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Thread: Long Acting Pain Meds; Lesser of the Evils

  1. #41
    Fentanyl is an opiod. It is one of the fastest acting ones.

    I'm not sure that I would trust a pharmacist on the phone to give you the most accurate advice. But we know that can be a challenge with doctors as well.

  2. #42
    A key question is what dosage of hydrocodone worked best for you? Opana and fentanyl are much more potent than hydrocodone. Extended-release formulations of oxycodone and morphine are often in much higher doses. If you were getting good pain relief with one-half or one 10 mg hydrocodone tablet every 6 hours and you switch to fentanyl or oxycontin you might end up WAY over-sedated. Calculate how many mg of hydrocodone you are taking per day and tell the doctor and pharmacist. You can find opiate equivalency charts on-line to double check.


    It's scary that someone told you fentanyl is not an opiate. It's a VERY potent opiate. There are several important safety considerations with patches. 1) If you get overheated they release more opiate into your system. Elderly people using heating pads and fentanyl patches have accidentally died from OD. 2) Fentanyl and other opiates can react with other drugs and food. Grapefruit juice can cause more fentanyl to build up in your sytem. 3) If you have kids or dogs, frankly I wouldn't use a fentanyl patch. Too many cases of kids, grandkids and pets finding a dropped one or leftover patch and chewing on it and accidentally overdosing.


    In pain management, they're supposed to start you at the equivalent dose of what you are currently taking, then slowly increase if your pain isn't managed. So if you are used to 30-40 mg of hydrocodone per day, they should try something like 10 mg Oxycontin (extended-release oxycodone) 2 or 3 times a day. I think a lot of the folks here are on higher levels of opiate per day than you are. It would be very dangerous for you to jump from a relatively low dose of hydrocodone to high-dose Oxycontin, or fentanyl or whatever. Pain management is a Godsend to those in pain but you really need to educate yourself as a patient and consumer. This is a really good link. There are very good web MD articles and the important patient info for all these medicines is readily available on-line. P.S. Generic Oxycontin is available. I don't know how expensive it is; I only took it a few months after surgery years ago. It made me incredibly depressed. If the doc is worried about the tylenol in hydrocodone, and you got good relief from 40 mg per day, why don't they just try you on plain old oxycodone at 20-30 mg per day (~6 5 mg tablets per day taken every 4-6 hours)? It'd be the simplest way, least expensive and the short-acting oxycodone tablets aren't as attractive to abusers as are the extended-release opiates.

    http://www.drugs.com/cg/pain-management-and-opioids.html

  3. #43
    Lin, thank you. I knew the insurance provided pharmacist was incorrect when I looked up Fentanyl. Exactly the reason I'm so nervous about changing and wanted to get some advise here also. I trust my Dr., but admit, with the new state law, he's been a little nervous and confused with the meds my last couple of appointments.

    I don't know about the availability issue. My insurance claims I can mail order these meds - hmmm, I didn't think that the gov allowed that. LOL, I can't imagine calling all over town asking, what long acting pain meds do you carry?! One more issue to confuse my doc. I'm happy for you that yours is available and convenient!

    My Walgreen's was robbed early this morning of 100 Xanax. Guess they won't be stocking that anymore! Do we live in crazy times, or is it just me?!? LOL

    I don't blame you for not branching out with your meds ...if it ain't broke, don't fix it!


    T



    Quote Originally Posted by ~Lin View Post
    fentanyl is an opiod narcotic. It's like all the others and depends on the individual. My best friend had the best pain control with buccal fentora but her insurance decided to only cover it for cancer patients and she switched to opana.

    I'd love to try fentanyl because it would be a dream come true to switch from so many oral pills a day to a patch every 3 days. But my pain is finally under control so I'm fine staying where I am!

    I've only found one walgreens that carries my meds, it's in the center of the city by the university hospital so I go there every month. I try to time it with my hospital appts. I have given up calling the local ones constantly. You probably already know this, but never accept for them to fill a partial script. With narcotics if they don't fill the whole script you can't get the rest and need a new script for more. Not like other meds where you can go back for the rest if they were short. So never take them up on the offer if they say 'we only have x many of that medication, is that ok?' Only do so if it's an emergency and you need the pills right away; and I'd call your dr immediately after about getting the script for what was left.
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  4. #44
    Nope, I won't be using that ins. service again!

