Q: I recently had to have additional surgery after a total knee replacement. Nothing the hospital gave me for pain helped at all.

My neighbor told me that after her surgery, she had the same experience. Her doctor told her that certain individuals on antidepressants have an issue with opioids not helping with pain. The research was done at Stanford in 2019.

I’m only taking Tylenol, and I am still in a lot of pain. Why don’t surgeons know that antidepressants make opioids ineffective?

A: We are so sorry to learn you are in pain after follow-up knee surgery. We are, however, grateful that you told us about this research (PLoS One, Feb. 6, 2019). More surgeons should be aware of this interaction.

Although opioid-type medications have come under a lot of scrutiny in recent years, they are still the first-line treatment for postoperative pain. At last count, 44 million Americans take antidepressant medications such as bupropion, duloxetine, fluoxetine, and paroxetine. These antidepressants block the action of an enzyme called CYP2D6. This natural compound is essential for activating pain relievers such as hydrocodone, codeine and tramadol (Expert Opinion in Drug Safety, Feb. 22, 2023).

That explains why people taking such antidepressants might not get adequate pain relief from opioid-type analgesics. In addition, they seem more susceptible to post-op delirium and may need longer hospitalization.

Certain opioids do not appear to require activation to work. Consequently, surgeons may want to consider whether a drug such as methadone, oxycodone or morphine might be better for pain relief in patients taking an antidepressant that could interfere with CYP2D6.

Q: A friend shared her happiness with your arthritis remedy of marinating golden raisins in gin. I am an alcoholic. Does the alcohol evaporate out, or is this a prescription to resume my illness?

A: We don’t recommend this remedy for people like you. Although most of the alcohol does evaporate, having gin on hand to soak the raisins might be too much of a temptation.

Some people have found that soaking golden raisins in apple cider vinegar and honey is a good alcohol- free substitute. On the other hand, there are many other remedies for arthritis pain that do not involve alcohol. You might want to explore some of those, which include Certo and grape juice or Knox Gelatine mixed with oatmeal.

Q: I occasionally suffer from excruciating headaches at climax. My doctor said they are “normal,” but I have only developed this within the last few years. What causes this unbearable pain? I am not ready to give up sex. Is there anything I could take to prevent these horrible headaches?

A: First, we would highly recommend a thorough medical workup with a neurologist. Sudden onset sex headaches are not normal.

Years ago, we heard from an emergency physician that it is critical to rule out cerebral aneurysms when people start experiencing sex-related headaches. She warned that ignoring such symptoms could have tragic results.

Sex headaches are not necessarily a warning of something serious, though. Neurologists have a number of preemptive treatment options, including NSAIDs such as indomethacin or a triptan such as sumatriptan (Current Pain and Headache Reports, July 2024).

In their column, Joe and Teresa Graedon answer letters from readers. Send questions to them via www.peoplespharmacy.com.