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Best Combo for Pain Relief

painenduser

painenduser

Bluelighter
Joined
Jul 13, 2011
Messages
404
Location
NJ
Hey guys, I am asking this question as I need some assistance from those of you who have better experiences then me.

Simply put, What would be the best combination of meds to help me deal with chronic pain due to end stage liver disease. I am in a lot of pain and some Dr's are telling me that the pain I am having would be in the same realm of having Liver Cancer, I mention this to give you and idea the pain Im in everyday.

I am currently taking (been taking meds for the last 2 years.

I was originally at 4mg's Dilaudid every 4 hours, then recently they change me to the cocktail below.

Long acting med:
30 mg's MS CONTIN (morphine sulfate) SR TID

Short acting break though med:
2mg Hydromorphone (Dilaudid) PRN

So my question is that right now the MS Contin does not really help all that much and the dilaudid works great but I need 4mg's PRN to get the best coverage but I have found my self taking more then prescribed because the pain pushes right through the meds. When I take the Dilaudid, it works great but wheres off in like 2 hours and I dont feel as though the MS Contin is doing much of anything.

I am on welfare so I don't have alot of money to have the docs just change my meds around on me, so I was hoping for some insight on other med options. The only pain meds I have ever been on is Dilaudid 2 years now and MS Contin + the small amount of PO dilaudid for only a few months, and because of this I have a tremendously high opiate tolerance

Im trying to find out if anyone can recommend either a better combo, or a change in one of the meds? My Dr is hesitant to make any major ch changes until mt GI Doc give him the clearance to raise the meds higher. However if you guys could give me some new combination idea's maybe with being a little more knowledge he may be willing to make some changes.

So what would you recommend? I'm looking for something that will give me a better longer lasting relief. I have found that snorting the dilaudid gives me a better / longer pain relief, and i dont mind doing that to get better relief but Im not one to really abuse my meds unless it helps me, so shooting or plugging are out of the question. Im interested in your POV experience with better combos.

If yall need me to elaborate on anything let me know, but I'm hoping I gave you enough to make some recommendations.

Thanks in advance.
 
I'm going to move this over to Other Drugs (they'll probably have a better answer for ya), although it may get moved again depending on the OD mods want to do.

B D D - - > O D
 
I personally believe that opioids alone should never ever be used for pain control because the risk of dependence, side effects, and abuse is just way too high. At the very least, for most physical injuries, they should be used in concert with a NSAID.

In your case I would recommend drugs with broader spectrums of action, including NMDA antagonists. Have you tried methadone or ketamine for pain control? DXM could also be used as a synergist - SNRI drugs are known to increase pain tolerance. Cannabinoids could also prove interesting, as well as 5-HT2a psychedelic drugs that act to reduce TNF-alpha.
 
Fentanyl patches are work great for chronic pain, but you have to think about it very well,cause your tolerance will get too much high, and after this is very difficult to get it down,so...Also you will need something for BT pain..Just thoughts...And of course,welcome to bl:)

MartinFn
 
how are you taking your drugs? both morphine and hydromorphone have poor oral BA...if you intent on swallowing your pills, i suggest finding other options for the best relief.
 
It doesn't potentiate pain relief, just the intoxicating effects. It may take down some of the anxiety associated with chronic pain--in this case, liver disease. I wouldn't hesitate to take your Dilaudid nasally, 2mg will almost feel like 4mg orally (PO). However asking for methadone or fentanyl could also work great in your situation, just ask if you can have the Dilaudid PRN. You could also talk to your doctor and just be honest and say your meds aren't doing what you need them too and maybe raise your MSContin, since that would give you better relief throughout the day, not just a higher dose of PRN meds so you're not experiencing peaks and valleys, as this will make it easier to keep the pain under better control.
 
next time you talk to your doc, you could ask him about gabapentin or lyrica. They are both designed for nerve pain but in my experience they numb the whole body slightly potentiating the other painkillers you are on. I think lyrica is a bit pricey since its newer but gabapentin is fairly cheap. If your suffering from end stage liver disease why are you hesitant about going up on meds? is is the doctor?

also, gabapentin is mostly eliminated through the kidneys so that might save your liver some unnecessary work.
 
GABAergic drugs (lyrica, benzos, etc.) would most likely be the easiest to acquire for pain relief potentiation. Talk to your doctor about your dosages if your pain isn't being controlled well enough, he may also have some ideas as for a drug he'd be able to add to your regimen, and/or dosage increases.
 
GABAergic drugs (lyrica, benzos, etc.) would most likely be the easiest to acquire for pain relief potentiation. Talk to your doctor about your dosages if your pain isn't being controlled well enough, he may also have some ideas as for a drug he'd be able to add to your regimen, and/or dosage increases. As seiko mentioned, cannabis may also help greatly if you're in a state with medical marijuana laws on the books, or find a friendly neighborhood pot dealer. Tramadol may be an option to add on to your breakthrough pain meds, as well. The mixed action of the drug increased analgesia, and the long half life makes it useful for just that.
 
I would say crush a30mg ir blue oxy up ur nose ans swallow a morphine. That will take care of your pain for a good 6-10 hours. Have some Xanax on hand to help relax and sleep well
 
I dont like oxycodone at all but it does kill the pain. Like mentioned above, take one 30mg IR Roxi & you dont need to snort them since their BA is very high orally. Plus, taking it orally will last alot longer. Also, dilaudid for breakthrough pain or vicodin (10/325's)


I see you take Morphine 30mgs a pill. I dont see how that even begins to touch chronic pain, if thats what you have. Ive done Morphine & like it & at the begining 25mgs was awesome but after a month or so, you will need between 50 & 100 mgs each time you take a dose.
 
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For pain relief - if you ever switch to oxy, swallow it for a higher BA (than snorting). Morphine is no doubt better to parachute than snorting (not good at all for BA reasons, check out related threads for numbers/percentages). Methadone is great for pain relief, just such a bitch to become tolerant to/dependent upon - and more-so to w/d from. However, if a lifetime or very long term pain condition - it may be worth discussing with your doctor (and to take only by mouth, if in tab form).

For SOME people, things like lyrica or gabapentin work wonders. Do you use cannabis? I find this works well for my (knee) pain in combination with my prescription of oxycodone IR (taken during the day, every 4 hours is how it's prescribed... though, that may not be the frequency of my use *cough*). I also am prescribed clonazepam/temazepam and lorazepam (all from same doc - everything). These help to take any remaining edge off and help me 'relax' and not focus so much on discomfort/s, esp at night.

There are MANY options. Discuss with your doctor that your meds are not cutting it 100% and tell him/her that you are willing to try something new or hear all options. If something doesn't work/feel right/has unwanted side effects for you - just make a new appointment and switch it up again!

Good luck in finding what you need.

*edit* - dilaudid is great. I take it on a regular basis. In fact, I've had 8mg today already (in addition to my prescribed oxy IR). It DOES work well but wears off quickly, which is why I wouldn't ask for it, prescribed. However, if you find it works well for breakthrough pain - great! Keep that and add something that lasts longer (instead of morphine sulfate perhaps try Oxy ER, if an option, or any above/aforementioned medication that combines safely).
 
woamotive said:
There are MANY options. Discuss with your doctor that your meds are not cutting it 100% and tell him/her that you are willing to try something new or hear all options. If something doesn't work/feel right/has unwanted side effects for you - just make a new appointment and switch it up again!
Click to expand...

Not many doctors are willing to try new pain meds. Some will try & help you with finding the right one but ive had doctors before that wouldnt budge after giving you something, no matter if I complained.
 
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