Harm Reduction The Pain Management Mega Thread Version 4

[Doomed2pain]

^ sorry but what has that got to do with chronic pain? This thread is for sufferers to discuss treatments and vent to each other about the problems us CPP's have.

 

[Lifeinpain]

Medication change, Strange Symptoms

Feb 1st 2013 both my main pain and breakthrough meds were changed from OxyContin to Hydromorph Contin (Dilaudid) Long acting and the same med in short acting for BT. The same day I began suffering Chest pain , dull uncomfortable heart palpitations and throbbing pain which comes on quick for no apparent reason and quickly runs down the back side of my left arm and the left side of my neck rising to my head where I have fluttering in left ear.
I was quickly prescribed Metoprolol Tartrate for heart rate and blood pressure and Clonazepam for nerves.

The new pain medication started out distant, like when you’re waiting for your meds to kick in with the relief, but in this case it just never really arrives staying fall away leaving me with moderate to severe pain from the get go and extreme pain if I exert myself. Having taken Oxycontin since its release I was used to fairly good relief without side-effects, it wasn’t perfect and there were some holes in its coverage but I’m now experiencing poor concentration, fogginess, impaired thinking, poor memory, sweating, fatigue, headaches, anxiety, depression, irritability, and I’m really emotional and I'm finding it all a more than a little terrifying.

The last few weeks have been painfully horrific as the meds just cannot catch-up and the pain seems like its increasing. The point of this post is. . . I’m wondering if anyone else has suffered the above symptoms after a main and BT medication change. Thanks, Moe

 

[Doomed2pain]

What I've learnt from medication changes is that all medications affect people differently regarding the side effect profile, and what affects one person one way, it is completely different for someone else. Wait a few more weeks to see if you get used to the side effects and if not I think I'd be asking my dr to try something else ESP as your pain has increased. Our bodies are different and this affects the way medication works unfortunately.

 

[tricomb]

Okay CPPers I have a dilemma. Preferably those of you who've taken both medications and can help me compare them for a long-term analysis. Because everyone react differently to medications, I was hoping your individual reactions could shine some light on this for me.

I'm currently RX'd Roxicodone (Instant release Oxycodone HCl) and I am debating trying instant release hydromorphone HCl, which is generic Dilaudid, and I have never used hydromorphone long-term, but I've been taking oxycodone for many years.

The United States basically got rid of the most effective time-released formulation of Hydromorphone Extended Release, it was called Palladone, then I think they banned hydromorph-contin, etc, and now the only time-released form of hydromorphone I know of that is not an implantable injection is the Exalgo 24 hour extended release hydromorphone hydrochloride, which is EXPENSIVE as hell and my insurance won't pay for it.

My provider covers basically every form of morphine you can imagine, which I find to be overly constipating.... (IR, ER, IV, rectal, PCA pumps, powder for injection) but only covers a limited option of alternative time-released opioid narcotics... weird stuff like that.

They cover Opana IR generics (oxymorphone instant release tablets) but I don't want to switch to Opana because during my previous trial with it, I got severe inter-dose withdrawals, worse than fentanyl even....

SO!!! They cover hydromorphone HCl in 1(?), 2, 3(?), 4, 6, and 8mg instant release tablets, and I'm sure that generic hydromorphone is boatloads cheaper than generic oxymorphone (without going into price discussion please, I was not asking. I know the price differences but we aren't allowed to discuss this aspect in greater detail than this)

One bonus switching to Dilaudid might mean a reduction the number of tablets per dose. I can't be more specific than this but you would be surprised what formulations of generic roxicodone the insurance has chosen to cover. It definitely allows the quantity of tablets to be exponentially higher overall so it could be yet another profit motivated decision without much further oversight, but I won't get into that off-topic/opinion-based/subjective feelings about the flaws of Capitalism and how the healthcare and pharmaceutical industry have exploited their customers, choosing cash over care usually IMO..... But Let's NOT GET DERAILED. MY BAD...

It would be helpful for me to have fellow chronic pain patients, in your subjective experiences, tell me about the following:
1.....As a breakthrough medication, which do you find superior and why (HYDROMORPHONE VS OXYCODONE)???

2......Besides comparing the analgesic components of dilaudid vs roxicodone, how do they differ in terms of side effects??? For example, Is one more or less constipating than the other, and does one produce more histamine response (itching/pruitus) than the other???

