince my doctor that my pain can be severe enough to warrant pain medication. Do I need to be screaming bloody murder and writhing on the floor in agony (which I do from time to time) during my appointments to get his attention? My fear is that he will be even less convinced of the need now, since I have somehow survived the past two weeks, despite asking for something for pain on those occasions. I don't want to take something regularly, but when the pain is bad enough to wake me up and keep me up, and I have already taken Tylenol and ibuprofen, I have nowhere to turn. Yes, if I survive the next couple weeks, I should be out of the woods completely, but I would just as soon minimize the suffering to get there...

Any insights would be most welcome.

[Sheryl]

This is a widewpread problem in Thai medicine. Thai doctors are extremely reluctant to ever prescribe narcotics, even say codeine with tylenol. They also tend to under-dose when they do prescribe, which I think reflects differences in Thai and Western response to meds (Thais are extraordibnarily susceptible to opiates and sedatives of any sort) but that's another matter.

The attitudes here with regard to pain control are similiar to what thet were in the west in the 1960's....excessive fear of the risks of patients becoming addicted etc. I also get the impression that there is great concern about getting into trouble for prescribing narcotics "too much" or "too often"; as elsewhere Thai doctors have to report on the quantities they prescribe, but I do not know if in fact the Thai drug authorities are actually that unreasonable and overzealous or if the doctors are just unnecessarily gun-shy about it. Perhaps it is highly stressed in their education. Anyhow, they pretty well all seem to be this way.

Add to this that I think many have a sterotype of farangs as being druggies or would-be druggies.

This answers the question but does not help your situation any.

You could try Tramadol which is available OTC in Thailand. Read up on its side effects before you do. It works well for some people, others find it ineffecetive, and a minority of people have serious mood swings/mental effects from it. But it is certainly worth a try if you are in a lot of discomfort.

Pain is usually the hardest to handle at night when one is trying to sleep since at that poiont there are no distractions. If this is the case, try Atarax 25 - 75 mg at bedtime, it is also sold OTC. Don't combine with alcohol or drive after taking it.

[MB1]

You could try Tramadol which is available OTC in Thailand. Read up on its side effects before you do

I'm prescribed Tramadol hdyrochloride prolonged release tablets 200mg (Tradorex XL) and they do relieve the pain, it does not stop the pain but I don't feel it as often or much.

Tramadol does have side affects and some are 1. very common, (1 in ten suffer from certain side affects) 2 common, 1 in 10 and 1 in 100) suffer from certain side affects. 3. Uncommon. (1 in 100 and 1 in 1000 suffer from certain side affects) and rare. (1 in 1000 and 1 in 10000 people are affected).

That said means read the side affects advised by Sheryl carefully and understand what they are, if buying over the counter in Thailand and if Info is not in English I'm pretty sure it can be found online.

I take the tablets once every day, 1 or two tablets and my only side affect has been a common one, which results in vomitting which does not happen all the time but on certain occasions when I have not eaten before taking so I always try to make sure I've eaten before taking.

Tramadol is a analgesic pain killer, (reliever).

Edited October 22, 2009 by MB1

[sabaijai]

I do not know if in fact the Thai drug authorities are actually that unreasonable and overzealous or if the doctors are just unnecessarily gun-shy about it.

I think it must be the latter. I know a couple of dodgy Thai doctors in Chiang Mai, one a leading orthopedist, the other a plastic surgeon, who prescribe all sorts of scheduled substances in quantity, for themselves and their friends. .

[Camelot]

You are right about the Tylenol. I was given 10 tablets when I saw an orthopedic doctor at BNH for treatment after breaking my arm at the elbow in an accident last year.

They didn't help in the slightest. I couldn't even get an injection to ease the pain.

Some years ago a Thai work colleague was denied proper pain relief at Rajvithi Hospital. The doctor treating her told me that as a matter of policy they do not give strong pain management drugs to patients for fear they might become addicted. Logical enough, but this was a terminal case of cancer and she did suffer unnecessarily before she died.

[Krap]

Fist take maximum dose of Paracetamol ( Tylenol) wich is 1000mg 3-4 times per day, and at the same time 3 times daily 400mg ibuprofen. This should be the foundation. If not enough try adding 50mg tramadol morning and night, increase the dose slowly if needed to about 100mg max 3-4 times per day.

[Sheryl]

Fist take maximum dose of Paracetamol ( Tylenol) wich is 1000mg 3-4 times per day, and at the same time 3 times daily 400mg ibuprofen. This should be the foundation. If not enough try adding 50mg tramadol morning and night, increase the dose slowly if needed to about 100mg max 3-4 times per day.

I would caution against the above. Both aceteminophen (Tylenol, Paracetemol) and NSAIDs have been linked to kidney damage especially if taken in high diosage and/or for long periods of time..and the combination of both aceteminophen and NSAID has been shown to be considerably more dangerous than either one alone.

If such a combination is being taken should be sure to get a baseline creatnine (blood test) and that it is in normal range, and repeat at least monthly if still taking these medications.

[Krap]

Fist take maximum dose of Paracetamol ( Tylenol) wich is 1000mg 3-4 times per day, and at the same time 3 times daily 400mg ibuprofen. This should be the foundation. If not enough try adding 50mg tramadol morning and night, increase the dose slowly if needed to about 100mg max 3-4 times per day.

