What is the strongest, non "controlled substance" painkiller available?
December 2, 2010 9:37 PM Subscribe
YANMD. What is the strongest, non "controlled substance" painkiller available?
I was sick in bed for a couple days with food poisoning or something similar. This kept me pretty much bed-ridden in my awful, uncomfortable bed. I've had minor scoliosis since I was a child, and I guess all this ill treatment of my back has made it angry. I now have severe pain all throughout my back, and it's pretty difficult to function.
I did go to the doctor about the stomach problems, but both the ortho and pain specialists are busy for at least the next 24 hours. The general practitioner would only give me medications related to my stomach. I can't wait another day or two to take care of this pain. It's crippling.
However, I live in Vietnam, and virtually all medications are available over the counter, without a prescription, except those typically classified as controlled substances. And they're cheap as hell. I just have no idea what to ask for.
This is not a long-term thing. I only need something for the next day or two, until I see a doctor, or most likely, until the pain goes away shortly. Does anyone have any suggestions as to a good pain killer/muscle relaxant?
Alternatively, would marijuana be helpful, without irritating my residual stomach problems?
YANMD I know... thanks in advance!
I was sick in bed for a couple days with food poisoning or something similar. This kept me pretty much bed-ridden in my awful, uncomfortable bed. I've had minor scoliosis since I was a child, and I guess all this ill treatment of my back has made it angry. I now have severe pain all throughout my back, and it's pretty difficult to function.
I did go to the doctor about the stomach problems, but both the ortho and pain specialists are busy for at least the next 24 hours. The general practitioner would only give me medications related to my stomach. I can't wait another day or two to take care of this pain. It's crippling.
However, I live in Vietnam, and virtually all medications are available over the counter, without a prescription, except those typically classified as controlled substances. And they're cheap as hell. I just have no idea what to ask for.
This is not a long-term thing. I only need something for the next day or two, until I see a doctor, or most likely, until the pain goes away shortly. Does anyone have any suggestions as to a good pain killer/muscle relaxant?
Alternatively, would marijuana be helpful, without irritating my residual stomach problems?
YANMD I know... thanks in advance!
Naproxen is my painkiller of choice. I can't take ibuprofen because it tears my stomach apart, but naproxen has never given me any problems. For me, it works even better than vicodin.
posted by corey flood at 9:47 PM on December 2, 2010
posted by corey flood at 9:47 PM on December 2, 2010
I don't know about Vietnam, but tramadol is sold over the counter in many countries. It has nearly the same effects as a mild narcotic such as hydrocodone, but for some odd reason is not legally restricted like other narcotics in most jurisidictions. I have used it with some success to relieve scoliosis-related back pain.
posted by mahamandarava at 9:50 PM on December 2, 2010 [4 favorites]
posted by mahamandarava at 9:50 PM on December 2, 2010 [4 favorites]
I also use naproxen for pain. Vicodin doesn't do too much for my actual pain, though it brings me a fair amount of euphoria. I'd rather have the pain go away.
posted by santaliqueur at 9:52 PM on December 2, 2010
posted by santaliqueur at 9:52 PM on December 2, 2010
Don't take an NSAID like ibuprofen or naproxen -- you'll risk irritating your stomach. Flupirtine is a novel painkiller (non-opioid, non-NSAID) that's fairly powerful. It's been in use in Europe for a while now, but clinical trials in the US have only recently started (it's not in one of the bad DEA schedules, though). If you can't find that in Thailand, try one of the NSAIDs that directly target COX-2 like Celecoxib.
posted by ayerarcturus at 9:59 PM on December 2, 2010 [2 favorites]
posted by ayerarcturus at 9:59 PM on December 2, 2010 [2 favorites]
Naproxen + acetaminophen. They provide pain relief in different ways and can be taken together. Works a treat. You could also do it with ibuprofen + acetaminophen, but I like it with naproxen because you take naproxen every 12 hours and acetaminophen every 6 hours, so the scheduling works out well. Ibuprofen you take every 4 hours, so you must keep track of which pill you're taking when. Don't take ibuprofen with naproxen; both are the same type of drug (NSAID) and you should only take one.
