I would have to wonder if it is so much the medication or the way we ABSORB our medication. With Crohn's (which I have and am unable to comment on UC as I don't have), we obviously have trouble absorbing and digesting, especially if you're like me:5 surgeries in 4yrs, having multiple pieces of bowel removed. Also, if you have short gut syndrome (yes like me) and/or you live in the bathroom (me), then how could we possibly benefit from pain relievers of any kind like the rest of general population.
I was up to 400mg of Demerol every 3-4hours when I was first diagnosed. I have had an uncountable amount of PCA's including while I was in the ICU, these were always used with breakthough injections of toradol and IV pushes of dilaudid when I would max. my pump for the time period or I would have uncontrollable pain.
When I wore out the demerol (which still doesn't touch me now) I switched to morphine long and short acting. I was placed on 40mg every 4 hours, and 40mg long acting 3x day. When Morphine started killing my organs at 23years old, I decided it was time to stop it all together. I tried taking amitryptaline, toradol, tramadol, tramacet, atasol 30's, tylenol 3's and 4's, nerve blockers, anti anxiety meds, anti seizure meds and local anasthetic. NOTHING worked. I was beyond miserable and got so stressed from pain required more surgery. Then I was put on 8mg of dilaudid every 3hours with long acting 3x day and flexerol with an additional sleep aide (as my pain is more severe between 4am and whenever I get up). Unfortunately that stopped working so I was then placed on percocet 2pills every 4 hours with 30mg of oxycontin 2x day. I was miserable! So I stopped the oxycontin and was to date placed on 12 percocets daily, and 25mcg fentanyl patch. I will say my pain is more under control but definitly NOT "under-control". My pain specialist is beyond frustrated with finding solutions to manage my pain! It has also been "off the record" suggested I smoke some marijuana to help alleviate my symptoms including pain.
My tolerance to pain is (believe it or not) fairly high
My tolerance to pain medications, I would think is elevated but not as much as it appears.
How often have we looked down after a bathroom dash (you know you do it) and see (sorry for being to brutally graphic) what you just ate?! It's logical to think the same would apply to your "pills". How often do you have to supplement your diet b/c your guts have decided to no longer absorb B12, Iron, electrolytes, or any other essential nutrient or vitamin? All too often for me!
So if you can't or don't absorb those things then it is very likely you won't with your pills or any medication you may take orally. When you're in the hospital it is usually b/c you just had surgery or are flared up which is excruciatingly painful so it would require MORE meds anyway and they work a little better b/c they are bypassing the gut, and they may not work as well b/c of the increased pain.
My best advice for anyone struggling with pain is to go to a clinic and assess how much of your guts you still have and how well you absorb through your guts, then look at a medication that bypasses the digestive tract (injections, "lollipops", patches),and try that as you may find a significant improvement.
Hope that helps,
GG