I would caution against the above. Both aceteminophen (Tylenol, Paracetemol) and NSAIDs have been linked to kidney damage especially if taken in high diosage and/or for long periods of time..and the combination of both aceteminophen and NSAID has been shown to be considerably more dangerous than either one alone.

If such a combination is being taken should be sure to get a baseline creatnine (blood test) and that it is in normal range, and repeat at least monthly if still taking these medications.

Ofcourse knowing ut healthstatus and considering any sideffect or personal limitations is key, paracetamol widley known for causing liverdamage in to high doses or in combination with alcohol. Ibuprofen is mostly known for gastrointestinal sideeffects.

Ther combination is widley used, checking kreatinin and alat/asat for liver is a good idea though.

"Pain-relief drug combines paracetamol and ibuprofen

4:00AM Wednesday Oct 28, 2009

By Kara Segedin

<H2 class=caption>Maxigesic will be available from pharmacies this month. File photo / Rotorua Daily Post</H2>New Zealanders will soon find a new and improved pain relief treatment on pharmacy shelves.

The new tablet, which for the first time here combines paracetamol and the anti-inflammatory ibuprofen, will be available this month.

It was developed and tested in New Zealand with help from teams in the United States.

Each tablet contains 500mg paracetamol and 150mg of ibuprofen"

[dsmandell]

Fist take maximum dose of Paracetamol ( Tylenol) wich is 1000mg 3-4 times per day, and at the same time 3 times daily 400mg ibuprofen. This should be the foundation. If not enough try adding 50mg tramadol morning and night, increase the dose slowly if needed to about 100mg max 3-4 times per day.

I would caution against the above. Both aceteminophen (Tylenol, Paracetemol) and NSAIDs have been linked to kidney damage especially if taken in high diosage and/or for long periods of time..and the combination of both aceteminophen and NSAID has been shown to be considerably more dangerous than either one alone.

If such a combination is being taken should be sure to get a baseline creatnine (blood test) and that it is in normal range, and repeat at least monthly if still taking these medications.

Ofcourse knowing ut healthstatus and considering any sideffect or personal limitations is key, paracetamol widley known for causing liverdamage in to high doses or in combination with alcohol. Ibuprofen is mostly known for gastrointestinal sideeffects.

Ther combination is widley used, checking kreatinin and alat/asat for liver is a good idea though.

"Pain-relief drug combines paracetamol and ibuprofen

4:00AM Wednesday Oct 28, 2009

By Kara Segedin

<H2 class=caption>Maxigesic will be available from pharmacies this month. File photo / Rotorua Daily Post</H2>New Zealanders will soon find a new and improved pain relief treatment on pharmacy shelves.

The new tablet, which for the first time here combines paracetamol and the anti-inflammatory ibuprofen, will be available this month.

It was developed and tested in New Zealand with help from teams in the United States.

Each tablet contains 500mg paracetamol and 150mg of ibuprofen"

Thanks to everyone for the informative posts. It was good to know that Thai doctors are simply reluctant and have a different approach to pain management than we have in the west. I was surprised to encounter this from my doctors since they are young and spent a good deal of time working in the US and doing fellowships in hospitals in the US. Anyway, I restated my needs much more insistently with the doctor and he prescribed Tylenol with codeine (albeit 15mg) as well as Arcoxia (120mg). These are doing the trick and the pain has become tolerable (a persistent dull ache that I will probably end up living with for a long time, if not permanently). But at least I don't have the sharp pains that make it absolutely impossible to sleep.

Thanks again to all who contributed to the thread.

Cheers,

Daniel

[zorro1]

I have seen many posts from people interested in getting pain medication without seeing a doctor. That's not my question.

I am wondering how doctors in Thailand determine when to prescribe pain medication, as I am recovering from a recent surgery and still endure severe pain. It is no longer a constant pain, but the prescribed 500mg Tylenol tablets don't make a dent, nor does combining ibuprofen with the Tylenol. I don't know what else I need to do to convince my doctor that my pain can be severe enough to warrant pain medication. Do I need to be screaming bloody murder and writhing on the floor in agony (which I do from time to time) during my appointments to get his attention? My fear is that he will be even less convinced of the need now, since I have somehow survived the past two weeks, despite asking for something for pain on those occasions. I don't want to take something regularly, but when the pain is bad enough to wake me up and keep me up, and I have already taken Tylenol and ibuprofen, I have nowhere to turn. Yes, if I survive the next couple weeks, I should be out of the woods completely, but I would just as soon minimize the suffering to get there...

Any insights would be most welcome.

I to suffer from pain and my doctor from bkk gave so many pain killers I was tripping seriously look for a forum on the net where people snuffer the same sort of pain from the same type of operation/source. More often than not their research is spot in

[hmficc]

Fist take maximum dose of Paracetamol ( Tylenol) wich is 1000mg 3-4 times per day, and at the same time 3 times daily 400mg ibuprofen. This should be the foundation. If not enough try adding 50mg tramadol morning and night, increase the dose slowly if needed to about 100mg max 3-4 times per day.

Tylenol and booze DO NOT MIX. Danger of liver damage.