Opioids 50mcg Fentanyl Patch Compared to MS Contin 60mg for Pain Relief/Other?

[King J]

Hello,

Just a quick question. In terms of pain relief/other, what would be best, a 50mcg Fetanyl Patch or MS Contin 60mg?

I was on 100mcg patch before. And then switched to Oxycontin 60mg. Being on OxyIR 30mg, the OxyContin only caused complications raising my Oxycodone tolerance to where I was prescribed 6x per day and didn't want to "pop pills" all day or even increase the 180 per month I receiving. Call me crazy but my back is broke and I want to be functional, no longer an addict (though I do slip up here and there with dope I'm not perfect..).

My injury is over 3 years old. I don't want - though I was offered Opana - to go that route yet. The pops are an option but similar situation with the high dosage Oxycontin.

I was then put on, after telling doctor about Oxycontin 60mg only raising my tolerance to Roxycodone, and they put me on MS Contin 30mg 2x per day. It helped only a little because it affected different areas on my spine the OxyIR didn't, but the dosage was too low. After researching online, I found that MS Contin in itself is 1.5x weaker than Oxycodone.

So, I told my doctor about this and the fact that I don't want to pop pills all day, respectively, unless need be to work and hopefully go to school. I am physically disabled and on disability and the money doesn't cut it, especially without GA - I break even every month because I live in a disabled apartment complex.

The good thing, after researching, is that Fetanyl and MS-Contin goes up and up. I told the doc I was on the 100mcg before but couldn't honestly remember the effectiveness, so they put me on the 50mcg patch to see where that leads.

I know the MS-Contin was very effective combination for my breaks in my spinal cord, chipped disc in neck, and 2 herniated discs in the neck as well as 4 bulged discs in the neck. I'm going to get an MRI of my entire spine because there is pain in the mid spine as well.

Due to my age, there are limited options in medication as well as surgery - they said I could be like this my entire life, and at 22 (just turned it!), I'd like to have a relationship and healthy sex life - that's not looking too good.

I've been on Dilaudid, but it had no relief even the 8mg. My only options are MS Contin or the patch so I requested the patch after saying MS Contin did work, but then again it's 1.5x weaker than Oxycodone. And again at least MS Contin and Fetanyl go up and up in dosage and over the course of my life, there will be options for me to increase dosages.

Suppose the 50mcg patch doesn't work, and even 100, where do I go for MS Contin. Again my tolerance is high, and I'm not good at math, so 60mg OxyContin, so what would that equate to in MS Contin since MS Contin is 1.5x weaker. I was switched from OxyContin 60mg to MS Contin 30mg and was taking more than I was supposed to? Honestly should I ask, if the patch doesn't work even at 100mcg (I want multiple patches as I get older for options, just in case), should I ask for MS Contin 60mg? That still doesn't equate to 1.5x OxyContin 60mg in strength; or should I just be bold and ask for MS Contin 100mg? Again these are medications that go up and up and have options for people like me to get out of bed, work, and go to school. That's what I want; i want to be PRODUCTIVE again. I regret the cliff diving accident and then being a passenger in a motor vehicle accident 2-3 months later (had NO idea the girl driving was intoxicated, saved my own life by cutting the wheel as she nodded). With MS-Contin, I believe it goes up to 200mg and then there's Morphine injectable medications as well as pumps that I could get surgically implanted.

Please give me your thoughts. This is very frustrating. With my new doctor, I stuck on 30mg OxyIR for 4 months and kept running out early due to pain and waking up in the middle of the night without it. There is of course a profile with my age so I tried to stick it through until finally gaining enough courage to explain the situation, tell/show the medications I was on before, my tolerance, and pain scale. This is a worse-case scenario so please don't judge. I hope the patches I have right now will help for 6-12+ months.

Advice/expertise appreciated. And do note, I've tried physical therapy but it's limited and they can't do anything due to the extent of my injury. After being flown by helicopter to a hospital about 35-45 miles away, I was told I'd never walk again. It's been a battle; I've thankfully relearned how to walk in my own way, been instructed to wear my hard-shell back brace within the past couple months at least an hour per day (before that, it was 24/7), and sometimes have to use a cane. Weather, like rain or cold or snow, really affects my pain scale as well.

Just looking at the best solution since surgery doesn't seem like an option and I'm stuck with 3 breaks in my lower back for 3+ years, damage throughout my neck, etc, and trying to get medication that is strong but "has no limitation" as I age as stated above.

