opiates for pain

Hi all. For all of you that have had a bad injury or experienced chronic pain in the past, What meds have you been prescribed? and what have you found most effective?

Codeine and tramadol are obviously the most common ones, but i'm wondering about the less common....I've had a painful tear of the lateral meniscus in my knee and have been seeing my gp for pain management for a few months. I've also had an opiate addiction when i was younger. so i've personally used quite a few opiates

When it comes to strong pain relief i've noticed personally and from people i know that Oxycodone is prescribed 90% of the time, Endone or Oxycontin in various strengths... So what other opiates do doctors prescribe?

I've been given Buprenorphine - Norsepan patches which wasn't effective....
and have even once used Dihydrocodeine - Rikodeine for pain relief!

Hydrocodone - Vicodin.... we don't get this in Australia?
Hydromorphone - Jurnista ER - apparently gp's prescribe this here?
Oxymorphone - Opana ? from what i've read we don't get this

Fentanyl - has anyone had this prescribed for chronic or breakthrough pain?

Hydrocodone we don't get, I'm pretty sure same with oxymorphone... hydromorphone not sure, I've maybe heard of it in a hospital setting or something.

Fentanyl... I think leftwing was prescribed that once?

Fentanyl - has anyone had this prescribed for chronic or breakthrough pain?

Click to expand...

A close friend has been on patches for ~ 21/2 years now for chronic back pain. He's now on the highest dosages and finds it's no where near as effective as it once was. Due to the dysphoria it creates, he was prescribed Venlafaxine about 6 months ago. Trouble is, when fentanyl no longer relieves him, he'll have no other choice but to be prescribed morphine, and as he's only in his mid thirties his dr is naturally reluctant to prescribe that just yet.

phase_dancer said:

A close friend has been on patches for ~ 21/2 years now for chronic back pain. He's now on the highest dosages and finds it's no where near as effective as it once was. Due to the dysphoria it creates, he was prescribed Venlafaxine about 6 months ago. Trouble is, when fentanyl no longer relieves him, he'll have no other choice but to be prescribed morphine, and as he's only in his mid thirties his dr is naturally reluctant to prescribe that just yet.

Click to expand...

Thats interesting, but unfortunate for your friend. so the strongest patch releases 100 micrograms of Fentanyl an hour.... thats a lot! if my calculations are correct that is the equivalent to taking 200 mg of Oxycodone a day.

Was your friend taking Oxycodone before the Fentanyl?

No he went from really high doses of Tramadol to bup, which left him in a rather serious state of withdrawal. His dr is the veterans doc in this area, (my friend's ex Navy) but surprisingly, the dr didn't seem to have much else to offer at the time. I recommended he ask about fentanyl, which at first allowed him to move around like he hadn't in years. Sad it was so short lived.

Mr Blonde said:

Hydrocodone we don't get, I'm pretty sure same with oxymorphone... hydromorphone not sure, I've maybe heard of it in a hospital setting or something.

Click to expand...

hydromorphone i'm interested about. i believe jurnista was added to the PBS in may 2009 which is a extended release form of hydromorphone. obviously not commonly prescribed, but i have read that it is being considered for opiate replacement therapy

phase_dancer said:

No he went from really high doses of Tramadol to bup, which left him in a rather serious state of withdrawal. His dr is the veterans doc in this area, (my friend's ex Navy) but surprisingly, the dr didn't seem to have much else to offer at the time. I recommended he ask about fentanyl, which at first allowed him to move around like he hadn't in years. Sad it was so short lived.

Click to expand...

Tramadol to Bupe is ok if you're not in a lot of pain, and you don't have any stronger opiates in your system.... but in my experience Bupe is not good for pain relief, but does have a nice opiate recreational value to it.... and personally think its a great drug for heroin addicts, i can't believe methadone is legal! the government needs to re think that one.

From what i was reading was basically saying the reason for considering jurnista ER(Hydromorphone) for opiate replacement program was much better quality of life than methadone.

Regarding your friend, he sounds like he's in an awkward situation... maybe he can get morphine prescribed? He shouldn't have to be taking an AD because of the Fentanyls effect on him, although i personally take Mirtazapine myself and think it's great after trying so many other AD's

Regarding your friend, he sounds like he's in an awkward situation... maybe he can get morphine prescribed?

Click to expand...

The problem is his condition isn't directly life threatening, meaning he could well live for 40+ years. If he goes on morphine now, his quality of life down the track will be shit if he has to up his dose as he's had to do with past medications. The effexor worked great for him for the first few months, and tbh, he sounds ok atm, but that stuff can be nasty on it's own, so we're hoping he's one of the lucky ones for which it continues to work.

