Harm Reduction The Pain Management Mega Thread Version 4

[RXology]

Hi Roxi,
If u want off dope u should try methadone. If you have not already. It is prescribed for pain and in my opinion works much better than suboxone. I wouldn't suggest cutting the patch even if it doesn't have the Aqua gel part but check the instructions or look it up online. There are pain management DOX that will do self pay mine is 200 per visit once a month if u don't have insurance. Plus you will have to pay for your meds. However I think being that you have sustained some serious bodily injury you really should be in with at least a decent pain doctor. They may combine methadone and Roxi for breakthrough and I would think this might be cheaper than your current monthly intake. Otherwise you will have to go to a clinic for the meth program. Or they might do oxy ER and Roxi for round the clock if u can't sleep. I woul highly recommend not divulging your H use to them if you go this route. Also cover any tracks with believable makeup.

In the short term why not try the full patch and nothing else? You have to be the judge here. 3 bags H plus 90 mg Roxi is similar to 6 high quality bags. Thus I would think you you should be able to tolerate a 75mcg patch. But you need to be safe the less mixing the better. Hope this helps

 

[BigG]

This is a slight break from topic but I've been on fentanyl patches 200mcg/hr for a few months now and found they weren't covering my pain well at all. I took to using them buccally to try to control the excruciating pain from poly arthrits damaged vertebra and a tumour on my spine. After doing this for a while I realised that this couldn't gpgo on so asked my gp to only prescribe me one lot of patches at a time which I change every 48 hours. However I now think I have totally fucked up my tollerance as even 200mcgs dont stop the pain or even keep me out of mild wds. Im at a loss as to what to do. My gp wants my to try to titrate off them alltogether but if im suffering now. How can I do that? I'm seeing my pain doc next week but he is never interested in discussing anything other tham fentanyl patches. My quality of life iszero and sometimes consider just reading it all...stupid as that sounds. Just dont know what to do :-(

 

[BigG]

This is a slight break from topic but I've been on fentanyl patches 200mcg/hr for a few months now and found they weren't covering my pain well at all. I took to using them buccally to try to control the excruciating pain from poly arthrits damaged vertebra and a tumour on my spine. After doing this for a while I realised that this couldn't go on so asked my gp to only prescribe me one lot of patches at a time which I change every 48 hours. However I now think I have totally fucked up my tollerance as even 200mcgs dont stop the pain or even keep me out of mild wds. Im at a loss as to what to do. My gp wants my to try to titrate off them alltogether but if im suffering now. How can I do that? I'm seeing my pain doc next week but he is never interested in discussing anything other tham fentanyl patches. My quality of life is iezero and sometimes consider just ending it all...stupid as that sounds. Just dont know what to do :-(

 

[Hammertime78]

Idont know where u are but is asking your gp if chronic pain dr is in town out of question I have had 2 discs removed and steel rods and screws are holding my back together so I know where you are coming from dont lose hope. Chronic pain sucks but the right dr helps alot. IMO you need to have a talk with your dr. If he is not listening to you call around find a different dr. It is ok to tell the offices your problem. That being said dont say the word withdraw, just let them know you are still in pain and your dr wont help. I hope you can find someone to help. I had a hell of a time finding mine. He is a psychiatrist who sees pain patients on the side. I am only 35 and have had many problems because of that. You might go through 10 drs before you find any compassion. The stigma associated with chronic pain is hard to break threw, BUT DON'T LOSE HOPE!!!! If nothing less you can always pm me when you need any help with chronic pain questions or just need to talk. Every day we fight the good fight, and I think if you can travel every 30 days or so you can find a dr that understands.

