Opioids Visiting pain management doc in 6 hours - need fast reply.

[Rybee]

Hi All - appreciate it's late but would really need help before I saw my anaesthetist at 12PM GMT

Have been taking 3x10mg Oxycodone IR for 6 months - not really helping with the pain and this dose anmyore.
I was taking 25xmg Amitriptyline which helped with the pain, but suffered too my side effects so was hoping at trying Nortriptyline mixed with an opiate rotation as I've been taking Oxy for 6 months to either:

- Fentanyl (had before)
- Buprenorphine (not had before)
- Hydromoprhone (not had before but seems a good option)
- Methadone (not had before, but sceptical because of the cardiac effects)
- Pethidine (not had before but unlikely)
- Tapentadol (had before but just didn't feel the effects)
- Morphine (had it a billion times before, doesn't help.

- Under no circumstances will I try transdermal patches again as I swim regularly and they just proved to be a nightmare so that my rule Fentanyl out - I don't think they will prescribe it in instant release.

- Buprenorphine, I'm not so sure on. I like the opiate high every now and again, who doesn't? But it doesn't see as this will be possible on bupre?

- Methadone - I really want to try this as I firmly believe it'll be the best painkiller, but there seem to be so many complications, and I will surely lose my ability to abuse them.

- Pethidine, old and don't really know much about it, but it's still tried here in the UK.

- Tapentadol & Morphine, had both before and didn't really help.


So realistically hat leaves me with Fent, Bupre, Hydro or possibly Methadone. I'm hoping that one opiate will have a high cross tolerance so I can really bring my dose down and rely on the Tricylics a bit more.

So that really leaves me with Fentanyl tablets, or Hydromorphone tablets.

Does anyone have any words of wisdom before I see my pain management specialist? I've tried substances like GABAPentin and Pregabalin and they just spaced me out so badly, I wouldn't want to try them again. Maybe Pregabalin at a lower dose, or even Dosulpein?

 

[Changa707]

Since you're in the UK, I would go for the Pethidine...although only if this is for short-term pain management, because pethidine has toxic metabolites such as norpethidine which build up in your system.
The only reason I liked pethidine is because it seems to be so different from typical opioids, and I have heard it is easier to quit (less psychological cravings). But if you need long term pain management I would look into either Methadone or Tapentadol. I have heard that those medications work great at relieving pain without producing all the euphoric feelings that make Dilaudid or Fentanyl so addictive.

Of the drugs you listed, I have only tried Pethidine, Buprenorphine, Morphine, and Hydromorphone. In my experience Morphine has been the best for relieving pain, then Hydromorphone...Pethidine was negligible, but I only took 100 mg orally (felt like 60 mg Codeine). You might wan't to look at Codeine too!
In regard to Buprenorphine, only tried it once when I was opiate naiive, but I took too much and got very sick. I can say that I don't remember getting any pain relief, but it did have a strong body high component while allowing me to retain strong mental clarity.

Hope that helps!

 

[LilikoiMoon]

How did your appointment go?

I was rx'd oxymorphone/opana almost 2 years ago, and it helps with pain. Actually, twenty plus years of trying pain meds, it works best for me.

And I like methadone as well. In low doses (20 mg or 2 10mg tabs) it helps with my pain and also keeps withdrawal at bay if I want to go off my meds.

I have to rotate medications and dry out once in a while, or I use too much opana. Not meaning I abuse my rx, just doing two in the morning of the opana 10mg makes me buzz around the house and work cleaning.

Hope you find the right rx to help with pain.

 

[Rybee]

Thanks for the replies, managed to read them before my appt.

Going to start Nortriptyline this week and go on Methadone next week.

Thanks guys, v. helpful.

 

[tacodude]

Hydromorphone even oxymorphone for suggestion. Does oxy/hydro/codine help at all? For me they manage pain during the daytime well when I am up yet cause some side effects that prevent me from resting well while oxy/hydro/morphine manage my pain and cause much heavier physical sedation that make them useful at nighttime when I'm resting although problematic when I need to function. I find what works best for me is having oxymorphone and oxycodone and managing between the two while avoiding using both at the same time while oxymorphone and hydrocodone combo also worked it created crash m certain issues that did not occur between the two oxy or just the natural two opiates although I have not tried hydromorphone and hydrocodone during the same period to manage pain so I can't say much on that although I'm sure it would be a good combo without the issue I had with the oxy hydro combo.

Anyways just sitting here in the hospital now..... Iv antibiotics yay. I'll add had my first hospital opiate injections. Morphine 4 mg was a joke and caused serious histamine release where hydromophone half mg I assume gave no itchy histamine release and was a significant difference, but not strong enough for sedation surprisingly.