Opioids best combo?

[malign67]

I have been in the "system" on and off for many years , chronic pain is a real disease and there are many ways to deal with, but my question here is what might be the best combo for all around pain control, day and night.
I am currently on oxycodone 30mg's and ms-contin couple 60 mgs a day, the oxy for breakthrough.
I was put on disability but have started to work again as ... well thats just what you do' But some days ,weeks,months are better than others, sleep is very difficult due to waking up with (out of control pain) this makes for a very unstable work schedule.
So for combo's , as with everything you gain a tolerance ... I back off the med's a bit (when I can) and continue with my next day ect.
Was thinking of switching my Ms- morphine to dilaudid/opana ER , or looking for suggestions, I am trying to hold this job as I have been in construction my whole life and after all the accidents and vehicle wreck's (many) I have no applicable skill's nor the consistency to be hired for a job that does not require me to build' something. ( I just could Never sit or stand like a desk or counter for example) But I want to work even though now it is messing with my disability as I am in review now, but I am very lucky as I am working a job I did 25 years ago with a owner who understand's my scattered working hour's. (building furniture frames) though sometimes I feel this might be a bit too physical but I don't see other alternative, Atm' this work's until I can find a long term plan.
(I am actually not too worried about them taking disability away, though I do have strong issue's about hospital's , I have had some bad experiences and refuse to go even when I should so it's really up to my PM doctor who is very understanding. (though I have to admit he was not happy when I fought and refused the ambulance the police wanted me to go in after a 4-5 car pile up... this was a poor decision on my part I admit)'
This bring's another issue , another "dark-side" about taking pain medication , covering up the problem and possibly not "feeling" when you are causing other injury's or aggravating existing problem's.
Wow' sorry for such a long post' really went away from my topic of what combo might be best for "working PM day and night" I don't take sleeping pill's nor will I , they do the opposite anyway from my exp.
Just want to give myself the best chance while I work on a long-term solution' and before I speak with doctor further as a change Any change can make a big difference for better or worse. Oh my last visit we didnt change anything but I did mention I'm thinking the 30mg oxy is too strong at night and is keeping me up, this is the main reason for post.... hrmmm should have started with that'

 

[southeast]

I had chronic pain issues for years and the biggest problem I had was waking up in pain so I got on time released dilaudid for a bit-- it's got some dose dumping problems so you have to be careful with that. Maybe you could switch to opana or dilaudid Er to see if your body does better with morphine-- mine does. I have to take morphine bases. All my other suggestions aren't very harm reduction like-- I started using heroin. If your getting a prescription and maybe get drug tested that may not be the best but some docs don't care about weed? My uncle uses that to get to sleep and Xanax sometimes, & his doctor doesn't care. He's on disability too but works construction when his breathing is okay.
I know the effects can be rough on opiates. After taking a certain amount in a day I feel like we can all get moody. If your noticing it that's definitely a start though! Just try to breath-- when I would get super pissed on drugs I would usually go sit alone in a bathroom for 20 min and focus on my breathing but that's the only thing I know to do there. There are probably better things.
Good luck, I had good experiences with dilaudid Er and I see people posting on here and know a few opana Er users-- it doesn't hurt to try sonething different if it may get you through the night. Good luck and so sorry-- your story really made me feel for ya. That sucks ass. At least you have a good doctor, man that makes a huge difference.

 

[adicted]

I am Spanish and I know a person in Spain who have severe pain of unknown origin (have done all diagnostic tests and find nothing) treated with narcotic analgesics. It began with NSAIDs (ibuprofen, Dexketoprofen, metamizol ...), then started with tramadol, hence it became tramadol combined with an NSAID and finally came to opiates / opioids powerful. It started with oxycodone until it stopped working after he prescribed hydromorphone and is currently being treated with fentanyl patches for maintenance and for breakthrough pain he takes oral transmucosal fentanyl (fentanyl lollipops called Abstral) and morphine 2 mg./ml. solution called Oramorph.

 

[Cane2theLeft]

There really isn't a magic combination out there to treat pain with. Each patient usually has to try many individually and in combination to find relief. The type of pain matters as well - the most effective for neuropathic (nerve related) pain are by far pregabalin (lyrica) or it's older relative, gabapentin. Lidocaine patches helped me immensely, basically they are 3" x 5" patches that use a local anesthetic and numb that area. You can use up to 3 at a time for 12 hours and then have them off for 12 hours. If you wear them at night it might help the insomnia (specifically waking up) some.