    I've had my share of Dr. challenges too!

    Thanks, HLH!

    T

    Quote Originally Posted by hlh View Post
    Fentanyl is an opiod. It is one of the fastest acting ones.

    I'm not sure that I would trust a pharmacist on the phone to give you the most accurate advice. But we know that can be a challenge with doctors as well.
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  5. #45
    Thank you so much for this information, Avic!

    I'm going to take a look at the chart you linked tomorrow. I want to reread this then, and ask some questions when I'm not so tired. You've addressed many of my questions AND concerns in this post.

    Thank you again!
    T



    Quote Originally Posted by avictoria View Post
    A key question is what dosage of hydrocodone worked best for you? Opana and fentanyl are much more potent than hydrocodone. Extended-release formulations of oxycodone and morphine are often in much higher doses. If you were getting good pain relief with one-half or one 10 mg hydrocodone tablet every 6 hours and you switch to fentanyl or oxycontin you might end up WAY over-sedated. Calculate how many mg of hydrocodone you are taking per day and tell the doctor and pharmacist. You can find opiate equivalency charts on-line to double check.


    It's scary that someone told you fentanyl is not an opiate. It's a VERY potent opiate. There are several important safety considerations with patches. 1) If you get overheated they release more opiate into your system. Elderly people using heating pads and fentanyl patches have accidentally died from OD. 2) Fentanyl and other opiates can react with other drugs and food. Grapefruit juice can cause more fentanyl to build up in your sytem. 3) If you have kids or dogs, frankly I wouldn't use a fentanyl patch. Too many cases of kids, grandkids and pets finding a dropped one or leftover patch and chewing on it and accidentally overdosing.


    In pain management, they're supposed to start you at the equivalent dose of what you are currently taking, then slowly increase if your pain isn't managed. So if you are used to 30-40 mg of hydrocodone per day, they should try something like 10 mg Oxycontin (extended-release oxycodone) 2 or 3 times a day. I think a lot of the folks here are on higher levels of opiate per day than you are. It would be very dangerous for you to jump from a relatively low dose of hydrocodone to high-dose Oxycontin, or fentanyl or whatever. Pain management is a Godsend to those in pain but you really need to educate yourself as a patient and consumer. This is a really good link. There are very good web MD articles and the important patient info for all these medicines is readily available on-line. P.S. Generic Oxycontin is available. I don't know how expensive it is; I only took it a few months after surgery years ago. It made me incredibly depressed. If the doc is worried about the tylenol in hydrocodone, and you got good relief from 40 mg per day, why don't they just try you on plain old oxycodone at 20-30 mg per day (~6 5 mg tablets per day taken every 4-6 hours)? It'd be the simplest way, least expensive and the short-acting oxycodone tablets aren't as attractive to abusers as are the extended-release opiates.

    http://www.drugs.com/cg/pain-management-and-opioids.html
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  6. #46
    Avictoria, I apologize that I had to come back to this. I have a lot of interruptions running around my home (teenagers), they seem to appear in large groups when I think I have time to myself! AND, my head is foggy from the 2.5 mg increase of Hydro. Jeezzzz!

    Your information is very helpful, thank you so much! I looked up the opiate equivalency charts, but have no idea how to calculate reduction for incomplete cross tolerance. After reading about these medications, the Oxydocone sounds like less risk for side effects and this echos my local Phamacist. I also hope if the Dr. Rx's this he'll start me in small doses.

    I've noticed other members take more meds than. The question is, how much pain relief should I expect? I aim for tolerance to function (ability to half way keep the household running), but have not been pain free in years. I have, what I call, the day after surgery pain, pain level, most of the time. Is that the norm for most folks with SCI? I've never thought I could tolerate enough medication to be pain free or even close to comfortable.

    I know I should have better knowledge of this but didn't grasp what I was dealing with until last fall. After my injury, my NS had told me, "sometimes these things heal on their own". I was counting on healing, and was late to realized that I had long pasted the deadline for healing. Even as it became more difficult to walk and the pain increased, I didn't acknowledge the actual SCI, just the arachnoid cyst, (Charlotte), and looked at it and explained it to others to be minor, as an ovarian cyst. I blamed my bladder and bowel deficiencies on side effects of the pain medication. LOL

    One thing I do know, this medication game with my Dr. is too hard on me ...I've lost 5 lbs since my last appointment 3 weeks ago - weight loss scares me.