 

[Ike69]

Your injury is very similar to mine. I crushed 1 of my vertabrae (L4) and I let them do a fusion where they took bone from my hip and basically fused the broken part of my back to the area above and below. Instead of helping with the pain it inceased the pain 100x. I have been on many different pain meds but what worked best for me is the MS Contin at whatever dose works for you with oxycodone IR for breakthrough. My doc gave me 2 week scripts and kept bringing me back to play with doseages till my pain was taken care of. Good luck with everything and feel free to contact me with any other questions you may have.
PS Careful with that hard shell case. I found that it weakened my muscles (muscle atrophy) if I used it much. I'm not saying go against what your doc says, maybe just ask him

 

[phatass]

from what i've heard/read Fentanyl is very potent for painkilling properties, and low rec. value, and you just put the patch on your skin (arm or whatevers easiest....) and it dffuses a regular steady amount of fent into your system for 24 hours..... gets rid of the popping pills all the time and relieves pain;;. you might have to adjust the dose of the patch but thats between you and your doctor,... just like a nicotine patch just stick it on you bisceps or sumn.....

àIke69, yes some breakthrough painkiller could be necesssary, àking J, you would have to work out whats best for you with a doctor

 

[tricomb]

^Fentanyl patches are designed to release fentanyl citrate over 72 hours.

I'm confused. Why would they replace 60mg OC with 60mg MS ER? Taken orally, oxycodone is twice as potent as morphine, but intravenously, morphine is twice as strong as oxycodone.

I'm not sure why your doctor didn't prescribe an equipotent dose of morphine, but by my calculations you should have gone to at least 100mg morphine ER.

Morphine, oxycodone, and fentanyl all have virtually unlimited pain killing potential provided your body can handle the side effects and CNS depression, but it usually requires ever-increasing doses.

I think you should try the MS ER before the patch, save the patch option for when all else fails.

 

[brutus]

^ Agreed. fentanyl should be an absolute last result for any type of chronic pain.

I can't even begin to count how many people I know that have died from fentanyl. I hate the shit to be honest.

 

[phatass]

^Fentanyl patches are designed to release fentanyl citrate over 72 hours..

Yes, you're right to add that a fent patch can last over 72 hours, i was just usng the comparison of having a fent patch on your arm 24/7 for steady, constant release of the same amount of fent into the system a opposed to "popping pills" which can be habit forming alone (eg. same applies to benzos, barbs, amps...).

I ave never tried fentanyl, but worn as a patch i would imagine it being less habit forming than "popping pills".... like the movement you make when taking a drag of a cigarette IMo one's brain anticipates relief, therefore popping pills does have it's addictive side to it because the brain may start to desire, want or "fiend" for the movement one makes when popping a pill, knowing the movement leads to anticipation, and eventually reief....

but thats just my opinion

regarding the potency of fent and the long release, there is a huge danger in misuse of the patch (maybe because of not getting enough pain relief which could lead to sucidal thoughts tendecies) , which is extremely dangerous, and has caused many OD'es

 

[tricomb]

Fentanyl patches are extremely habit forming, just as addictive as pills if not more.

However, I do get your point, which is that it's better to have steady levels of medication in your bloodstream rather than constant ups and downs, or peaks and valleys whatever you want to call it. Better for pain relief certainly, but I don't think that it's less habit forming in the slightest, as you get towards the end of the patch you get nasty, violent withdrawals, which is why most people have to rely either on extra breakthrough medication during the transition between patches, or work with their doctor to apply the new patch at a predetermined time before the old patch runs out.

 

[RedRum OG]

In term of physical addiction, fentanyl can only be rivaled by maybe methadone. I saw a guy in detox kicking fentanyl and good god he made my 1g dope+ 300mg oxy a day habit look like a vacation detox

Your doc messed up with conversion, if you had 60mg oxy a day you should've gotten about 90-100mg morphine. Morphine is the golden standard for painkilling properties, and IME less mentally rewarding than oxy (less "high"). Morphine ER can last a very long time IME, especially if you drink some white grapefruit juice 6 hours after taking morphine, will revive the effects, in a pretty strong way, so be careful. Also this will raise your tolerance, so don't make it a habit. Before I got into dope, one morphine ER taken in the AM and small glasses of white grapefruit throughout the day afterwards, pain relief will last 24 hrs. But like I said, save the juice for especially painful days, it WILL feel like you've taken another dose, and it WILL boost your tolerance/habit if done erryday

I've got a ruined back too, I'm only 21, feel your pain man. At this age we should be out getting laid, partying, socializing, but eh.... Opiates help ya forget. Good luck man

 

[tentram]

yeah, the (1x) 60mg oxy to (1x) 100mg mscontin is the right change. i made this transition going back a few months now. though was taking 60mg oxy b.d so naturally am taking 100mg morphine b.d. they're equipotent in terms of analgesia when taken as directed,

 

[tricomb]

^Totally, I would even go as far as to say 60mg oxy should go to 120mg morphine.