3.......I am not asking for someone to tell me the half-lives of the medications, I obviously know this stuff already.
But as a pain killer, hydromorphone vs oxycodone, how long does each respective medication last between doses? What is the normal duration for you for a single dose of oral hydromorphone IR, and for oral oxycodone IR?

4......Does the higher potency of hydromorphone make up for it's lower oral bioavailability in comparison to oxycodone (which is almost completely absorbed via the oral ROA unlike hydromorphone which has a low and variable oral BA)???

4 part B.......I am not an intravenous drug user. So besides the IV ROA, Do you ever have to use other routes of administration to get desired effects from the medication???
This was going to arise sooner or later, it's always why people say Dilaudid is only worth it via the IV ROA, but I hear most of this coming from addicts, not from chronic pain patients who are much more likely to have spent more time giving the oral ROA a chance, or perhaps experimenting with intranasal or rectal methods of administration?

5..... If I were to switch to hydromorphone, say to 4 x 2mg hydromorphone, as needed up to 8mg a day, in YOUR experience (PLEASE NO ONE ANSWER USING NARCOTIC CONVERTERS/EQUIVALENCY CHARTS, EXPERIENCED ANSWERS ONLY), how much oxycodone IR would provide the same amount of relief as 4 x 2mg hydromorphone?


TL;DR I am not asking for suggestions for a pain management regimen, I am asking for experienced patients to answer these questions to help better my understanding of each of the medications actual efficacy, which often varies dramatically on a case by case basis.

 

[Lifeinpain]

Having just switched Feb 1, from Oxycontin to Hydromorph Contin, CAP (PUR) which is (Dilaudid)
I personally would choose OxyContin.

I am taking both the long acting and short acting Dilaudid and am suffering many side effects and the med has a much more euphoric effect on me, which I personally don’t like.

I started taking both long acting and short acting OxyContin when it came on the market and found it a stable medication with little to no side effects.
Constipation has been constant and the same for all these medications. Natural Senokot Tabs daily work very well.
Unless you enjoy the up and down of short acting pain meds, many do. I found the long acting constant and stable pain control a huge benefit to continuing with life. Good Luck

 

[tricomb]

Having just switched Feb 1, from Oxycontin to Hydromorph Contin, CAP (PUR) which is (Dilaudid)
I personally would choose OxyContin.

I am taking both the long acting and short acting Dilaudid and am suffering many side effects and the med has a much more euphoric effect on me, which I personally don’t like.

I started taking both long acting and short acting OxyContin when it came on the market and found it a stable medication with little to no side effects.
Constipation has been constant and the same for all these medications. Natural Senokot Tabs daily work very well.
Unless you enjoy the up and down of short acting pain meds, many do. I found the long acting constant and stable pain control a huge benefit to continuing with life. Good Luck

I would agree with you, but where I'm from, unless you're seeing a phoney doctor, I've been routinely told that "I'm too young to be on time released narcotics" but that doesn't stop them from dosing me with a pretty much equivalent pure IR regimen, and yeah, Im the type of person who really does enjoy the little things like extra euphoria, BUT it's not a deal breaker for me. I'm not in it for the pleasure, I'm in it to reduce my pain as much as possible, any perks that come along with it are just an added bonus.

Would you say that the Dilaudid IR lasts longer than Roxicodone? Plus, like I said, my insurance does not cover time-released formulations of hydromorphone anyways.

 

[Lifeinpain]

I would agree with you, but where I'm from, unless you're seeing a phoney doctor, I've been routinely told that "I'm too young to be on time released narcotics" but that doesn't stop them from dosing me with a pretty much equivalent pure IR regimen, and yeah, Im the type of person who really does enjoy the little things like extra euphoria, BUT it's not a deal breaker for me. I'm not in it for the pleasure, I'm in it to reduce my pain as much as possible, any perks that come along with it are just an added bonus.

Would you say that the Dilaudid IR lasts longer than Roxicodone? Plus, like I said, my insurance does not cover time-released formulations of hydromorphone anyways.