    In any case, it's in the Dr.'s hands tomorrow morning! Thanks to all of you, I'll be a little better educated!

    Many thanks!!!

    T



    Quote Originally Posted by avictoria View Post
    A key question is what dosage of hydrocodone worked best for you? Opana and fentanyl are much more potent than hydrocodone. Extended-release formulations of oxycodone and morphine are often in much higher doses. If you were getting good pain relief with one-half or one 10 mg hydrocodone tablet every 6 hours and you switch to fentanyl or oxycontin you might end up WAY over-sedated. Calculate how many mg of hydrocodone you are taking per day and tell the doctor and pharmacist. You can find opiate equivalency charts on-line to double check.


    It's scary that someone told you fentanyl is not an opiate. It's a VERY potent opiate. There are several important safety considerations with patches. 1) If you get overheated they release more opiate into your system. Elderly people using heating pads and fentanyl patches have accidentally died from OD. 2) Fentanyl and other opiates can react with other drugs and food. Grapefruit juice can cause more fentanyl to build up in your sytem. 3) If you have kids or dogs, frankly I wouldn't use a fentanyl patch. Too many cases of kids, grandkids and pets finding a dropped one or leftover patch and chewing on it and accidentally overdosing.


    In pain management, they're supposed to start you at the equivalent dose of what you are currently taking, then slowly increase if your pain isn't managed. So if you are used to 30-40 mg of hydrocodone per day, they should try something like 10 mg Oxycontin (extended-release oxycodone) 2 or 3 times a day. I think a lot of the folks here are on higher levels of opiate per day than you are. It would be very dangerous for you to jump from a relatively low dose of hydrocodone to high-dose Oxycontin, or fentanyl or whatever. Pain management is a Godsend to those in pain but you really need to educate yourself as a patient and consumer. This is a really good link. There are very good web MD articles and the important patient info for all these medicines is readily available on-line. P.S. Generic Oxycontin is available. I don't know how expensive it is; I only took it a few months after surgery years ago. It made me incredibly depressed. If the doc is worried about the tylenol in hydrocodone, and you got good relief from 40 mg per day, why don't they just try you on plain old oxycodone at 20-30 mg per day (~6 5 mg tablets per day taken every 4-6 hours)? It'd be the simplest way, least expensive and the short-acting oxycodone tablets aren't as attractive to abusers as are the extended-release opiates.

    http://www.drugs.com/cg/pain-management-and-opioids.html
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  7. #47
    Charlotte, I hope things go well tomorrow. Pain and managing it requires a bit of 'tweaking' to find the right balance that reduces your pain levels without leaving you fuzzy headed or with side effects. And it's all kinda confusing and you need to communicate really well with your doc. I'm sure when you have a plan in place with your doc you'll feel less stressed and hopefully will get your appetite back.

    This forum is a wonderful resource and there are so many people willing to share their insight and advice. Please post back and let everyone know how it goes!
    All the best!

  8. #48
    Senior Member fromnwmont's Avatar
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    If my Dr is correct even 7.5-500 hydrocodone will be changed to just 325mg of acetmetphen by 2013 due to liver concerns if you are cutting 10-325 in half perhaps 7.5 or even 5-500 would work for you? One pharmacy in town has yellow 10-335 other white do you have option to check different pharmacy? I have tried many types phentanol, oxycontin, Ms contin but due to cost, relief and side effects use methadone & oxy for break thru pain

  9. #49
    I myself on methodone for 5 yrs as a chronic pain! I believe the pain is always here to stay unless one do as Larry Flint did, cut the cord! He said it was the best thing ever from 10 yrs of pain. Overall, as for the the pain meds, I believe that it takes our thoughts of the pain and its what the meds do for us. I realise as a SCI this is part of our lives and find te meds best keep you focus off the pain that stop us from being down and out, day in and out for what life offers. Wish us all a well balance life cause it sucks. Peace and love be upon us!
    Sammy..
    life begins when you walk in spirit papito189@gmail.com

  10. #50
    Senior Member ~Lin's Avatar
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    you'll never feel pain free with meds. I also shoot for functional. I wasn't for years, now that I'm starting to be I consider my pain undercontrol. It's definitely not gone, but I think this is as good as it gets.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

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