If you take ibuprofen, be aware that the suggested over-the-counter dose is pretty weak. I have had a doctor suggest doubling it.
posted by kindall at 10:02 PM on December 2, 2010 [2 favorites]
If you take ibuprofen, be aware that the suggested over-the-counter dose is pretty weak. I have had a doctor suggest doubling it.
posted by kindall at 10:02 PM on December 2, 2010 [2 favorites]
Sure, ibuprofen and naproxen could irritate your stomach, but this is unlikely if only taking them for a day or two. IANYD but I see no reason why you couldn't take a good sized dose of an anti-inflammatory for your back pain. I typically tell my patients to take 800mg ibuprofen (which is a high, extra strength dose) every 6 hours for a few days for back pain, if they don't have any reasons not to do so. If tramadol's available that could be a good option, but it is considered 'controlled' in some jurisdictions, even though it's over the counter in others!
posted by treehorn+bunny at 10:36 PM on December 2, 2010 [1 favorite]
posted by treehorn+bunny at 10:36 PM on December 2, 2010 [1 favorite]
Advil doesn't do anything for me, but you can take a lot of it without suffering too many ill effects (in the short term). Another vote here for naproxen (Aleve).
posted by phunniemee at 10:42 PM on December 2, 2010
posted by phunniemee at 10:42 PM on December 2, 2010
At least one website seems to indicate that Tylenol with codeine is available OTC in Vietnam, so if you can get that, get that. I have no idea if you're supposed to, but I have taken that at the same time as naproxen with good results before. Codeine is good, if not for really killing the pain, for making it much easier to survive being in awful pain for a short period of time from a mental perspective.
posted by gracedissolved at 11:14 PM on December 2, 2010
posted by gracedissolved at 11:14 PM on December 2, 2010
Jesus. This whole Vietnam thing confuses me. Were you a patient in the US, I would say something like, "If you're suffering crippling abdominal/back pain and can't see a physician, that is a very good reason to go to an emergency department." If that option is open to you, then I would still recommend that.
Here's what I hear you saying: "I have gastroenteritis and scoliosis. My gastroenteritis is under control, but I've been immobile, which has exacerbated my scoliosis, leading to back pain. Help me treat my back pain." I want to clarify what I hear you saying, because if it's not what you're saying, anything I say could be totally inaccurate-- could lead to you doing something unsafe.
If your back pain IS musculoskeletal back pain, then NSAIDS (naproxen, ibuprofen) are appropriate for it. If you can keep food down and lack bleeding or kidney problems, 800mg ibuprofen, every 4 hours as needed, is appropriate (6 hours is safer, but in the absence of other risks, 4 hours is safe). You can add acetaminophen to this, if you're not taking any drugs containing acetaminophen and you don't have any liver problems. In the US, current recommendations, I think, are <3.2gm acetaminophen daily, so call it 650mg (2 Tylenol) every 8 hours.
Ibuprofen is an NSAID, which is the same category as Aleve (naproxen), so you shouldn't take both at once. An alternate to either is Toradol (ketorolac) which does work better. If you take Toradol, don't take ibuprofen or naproxen. Take 20mg, and then take another 10mg every 6 hours.
Skeletal muscle relaxers are also appropriate, and safe to take in conjunction with NSAIDs or acetaminophen. They may be considered a controlled substance. In my experience, the most common is Flexeril (cyclobenxaprine). If you can get this, and need it, take 10mg every 8 hours. There are other options, but don't combine them.
Ultram (tramadol) may be controlled, or may not be. Some formulations include acetaminophen, so don't take with other acetaminophen products. Take 2 tablets (75mg) every 4 hours as needed for pain. Don't take if you're taking other opioids.
Explore non-pharm pain relief. Ice packs and heat packs can relieve back pain. Use either, depending on convenience and availability. Apply for 20 minutes at a time, as often as you find useful.
Distract yourself. Watch TV. Get a good bed, if you can. Some people have found marijuana useful. If that's available to you and effective, that's fine. It has no drug interactions with any of the drugs I've mentioned. Alcohol is probably more effective for most than any of the drugs I've listed. That's fine too. It has some drug interactions, so skip the meds or post if you're going to use alcohol. If there are other illicit drugs that you have access to, let us know, and we can probably figure out if they are safe and/or effective.
Whatever you decide to do, ask your pharmacist about drug interactions and instructions. My go-to for drug info is www.rxlist.com. Look at it and make sure everything's safe.
If your abdominal pain is not controlled, there are other options. Like I said, this is in the assumption that your back pain is the problem, not the abdominal pain. There is the potential that either pain is more serious than you give it credit for. These pharm recommendations are only given if you're sure that you know what's going on. (Because back pain can be a heart attack. Abdominal pain can be an aneurysm, in which case NSAIDs are a bad idea. Etc.)
posted by nathan v at 11:20 PM on December 2, 2010 [6 favorites]
Here's what I hear you saying: "I have gastroenteritis and scoliosis. My gastroenteritis is under control, but I've been immobile, which has exacerbated my scoliosis, leading to back pain. Help me treat my back pain." I want to clarify what I hear you saying, because if it's not what you're saying, anything I say could be totally inaccurate-- could lead to you doing something unsafe.