I was prescribed short acting medication at a very young age, but just like long acting meds the effects lesson with time and my coverage was reduced to 2-3 hours. This went on until my teens when I was finally diagnosed with pain that would be ongoing and prescribed a long acting medication.
The change to long acting meds was life changing for me and although their effects and coverage has also reduced with time, it’s certainly the better of the two for me.
I had my Dilaudid IR BT Meds Mg. bumped up this week and the relief is better but in comparison to OxyContin IR or any IR Oxicodone it’s burning off quicker and the pain control is not consist or dependable and much, much more euphoric which I really don’t like.

 

[Jktm]

Okay CPPers I have a dilemma. Preferably those of you who've taken both medications and can help me compare them for a long-term analysis. Because everyone react differently to medications, I was hoping your individual reactions could shine some light on this for me.

I'm currently RX'd Roxicodone (Instant release Oxycodone HCl) and I am debating trying instant release hydromorphone HCl, which is generic Dilaudid, and I have never used hydromorphone long-term, but I've been taking oxycodone for many years.

The United States basically got rid of the most effective time-released formulation of Hydromorphone Extended Release, it was called Palladone, then I think they banned hydromorph-contin, etc, and now the only time-released form of hydromorphone I know of that is not an implantable injection is the Exalgo 24 hour extended release hydromorphone hydrochloride, which is EXPENSIVE as hell and my insurance won't pay for it.

My provider covers basically every form of morphine you can imagine, which I find to be overly constipating.... (IR, ER, IV, rectal, PCA pumps, powder for injection) but only covers a limited option of alternative time-released opioid narcotics... weird stuff like that.

They cover Opana IR generics (oxymorphone instant release tablets) but I don't want to switch to Opana because during my previous trial with it, I got severe inter-dose withdrawals, worse than fentanyl even....

SO!!! They cover hydromorphone HCl in 1(?), 2, 3(?), 4, 6, and 8mg instant release tablets, and I'm sure that generic hydromorphone is boatloads cheaper than generic oxymorphone (without going into price discussion please, I was not asking. I know the price differences but we aren't allowed to discuss this aspect in greater detail than this)

One bonus switching to Dilaudid might mean a reduction the number of tablets per dose. I can't be more specific than this but you would be surprised what formulations of generic roxicodone the insurance has chosen to cover. It definitely allows the quantity of tablets to be exponentially higher overall so it could be yet another profit motivated decision without much further oversight, but I won't get into that off-topic/opinion-based/subjective feelings about the flaws of Capitalism and how the healthcare and pharmaceutical industry have exploited their customers, choosing cash over care usually IMO..... But Let's NOT GET DERAILED. MY BAD...

It would be helpful for me to have fellow chronic pain patients, in your subjective experiences, tell me about the following:
1.....As a breakthrough medication, which do you find superior and why (HYDROMORPHONE VS OXYCODONE)???

2......Besides comparing the analgesic components of dilaudid vs roxicodone, how do they differ in terms of side effects??? For example, Is one more or less constipating than the other, and does one produce more histamine response (itching/pruitus) than the other???

3.......I am not asking for someone to tell me the half-lives of the medications, I obviously know this stuff already.
But as a pain killer, hydromorphone vs oxycodone, how long does each respective medication last between doses? What is the normal duration for you for a single dose of oral hydromorphone IR, and for oral oxycodone IR?

4......Does the higher potency of hydromorphone make up for it's lower oral bioavailability in comparison to oxycodone (which is almost completely absorbed via the oral ROA unlike hydromorphone which has a low and variable oral BA)???

4 part B.......I am not an intravenous drug user. So besides the IV ROA, Do you ever have to use other routes of administration to get desired effects from the medication???
This was going to arise sooner or later, it's always why people say Dilaudid is only worth it via the IV ROA, but I hear most of this coming from addicts, not from chronic pain patients who are much more likely to have spent more time giving the oral ROA a chance, or perhaps experimenting with intranasal or rectal methods of administration?

5..... If I were to switch to hydromorphone, say to 4 x 2mg hydromorphone, as needed up to 8mg a day, in YOUR experience (PLEASE NO ONE ANSWER USING NARCOTIC CONVERTERS/EQUIVALENCY CHARTS, EXPERIENCED ANSWERS ONLY), how much oxycodone IR would provide the same amount of relief as 4 x 2mg hydromorphone?


TL;DR I am not asking for suggestions for a pain management regimen, I am asking for experienced patients to answer these questions to help better my understanding of each of the medications actual efficacy, which often varies dramatically on a case by case basis.

