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Opioids Pain Managment for Severe Knee Injury

Thanatos

Thanatos

Bluelighter
Joined
Feb 21, 2008
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Ex-staff Ex-crulighter
Hey bl, I've got a question for those who have experience with chronic severe pain. I've had multiple injuries to my left knee including: meniscal tears, extreme strains/torn PCL and MCL, extreme bone bruises, disclocated patella, and multiple severe hematomas.
Going back to the sports medicine orthopedic surgeon on Monday for the 6th or 7th time in the last year (aformention injuries occured in two seperate events)
Im coming up on the 50th day of rehab and things are getting worse. What are my options for pain management? I need some advice before my consultation because of the ineffectiveness of hydro/oxycodone.
Keep in mind that I will most like go under arthroscopic surgery sometime after next week. Any advice is greatly appreciated.
 
Hey entheo,

Other Drugs mainly deals with well drugs and in your case I feel like you are looking for advice on alternative options no? If not then obviously you would be looking for stronger painkillers like hydromorphone, oxymorphone, and fentynal, and/or non-narcotic options like NSAIDs, gabapentin, muscle relaxants, maybe topical anesthetics, and steroids.

I'm not really sure what you are asking so perhaps if you could clarify would could get you some more info or I could move this to the pain management thread (though it is generally for chronic issues).
 
I am simply lookin for the best opiod for severe knee pain, since I'll be going into surgery and have run the course of my orthopedist directed physical therapy. I've strengthened the surrounding muscles, but the debilitating pain comes back after just 10-15 minutes of light exercise, walking, jumping, etc.
I know that certain opiods have a higher affinity for analgesia for different parts of the body; and i would like to know what potent compounds are best for pre and post surgical procedures on the knee when severe pain is involved. I have been on NSAIDs and paracetimol for the last two years, they are no longer an option for my pain management.
Simply put; I need to know what long acting, super potent opiods are best to mask this knee pain.
 
I forgot to mention that I am no longer a canidate for corticosteroids because of their previous ineffectiveness and repeated treatments. My knee has not been healthy since mid march of 2010, and the degenerative effects on the knee structures are building up. Pain management is not going to fix this, but I need some sort of analgesic to control the suffering, insomnia, and depression inducing effects of this pain.
Also, I would appreciate it if someone could walk me through the process of asking my surgeon for these strong opiods.
 
No one is going to be able to accurately predict which opioid will work better for your pain and I have never heard of them targeting parts of the body before. Either way you are going to want an extended release for general management and an instant release for breakthrough pain.

For narcotics stronger than oxycodone... A common combination is Opana ER and Opana IR (oxymorphone) however other alternatives are fentynal dermal patches for sustained release and instant hydromorphone (Dilaudid in the states).

edit:
Also, I would appreciate it if someone could walk me through the process of asking my surgeon for these strong opiods.
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This is not permitted under our guidelines. Simply be honest with your doctor and work together to find a solution that works for you.
 
I'm sorry, I didn't mean to make it seem like I'm shopping for these. I jut don't know how to bring up the fact that the medication prescribed to me isn't working. I'm fairly nervous about it to be honest. I don't know how to ask about changing my medication, under such serious circumstances.
I didn't exactly mean that certain compounds directly affect certain parts of the body, I was trying to articulate the fact that different medications tend to have higher affinities to different opiod receptors in the body, thus affecting what they are indicated for.
Are you privy to intimate knowlede of the combinations you listed? I can't afford anything but generics and I have no experience with anything potent besides morphine and iv dialaudid for post surgical pain in the hospital.
 
I found for me, transdermal fentanyl most effective for an injury i had, for honest pain management and not just getting high. The constant release got rid of up and down in the pain levels vs pills, and the up and down in the psychogenic effects and the adverse effects such as vomiting. (i.e. popping a pill, getting rather intoxicated, maybe throwing up, then have it wear off so you can repeat the cycle)

again, personally, I find ketorolac to be the most effective NSAID, but its very harsh on the stomach.

pregabalin and SSRI's worked for my neuropathic pain better then opioids... Not sure if you have neuropathy though...

chlorpromazine seems to increase the analgesic effect of opiates for me...but that is probably not recommended.

that is just me and my injuries, your mileage may vary.

as for bringing it up; be honest with your doctor and say your still in a lot of pain and could she or he prescribe some kind of change (don't ask for a stronger opiate, just ask for any of the options your doctor feels is suitable) in your pain control regime.
 