If your back pain IS musculoskeletal back pain, then NSAIDS (naproxen, ibuprofen) are appropriate for it. If you can keep food down and lack bleeding or kidney problems, 800mg ibuprofen, every 4 hours as needed, is appropriate (6 hours is safer, but in the absence of other risks, 4 hours is safe). You can add acetaminophen to this, if you're not taking any drugs containing acetaminophen and you don't have any liver problems. In the US, current recommendations, I think, are <3.2gm acetaminophen daily, so call it 650mg (2 Tylenol) every 8 hours.
Ibuprofen is an NSAID, which is the same category as Aleve (naproxen), so you shouldn't take both at once. An alternate to either is Toradol (ketorolac) which does work better. If you take Toradol, don't take ibuprofen or naproxen. Take 20mg, and then take another 10mg every 6 hours.
Skeletal muscle relaxers are also appropriate, and safe to take in conjunction with NSAIDs or acetaminophen. They may be considered a controlled substance. In my experience, the most common is Flexeril (cyclobenxaprine). If you can get this, and need it, take 10mg every 8 hours. There are other options, but don't combine them.
Ultram (tramadol) may be controlled, or may not be. Some formulations include acetaminophen, so don't take with other acetaminophen products. Take 2 tablets (75mg) every 4 hours as needed for pain. Don't take if you're taking other opioids.
Explore non-pharm pain relief. Ice packs and heat packs can relieve back pain. Use either, depending on convenience and availability. Apply for 20 minutes at a time, as often as you find useful.
Distract yourself. Watch TV. Get a good bed, if you can. Some people have found marijuana useful. If that's available to you and effective, that's fine. It has no drug interactions with any of the drugs I've mentioned. Alcohol is probably more effective for most than any of the drugs I've listed. That's fine too. It has some drug interactions, so skip the meds or post if you're going to use alcohol. If there are other illicit drugs that you have access to, let us know, and we can probably figure out if they are safe and/or effective.
Whatever you decide to do, ask your pharmacist about drug interactions and instructions. My go-to for drug info is www.rxlist.com. Look at it and make sure everything's safe.
If your abdominal pain is not controlled, there are other options. Like I said, this is in the assumption that your back pain is the problem, not the abdominal pain. There is the potential that either pain is more serious than you give it credit for. These pharm recommendations are only given if you're sure that you know what's going on. (Because back pain can be a heart attack. Abdominal pain can be an aneurysm, in which case NSAIDs are a bad idea. Etc.)
posted by nathan v at 11:20 PM on December 2, 2010 [6 favorites]
Oh, and if you have any problems with understanding English, please say so, and folks (including me) will say things more simply and more clearly.
posted by nathan v at 11:22 PM on December 2, 2010
posted by nathan v at 11:22 PM on December 2, 2010
I am neither a doctor nor your doctor, but I do suffer from back problems and have been prescribed various muscle relaxers, including Flexeril. They do work but just be aware that they can GREATLY mess with your stomach and cause vomiting if you're not careful. They might not be the best idea if you're just getting over a stomach related issue.
posted by katyggls at 12:58 AM on December 3, 2010
posted by katyggls at 12:58 AM on December 3, 2010
Oh you poor thing. I was able to buy Panedine Forte over the counter in Vietnam. I needed it for really bad period pain and ran out. I just wrote down the ingredients (formula?) on the back of the packet, showed it to the pharmacist and mimed clutching my stomach. She gave me another medication and pointed to the packet to show me the formulation was the same. It's Paracetamol 500mg and Codeine Phosphate 30mg FWIW. I did the same thing with antibiotics and Immodium in the wake of some minor stomach bug, so this strategy might be worth a try whatever you decide to try and get hold of. This was in the centre of Ha Noi. I'm assuming you're an expat... (apologies if I'm wrong). Could you shell out to go to one of the international clinics? They were about USD $100 when I was there, but could be better than waiting if you've got the cash.