 

[BigG]

Thanks for replying man. Im from England and things are slightly different to the states. While all healthcare is free at the point. Of contact (I know people have different ideas on this and what constitutes free......what I mean is they dont ask for money and your prescriptions are either free or only a small nominal charge of about £8 or $12 for any drug). Your primary doctor can then refer you to a pain specialist but it is not always an option to go to a different doctor if your not happy.......one of the drawbacks of nationalised healthcare. However they won't discard you if you admit to having a problem as they have to treat you. The last time I saw the pain guy he just wasnt interested in anything other than the fent patches and wouldnt even discuss bt meds. My gp will only prescribe what the pain doc recommends and won't overrule him. It's all just got too much for me at the moment and my girlfriend is less than sympathetic and moans that I'm not interested in sex when I'm in so much pain I can hardly breath...... I mean WTF!!!!!!!. I may take u up on your offer to pm you to explain my story in a bit more detail when the pain (which is currently drivinng me out of my f....ing mind) dies down a little bit. Thank you again.

 

[Hammertime78]

wow that amazes me that they are not interested in anything other than the patches. Is there any history of abuse they are using to make this decision? I told my dr I dont like the patches because they would not give me bt meds with them. He wanted me to try them first because of my age by the way I have been a cp patient since jan 2005 so I started in my mid 20s.,and at that time the patches were thought as low risk for abuse? IMO if you are having wds anyway and they wont budge maybe you should consider not using the patches at all for a little bit. I have detoxed off more meds than that b4 it wont kill you but it will feel like it. I am telling you this because a little time off will reset your tolerance to a point. If you can cop some suboxone this will be relatively painless. I can walk you through the process as I have had to do this many times for 1 reason or another. Talk with your mates it wont take many, most people take way too much of it to begin with. It also helps with pain tremendously. Maybe not as much as the patches used to, but a million times better than nothing. unfortunately cold turkey with your pain issues might put you in hosp. I keep thinking about your dr and so-called pain dr. Wow how fucked up a situation that is. I will keep racking my brain for a solution to your problem. You may want to study up on fentanyl find out as much as you can about it so you are in know when you speak to your dr. if you can come up with a list of valid reasons a different med would be better for your peticular situation you might get a little farther with your dr. That's all I got for now check on the suboxone it is a life saver just to have around when you are on pain meds! you never know when you might need them. keep up the good fight. Hit me back when you need to chat I am several timezones away but I dont ever really sleep and I will reply in a couple hours I am currently helping a couple other people in our situation here in my town we have a cp support group here I am the youngest member but I have been pain patient the longest aint that fucked up?

ANYWAYS KEEP UP YOUR SPIRITS IT IS VERY OVERWHELMING BUT EVERY CHRONIC PAIN PATIENT GOES THROUGH YOUR SITUATION AT SOME POINT! THIS TOO SHALL PASS.

I have sent you a pm please use it

 

[pandacone]

I'm on pm and here is thing I want to stay at the 15mg oxymorphone ER but I would like a stronger breakthrough med. I am currently on 10 mg hydrocodone for breakthrough. What are some stronger options and what would beththe best way to ask my pm doc?

 

[tentram]

Just though id share with you all my latest find in a damn effective anti-inflammatory cream; difflam extra strength cream; benzydamine hcl 5% w/w.

Its good for strains n sprains, contusions, bursitis, myalgia and soft tissue damage.

Ive a DDD called spondylolisis and it helps immensely to cover the gaps that my morphine andd bt oxy alongsude the valium. All over baby.

Its not recommended to use daily longer than two weeks unless you consult your pharmacist or dr.

 

[Ondine]

hi guys,

I'm currently recovering from a shattered calcaneus and fractured hip. The pain is pretty rough, especially after PT. I've been prescribed 2mg pills of hydromorphone. With the amount I'm being given at one time, I have to basically dose it out to 4mg every 4 hours. It hasn't been too effective for me to be honest. I'm considering asking my doctor if I can change medication, but in the mean time, do you guys think I would get a better effect by taking 2mg every 2 hours instead? My thought being that because it only lasts around 3 hours, taking a small amount every 2 hours would at least allow the effect to stack somewhat. Or would that not be the case?