Thank you rangrz. Are there any fentanyl transdermal patches in generic form? I really can't afford to pay for trade name medications along with my physical therapy, doctors visits, and surgery.
I am only 19 and my knee is almost as bad as a 50-60 year old. I tend to tolerate opiods very well besides the itching and occasional over intoxaction. So hydromorphone, oxymorphone, and fentanyl are my best options at this point in time? Or would extended release oxycodone in high doses be suitable as well? It takes 50+ mg to get substantial pain relief because of my continuous need of pain relief.
 
I jut don't know how to bring up the fact that the medication prescribed to me isn't working. I'm fairly nervous about it to be honest. I don't know how to ask about changing my medication, under such serious circumstances.
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If you're about to go in for knee surgery for a severely damaged knee and high doses of oxycodone are no longer effective I doubt you have much to worry about. Just be honest, tell him what you've been taking, and the pain you are experiencing. Honestly one of the worst case situations for you is that you build up too high a tolerance so that nothing works and your doc will help prevent that as well as manage your pain.

I didn't exactly mean that certain compounds directly affect certain parts of the body, I was trying to articulate the fact that different medications tend to have higher affinities to different opiod receptors in the body, thus affecting what they are indicated for.
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In practice it makes little difference what the slight changes in affinity for mu1, mu2, kappa, delta etc. are opioid to opioid and the resulting overall effects will be effectively the same. Basically all the full mu agonists are going to work the same with respect to analgesia just some will be more or less potent and some may have worse side effects.

Are you privy to intimate knowlede of the combinations you listed? I can't afford anything but generics and I have no experience with anything potent besides morphine and iv dialaudid for post surgical pain in the hospital.
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Well I've definitely never touched anything that strong but I've modded a forum with a large opioid and pain management content for several months. Again though you're just going to have try the different combos and find what works for you. A lot of it will depend on the experience and training of your doctor as well as prescribing practices in your location.
 
entheo said:
Thank you rangrz. Are there any fentanyl transdermal patches in generic form? So hydromorphone, oxymorphone, and fentanyl are my best options at this point in time? Or would extended release oxycodone in high doses be suitable as well? It takes 50+ mg to get substantial pain relief because of my continuous need of pain relief.
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I dunno about elsewhere, but here in Canada, ratio-pharm markets transdermal fentanyl as a generic.

Hyrdomorphone,Oxymorphone and fentanyl are very potent opioids, but I personally found, sometimes, certain weaker ones with added pharmologic effect where more effective. I'm thinking of the serotogenic ones such as Pethidine(rarely RX'd due to its risks), Tramadol(too weak for your tolerance), and tapentadol. but that was for neuropathic pain where serotogenic properties probably play a bigger role.

As the above poster said, any full Mu agonist opioid will tend to be similar in effect. milligram potency is not everything; Morphine is as good as dilaudid IMO, who cares what the MG dose is, the end effect is really what matters.

you can also ask for a referral to a pain management doctor.
 
My surgeon is very highly regarded as one of the best orthopedic surgeons specializing in sports medicine. He is very conservative about what he prescribes for fear of me becoming overly tolerant prior to the operation, but the pain is continuing to elevate and the structural strength and stability continues to decline. It's just becoming to much for me to physically handle, and the stress greatly increases my anxiety and already severe insomnia.
Thank you so much for the input. I hope this conversation can continue with some other personal experiences and educated information.
 
^ I was not referring to potency on a mg-mg basis, but rather the overal effectiveness of different coumpounds wighing the safe range of the therapeutic index.
Equally potent doses of hydrocodone actually works better for me than oxycodone, so I know where you are comin from. I need a preparation without any NSAID's, so it seems as if the stronger mu agonists are my best bet. I just don't know very many of them prescribed in the US.
 
I don't the RX'ing habits, but you have hydromorphone, oxymorphone, fentanyl, oxycodone, methadone (yes, its used for pain too) buperenophine (not sure if on label for pain in US), levrophanol, butorphanol, just to name some of the high potency opioids in the US pharmacopia.
 
To be honest I wish I could just stop taking them. Recreational value wore off long ago and they make it impossible to keep my weight up. For someone my size, 6'4-6'5, it is a real problem weighing 165 pounds. Thank you sk muh for all the links, information, and experiences.

If anyone could pm me with more any personal expiernces/advice I would be happy to let this thread die and use the alternative sources presented to me.
 
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