Real Pain patient looking for better ER Opioid, help me out if you can

[isryanthis]

Hello all.

This is my first post so I will try to introduce myself here as quickly as possible with the relevant information. I have a spinal fusion as well as a rod inside my tibia. My arm is also bolted together with plates in four places. Mainly I need opioid therapy for my back, I could deal with the leg and the arm pain but it’s my back with 2 rods fusing four vertebras together that gives me the pain that forces me to use opioids. This was 3 years ago now. I was started on Morphine sulphate ER with Oxycodone IR, that combo did not work and was quickly switched to the good old Oxycotin ER (OC), with doses reaching 40mg 4 times a day ER, and 5MG up to 16 times a day of oxycodone. When OC switched to OP in fall of 2010 I switched to Opana because that plastic OP shit does not work for pain, or for recreational pleasure purposes. Dosing on Opana went up to 40mg four times a day with 5mg IR Oxycodone just 4 times a day. In Feb 2011 I stopped using all opioid in hopes of gauging my real pain level and to see if I could live life without opioids. Four months later I realized I could not have a good quality of live without opioid pain killers. I went back to Opana 10mg 2x a day and 5mg Oxycodone 2 times a day. That rapidly increased to 60mg a day of Opana. And the MAIN PROBLEM was these pills were finding their way into my body in way other than oral ingestion, I never IV anything nor did I put it up the butt, so that leaves you with one option. With Opana having such a low Oral Bio Availability and a high nasal I was forced to keep doing the bad method of ingestion for any pain relief. Tired of having to take these pills in a manner that was not the best forced be to go looking for another pill that I could take orally 85% of the time and the other 15% take it that bad fun way. So I tried OP oxycotin again, useless. I tried this new drug called EXALGO, usless except for the first 2-4 times that you break it open and melt the white part and drink it. I am thinking of trying methadone but if I do that I can no longer take any other opioid medication for breakthrough, being that methadone blocks out all other opioids. I think, right? My pain doctor will want me to stay on a base of extended release medication so I cannot just get 120mg of Roxicodone like I wish I could. So it is going to need to be a mix of ER and IR medication.



To the question.
What other Extended release medications are out there in the United States? Other than Oxycotin OP, Exalgo, Methadone, and Opana

 

[Epsilon Alpha]

Have you looked at non-opioid options? Pregabalin, gabapentin, cannabis, and even some antidepressants have considerable effects on pain sensation.
Sucks to hear that a change in your medication has had this bad of an effect on you, also don't rail your medication. Its a giant ass warning sign for having your Rx dropped.

Also moving to OD as you'll probably get more responses there.
Guessing you're a car accident survivor?

 

[Doomed2pain]

Try the anti epileptics, trycylic anti depressants, nerve blocks either lumbar or guanthedine, physio, gentle exercise, CBT therapy and also a lot of meditation. I am a chronic pain patient and disabled, currently been bed bound since the 2nd December. Also ketamine infusions are good for nerve pain but only certain countries do it. Have you tried a spinal cord stimulator?


Also methadone is good for a long acting med, very long half life and cheap.

 

[Tommyboy]

The methadone blockade effect occurs around a certain dose, so if you stay below that dose you can take it, and also take a breakthrough med with it.

Could you try getting off the opioids again? You said that you stopped for 4 days and were in too much pain, but you have to consider how much of that was withdrawals. Back pain is very common with opioid withdrawal, so it would be hard for you to tell if you were feeling pain from withdrawal, or because of your back condition.

 

[Hooddood78]

I would suggest also you to try some other medication in the side of all those opioids.. Pregabalin, Amitriptylin ans stuff like that should help and they will increase also the strenght of the opioids so it might leave you to the "normal" stuff - don´t have to go to the methadone.

Neurostimulator don´t work on back pain - I´ve heard. For legs or arms it would so I strongly suggest you to also consider that possibility with your paindoc. I was just couple months ago at the hospital for neurostimulator for my hederitary disease which has destroy some of nervsystem in legs and arms. The main problem is pain in legs which was very much helped with the neurostimulator treatment. I´m also a professional at medical job and was at the lecture where this subject was also introduced and it was said that there is no use in backpain.
Neurostimulator is currently coming more and more but still it is quite expensive - at least in my country so not that many patients don´t get one. Or they choose the patients very carefully...