Thanks

 

[Hammertime78]

hi guys,

(I'm currently recovering from a shattered calcaneus and fractured hip. The pain is pretty rough, especially after PT. I've been prescribed 2mg pills of hydromorphone. With the amount I'm being given at one time, I have to basically dose it out to 4mg every 4 hours. It hasn't been too effective for me to be honest. I'm considering asking my doctor if I can change medication, but in the mean time, do you guys think I would get a better effect by taking 2mg every 2 hours instead? My thought being that because it only lasts around 3 hours, taking a small amount every 2 hours would at least allow the effect to stack somewhat. Or would that not be the case?)



In my many surgeries hm has only been useful IV in very small doses I control with a pca machine with larger doses every so often to eat and use the shitter. If your meds are not lasting 4 hours which hm rarely does try making it work every 2 or a half every 1. Everybody is different but hm is notorious for burning fast and bright. if it is not working no matter how you try it. You may want to ask for a equal dosing of oxycodone it should last longer and is available in continuous dose tablets. Everybody is different but you never know until you try. Dont take more than you are supposed without speaking to dr you will probably run out and your tolerance will go up faster than that (more pain with less meds) good luck.

 

[2010SterlingGT]

Pain Management/Drug Selection Advice

I am a pain patient. I have a great doctor that prescribes me pain medication although the social stigma is more than negative. I have been taking 20mg x 6 Oxy IR + 1 5/325 Perc daily for about 2 years now.

Unfortunately, like all pain medication, I metabolize a 20mg Oxy IR in about 2 hours, if that. So I am not adequetly being treated any longer by the meds I have. Instead of increasing my dose, my doctor asked if I wanted to try something extended release.

I can pretty much choose whatever I want to try. In New Mexico, anyone taking Oxycodone is pretty much immediately classified as a drug abuser, or diverter. We have a huge problem with Heroin and prescription pain medication abuse. I had to sign a contract and take random drug tests. Neither of which bother me because I have a good doctor and great insurance so I have no reasons to even bother self medicating. I don't rarely drink. All I do is take what my doctor says to take and I take it how I am supposed to take it. Its absolutely stupid but being on Oxymorphone, Hydromorphone or Fentanyl does not carry the negative stigma of Oxycodone, so my doctor would prefer that I move from Oxycodone, although if I decide I dont have to move at all.

The main candidates are
Oxymorphone
Hydromorphone
Fentanyl

Of these three medications which one would you prefer? The Oxycodone works very well orally because of its high bioavailability. I want a medication that does not make me tired, that does not keep me up at night and does not affect my sex life. All of which are found in oxycodone.

Also, I do not have any issues with constipation. I had taken Vicodin and morphine in the past and had issues with constipation. With Morphine I had to take a laxative no matter how much water I drank. Also I was very tired on Morphine and vicodin. I do not like that. I am not looking for a euphoric feeling. I do however want to feel "good", just for the sake of my emotional state.

From what I understand Oxymorphone is a derivative of Oxycodone. It seems as it is about twice as strong orally, so I may be able to convert to taking four 15ER instead of six 20IR per day. Hydromorphone seems to be stronger as well. Fentanyl is definitely stronger because its micrograms instead of milligrams.

From what I read Oxymorphone is very comparable to oxycodone in how it makes you feel. It kills the pain and gives you an energetic feeling and just an overall better feeling of well being.

I read that Hydromorphone is more like morphine wherein it makes you tired, but it kills the pain very well. I have also read that hydomorphone can cause a histamine reaction. I do not like the itching. Oxycodone does not do this to me. Also, I can't be nodding off at work.

I have read the Fentanyl patches work very well for pain, but they dont last 72 hours as prescribed and only last 48 hours.

I understand that if I change from IR to ER I will need a breakthrough medication. So I may end up keeping 1 20mg oxycodone or something like that.

Is there anyone with experience with all of these meds? The patch seems like it would be very easy to use because you just put it on and forget about it. I am tired of taking pills. I don't want to take them any other way than mouth or a patch. No IV or Rectal for me.