Wish I could help you out man, but you know as well as I, that I haven't been properly tried on decent pain medications. I couldn't handle it anymore, and with one stunt labeled myself as a danger to myself, and still cannot get proper medical attention, even with psychiatric issues. I'm in that same "you're too young" boat, as you, but goddamnit, I'm not too fucking young for the pain apparently and the need for a cane.

Sorry for the rant, just so pissed about my situation it's killing me. Buttfucking tramadol is what I get, and I wouldn't get high if I swallowed 20 norcos right now. Once again, sorry all, but fuck this shit.

 

[tricomb]

I bet they'd put me on tramadol if they thought they could convince me into it..... =\

 

[tentram]

^after many years using tramadol for pain mgt and oxy aswell i had my latest dr mutter to me, first visit mind and no visual (xray) evidence "why cant you kids just stay on tramadol?" in a jestful but serious manner.

It wasn't long after seeing my xrays and time to build a relationship with him that he was open to my suggestions. Ive been through most all the meds available here, er HM included, and have found fentanyl and morphine best for me.

 

[tricomb]

^after many years using tramadol for pain mgt and oxy aswell i had my latest dr mutter to me, first visit mind and no visual (xray) evidence "why cant you kids just stay on tramadol?" in a jestful but serious manner.

It wasn't long after seeing my xrays and time to build a relationship with him that he was open to my suggestions. Ive been through most all the meds available here, er HM included, and have found fentanyl and morphine best for me.

What do you use as breakthrough medication? Would you recommend hydromorphone IR?

 

[Morphling]

Generic oxycontin(old formulation) may be coming back soon.

http://www.drugs.com/availability/generic-oxycontin.html

Tricomb, all I'm on is IR hydromorphone, and it's pretty lacking as far as I am concerned. It's there and then *POOF* it's gone two hours later. Sucks.

 

[yoyoyoboy!!!!]

<snip>

No sorry we aren't able to help you acquire controlled substances.

Read the guidelines and the BLUA which you agreed to read and abide by upon creation of your account.

Sourcing narcotics will result in your revoked membership, so please don't post until you've read the BLUA and OD Guidelines.

 

[tricomb]

Generic oxycontin(old formulation) may be coming back soon.

http://www.drugs.com/availability/generic-oxycontin.html

Tricomb, all I'm on is IR hydromorphone, and it's pretty lacking as far as I am concerned. It's there and then *POOF* it's gone two hours later. Sucks.

Yeah bro see that's the problem I have with IR oxycodone. Although I may be generous and say that (dose depending) I can get 2.5-3 hours out of oxycodone.
Annnnnnyways thanks everyone for the information so far.

 

[Jktm]

is your doctor open to/can you afford opana ir?

Also...to those of you that have had surgery...how long do you think the recovery for a 2 or 3 level fusion would be?

edit: hell...even a 1 level fusion...

and does anyone know the best way to go about doing this? ALIF (really don't want this), PLIF, or XLIF?

and what should I look out for afterwards, and what alternatives might I have for a fusion? I know a microdiscectomy won't do fuck all for me...I'll be reinjured in a month with my luck and back to square 1...fuck, this surgery stuff scares the shit out of me, but apparently this is what I have to resort to for PM. :/

Goddamn DEA...sure...give me something that will make me seize and cause SSRI dependence instead of something traditional...good plan...

 

[yoyoyoboy!!!!]

I'm not trying to acquire narcotics from this page. I am in a city that i am not familiar with and am simply looking for a doctors office i can go to. As I said before I am having an issue as the doctor offices I have spoken with are reluctant to refill my current script due to the opiate problem in this area. I'm not sourcing meds i'm sourcing a legitimate doctor in the area.

 

[Snake_Eyes]

I'm currently on 150mg of Lyrica a day for nerve pain in my back and it's no longer working as well as it once did and I'm thinking about asking my doctor about adding Cymbalta. Does anyone know if it's possible to get pain relief from it without having to take it everyday?

 

[Jktm]

I'm not trying to acquire narcotics from this page. I am in a city that i am not familiar with and am simply looking for a doctors office i can go to. As I said before I am having an issue as the doctor offices I have spoken with are reluctant to refill my current script due to the opiate problem in this area. I'm not sourcing meds i'm sourcing a legitimate doctor in the area.