Don´t start to mess with the meds too much because you´ll loose the effects and then you´re dealing with no help from opioids. Don´t in any circumstances start to inject anything - there´s no return. Even plugging is better but I strongly suggest not to play too much recretionally.. Since you really seem to suffer from massive pains.

-Hooddood78

 

[negrogesic]

I'd rather not get too specific here but:

Methadone is a decent option provided it is not dispensed within the confines of a methadone 'clinic'. In US tablet formulations, methadone is rather difficult to abuse via routes other than po, and with some diligence on the part of the physician, a patient can determine a dose they find 'sufficient'. While the differentiation between addiction-tolerance may be in reality quite ambiguous, the law is decided less so......and, while any seasoned physician specialized in treating severe pain disorders may be aware of this ambiguity, once you have been identified as an 'addict', you will be effectively treated as one.....

If you are scheduled for additional invasive surgery, it may be prudent to wait before beginning MMT. Patients maintained on very large doses of methadone pose a number of perioperative concerns, and may potentially sacrifice patient comfort over generally safety concerns if not carefully orchestrated.

Do superior analgesics exist to methadone? Sure, for a price, treatment can be highly individualized using a host of agents, but in the end, methadone is cheap and unique in its ability to treat a wide variety of severe pain disorders without the same degree of dose escalation.....

 

[muvolution]

A couple things:

as it seems you are aware of, abusing your pain meds not only leads to issues with addiction and habituation, it also really decreases the effects of your legitimate pain medication. I cannot advise strongly enough how important it is to not abuse your medication.

most pain patients only get about 20% of their relief from opiates - what else are you doing to help your pain? Have you considered direct-intervention therapies? Steroid shots, painkiller depot shots, nerve blocks, lumbar sympathetic blocks, etc...

If you have more ?s, please let me know.

 

[persianslipper]

I'm not sure opioids are the best thing for you right now, honestly ... those are some pretty strong medications and sometimes they can do more harm than good. Here's an article I found that may help: http://www.spine-health.com/treatment/spinal-fusion/rehabilitation-following-lumbar-fusion

I'd suggest physical therapy and pot. Strengthening the muscles around the spine will help facilitate better, more fluid movement. Just don't push yourself. Also, noting your appreciation for recreational use, it would help there as well. There are a couple of cannabinoid medications in pill form in the US, I think, though it's synthetic. Just depends on what state you're in.

But yeah ... I would say that if you wanted to use a substance recreationally, it shouldn't be the substance you require at a specific dose to function. Opioid tolerance happens rather quickly.

Best wishes!

 

[Doug2113]

I'm not sure opioids are the best thing for you right now, honestly ... those are some pretty strong medications and sometimes they can do more harm than good. Here's an article I found that may help: http://www.spine-health.com/treatment/spinal-fusion/rehabilitation-following-lumbar-fusion

I'd suggest physical therapy and pot. Strengthening the muscles around the spine will help facilitate better, more fluid movement. Just don't push yourself. Also, noting your appreciation for recreational use, it would help there as well. There are a couple of cannabinoid medications in pill form in the US, I think, though it's synthetic. Just depends on what state you're in.

But yeah ... I would say that if you wanted to use a substance recreationally, it shouldn't be the substance you require at a specific dose to function. Opioid tolerance happens rather quickly.

Best wishes!

Pot actually causes me more pain than it relieves oddly enough (and I know I'm not the OP, but just stating it as everyone thinks pot helps everyone's pain...it doesn't...it makes me more sore and I have ungodly muscle spasms EVERYWHERE)...

and if they live in texas, there is no accepted medical uses for THC...

js;nbd

 

[Doomed2pain]

I have to buy pot in the uk, it really helps me, only smoke it in bad pain relapses I would love medicinal thc

 

[Kanga]

I feel the same way, people tell me to smoke weed when I'm going through W/D's, but I feel like being high just intensifies my WD symptoms.

