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"Best" Opioid for Breakthrough Pain

D

Dope_User

Bluelighter
Joined
Jun 20, 2004
Messages
465
Location
Northern NJ
Hypothetical situation here:

Let's say a chronic pain sufferer is on a regular schedule of high dose opioids (say an OxyContin 80 mg twice daily or 100 mcg/hr Duragesic) but they have occasional breakthrough pain. What are commonly prescribed opioids for this breakthrough pain? And for anyone with personal experience, what opioids do you find work best for this pain?

I think Diluadid is often prescribed for breakthrough pain, but I'm just wondering what people find to be most effective (for pain management, not recreation).
 
15 and 30mg roxicodone (IR oxycodone)
30mg MSIR
Actiq
dilaudid

Those are a few off the top of my head. breakthrough meds are totally up to your doc. if you are on mscontin, for instance, then you might get MSIR for breakthrough. if you are on OC's, then you may get roxicodone. i know 2 people, one on OCs and the other on duragesic, and they both get roxi's. i have a friend on massive amounts of mscontin, and he gets MSIR for breakthrough.

i have found, for pain, oxycodone to be the most effective oral analegesic (for myself). i have 1 slipped and 2 compressed disks, and the pain can be excrutiating. but, a pain med alone isn't the best route for me. i need a muscle relaxer too, because a lot of the pain is spasm related (muscles spazzing to protect the area that hurts).
 
I have found that I get better relief with a pain med for breakthrough that is a different chemical than the long acting med. I am on oxycontin tid and I find that 8-12mg of dilaudid gives me better pain relief than a short acting pure oxycodone product like oxyfast or roxicodone. It is really up to you and your doc to find what is best for you though.
 
Hmmm, two seemingly different opinions. If I read the replies right, it seemed like naturalone was suggesting that an IR version of the long acting med is often used whereas Salhareductase believes that a different med is more effective than the long acting med.

To anyone else with personal experience: do you prefer an IR version of your long action pain med or a different med? Please include the long acting and breakthrough meds and dosages.
 
i'm not necessarily saying that the IR version of the same drug is better, but that's what i have seen prescribed more often than not. it seems to me that some doctors like to keep it in the same family. i have seen another person on OCs that got 8mg dillies for breakthrough. for him the dillies didn't seem to do the trick (until he started banging them). also, my friend who gets the MSIR with his MScontin IMs them (don't ask why he doesn't just IV).

so, really, i was just throwing out some stuff that i knew, but not necessarily recommend. doctors are VERY different, and it will be totally up to them. if you're going to see a doctor for pain management, and to get breakthrough drugs, play somewhat dumb. you don't want the doctor thinking that you are seeking a specific drug. you can always take what he/she gives you. then, if it doesn't work, him/her prescribe something different.
 
It would vary from pateint to pateint. There are lot of alternatives. For someones being on a rather high dose of narcotics, I'd say for break though pain, Roxicodone 15 or 30mg, Actiq (fentantyl), Dilaudid (hydromorphone).. which by the way sucks for oral use. I get better pain relief from 2 5/500 Vicodin, than a 4mg dilaudid orally. IV, now thats a different story... MSIR (morphine sulfate instant release), or even some Percocet/Vicodin. Anything really that doesn't have a time release mechanism on it.
 
^I'm not on any long-term opioid therapy, but I am passing kindey stones, and the Doc's won't give me anything better than Vicodin or Vicodin ES. "People seem to enjoy the oxycodone products a little too much, and it can be tricky coming off it". Blahhh, whatever, the hydro takes the edge off...

I wish I could find some heroin...
 
vicodelicious said:
^I'm not on any long-term opioid therapy, but I am passing kindey stones, and the Doc's won't give me anything better than Vicodin or Vicodin ES. "People seem to enjoy the oxycodone products a little too much, and it can be tricky coming off it". Blahhh, whatever, the hydro takes the edge off...

I wish I could find some heroin...
Click to expand...

Christ, that must be so damn painful for you! Why won't they operate to break them up to pass more easily?
 
B/c apparently theyre not big enough for that kind of procedure. I did go to the ER on night and got IV Dilaudid. Wow did that take the pain away. Not to mentiont he intense rush. Wow, that was amazing. But yea, it is painful, and the Doc's wont give me any oxycodone b/c they know of (some) my past drug use history. To be honest, I thought I was lucky to get the hydrocodone...

Kidney stones suck. I wouldn't wish them on my worst enemy...
 
I have heard that Kidney stones can be one of the most excrutiating pains humans can possibly go through. I would have thought that even previous drug use/abuse could be looked past if your requirements are genuine (which i have no doubt they are).

Vico, is it possible for you at all to seek other medical advice? Or is there some kind of record that all doctors can access to find out about your prior drug use? I can understand that maybe you do not want to pursue the doctor shopping regime, which can be tiresome and frustrating, but surely with your condition, compassionate doctors wouldn't be so hard to find??!!??

In any case, good luck with the kidney stones and the pain - i hope someone can help you out soon.
 
Why hasn't the doc suggested treatment with a lithotrypter. It works by producing high intensity pulses of ultrasound that are at the specific frequency to break up the stones (usually calcium oxalate). It's totally painless, and it reduces the pain from passing the much smaller fragments (and it;s cheaper, as it's non-invasive).

