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I Am Allergic to Codeine. Any Suggestions for Pain Control After Mommy Makeover?

Doctor Answers (36)

Alternatives to codeine for pain relief

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All narcotic pain relievers have some resemblance in their chemical structure, and an allergy to one can mean being allergic to others.

Many times when patients tell me they are allergic to codeine  it is not a true allergy, but rather a sensitivity, meaning they get nauseated or have some other side effect, rather than a rash, hives or other true allergic reaction. It is best to define this first, and then look at some of the alternatives, both narcotic and non-narcotic.

Although we have relied on the use of narcotic pain relievers for pain  since the Civil War, they have some negatives and some patients just don't tolerate them. Or, in the case of recovering addicts, they never want to touch them again. Does this prevent us from being able to do surgery because of inability to deal with the pain? Not at all.

There are non-narcotic alternatives available which may be sufficient with proper mental preparation and  good planning. 

Discuss this with your doctor at length and I am sure a good program me can be planned to give you peace of mind going into surgery


Vancouver Plastic Surgeon
5.0 out of 5 stars 7 reviews

Consider using a pain pump for post operative pain control

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Alternatives to codeine include oral Demerol and synthetic forms of morphine.  I usually place a pain pump and this greatly decreases post operative pain and discomfort.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Ultram & Double Strength Tylenol are Great Options

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Pain control is extremely important following cosmetic surgery. Patients frequently report allergies to various pain medications and as a result, pain management may require adjustment in the postoperative period.
Most patients who say they are allergic to codeine don’t have a true allergy. They usually have severe nausea, which codeine is notorious for causing.
We typically use a synthetic codeine derivative called Hydrocodone, which has a decreased incidence of nausea compared to codeine.
Examples of prescription Hydrocodone commonly used include Vicodan and Lortab. When these don’t work or patients are allergic to them as well, we use Ultram. We replace narcotic pain relievers with double strength Tylenol as soon as possible following surgery to avoid the potential for drug problems.
Pain tolerance varies from patient to patient and with appropriate care can usually be managed without difficulty. When allergies to pain medications occur, multiple alternatives exist to deal with this problem.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 73 reviews

Allergic to Codeine Pain Medications

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The allergy to codeine in pain medicines is so common that I rarely use these pain medications in my practice.  Artificial codeine, hydrocodone, is more commonly prescribed and used in products like Vicodin and Lortab and these medications are surprisingly effective on many individuals who cannot tolerate codeine but can tolerate hydrocodone.

Even when I have prescribed the hydrocodone medications, I encourage my patients to as quickly as possible to convert to anti-inflammatory medications like Advil, Nuprin and Motrin which are Ibuprofen products and Alleve which is a different anti-inflammatory product.  These medications actually effect the pain problem itself instead of hiding the symptoms in one's brain and have less side effects.

Never forget the use of ice and cold packs to reduce the amount of pain on almost all areas of the body following surgery.

John K. Long, MD
Houston Plastic Surgeon
5.0 out of 5 stars 3 reviews

Allergic to codeine, any alternatives for pain control

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I would make sure you have a true allergy to Codeine. If you have a history of an anaphylactic reaction or severe rash with Codeine, I would try using Tramadol or Toradol for your pain control.

Robert Najera, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 4 reviews

I Am Allergic to Codeine. Any Suggestions for Pain Control After Mommy Makeover?

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Thank you for the question!  Codeine is metabolized to morphine in your body and morphine frequently causes a histamine release and occasionally nausea.  I recommend speaking with your physician about your symptoms after codeine.  Your surgeon can prescribe powerful anti-nausea and anti-histamine drugs to prevent your side effects.  Other alternatives are available to the opiate family, but most are not as effective and do not have the safety profile that opiates have.  

Best of luck,

Dr. Mussman

Jason Mussman, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 3 reviews

Exparel for Post-operative Pain Control

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I have been very impressed with the new formulation of Marcaine called Exparel. (I do not have any stock or interest in the company, I just like my patients to have less pain!)
My breast augmentation patients usually complain of discomfort and pressure, but very rarely complain of deep muscle ache, pain or spasm. MOST of my breast augmentation patients take Tylenol only. I often have difficulty keeping them away from activities over the first several days because they have tended to feel so well.
The tummy tuck is the most painful operation that I perform, especially when muscle tightening is involved, which is usually the case. I have seen a DRAMATIC decrease in the amount of pain postoperatively when using Exparel. I do not inject it into the skin; rather I place it as a nerve block (called "TAP Block" for "Transversus Abdominis Plane") where I directly inject the anesthetic between the internal oblique and transversus abdominis muscle. My patients are able to take much less with regard to pain medications because of this technique.
In patients with narcotic intolerences, I use one of three medications for postoperative pain (in addition to the Exparel TAP block): Valium; Tramadol, or Flexeril.
I think most of the pain of the tummy tuck is related to muscles spasm (early) and lower back pain (later... after the first week). I have had good success with these medications and narcotics are not always the most beneficial for postoperative pain. In addition, I recommend around the clock Tylenol as well as a nerve medication called Gabapentin before and after surgery. Hopefully your surgeon is sensitive about your needs and can help devise a medication regimen and nerve block plan that will minimize your pain!

Adam J. Oppenheimer, MD
Melbourne Plastic Surgeon
5.0 out of 5 stars 28 reviews

Allergic to codeine

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We have several different kinds of pain medications available for patients who may be sensitive or allergic to one kind.  Some patients get nauseated from narcotics in general and this can be helped by eating bland food prior to taking the medication.  If all narcotics are a problem several non narcotic pain meds are available such as tramadol.  Your surgeon should have seeveral options available to you.

Michelle J. Place, MD
Danville Plastic Surgeon
5.0 out of 5 stars 5 reviews

Pain Control After Mommy Makeover

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Pain control after mommy makeover is usually approached from many different ways.  Post-operative pain pills are less important than some intraoperative medications that can provide long term pain relief.  Recently, we have began using EXPAREL, which is a special form of local anesthesia that gives profound relief of pain for up to 72 hours after surgery.  This coupled with no drains using a progressive tension style tummy tuck helps cut down on the pain experience after surgery.  The EXPAREL can be used all over the tummy to help the incisional pain as well as the deep pain that you may experience from the tightening of the muscles.  As for oral pain medications, we typically use Nucynta which is a new narcotic pain medication with a lower incidence of nausea and vomiting as well as less constipation.  This may be a good alternative for you.  You should ask your plastic surgeon for their recommendations.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.5 out of 5 stars 29 reviews

Many options

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Pain control postop is of great importance.  The less pain, the more you are walking around which equates to less complications and a better overall sense of your recovery.  Narcotics, like codeine, have issues.  Still, most patients need something postop.  In addition to narcotics, other meds can be used like muscle relaxers, gabapentin/Neurontin, Celebrex (if not sulfa allergic), etc.  All are non-narcotic in nature.  Another option which I have used for the past year is Exparel which is an injectable, long lasting (3-4 days), delayed release pain medicine (Marcaine) which is injected into the muscle layer.  I found this works amazingly well for most patients.

Aaron D. Gorin, MD
Portland Plastic Surgeon
5.0 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.