 

[shekaal]

I am also a Chronic Pain patient myself. If you have gotten to the point in which pain meds are no longer managing your pain, then would you have access to the Intrathecal narcotic Pump where you live? I can tell you that Hydromorphone has a horrible bioavailability orally. Fentanyl kept me up for 3 days straight and effected my mood in a bad way, but everyone is different. Oxymorphone are not good at all because of the bioavailability as well. If you could receive the Medtronic Intrathecal Narcotic Pump, then you would have med. delivered 24/7 into the area within your spine that the pain is. I would suggest you do a google search on this. If you have this pump, your need for oral pain meds is cut considerably, but you will still have "flare ups" of severe pain if you are lifting too much and all of the things that aggravates the pain and puts you into a high level of pain.

Oxymorphone is not a derivative of Oxycodone....it's a derivative of Hydromorphone and HIGHLY addictive!!! Plus, they have changed these pills from when they first came out with them. Some people are unable to ingest them properly and not all people, but some people have reported that their Oxymorphone came out in a "clump" after a bowel movement within their stool.

 

[2010SterlingGT]

Oxymorphone is not a derivative of Oxycodone....it's a derivative of Hydromorphone and HIGHLY addictive!!! Plus, they have changed these pills from when they first came out with them. Some people are unable to ingest them properly and not all people, but some people have reported that their Oxymorphone came out in a "clump" after a bowel movement within their stool.

From what I have found Oxymorphone is created when your body converts Oxycodone. Hydromorphone is created when your body converts Hydrocodone. Oxymorphone is a metabolite of oxycodone. It is something that they test for in urine tests.

I have seen that some people have had issues with the Endo version of the ER because its pretty much a solid plastic pill that is tamper resistant. I would be requesting the generic version., which does not have the patented Endo tamper proof system. So from what I understand it works much better. My insurance copay for generic is $$$. Again I can just "try" a week or so of any of these meds, and I still have my other meds available. So if I change to something and it doesnt work, I can change back. Or try something else.

I dont know if I am ready for a surgical pump. I don't mind taking meds really. Its just remembering to take them. I would rather take them before I start to hurt again, I always just forget and start hurting and have to wait for them to kick in again. I would rather take fewer pills and have them last longer. Also, if I take a dose and it doesnt work, my doctor is not against raising the dose. My doctor is probably one of the best pain doctors you can find. I could probably ask him for a weeks worth of all three and try one each week if I wanted to. But I don't want him to ever feel like I am trying to take advantage of him.

 

[shekaal]

I am fortunate as well to have an empathetic doctor who cares If you are able to get the Oxymorphone that isn't like the plastic pills, they do work very well, I am just going to warn you that they are highly addictive. Stick to using orally and don't fall into temptation of "snorting" them.....that is asking for a drug habit like no other. I wish you the best.

 

[Geaux Tigers!]

Of your options, I imagine the Opana (oxymorphone) would be best suited if you can get the 10mg. IR. If not, I suggest the Diluadid route since they're not as tamper proof (thus not as effective for pain relief). The fentanyl could be a great choice for ER.

As your doctor, I'd give you three options:

Option 1: Switch your IR oxycodone regimen to: #180 Opana 10mg. (oxymorphone)
Option 2: Switch your oxycodone to #60 Opana ER 30mg.
Option 3: Fentanyl 50mcg. patch with IR oxycodone for break-through pain (doctor's discretion) You may be able to do the 75mcg. patch without break-through.

I suggest the oxymorphone over hydromorphone.

 

[Morphling]

You can get the older formulation of OpanaERs again, which don't contain all the plastic shit in them that screws up everyone's stomaches and seems to release really poorly. I was on those for years, along with breakthrough meds(oxy, opanaIR, morphine), and my pain was very well managed. It was, however, incredibly expensive, even with my very good insurance. Those were the brand name, tho, I'm not sure how much the new generics cost. Hopefully much less.

