A discussion of all the different medications that interact to greater and lesser extents with Coumadin is beyond the scope of this blog. However, the take home point here is that Coumadin is not an absolute contra-indication to many pain medications. Being on Coumadin does mean that your doctors will need to confer and carefully consider which is the best pain medication for you that will be safest and most efficacious. Taking any pain medication can have risks, but living in chronic pain also has its risks; risks associated with immobility and pain.

Once you start a new pain medication, your doctors will simply need to more closely monitor your bleeding time (INR) to make sure your Coumadin is maintained at a safe and steady dosage.

What happened with Mary? After talking with her doctor, I started her on a Lidoderm patch, which is a topical anesthetic patch. The patch reduced her pain enough for her to get physical therapy. I talked with her about nutrition, but she was not interested in changing her diet or taking any supplements. I also gave her a medication called tramadol (Ultram) to help her sleep at night. Her INR was monitored by her cardiologist and was not affected by the treatment.

After six weeks, she finished her physical therapy and her pain was at a pain level of 3 on average. She no longer needed the tramadol. She continued to use the Lidoderm patch occasionally but overall was feeling much better and was able to play with her grandkids in the backyard -- something she had not done in years.

Are the above medications appropriate for everyone on Coumadin? No. Only your doctor can tell you what medications may or may not be appropriate for you. There are many contra-indications and every individual is different.

My goal in this blog is to empower patients who may be on Coumadin to talk with their doctors about what pain medications may or may not be right for them. If your doctor says that nothing can be done for your pain because you are on Coumadin, make sure you get a full explanation and probably a second opinion.