I'm surprised OP hasn't been put on Fentanyl yet.

 

[LOGan1314]

^^I'm the same way. Well, it depends on the type of weed. A HEAVY indica will kill my pain and put me to sleep but a indica/sativa mix or a sativa will DEFINATELY make the pain worse as it causes me to think about it more.

 

[Doomed2pain]

Nah this is a real nice strain, strong and chilled like weed should be

 

[Alex000]

I recommend going back to morphine extended-release, there is MS-Contin and Kadian. I know this did not work for you initially, but if you get it at the right dose it could help. I might also recommend Lyrica or Neurontin in addition to whatever opioid you are using, but Lyrica would probably work better. This was mentioned before, as was cannabis, it works very well for certain individual suffering from pain conditions. An NSAID could also help, maybe Celebrex or Mobic.

 

[Doug2113]

I recommend going back to morphine extended-release, there is MS-Contin and Kadian. I know this did not work for you initially, but if you get it at the right dose it could help. I might also recommend Lyrica or Neurontin in addition to whatever opioid you are using, but Lyrica would probably work better. This was mentioned before, as was cannabis, it works very well for certain individual suffering from pain conditions. An NSAID could also help, maybe Celebrex or Mobic.

I don't know about lyrica, but gabapentin actually lowers the BA of hydrocodone, so that isn't completely true...It does help the morphine out though...

I take gabapentin, and I could take 4 vicodin and not get a head change...

 

[Tommyboy]

I don't know about lyrica, but gabapentin actually lowers the BA of hydrocodone, so that isn't completely true...It does help the morphine out though...

I take gabapentin, and I could take 4 vicodin and not get a head change...

Ya know, I don't find any "gaba drugs" to potentiate opioids in terms of euphoria, and actually find them to make it less euphoric. Sure they may add to the nod, but for euphoria, meh.... I think it's because my mind needs to be very "fresh" to feel the full euphoric effects, which is why I need to get a good nights sleep before I use opioids or else I will just feel cloudy. Not sure if it has to do with BA at all, but I always attributed it to mental awareness.

 

[Doug2113]

I wasn't talking about potentiating them for euphoria...I was talking about potentiating them for analgesia...

I was merely using myself as an example as to why the BA of hydrocodone is obviously lowered by gabapentin...

There are studies that show that it increases the amount of morphine in the bloodstream (or something to that effect)...

 

[Doomed2pain]

Morphine is the biggest was of time, does nothing for my pain and just gives me severe side effects meh

 

[Doug2113]

It helps me out lol...granted...I have to rely on tramadol...

 

[isryanthis]

Thank you all so much for your responses. Sorry for my delay but I just finished 3 straight days of finals here at school. I also apologies for posting in two different forums but I thought I deleted the first one.

Yes I was in a motorcycle accident, a car took a corner to wide and came over the double yellow into my lane in the canyons and swiped me head on, luckily I hit the corner of the car and did not just stop and get smashed, I flew away unfortunately and that broke me back when I hit the guard rail or a tree or something. Really I don’t recall anything, even the helicopter ride.

I have been in physical therapy for almost 8 months now after a 6 month break when I was abusing drugs, but I got back into it and sobered up. Started going 1-3 times a week. It has most defiantly gotten my muscle stronger and I can do things for longer periods of time before I feel the pain. Unfortunately the pain does come on eventually and it is still on the top end of the pain scale.

Sorry if I said I got opioids for 4 days, but I meant 4 months. I hoped my brain would start to get UN hyper-analgesic but for the most part the pain came back after the initial first weeks of having an "emotional high" and being on huge doses of Neurontin and baclofen.

As for non-narcotic meds I’m on currently: Lyrica 75mg TID... Cymbalta 20mg once daily. Baclofen PRN. lidocane patch.. And 600mg IB pro TID
I have also tried every muscle relaxer on the books and those work great but make me far too sleepy and I cannot do anything.
Pot is also good I use that a lot at night.
What I really need is a new extended release opioid that is one the higher end of the potency chart.