Just don't be tempted to abuse them, that road leads to hell and a massive tolerance, I can tell you that from personal experience.

If you're having trouble with the duration of oxycodone, definitely do not switch to hydromorphone. It lasts about two hours. Need at least 8 of the ir's a day to get by on those things. Hate em. They suck orally, and are like crack via any other roa.

I don't think you want to switch to fentanyl with such a low opioid tolerance. Keep that one in the wings for years from now, if you need it.

 

[midnight11]

I'd definitely recommend asking your doctor for oxycodone ER if you have found your oxycodone IR to be helpful. I'm sure your doctor would be willing to work with you on finding an alternative to using just IR oxycodone, and with 1 or 2 40mg or 60mg tablets per day, you could probably slash your need for oxy IR from 20mg X 6 per day to 20mg X 3 per day. Even if your doctor doesn't like the stigma associated with oxycodone, it's possible he's slightly uncomfortable giving you a script for 180 oxycodone IR per month. Many PM doctors hate prescribing that amount nowadays of an IR medication, mostly because of the risks of diversion, abuse, and ability to change its ROA as desired.

Good luck, take care, and just let your doctor know that you're unsure if it'd be worth trying other opiates / opioids if the oxycodone has been helping you most. Getting on an extended-release prep may also allow you to have an easier transition to a smaller dosage, or a different analgesic ER formulation if that's necessary. I think it'd definitely be easier for your body to adjust by first getting onto extended oxycodone before switching to another ER medication without even trying it first.

 

[RTrain]

Go with the hydromorphone, I am around a lot of pain patients in my line of work and Dilaudid(hydromophone) is one that most say works very well when others don't touch their pain, though often this is IV administered. Realize it will take less of it to help you than of the oxycodone(factoring the equivalency ratio of the drug's strengths) , they say typically when switching opioids that you will need about 2/3's of the equanalgesic dose of the past opioid you were using. So consider Hydromorphone is about x3 as strong as Diluadid, they would start you off around 20 mg qid (you do 125 oxycodone so 125x.66= 82.5 mg, typically with ER type dose 3-4 times a day with hydromorphone ER b/c it has a shorter half life then oxycodone).

Keep in mind that a lot of people find the ERs to be much weaker, particularly with the new abuse-proof formulas. I don't know about hydromorphones ER, but when oxycodone ER came out with the new formula a lot of people thought it was slightly weaker, and were not getting the adequate pain management they desired from the medication. The same was said by many for Opana (oxymorphone), by an even larger amount of the pain patients. And you are definitely in the minority of pain patients when asking to switch from IR to ER, honestly I would reconsider and research the internet to see what other pain patients thought when they switched over form IR to ER. I think most you will find did not like the switch. You may find yourself never getting full relief, but it won't be as bad when you are nearing the time for you next dose. Another thing to factor in is they will still not factor in you fast metabolism when dosing the ER medication. They will prescribe as directed to them, and with ERs it will mean you dose fewer times, so you might find the times when you are approaching your next dose to be (again, sorry to repeat myself) slighly more tolerable, but they will be longer periods of time. Believe me when I tell you that ER does not give out a steady amount of medication over a 6 or 8 or 12 hour period, as the medication will claim. It will take maybe 2 hours to hit its max strength, then it will wear off slower, but around the 4-6 hour mark (depending on metabolism) you won't be getting much relief from the medication. These are just my experiences, obviosuly I am not a MD, but I doubt your MD has taken oxyodone IR, ER, oxymorphone IR, ER, vicodin, percocet, codeine/APAP, and MScontin like a certain person (who i giving you suggestions) has.

Just let me stres to do research before you make this decision because you may very well regret it and have to live a month with the decision you regretted. Go to other forums, actual health and chronic pain forums and see what those people think about what you are considering.