Wish we could help you bud, but that's not allowed here either.

I'm currently on 150mg of Lyrica a day for nerve pain in my back and it's no longer working as well as it once did and I'm thinking about asking my doctor about adding Cymbalta. Does anyone know if it's possible to get pain relief from it without having to take it everyday?

SNRIs never really helped my pain, but it's worth a shot...use up every available option you have at your disposal, man. Don't give up on pain relief, I'm considering surgery now...something I've been terrified of for years. I will say though, you're lyrica can be increased to as high as 600mg/day in the US. And lyrica, while pretty effective at first, tends to build a tolerance VERY rapidly. Quicker than benzos IMO.

 

[tricomb]

Opana's duration is even shorter than oxycodone's for me, and I don't want to have to use other ROA's to get the pain relief that I need.

I wouldn't ever buy Opana IR even if I could afford the name brand shit, because I don't like supporting pharmaceutical companies that pull tricks (I know they all do, so I just try to pick the least evil generic company IMO, just like when I have to fill up my tank with gasoline. All the oil companies are corrupt but certain ones will never get a dime from me) like Endo did with reformulating Opana ER, and like Purdue did reformulating the OCs.

It's hard because they're all almost owned by the same mega conglomerates but I vote with my dollar, I believe that the dollar vote counts more than pretty much any other form of vote. If more people had boycotted the reformulated versions of the OxyContin and Opana ER and who knows what will be next, I bet Purdue and Endo would have switched back to OC and Opana ER OG Octagons within the fiscal quarter. But I know that would be asking a TON out of many chronic pain patients.... however often I feel like if we don't team up and stand up for ourselves together, we'll just keep getting walked all over on and keep financing these bullshit ineffective abuse-deterrant mechanisms that fuck up the medications ability to release steady and consistent time-released opioids.

What's left, Morphine ER and Methadone? Not everyone can tolerate these medications despite them both being DIRT cheap and it's easy to navigate around the silly patent wars big pharma are constantly litigating against eachother. It's too bad though, because I bet if CPP's nationwide wanted the original formulations back, I bet all we'd need to do to get the OG formulations back is protest by not filling any of the bullshit abuse-deterrent-at-the-cost-of-efficacy formulation ER medications for one month / one RX, by filling their scripts for morphine ER through non-Endo and non-Purdue companies.... But like I said. Unfortunately that would be asking way too much of CPP's nationwide to have to do such a thing to bring the OG's back.

I try my hardest to only financially support / fill my prescriptions from the generic pharmaceutical company that IMO practices the best business ethics (that I'm aware of) We can't get into brand discussion due to the OD Guidelines unfortunately as I have very strong feelings about certain generics vs others, and I have YET to run across a generic medication that has not met and usually exceeded my expectations and experience with the brand name drug.

I'm not saying that any generic company makes STRONGER medications than others, they are all allegedly therapeutically equivalent as quality control is maintained by the FDA / Health Canada and the like, and for the most part I'd agree that they manage to achieve this... It's just hard knowing about how corrupt the FDA is.

So yeah man, opana IR is an option but I'm taking it off the table because I cannot stand the interdose withdrawals that oxymorphone brings. It's seriously like the agony of day 2-3 of a fentanyl patch, those 8-13 hours while you're waiting for the new patch to kick in usually hitting your breakthrough medication extra hard to compensate....... No.... No thankyou. I respect oxymorphone immensely but I would probably only use it either short-term, or when I'm hospitalized. And most hospitals fight you on this.... but settling for PCA controlled hydromorphone works too and is usually standard post-op PCA medication (If you ask me, it's totally replaced morphine as the gold-standard / first line of treatment at least for use of pain management in the hospital setting).

 

[tentram]

What do you use as breakthrough medication? Would you recommend hydromorphone IR?

my doctor only gives me codeine forte, which are 30mg a tab, 280 a month. i hit him up for oxynorm (IR oxy) after a while but he declined.

i've never had instant release hydro and never really bothered trying to get round the OROS time system in the Jurnista (ER hydromorphone) i was on so can't help out, sorry. i've requested this before as well and he's knocked me back.

if my morphine dose was lower he would be more open to the idea, i think.