Opioids Pain Management Regiment

[Jbehcet]

Hi all, first post. I have a rare disease called Behçet's disease and have a very severe version of it. I've needed narcotics for the joint pain since it's onset over the last few years.


I currently take humira which drastically reduces the affect of all pain medications. I've tried every single one except morphine - will there be any difference if I was to try that? OxyContin works OKAY, because my antidepressant happens to increase the levels of oxycodone in my body and oxycodone increases the amount of antidepressant in my body. So far it has worked the best. But by no means do I feel euphoric ever, if anything just tired really.


Overall, my humira dose hogs the 450p enzyme and like I said reduces the effectiveness of my pain meds. I seem to also not have the greatest oral bioavailability due to my GI issues associated with the disease, although I can't guarantee this scientifically.


I meet with my pain management doctor soon and right now am on the equivalent of around 170 mg of oxycodone, through 2x 40 mg OxyContin and 3 8 mg dilaudid. I'm trying to decide if I should put all my eggs into one basket and almost purely switch to OxyContin since it works okay, or switch to morphine either as my IR. For some weird reason long acting pain med OxyContin is absorbed very well in comparison to IR. It must have something to do with my GI? The only issue with morphine is my insurance company may fire back I shouldn't have taken it and cancel my oxy because it's a prior authorization drug. I could buy the medication without insurance for the morphine since it's very cheap.


I'm very sick of juggling my pain by attempting to switch medications so often. It's running me into the ground. Last month the oxymorphone I thought was working well worked so poorly that I went into withdrawal for a very long period of time. It was frustrating.


Overall, I will not IV medications so please do not suggest it. For some weird reason dilaudid doesn't do much snorted for me. I don't snort often and only do it for an occasional high. I use my medication as directed about 98% of the time and never run out early or doctor shop, even after years of narcotics. I don't touch alcohol, so I "treat" myself every once in a while since I generally take less of my medicine than I need since my pain is very severe when I do activities and moderate when I lay down. I snorted the opana once I got desperate, which was the first time I've ever insufflated a medication and it was very strong. Pain was fully relieved and occasionally I nodded from it if done at specific times.


My overall goal is pain management, but if you know a medication combo I could take and suggest that could result in being able to take a recreational dose here and there through a non-iv ROA I'm up for suggestions.

Edit: my doseage can go up by 20% per visit. Easier when I'm using the same type of medication. With the pain meds I'm in right now pain is about a 4/10 when not working/attenuating and 7-8/10 when working/standing/sitting in a shit chair. I'd like to bring it down. I was bringing my dose down to make my parents accept me because they hate opiates. However, unless I'm off them completely they told me they're done with me in December. I get internal bleeding everywhere so NSAIDs are a no-go, I already take a drug for arthritis, and it doesn't help enough even with 3 grams of Tylenol a day.

Thanks all, long time reader.

 

[Kittycat5]

Morphine doesnt require CYP450 enzymes for activation or metabolism so may be an option. You would need quite a bit of it since you are on 170mg oxy equivalent daily.

Theres also transdermal fentanyl and buprenorphine for long acting pain management that may be a non IV option.

 

[Jbehcet]

Morphine doesnt require CYP450 enzymes for activation or metabolism so may be an option. You would need quite a bit of it since you are on 170mg oxy equivalent daily.

Theres also transdermal fentanyl and buprenorphine for long acting pain management that may be a non IV option.

That was my theory with the morphine! I figured for that reason it might work well. Suboxone probably isn't much of an option because I don't think it'd be more effective than regular opiates. Fentanyl I tried and had really bad success with. It did almost nothing for pain, I don't know if it's because my body fat is pretty low due to weight loss from my disease or what it was. The only other opiates I haven't tried are methadone, subutex, and morphine. Methadone and subutex don't seem like strong options when I could just increase my dosage of oxycodone to cover the conflict caused by my humira doseage. Overall though, if I could take morphine and discovered I could take 100mg worth of
morphine to oxycodone equivalent and it helped significantly, I would be very happy. This isn't something I'd like to be on my entire life, but it's the situation I'm stuck in at the moment.

 

[Gyrospeck]

IME, morphine is very effective for long term pain management. I would recommend giving it a try.

 

[Jbehcet]

Has anyone ever taken hydromorphone orally, not had great luck with it, then switch tommorpgine and be very happy with the results?

 

[keeping]

Has anyone ever taken hydromorphone orally, not had great luck with it, then switch tommorpgine and be very happy with the results?

have you tried other ROA of the hydromorph?
for instance, nasally double#s its strength from standard oral.

 

[Jbehcet]

Personally I found it isn't very strong through oral. Further, I found the duration at most to seem like it lasted an hour if I did feel something. I tried plugging it too. That also didn't feel very effective. Orally I've found works alright for the pain, but that's about it. I think in order to feel things I'm gonna need a large increase on my daily opiates through my extended release amount. For some reason ER drugs seem to be less effected by the humira issue.