Pain meds and post-op depression

[Maddee]

Is there any connection between the type of pain meds administered post-op to the severity of possible post-op depression? 
I have some choice in the type I will be getting.  Wondering if narco vs non-narco is known to make a difference with this potential side effect. 

[Vidanjali]

There is a connection between narcotic pain killers and depression. The reasons are likely myriad. Opioids act on neurotransmitters to produce the pain killing effect. There's a bit of a hangover phenomenon after taking an opiod in which your body must recover its own chemical balance. When one relies too much on the opioid to feel better, it's as if the body's natural ability to regulate the neurotransmitters becomes atrophied which can make a person feel physically bad. A cycle of dependency can develop when one begins to rely on the opioid to also stave off any unpleasant opioid aftereffects. 

 

However, persistent physical pain can also trigger depression. Pain is stressful to the body and makes healing slower (and potentially more problematic). 

 

So, unless you have had the experience of opioid induced depression before, allow yourself options. Don't try to wait out post-op pain or power through it. It's not good for the body or mind. If you need an opiod, take it. Just remain mindful of any extreme changes in the mood, and if you notice anything alarming, then at that point determine whether you should switch to something else for pain. If your mood is effected by taking an opiod, just know it'll wear off and no permanent damage will be done. And if you have no mood side effects from an opiod, just be cautious to use it as needed and as directed. 

 

One thing to note, opiods can cause constipation, and straining from constipation can cause pain post op. So, if your doctor prescribes an opiod, you may want to ask them if they could also suggest a laxative to have on hand just in case. 

 

Good luck!! 

[VickySGV]

My surgeon's pain protocol only had me on morphine for 36 hours and 24 hours  on codeine, and then all non-narcotic meds at prescription doses., I did leave the hospital with a small supply of Tylenol 3, which, a year later had only had about two hits from it and the rest turned in at the expired meds drop box at my medical center.  Other than the first few hours as general anesthesia you will not have severe pain as a rule, and if you do have the severe pain, you need a doctor to check out what is happening, and not a  Pill.  It did take me 72 hours to get enough food back in my body to warrant a good bowel movement and the opioids did not help, but it all worked out fine in the end.

This is anecdotal, although a few of my Psychologist friends bear it out from their practices, but the post-op depression hits worst several weeks into healing.

You will have gone through a high energy, totally stressed number of weeks before the surgery.  Other post ops here agree that life goes off the rails with the preparation and planning for the surgery that are unlike anything you have done before.  

 

The surgery itself is a MAJOR INJURY, most people do not think of it that way, but keep it in mind and it will help.

For a few weeks after the surgery, you are going to have celebrity status among your family and friends and all kinds of attention that will feel good, but then they forget you are still healing and its get back to business for them and your new solo life starts getting to the point where it is a total chore that you will have to put up with.  In reality, you need to keep an open line to your therapist during this time, which many do not think to do.  Many therapists themselves are getting this message these days and it is helping to prevent the depression that is the cause of many wishing they had not had surgery.

[Maddee]

My first surgery will be major FFS and BA combined.   I'm told, and have read, others accounts of these things, and I am preparing myself for pain.  I don't have a personal history of opioid use, so I am leaning towards narco, with caution.  Thank you @Vidanjali

 

As far as celebrity status goes, I will need to create friends or family in the next couple months for that.  I won't have anyone with me other than paid caregivers.  I don't have anyone to put down as an emergency contact, unless I make someone up.  I'm thinking a lesser known movie character....

I have no social media other than some aqquaintences on trans forums, and might be relying on them more than ever.  Thank you @VickySGV

I will take your advice and keep a counselor close.  We don't really connect, but he's willing to work with me.  Hopefully he will still be my counselor then.

 

Two months after the FFS/BA, I am scheduled for bottom surgery.  I have been told that that can be an easier recovery, and what I think you were answering to Vicky.  Sorry not clear.

 

In any case, I'm grateful to have attention and support here in forum. 

 

And insurance, thru my employer, that will cover all these procedures. 

 

It's been a long time for me since I was "finally" diagnosed with gender issues...in 1999.

 

I'm excited and hoping for amazing life changing results.

 

 

[Jani]

I will not take opiates.  I was given them after surgery years ago and it gave me nausea and made me throw up.  Never again.  Tylenol works for me.  That said we're all different.  With your past history I would be leery of taking opiates. 

 

It is important to take pain meds before the pain ramps up in order for them to work.  

[Maddee]

I don't have any past history of taking opiates.  But I will consider your advice @Jani

[Vidanjali]

1 hour ago, Jani said:

 it gave me nausea and made me throw up. 

 

Speaking of which, @Maddee be sure to take yours with food else you may experience nausea. Nonetheless, some folks cannot tolerate opioids at all regardless of whether they are taken with food. And @Jani is right on - don't wait til you're in hideous pain to take something. Rather take them preventatively according to a protocol as Vicky shared. ?

[Jani]

22 hours ago, Maddee said:

I don't have any past history of taking opiates.  But I will consider your advice @Jani

@Maddee I'm sorry, I miss read the line in your post.  I apologize.

 

Jani

[Maddee]

@Jani
You are so good hun.
I'm lucky not to have fallen into deadly addiction like that.  For a struggle in life, I'll take trans over that anyday