There are many, many other medications used as opioid adjuvants such as tricyclic antidepressants, muscle relaxers, antihistamines, benzodiazepines (which might make a huge difference with sleep issues), SNRI's, NMDA antagonists, NSAIDs and more. All of these can have an 'opioid sparing' effect meaning they stretch the opioids doses and increase the pain relief.

There are many non-pharmacological interventions as well. The most accessible is likely a TENS device (Transcutaneous Electrical Nerve Stimulation). You buy (or your insurance buys) a little machine, you attach little patches and dial the amount of electricity to the optimal amount. Essentially, the brain can only interpret so many signals and if it's receiving the benign signals from the TENS unit, it doesn't process the pain as much - this is why people massage a painful area; the brain can't process as much of the pain if it's receiving interfering messages from the same area. Professional massage and/or PT can be very effective as well. If I didn't do daily PT stretches/exercises, I wouldn't be able to walk without a cane let alone work 30+ hours a week as I do.

Depending on condition, there are many procedures that could be beneficial such as nerve blocks, epidural steroid injections, neuro/biofeedback, spinal manipulation (from a chiropractor), acupuncture - the latter 2 if done by non-quacks because many are.

Check out the chronic pain mega thread in this forum as well. There is a lot of helpful information, you can read about others' experiences and it's really a community within a community of people struggling to find relief.

 

[TheLostBoys]

Do you think your doctor could prescribe you 50mg Zohydro ER pills? Hydrocodone w/o the apap........

 

[adicted]

A good combination would be 15 mg. oral methadone tid, a fentanyl patch of 0.025 mg./hour adherent to the body and 25 mg. dexketoprofen tid

 

[malign67]

This gives me information I didnt have, I went to "pain management offices $250. each time and they all said I needed to find a PM doctor as they are mostly all suboxone/ buprenophine clinics now, this was a few years ago, one sent me out with nothing ,other with morphine to get me by, other with fentanal patches but they wanted $70.00 per, but Ya I have a good doctor just needing to change as with anything you gain such a toleranc, I am currently taking 10 30mg oxycodone, 2 60mg morphine and soma and I do have some zanax and.... ya I really wish there was a magic pill or combo.
I will do some research and bring "mentioned" to my doctor, visit before last he thought I wanted too up my dosage and was surprised when I mentioned possibly lowering them, I have no red flag's other than so many injury's no dirty UA's I was straight up with my doctor "partying days ect."
All my choice to walk away from friends And money as just not the life I wanted for myself, sadly so many injuries didnt really matter as I had to drop remodeling company 3 times, now I dont have the resource's nor well known in construction field anymore ,so I am staying with med regiment as now its such a part of my life'
Just dont want to cause waves' by asking for this medication or that .. then maybe end up going back to what work's now. Round and Round'
Heh both arms broken , ribs from a fall off 2 story house, shattered 2 windshield's spidered another (only one vehicle accident at fault , I wont bother going into wake/snow boarding incident's. I just want my life back and sadly now that I am reporting income, I am getting sent a bill for insurance now ( the one that pay's around $500. for all my med's) probably should have just worked under the table, I hate trying to be honest anymore you get screwed. Thanks people'

"Nobody is perfect ... well there was this one guy, but we killed him" C. Moore

 

[Lorne???]

Methadone for chronic pain, morphine/oxycodone/hydro morphing for rescue.

Seriously, though, methadone fucking annihilates pain.

Morphine is still my preferred(well other than methadone, if we're talking *only* analgesic properties) but a lot of people don't like the side effects, and it's unlikely a doctor would ever prescribe an appropriate dose of oral morphine for breakthrough(at even moderate-high doses, chronic methadone can be 5-10x as potent as chronic oral morphine).

But frankly, if your on a sufficient dose of methadone and morphine, you shouldn't be feeling any pain. That is my perfect pain combination.

(Of course, certain types of pain don't respond quite as well to opioids, but the OP asked about them specifically.)

 

[southeast]

I think different pain reacts to things differently-- I had a bad brain injury and dilaudid was what I was prescribed from the start. It's all depends really-- methadone didnt cut it and I was on 120 mg.

 

[Lorne???]

I think different pain reacts to things differently-- I had a bad brain injury and dilaudid was what I was prescribed from the start. It's all depends really-- methadone didnt cut it and I was on 120 mg.

You were clearly taking it for maintenance at a dose of 120mg. That is different, since it would take about a fucking gram of oral morphine to equal that dose.

But for people without insane tolerances(IE, people who actually take it for pain) methadone is well known for it's effectiveness and long duration. It also has multiple modes of action, and tolerance generally builds slower to methadone.

But of course, everyone is different...