^^^^

maybe suggest to your friend to look into Hydromorphone.... like i said the PBS approved this recently and from what i've read it seems ideal for your friend. It seems like a realistic alternative given your friends condition and i wouldn't think there'd be a problem. either way, your friend deserves quality of life and i hope that he does find a good solution

one Jurnista ER(24hours) 64mg tablet is the equivalent of 131.5 mcg/hr of Fentanyl.... Although i've had nither, i'd imagine that the Hydromorphone would be a lot superior from what i've read. just something you might find interesting


from wikipedia

Hydromorphone is used to relieve moderate to severe pain and severe, painful dry coughing. Hydromorphone is becoming more popular in the treatment of chronic pain in many countries. Hydromorphone displays superior solubility and speed of onset, a less troublesome side effect profile, and lower dependence liability as compared to morphine and diamorphine (heroin). It is thought to be 8-10 times stronger than morphine, but with a lower risk of dependency. Hydromorphone is therefore preferred over morphine in many areas ranging from the emergency department to the operating suite to ongoing treatment of chronic pain syndromes. However, other studies have suggested hydromorphone is less than twice as potent as hydrocodone or oxycodone and therefore just over twice as strong as morphine via oral administration.[3]

Hydromorphone lacks the toxic metabolites (e.g. norpethidine) of many opioids related to pethidine and some of the methadone and tends to cause less nausea than morphine. It is a common alternative for those who tend to have hallucinations from fentanyl administered in the form of skin plasters and other dosage forms.

In addition to the above, hydromorphone usually proves to be the first alternative of choice to morphine and fentanyl in severe chronic pain

Click to expand...

Yeah, thanks Sublimit, I'll look into it and will definitely mention it to him.

Haven't heard of any fentanyl prescriptions personally, most I know about this substance is a few folks dying from taking heroin it was laced with (not here though, overseas)

leftwing will be one of the better authorities on the subject matter... if you dig up (so to speak, don't think you'd have to look far!) some of his recent threads you may get some indication

Sounds like a rather unfortunate predicament for your friend p_d, on a side note

yeah all the hydro-opioid analogues look grand infact.. superior in everyway to their counter-parts.. especially in terms of pain relief, and euphoria

Sounds like a rather unfortunate predicament for your friend p_d, on a side note

Click to expand...

Yeah, not so good. He was once an aspiring DJ, and a good hand on a sound and lighting crew. But he has a fabulous wifey and unconditional support from his friends, so things aren't too bad.

hi i just wanted to add that im currently taking jurnista for pain 20mgs and it works albeit u dont get high, but it does work for pain, would like to increase tho to 32mgs, i think that would be ideal for me but i have to convince the powers that be this

elz said:

hi i just wanted to add that im currently taking jurnista for pain 20mgs and it works albeit u dont get high, but it does work for pain, would like to increase tho to 32mgs, i think that would be ideal for me but i have to convince the powers that be this

Click to expand...

Wow! this is the one that i'm most interested in... especially for pain relief..as you say it works great. If you don't mind me asking... were you on oxycodone before, and what pain was the jurnista prescribed for?

20mg of Hydromorphone 24 ER jurnista is the equivalent of taking 40 mg Oxycodone twice daily which i think would be perfect for my own pain atm in a perfect world! ive a good relationship with my GP so who knows...

Sublimit said:

hydromorphone i'm interested about. i believe jurnista was added to the PBS in may 2009 which is a extended release form of hydromorphone. obviously not commonly prescribed, but i have read that it is being considered for opiate replacement therapy

Click to expand...

dilaudid is available for prescription in australia as well. the jurnista are the new OROS system to deter abuse. i hadn't heard about it being considered as part of the ORT scheme, do you have any links to that? i've wanting to mention the jurnista brand of hydromorphone to my doctor for a while now - although i would prefer dilaudid

Sublimit said:

Hi all. For all of you that have had a bad injury or experienced chronic pain in the past, What meds have you been prescribed? and what have you found most effective??

Click to expand...

as i've answered in another thread i've used (in this order, i'm only 24 btw)
NSAIDS

Codeine/doxylamine succinate - not a write off like it get's. if it were supplied more liberally in its pure form it would save a lot of peoples livers. good for breakthrough

Tramadol - great, even when my tolerance is through the roof to other traditional opiates.

Norspan - Buprenorphine Patches - worked brilliantly! max dose, had allergic reaction to silicone in the adhesive so changed to

Durogesic - Fentanyl - again i had a problem with the adhesive. opiates being water retentive i sweat a lot more on fentanyl than most other opiates in general and had trouble with the adhesive working properly. i tried many makeshift ways of taping them on. worked fantastic, best with bupe. was able to stay on a stable dose for most the time without raising dose that often.

