Meds for pain

[PEdroelfufu]

Wotcha guys.
At the moment I'm being prescribed pain meds for a slipped disc and nerve pain, I have been for over a year now. The problem is that the pain meds magic is stopping & rapidly at that
Daily meds are:
3 x 15 mg Oxycontin ER
5 x 10 mg Oxycodone IR

The Er is labelled as 12 hourly....big load of balls....8 hours max, sometimes even struggles to do that.
I'm chucking the IR down and there seems to be no noticeable effect until I hit quite a high doseage, my quack would have an embolism if he knew I was doing that.
Morphine gives me god awful headaches as we've tried using that to contain the pain.
My questions are has anyone been prescribed hydromorphone?
Would that be the next logical step or would it be an increase in oxy?
Has anyone ever had a rapid drop in effectiveness from pain meds?

 

[jaspersilence]

You are on a scary road my friend...I know back pain is no joke,but you cannot rely on the pills...DO NOT graduate to hydromorphone.I would actually recommend asking your doc to up your oxycontin to 20mg and drop your oxycodone to 5mg...Just because the buzz goes away,does not mean the pain killing quality does...good luck

 

[PEdroelfufu]

Cheers for the response jasper.
Just to clarify this isn't for getting a buzz, it's for pain relief. I do my pilates, yoga and physio to try and relieve it.
Unfortunately my work involves a lot of lifting in tight areas, if it was as easy as getting a new job I would but unfortunately the economy doesn't allow for that.
Recently the pain killing quality has just dropped off which has baffled me

 

[thixotropic]

(Agreement with Jaspersilence that hydromorphone is not a good idea.)

If you have neuropathic pain, I would suggest something like gabapentin be added. If you have pain from a vertebra pinching a nerve... my sympathies.

So the drop-off in oxycontin pain relief the reason you're scarfing the oxy IR?
Did both drop off in effectiveness, or just the oxycontin?

Did your oxycontin change around the time of the drop-off? Many of us have found that the new plastic reformulation of OxyContin is both far less effective and wears off more quickly.
If you are able to get a generic of the oxycontin, I'd advise you to do so. The generics seem to work just fine.

Best of luck to you.

 

[tentram]

have you been abusing your pills by any chance? i'm not accusing you or anything but if you have that would certainly explain the rapid increase in tolerance. usually it's a pretty steady course when taken as prescribed for most people. a lot of people are able to settle on a dose and have it be adequate long term, perhaps needing the odd dose of BT meds as needed..

you have been on them for a year so i'm certainly not discounting the fact that you legitimately need a raise in dosages.

 

[PEdroelfufu]

I'm using amitriptyline for nerve pain and that works a treat for my nerve pain highly recommend it. The sedating side effects wear off after a few weeks of using it.
No abuse of my pills guys.
The drop off in relief is from the ER & IR and is why I'm smashing the IR as I am. Similar thing happened when I was taking tramadol, which over a period of days just stopped being effective. No abuse there either.
The oxys are still the same brand and formulation (as far as I am aware) as I've always had. They are "Napp" branded if that helps, they are UK market drugs.

From information I have garnered from around the internet a change in opiates can help bring down tolerance of the ones I'm on at the moment.
Why is hydromorphone such a no-no?
Luckily I have an extremely good doctor that listens and was hoping to get some advice from someone less opiate naive (information wise) then myself that I could bring to his attention.
Dislike intensely that I'm on these things but unfortunately shit happens and now just got to deal with it.

 

[twotoomany]

Hydromorphone has low oral bioavailability. It's also, ime, the crack of opiates. The effects are very short lived for me. It's also stronger, but where do you go from there?

 

[Morphling]

Hydromorphone is rather shit, in my experience. I'm so sick of the damn things, but I have no insurance right now, and it's cheap.

Well, that's a while to be on the meds. Tell the doctor you're not getting 12 hours out of your ERs, I never did either. You could try OpanaER, it should have a longer duration. They're available in generics again.

You can get oxy IR's in 15 and 30mg strengths, also, if you're in the US, which I'm assuming you are if you're getting oxy.

 

[PEdroelfufu]

In the UK.
I've mentioned the ER not lasting anywhere near the 12 hours that is claimed on the pack.
Same with the IR, barely last 4 hours, always been the same.
Is this a common thing with oxys?
I've checked the BNF and it seems that oxymorphone isn't available in the UK on script.
Given the fact that hydromorphone is shorter acting, I won't be asking for a try out on them.

 

[Morphling]

No, that isn't uncommon, what you are experiencing. I had to take ER pills thrice daily, as they lasted me 8 hours as well. 4-6 hours is typical for IR oxy, although some people get three. I'm surprised your doctor gave you oxy immediately, that's very uncommon in the UK. You could try fentanyl patches for round the clock pain, and DHC for breakthrough. I'm a pain patient as well, and the trick is finding another med that works for your pain that you are not incredibly cross-tolerant to.

 

[PEdroelfufu]

Definately not immediately, went through the ladder Co-codamol, Tramadol, then the Oxys. I was up to 30mg oxy twice a day last summer plus the 10mg for BT pain. Been a long journey to get where I am at the moment.

 

[Morphling]

Ahh, ok. Well, with pain medications, your only options are to either increase dose(can get oxycontin up to 120mg ER in the uk) or try a different drug.

 

[pasha]

Hydromorphone will jack up your tolerance, and for what?

- Low oral BA
- Extremely short duration of action