There are ways to manage chronic pain when you’re living with MASH

I start my day every morning by swallowing a handful of pills with water I keep on my nightstand. It has been this way for so long that I sometimes forget what life was like before pill management became part of my morning routine.

The good news is that I have whittled my prescription medications from 21 pills a day to six. The less glamorous news is that I also take two acetaminophen, commonly known by the brand name Tylenol, to manage the chronic pain that has lived rent-free in my body for years.

My doctor has approved that dose, so I can take it without spiraling into panic every morning. Still, I am careful. People with liver disease often have different medication limits, and acetaminophen can hide inside cold medicine, sleep aids, and prescription pain pills. I also avoid aspirin because of bleeding concerns and ibuprofen because of kidney risks. When you have practically held hands with death, following directions becomes less of a virtue and more of a survival skill.

People sometimes ask me to share my medication regimen, especially fellow metabolic dysfunction-associated steatohepatitis (MASH) patients. I don’t share the whole list because we are different people with different bodies, doctors, lab results, and risks. I also don’t want to offer false hope or accidentally hand someone a medical shortcut with a trapdoor under it.

But I am happy to share questions worth taking to your doctor, especially about chronic pain.

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Managing chronic pain

To understand my situation, you should know that I had one knee replaced last fall and will have the other replaced soon. After that, I expect to schedule both shoulder replacements, one at a time, as my family and recovery schedule allow. So yes, my joints are apparently staging a full production of “The Tin Woman.” Still, I have learned that pain and MASH can sometimes be managed together with the right team, the right questions, and a lot of patience.

Before my arthritis became bone-on-bone, movement helped. Swimming and walking reduced my pain and helped me sleep better. That does not mean everyone should push through pain. If your pain is severe, new, or worsening, talk with your doctor or physical therapist before launching yourself into a fitness montage.

Physical therapy (PT) helped me delay surgery for years. It was never instant relief. It was more like learning how to move through the world without setting off every alarm in my body. PT for my shoulders helped until surgery became the only realistic way to keep my arms useful. PT for my knees helped, too, until the options became surgery or not walking. I chose walking.

If surgery is not possible or your pain is still excruciating, ask your doctor whether pain management is appropriate. A pain management clinic can be helpful because it offers monitoring, medication oversight, and other treatments in a clinical setting. When I once considered long-term opioids, that kind of supervision appealed to me. I wasn’t consumed by fear of addiction, but the concern existed. I also needed to know that any medication plan would not create new problems for my liver.

That is especially important for people with advanced liver disease. Some pain medicines can stay in the body longer, cause confusion or sedation, worsen constipation, or raise the risk of falls. Opioids may also increase the risk of hepatic encephalopathy, a serious brain-function problem that can happen when a struggling liver cannot clear toxins well. I have experienced hepatic encephalopathy before, and I am grateful it has not returned in many years.

Before taking any pain medicine, even one that seems ordinary, ask whether it is compatible with your liver disease, your kidneys, your other medications, and your history. My doctors know I will always have questions. I no longer treat that as being difficult. I treat it as being alive.

Sometimes surgery becomes the final answer. I have no regrets about replacing my busted-up knee. I can now walk without pain in that leg, and that kind of relief is not small. It is freedom wearing spendy sneakers.

In the end, I don’t want anyone living with MASH and chronic pain to feel hopeless. What makes sense for me may not make sense for you, and the reverse is also true. But there are options worth discussing: physical therapy, safer movement, pain management, carefully chosen medications, and, sometimes, surgery.

Here’s to finding the relief you need, and to keeping your liver from throwing a tantrum while you do it.

Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.