PANADOL (Paracetamol, Panadol Osteo)

This is a simple pain reliever, which should be taken on a regular basis to reduce your need for stronger medications. Take 2 tablets 3-4 times per day. Panadeine forte has codeine added for extra pain relief but may cause drowsiness or nausea or constipation. Do not take paracetamol and panadeine forte together at the same time. Do not take more more than 8 tablets of either medication in 24 hours.

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ANTI-INFLAMMATORIES

These include MOBIC, CELEBREX, NAPROSYN and VOLTAREN. Take with a glass of milk or after a meal. If you have kidney disease, stomach ulcers, heart failure or previous allergic reactions you may need to avoid these tablets. Otherwise continue to take these every day during the first week after surgery then once daily only if needed in the second week then stop. Some patients may continue to take anti-inflammatories longer term after discussion with your doctor.

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LYRICA (Pregabalin)

This is an additional pain reliever which can reduce moderate pain. It may cause dizziness and drowsiness or occasionally hallucinations in some individuals. At higher doses it may also cause blurred vision which is relieved by reducing the dose. Initial dose is typically 25 - 75mg twice daily or simply once daily at night.

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STRONG PAIN TABLETS

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Palexia (Tapentadol)

This is a pain relief medication for moderate to strong pain. There are two types of this medication. The slow release (SR) tablet lasts ~ 12 hours and can be taken twice a day. The immediate release (IR) tablet starts to work sooner than the SR tablet and but doesn't let as long and can be taken every 2-4 hours. 

 

PALEXIA is generally well tolerated but may have some side effects similar to morphine such as nausea, sedation, constipation & itch.

 

Most patients will be prescribed PALEXIA but if required there are alternatives listed below.

 

Dilaudid (Hydromorphone - IR)

This is an alternative to Palexia IR. It is used for strong pain relief and available 2-4 hourly in hospital as needed.

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Targin (Oxycodone/naloxone)

This is an alternative to Palexia. It is also available twice daily as needed. It may cause more nausea than Palexia.

 

Endone (Oxycodone)

Comes as 5 or 10mg available every 2 hours in hospital then 4-6 hourly when at home. It is a strong pain medication with a quick onset but only lasts ~2 hours. This is suitable to take before physiotherapy or when pain is not well controlled.

 

Temgesic (Buprenorphine)

This tablet goes under the tongue and is similar to endone but slightly slower in onset and longer acting. The dosage is 200 - 400 micrograms 4-6 hourly.

 

Norspan skin patch (Buprenorphine)

This contains the same medication as Temgesic. Some patients will be offered a norspan patch, which is applied to the skin and lasts 1 week. The patch comes in 5 or 10 microgram strengths. This may also cause side effects such as nausea, sedation, constipation & itch.

 

Tramadol

Available as slow release (twice daily) or immediate release (x4 per day). This is for moderately strong pain and may suit some patients. However it is not well tolerated by all and sedation and nausea is not uncommon. Avoid if any history of seizures.

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SIDE EFFECTS

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All strong pain medications have the potential for side effects, which include nausea, vomiting, dizziness, confusion, itch, dry mouth, constipation and possibly hallucinations. If you are on strong pain relievers avoid alcohol, driving and operating machinery. Sedation may be improved by reducing the dose or taking the medication less often. If you feel excessively light-headed, spaced out or nauseated, try reducing your dose. If your symptoms persist try an alternative pain reliever or contact your doctor (see below). To prevent constipation, ensure you have adequate fluid intake and dietary fibre. You may also need to take regular laxative until you no longer need strong pain relievers. If you have a Norspan skin patch on and you have experienced persisting nausea or sedation the patch may have to be removed to alleviate the side effects and an alternative pain reliever used.

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