Please help me find safe pain medication for my liver./Hep C.

[Amberh09]

Hello everyone. My doc has me on tramodol for pain.
It's not doing a thing for it. I have kidney stones,fibromyalgia and
was just diagnosed with Hep C. I meet with my doc on Wednesday
and I need to come up with a list of safe pain meds I can take that
Do not effect my liver. PLEASE HELP! Thanks to everyone who responds!
:)

[HectorSF]

What is the cause of the pain you are treating?

"I need to come up with a list of safe pain meds"
A patient should not be deciding what pain meds they are going to take. That is the doctor's job. If the stage of your liver disease is unknown determining what is safe to take is not possible. What meds a patient can take safely is based on the stage of liver disease and any other health conditions a patient may have.

Your doctor should know what is safe or unsafe for you as they know your medical history and we don't. If you have chronic hepatitis C infection you should at minimum be seeing a gastroenterologist (a hepatologist if you have cirrhosis) who is familiar with managing liver disease and hepatitis C. Improper treatment treatment of a patient with advanced liver disease can be dangerous.  A PCP is not qualified to care of treat you.

Tramadol is a narcotic-like (potentially addictive) pain reliever used to treat moderate to severe pain. Tramadol extended-release is used to treat moderate to severe chronic pain when treatment is needed around the clock.
Narcotic (opioid) analgesic agents are extensively metabolized by the liver, and several of them (e.g., codeine, hydrocodone, meperidine, methadone, morphine, propoxyphene) have active metabolites that are further converted to inactive substances. The serum concentrations of these agents and their metabolites may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with opioids should be administered cautiously and initiated at reduced dosages in patients with liver disease. Subsequent doses should be titrated based on individual response rather than a fixed dosing schedule.

Ibuprofen is a NSAID that is for treatment of mild pain. It should not be taken by patients with liver cirrhosis. They can cause bleeding in patients at increased risk of bleeding as a result of thrombocytopenia and coagulopathy associated with advanced liver disease. This risk is even greater in patients with portal hypertension–related complications, such as esophageal/gastric varices and portal hypertensive gastropathy or gastric antral vacular ectasias. They can also cause kidney failure. Hepatorenal syndrome is a dreaded and frequently fatal complication of advanced liver disease.

Please find a gastroenterologist to manage and if needed treat your hepatitis C. They will order a liver biopsy to determine how advanced your liver disease is.

Hector

[ActingBrandNew]

Recommended Use of Opioids in Hepatic Dysfunction

"Codeine should be avoided since the liver is required for biotransformation of the drug into the active metabolite, morphine, so pain control could be compromised [Gasche et al. 2004]"

"....For most patients with renal or hepatic dysfunction, either morphine or hydromorphone could be a good starting therapy if an opioid agent is used."

"Fentanyl -Appears safe, generally no adjustment necessary. Decreased hepatic blood flow affects metabolism more than hepatic failure. Dosing adjustment usually not needed. "

http://pain-topics.org/pdf/Opioids-Renal-Hepatic-Dysfunction.pdf

[Amberh09]

Thanks! I have read that thread before but my doc tells me ibprofen and codine are bad for the liver? Idk. And no I have not had a liver biopsy yet. I'm going to bring that up to him at my next appt this week. I'm just so confused on what to bring up to him?

[ActingBrandNew]

Since you were just diagnosed, did you happen to also have a liver biopsy as well and if so what is the condition of your liver?
___________________________________________________________

Pain Management in the Cirrhotic Patient: The Clinical Challenge

"..... Although methadone and fentanyl are also heavily protein bound and as such require reduced dosing in patients with cirrhosis, the metabolism of these agents does not yield toxic metabolites, and hence they, along with hydromorphone, may be better tolerated37,38 (Table 2)."

".....Hydromorphone and fentanyl appear to be the least affected by renal dysfunction, and fentanyl has less hemodynamic disturbance (due to lack of histamine release associated with other opioids).39"

"NSAIDs and opioids may be used at reduced doses in patients with chronic liver disease without cirrhosis. Patients with cirrhosis have fewer analgesic options. NSAIDs should be avoided in those with both compensated and decompensated cirrhosis, primarily because of the risk of acute renal failure due to prostaglandin inhibition. Opiates should be avoided or used sparingly at low and infrequent doses because of the risk of precipitating hepatic encephalopathy. Patients with a history of encephalopathy or substance abuse should not take opioids. When appropriate, anticonvulsants and antidepressants are options worthy of exploration in chronic neuropathic pain management in patients with advanced liver disease. "

Full study here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861975/

[ActingBrandNew]

Heres an old thread on the topic

http://www.medhelp.org/posts/Hepatitis-C/LIVER-SAFE-PAIN-MEDICATION/show/94880