As far as fentanyl, I would suggest against that. But to each their own, and don't completely rule it out because it might work best for you, its hard to say without trying it. It works much better in combination with something like what you are already on, though. I would think maybe adding a 50 mcg/hour patch to your current meds would be a simple solution to your problem. But like you said, the doc won't prescribe more meds even though you have built a tolerance and are not getting the relief you need.

Edit: Had to add this in, noticed you mentioned bioavailability, well oxycodones is much higher orally then oxymorphone or hydromorphone. Even though oxycontin was the original chronically abused med, it actually has a higher BA when orally taken than when nasally. As opposed to oxymorphone, which is like 2.5-3x stronger when snorted. I do not recommend that you snort it and the new ones are 100% impossible to do so anyway.

And as to why your Dr wants to move away from oxycodone is beyond me, aside from rotating meds every few years can help limit tolerance, but its not really a reason to switch. I mean you are happy, so whats the big deal.

 

[shekaal]

Please take Morphling's advice concerning not abusing the Opana ER's....I have been down that road myself as well and I chose to never walk down it again!!! As a patient myself, I have found that 1 med may not work well for me, to where it worked well for someone else. Good luck to you!!!

 

[2010SterlingGT]

Please take Morphling's advice concerning not abusing the Opana ER's....I have been down that road myself as well and I chose to never walk down it again!!! As a patient myself, I have found that 1 med may not work well for me, to where it worked well for someone else. Good luck to you!!!

Thank you everyone for the replies. I do not abuse my meds. My doctor manages my pain very well. I am already physically dependant on opiate pain medication. I would't purposely turn a dependency into an addiction. Also, it would ruin my relationship with my doctor because he does test me, so if my blood concentration was way up because of me being an idiot and trying to get high then I would lose trust. My wife also helps me manage my pain. She actually keeps my meds locked up and gives me a day worth at a time. I asked her to do this. As most people know it can be tempting when you have 200 pills sitting in front of you to just say "oh, it didnt work fast enough, so I will double my dose". So even if I wanted to, I can't do it. I don't have any history of abusing my medications but I asked my wife to do that for me. Plus she is the only one that knows where they are. This is also to avoid any kids getting into my meds. I have a lot of kid traffic in my home, I don't even want to create an opportunity for one of my older daughters friends to be snooping and see a huge bottle of oxycodone and get a stupid idea.

People can be very shady when it comes to pain meds, we all know that. There are only a handful of people that know I am even on pain management meds. My kids, my wife, my doctor and my parents. Not even my brothers and they have the same doctor. Somehow some way some guy at work found out that I take pain meds. I figured out that someone had noticed my pattern of taking my morning medication with breakfast and noticing that I use a pill container and not a tylenol bottle, so they figured I had something "good". So he immediately started asking if he could buy some. I don't even want to be put on the radar as someone that would consider something like that. He was like "Come on man, you can make some easy money depending on what you have, blah blah blah". I told him that I do not and will not sell my medicatoin. This guy was a complete moron because not more than 3 months ago we had an HR meeting on top 10 stupid ways to get fired, one of the reasons was asking to buy someones prescription pain meds. I told my leadership team that he was propositioning me. I also mentioned that he smells like a bottle of Vodka every morning. He was fired within a few hours.

I spoke exstensively with my doctor yesterday. I verified that there is a generic version of Oxymorphone available. I did read that the new tamper proof Endo ER pills have been known to cause problems. I told him that I would only change if I could get generic, because the generic formula has good reviews and I couldnt find anything negative about it, also the generic version cost significantly less. So I am going to try the Oxymorphone ER's first. If the dont work I will try the Hydromorphone. Then if those don't work I will probably just go back to the Oxycodone. I honestly don't think I would try the Fentanyl patch.

So when I do a one week run on the ER's I will post back up my experiences. He said that I would keep one of my 20mg Oxy IRs as my breakthrough meds. We just need to figure out what dose schedule. The goal is less pills, so I may take 2 x 30mg ER. That or 4 x 15mg ER.