posted by t0astie at 3:36 AM on December 3, 2010
posted by t0astie at 3:36 AM on December 3, 2010
Oh! I see from your profile you're Canadian and in Saigon. I think actually, you'd be able to find an English speaking pharmacist without too much trouble. Or ask a Vietnamese friend who speaks good English to go with you. Other friends who needed medical supplies but didn't want to go to the doctor did this and the pharmacist prescribed as well as dispensed. Caveat: I kind of got the impression that pharmacies were sick of Westerners trying to score Valium and strong painkillers, so maybe try in a non tourist area (somewhere other than Pham Ngu Lao) and be prepared to explain your symptoms.
posted by t0astie at 3:48 AM on December 3, 2010
posted by t0astie at 3:48 AM on December 3, 2010
I very much doubt they will have fentanyl but try and ask for hydrocodone or oxycodone - it's likely that some pharmacists will give it to you, especially if you explain your problem.
If not, you can almost certainly get hold of tramadol in Vietnam and it will be dirt cheap.
If not, get codeine or dihydrocodeine (preferably without other painkillers added in).
If not, and this is a last resort you shouldn't come to in Vietnam, take ibuprofen and paracetamol.
Don't take cannabis, it will not help with the pain and will probably make you feel worse.
How far are you from Cambodia?
posted by turkeyphant at 3:51 AM on December 3, 2010
If not, you can almost certainly get hold of tramadol in Vietnam and it will be dirt cheap.
If not, get codeine or dihydrocodeine (preferably without other painkillers added in).
If not, and this is a last resort you shouldn't come to in Vietnam, take ibuprofen and paracetamol.
Don't take cannabis, it will not help with the pain and will probably make you feel worse.
How far are you from Cambodia?
posted by turkeyphant at 3:51 AM on December 3, 2010
and you mnay find many of these preparations such as voltarol, naproxen, etc., availible as suppositories which will help your stomach
posted by Wilder at 3:54 AM on December 3, 2010
posted by Wilder at 3:54 AM on December 3, 2010
Ibuprofen makes my blood pressure skyrocket and gives me rebound headaches just from the recommended dose. And I am a normal and healthy person. Don't take 800 unless you know what you are doing, it sounds dangerous to me.
Be aware that codeine tends to cause constipation, so watch out for that.
Why not just ask the pharmacist?
posted by gjc at 5:54 AM on December 3, 2010
Be aware that codeine tends to cause constipation, so watch out for that.
Why not just ask the pharmacist?
posted by gjc at 5:54 AM on December 3, 2010
Ibuprofen makes my blood pressure skyrocket and gives me rebound headaches just from the recommended dose. And I am a normal and healthy person.
These two sentences do not make sense together. A normal person does not have the side effects you have when taking ibuprofen. If they did, it would not be an OTC product.
posted by kindall at 10:54 AM on December 3, 2010
These two sentences do not make sense together. A normal person does not have the side effects you have when taking ibuprofen. If they did, it would not be an OTC product.
posted by kindall at 10:54 AM on December 3, 2010
These two sentences do not make sense together. A normal person does not have the side effects you have when taking ibuprofen. If they did, it would not be an OTC product.
gjc may be an otherwise normal and healthy person who has a hypersensitivity to something that's in ibuprofen. People die from eating peanuts, after all--hypersensitivies and allergies don't make one not "normal" or not "healthy" as long as one avoids the triggering substances.
But I totally agree that that is a very unusual reaction to a medication that's extremely well tolerated by the vast majority of people using it.
posted by Sidhedevil at 6:29 PM on December 3, 2010
gjc may be an otherwise normal and healthy person who has a hypersensitivity to something that's in ibuprofen. People die from eating peanuts, after all--hypersensitivies and allergies don't make one not "normal" or not "healthy" as long as one avoids the triggering substances.
But I totally agree that that is a very unusual reaction to a medication that's extremely well tolerated by the vast majority of people using it.
posted by Sidhedevil at 6:29 PM on December 3, 2010
I also live in Vietnam, and my go-to strong painkiller is Codeine/Paracetamol. Most easily available as Efferalgan Codeine effervescent tablets (500 mg paracetamol, 30 mg codeine). Non-effervescent Dafalgan Codeine is also available, but less common. I believe that there is now a law that requires a prescription for opiates and benzodiazepines, but it doesn't seem to be regularly enforced. (Note that Efferalgan is also available in paracetamol-only.)
posted by Etaoin Shrdlu at 9:23 PM on December 3, 2010
posted by Etaoin Shrdlu at 9:23 PM on December 3, 2010
This thread is closed to new comments.
posted by miss_kitty_fantastico at 9:44 PM on December 2, 2010