Oxycodone - started on oxy for a couple of months until my doctor recommended switch to morphine. worked great, tolerance builds rapidly though

Morphine - currently been on it for around 5 months but have slipped further into addiction than ever - picked up a nasty IV habit on top. i find i also still use scripted Tramadol for pain along with codeine, muscle relaxants and benzodiazepines. the morphine class of drugs work well in regards to my pain. only problem with codeine is i have to redose 4-5 times a day which adds up to a 20 pack of pure 30mg tabs - not viable for around the clock, but good for breakthrough.

i'd rather be living pain free, dependent and addiction free.

@Leftwing hey i didn't realise dilaudid was avalable here... regarding jurnista being considered for ORT well i know it is in some European countries and from reading http://en.wikipedia.org/wiki/Hydromorphone#Formulations this (second paragraph).... but i can't find any information about it being used specifically for ORT here yet.

I'm sure your doctor would be well aware of hydromorphone and jurnista for chronic pain maintenance, you should ask him! I recently went from 5mg oxycontin to 10mg for my knee injury, but when i see him next i'm going to be asking about jurista for sure.

Thanks for your summery BTW, you seem to be in a great deal of pain to be prescribed some of those, what sort of pain are you suffering from if you don't mind me asking? sorry to hear about your tolerance to morphine and IV habit developing... I know about that all too well as i'm now 27 and first IV'ed heroin when i was 21, but never had an experience with opiates prior to first using heroin... my interest in other opiates is a result of myself trying to suppress my addiction to heroin. with the 10mg oxy i bought some wheel filters and some 3ml barrels and gave them a go, but really isn't worth it unless i was given stronger oxy pill... i've never had morphine(only the small amount my liver makes me when i use codeine) but would like to someday try it... do you get MS contin? i think someone offered that to me once but i didn't know what it was at the time!

I agree that tramadol is good and find it useful in decreasing my tolerance to stronger opiates as it has good analgesic property's for me, but almost no recreational value IMO

what you have to consider about hydromorphone when taken orally its very poor ive had the jurnista 16mg tablets and your right there virtually anti-abuse proof rock hard coating on outside when sliced in half half the pill is grey filler i think other half is waxy white you can only eat them i know we are not talking about abusing meds but for people with chronic pain i still would have oxycodone hands down than oral hydromorphone

megawoof said:

what you have to consider about hydromorphone when taken orally its very poor ive had the jurnista 16mg tablets and your right there virtually anti-abuse proof rock hard coating on outside when sliced in half half the pill is grey filler i think other half is waxy white you can only eat them i know we are not talking about abusing meds but for people with chronic pain i still would have oxycodone hands down than oral hydromorphone

Click to expand...

Thats partly why i'm interested in it, because being a recovering H addict i tend to abuse things like pharmaceutical opiates. with a recent scrip of oxy i was snorting, iv'ing and even stuck em up my arse... just because i could, and subsequently went through 60 10mg pills in 4 days, but with this Jurnista pill, there wouldn't be the urge to do any of that, just take it as prescribed and responsibly... However, i read someone say in another forum that they can be abused by putting the pill in a cup of water for several says and viola! evaporating the water down to a shootable quantity etc.. don't quote me on that. from what i've read, iv hydro is grouse.

So oral hydromorphone's oral bio isn't that great.... how did you find the 16mg pill over 24hrs? from reading your post you seemed pretty underwhelmed

so has anyone been prescribed dilaudid before? i honestly thought that wasn't available here... i guess doctors here aren't going to prescribe hydromorphone as a first line chronic pain med anyway, and i assume the only way would be from not responding well to more traditional opiates, or to ask for it like i'm thinking about doing on my next visit to the gp.

i want to try as many as i possibly can%) responsibly.... and maybe not so responsibly

Sublimit said:

Bupe is ok if you're not in a lot of pain.

Click to expand...

Sorry, but that is bullshit. I have been on many different opiates/opioids over the past 10 years, and buprenorphine is hands down the best opioid I have used for prolonged pain management. (Used every day)

For long term PM you want the following:
1. Low abuse potential;
2. Long halflife;
3. Minimal effects on your GI tract;
4. Minimal effects on your immune system;
5. Minimal effects on your cognitive function;
6. Minimal CNS depression.

If you can find me another opiate drug apart from fent that even comes close to the profile of buprenorphine I would be very interested.

Short acting opiates are fun, but they will end up biting your in the arse... sooner rather than later.