Why won’t they fill my pain medicine? Told me to use Tylenol after tummy tuck, arm lift and breast lift.

Question

I had a tummy tuck with muscle Tightening, Arm lift and a breast lift on August 3rd I called yesterday to refill my pain meds and the nurse told me to take Tylenol. I was in so much pain last night from back pain and my arms and muscle still hurt really bad (I had no discomfort from it while I was on meds) I don’t understand why didn’t they fill my medication because it worked and I was in no pain. Do I call again tomorrow and ask for it !?

Christine Rodgers, MD · Answer

HI jasmina,  I am sorry that you are having so much pain. To be honest, the pharmacies and medical monitoring boards in each state are restricting a doctor's ability to refill narcotics for pain relief, even for physicians who have had surgery themselves. In Colorado, the amount of narcotics that a physician can prescribe is limited after the first week of surgery, except for terminal patients. These rules were put in place secondary to the opioid crisis in the US, so it is not that your own PS does not care about your suffering. He/she is restricted and very carefully monitored due to this crisis.I would suggest that you meet with your PS and discuss alternative methods of pain control.Best Wishes to you.Dr. Christine Rodgers

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your discomfort.  I would speak with your surgeon and see them for an in-person examination to discuss your pain, and treatment, options.  Though narcotic use has reached a crisis it is important to treat your discomfort to limit complications during healing.  Since we do not know how many pills you were originally given it may be totally reasonable to need additional prescription pain medication, or supplementation with antiinflammatories and muscle relaxants.  Talk to your surgeon directly.  Best wishes

Jane M. Rowley, MD · Answer

Unfortunately plastic surgeons are doing more and more combined major procedures and at the same time as the narcotic crisis is peaking.  You had a huge procedure and I am sure you are still experiencing significant pain less than 10 days post op.  Talk to your surgeon, hopefully you can get another narcotic prescription and alternate with non narcotic drugs.  Good luck, sorry for your experience. Janeps I do think muscle relaxants help a lot.

Patricia A. McGuire, MD · Answer

The opioid crisis has the medical community looking for options other than narcotic pain medicine. Legally we are limited as to how much and how often we can prescribe narcotics after surgery. Anti inflammatory, non narcotic pain medication can actually be more effective than narcotics after the initial couple of days post op. Ask your surgeon when you can take Ibuprofen, which can work better than Tylenol for some patients. Because of potential bleeding risks, surgeons have different protocols as to when these can be started. Other non narcotics such as Celebrex and Neurontin can also be useful. I personally had surgery  two weeks ago and didn’t take anything except Celebrex. Talk to your surgeon about your options for pain control.

Robert M. Tornambe, MD · Answer

Jasmina.  I appreciate your dilemma, however because of the opioid crisis in America, plastic surgeons and doctors cross the country are trying to decrease dependence on pain medications, especially this late after your surgery. It sounds like muscle relaxents or prescription anti-inflammatories are a better option for you. Check in with your plastic surgeon to explore the best options for you. Good luck!

Camille Cash, MD · Answer

I'm sorry to hear you are still having so much pain from surgery.  Pain and recovery is unique to each patient.  I would contact your surgeon to request an appointment to discuss your pain level.

Robert H. Hunsaker, MD · Answer

Everyone is different in their response to pain. The vast majority of patients do not require narcotic pain meds at ten days after surgery though many require more than Tylenol. I have found that Ibuprofen in adequate doses offers quite acceptable pain relief - in fact, we have gone to a completely non-narcotic post-operative pain regimen with great success using Gabapentin and Ibuprofen to start and then switching to Ibuprofen only.

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