For breakthrough pain in the UK, the main drugs used are dextromoramide (Palfium) and dipipanone (Diconal - also includes cyclazine), although fentanyl is starting to come into use as well. If you're in a hospital, and you get breakthrough pain, some nice doctor will come and whack you full of IV diamorphine
 
^ Really? They use diamorphine in the ER in the UK? Wow thats nice. I got IV Dilaudid, and that was most pleasureful.

I'm really just sticking it out with the kidney stones. Yes it is VERY EXCRUCIATINGLY painful. I should be getting more powerful drugs for my pain, but whatever. I feel lucky to get hydrocodone. Maybe I should complain more. And i don't have the $$ or time to Dr. shop. Fuckin stingy US docotrs. I had a friend who had a kindey Stone, and was Rx'd OC 20's for 2 weeks. And i get 5/500 Vicodin... whatever. Life goes on. And it's not like I can't get OC or heroin anyways through other means... *sigh*....
 
in my neck of the woods, the same pain killer is usually prescribed (in extreme cases, oxycontin, and oxycodone IR)...in fact, doctors in this area mistakenly refer to oxycodone IR as "activators" and often tell their patients that this particular drug will better "activate" the painkilling effect. Eg, oxycodone 80mg every 12 hours, oxycodone IR 5mg as needed for pain, not to exceed XXX...and, dont we all know, there is no XXX for bluelighters?

swybs
 
I'm not a big fan of oxycodone or hydrocodone for breakthru pain, they both take about an hour and 20 minutes to really get going and get up to peak effect. That's a long time to wait if you are in severe pain.

If you have really good insurance, Actiq is the fastest acting one on the market. Get good relief within 5-10 minutes with those. It does destroy your teeth though and inflame your gums. It's also expensive as all hell. If you can't get Actiq, they make MSIR in a liquid which works pretty well, and seems to be a lot faster than the oxycodone.
 
SacredNaCl said:
I'm not a big fan of oxycodone or hydrocodone for breakthru pain, they both take about an hour and 20 minutes to really get going and get up to peak effect. That's a long time to wait if you are in severe pain.
Click to expand...

They only take me about 15 minutes to start to take effect. They peak around 30-45 minutes for me. But everyones different I suppose.
 
I thought Diconal was Class A or I or whatever they call it, meaning it was completely illegal. Some guy in saudi arabia was hording some and i was lucky enough to get some of the pills from him. That dipipanone and cyclizine when IVed is good stuff, the shit is like one of those ice-breaking boats for your opioid receptors, it even breaks through my methadone with relative ease. But i think its quite rare to be prescribed anywhere, though i could be wrong. You certainly are NOT going to encounter diconal in the US, you have a better chance finding a bottle of original qualude "lemmon 714s" (no, not the fake ones that have 20mg of diazepam in them). I do think that it is illegal in the UK, but im too lazy to confirm that (anyone care to search?).

In anycase, higher dose actiq work if you chew them up (or if you so inclined to IV them, though it lasts 20 minutes this way, AT BEST). IV dilaudid works, though again short lasting. Diamorphine amps are great for breakthrough pain, if your lucky enough in the UK. And if you doctor is a stupid opioiphobe like most in the US, go get some good old street heroin and fix up a shot, it works surpisingly well for pain, and it lasts suprisingly long. And dont dismiss the power of a good instant release morphine oral solution if the needle is not your thing.

I have kidney stones despite my young age, and ive actually had worse ear-aches (ive had tubes put in 3 times), which supposedly rival the pain of child-birth (over-rated, especially after they get their fentanyl epidural). But ive passed some pretty big, and odd shaped stones, some PARTICULARLY jaged, so it tears me up all inside when i pass them, and i piss blood. I can feel them starting right when they get out of kidney untill they pass.

I know this is unorthodox, but a GREAT breakthough pain control drug is IV ketamine (has to be IV to get the full general anesthetic effect). If you are in immediate pain, a shot of IV ketamine (especially mixed with heroin or dilaudid) really makes you not feel the pain. I IV it during migranes, and its the only drug that seems to help them, and believe me ive tried all the migrane meds, even stadol, which sucks. If you IV, its worth a shot (try to IV sealed vials only, injected cooked powder ketamine is probably a bad idea). The IV ketamine basically feels like you peeled off ALL your skin, and took a bath in concentrated lidocane solution....

And ketogan (ketomibidone) is great stuff IV, but is not very common and is not used in the US.
 
Diconal (actually dipipanone) is a Class A in the UK, but it's sch 2 and still gets prescribed (my dad got some a few years ago), and people manage to come across them now and again, but they're very expensive.
Ketamine gets used in pain management clinics and in burns units, as even large IV doses of diamorphine doesn't adequately control burns pain. Ket also gets handed out for fuck off neuralgic pain (like phantom limb pain).

I believe that the UK is one of the few countries to have heroin in clinical use (as well as some others like dipipanone that other countries have backed away from - most probably DEA influenced)

negrogesic
I read something a while ago that said given the choice between ketobemidone and diamorphine, most experienced opiate users actually went for ketobemidone. Is it that good?
 
What are ketobemidone, diconal, and those other british opioids like? Say, compared to oxycodone, hydrocodone, or heroin? Dose per dose, and subjective high, i mean.
 
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