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  #1  
Old 30-11-2011, 02:35
MindFunk MindFunk is offline
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advice on changing opioid meds for chonic pain managment

Hi Everybody! thanks in advance for all your replies,

I need some serious advice about "Chronic Opioid Therapy"

First off a little background info, I've been on opioid therapy for a couple years, and i've taken mostly Oxycodone ER and IR, but for insurance reasons i've had to switch, so after that i tried Morphine ER and IR for a few months, and then onto Oxymorphone (OPANA) ER and IR. I have serious chronic pain, and these meds only work to take the edge off mostly, but it's a BIG difference then full on pain.

So this is my question, I am having trouble sleeping on OPANA (oxymorphone), and the meds do not work well enough, after a dose increase they work decent for about 3 months, then if I don't get another increase i'm in terrible pain half the time, and it's severely hurting my family life, and work.. I have taken lots of time off, and i'm having to live at home with the folks. (thank god i don't have kids to raise).

So i'm thinking of telling my Dr. that i want to change meds again, but i have no idea what to change to. I have been searching and reading much about different Opioid meds over the past few years, so i'm not short on info, the problem is, I have no idea how they will work for me, and I don't have any feedback from others that are taking them personally.

The meds that i'm thinking of trying:

Fentanyl Patch (if it's still on the market in the USA)
Methadone
or back to Morphine (i sleep well on morphine, but daytime i'm more clouded, but it might be the best option)
or another option that I have not thought of yet, maybe yall can help with...

All the meds need frequent dose increases so far.. and that's quite difficult to get, i don't know what to do about this problem, i need any advice yall can provide, as to chronic opioid therapy, especially from those that have been in therapy for a few years or more, and have had to change meds.

what works best for you, and what are the pros/cons?

Thanks brothers!
~MindFunk~










  #2  
Old 30-11-2011, 04:59
blondemoment blondemoment is offline
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Re: advice on changing opioid meds for chonic pain managment

Fentanyl is the best for pain relief, imo. The patch is great for long acting pain. And for breakthru pain they have Fentora (buccal tabs) and just approved by the FDA Lazanda which is a fentanyl nose spray. I just got a scrip for it today. After I get it filled I can report back how well it works, but I do take Fentora and its amazing. It works within 3 to 5 mins.

These may not be options for you, but I wanted to mention it because after I burned out on all the meds you just named, fentanyl was a miracle for my pain.
  #3  
Old 01-12-2011, 14:15
MindFunk MindFunk is offline
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Re: advice on changing opioid meds for chonic pain managment

I have been leaning towards Fentanyl, for my 60mg Oxymorphone a day, the converter that i used says 50mcg/hour patch is what i need, i also read from drugs-forum, that the patches actually have more than 2x the amount of Fentanyl in them something like 8.4mg total, that would be over 100mcg/hour if it used up all.

Naturally i'm wondering if the used patches can be reused to breakthrough pain?
Perhaps by cutting into pieces and cheeking them? is this viable? If so, is it possible to get 100% of the leftover? this would be perfect along with normal breakthrough meds, it would perhaps completely solve the dosage problems....

thanks a bunch, hope to hear back from you, and many others, until next time, take care.

~MindFunk
  #4  
Old 03-12-2011, 05:35
Tacticool Tacticool is offline
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Re: advice on changing opioid meds for chonic pain managment

Could you care to elaborate on your history and condition ?

Because you realize if youre on Opana for " chronic pain" you're basically on the second strongest thing there is straight up. Fentanyl is stronger but once you start on it and go to the patch your entire body / brain chemistry / metaphysical etc changes.

I just had total disc replacement. I had an artificial disc installed n my spine. Thru my stomach. So I have the scars and shiny x-rays and Mris and setting off metal detectors to prove my plight. But I had no idea what I was getting into when I started with the patch. " taking the edge off" would be nice actually. But the fentanyl over the past year has completely set my tolerance so hi that 75 mug/h of fentanyl makes me feel ok enough to do some stuff, it would kill most people. Oxycodome no longer effects me , 10 30mg tablets a day don't even put me In a better mood. I can't switch really from fentanyl to another med without obscene downright obscene dosages and amounsts.

So I say to you , think long and hard about where you're at and where you really want to be before just jumping into nw, more, and stronger medicine for 'chronic pain'.
  #5  
Old 04-12-2011, 23:22
MindFunk MindFunk is offline
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Re: advice on changing opioid meds for chonic pain managment

doesn't sound like you've even tried to switch, considering 75mcg/hour patch is = to 180mg/day Oxycodone (maybe thats what you meant by "obscene downright obscene dosages and amounsts"). all opioids and opiates at dosage are totally life changing for those that use them 365 days a year, for years...

keep this in mind everybody, they all do the same thing... some people take much much more , say oxycodone or morphine, like 500mg /day after many many years in therapy, and it all amounts to major changes, thats what it means benefits out way the cons.

MindFunk added 2 Minutes and 12 Seconds later...

also i should say, that many many people take opioids for years and years, and even though they take high dosages it's NORMAL to them, and beneficial.

oh and SAFE.

Last edited by MindFunk; 04-12-2011 at 23:22. Reason: Automerged Doublepost
  #6  
Old 04-12-2011, 23:47
Herbs&Hopes Herbs&Hopes is offline
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Re: advice on changing opioid meds for chonic pain managment

LISTEN to Tacticool, I was started on fentanyl right after codeine, 25mcg per hour patch, up to 50 after two weeks, after another month back to oxycodone, only problem. I only had an hour to two hours relief from it, and NO psychological mood lift whatsoever. I completely got cheated out of my chance to enjoy opes due to this. I was denied opes for years prior to this and I finally recieve them and they dont work. Dcotors and pharmacists claimed I was simply taking my meds in higher doses than I was supposed to and told me the fentanyl dose not work like that. I have no more to say about this, thik long and hard about the fentanyl, max out all your multimodal options which supportyour opes, are you taking an antidepressent, they surprisingly work well on pain if you get the right one for your body and condition. I am on duloxetine which seems to help a bit, I would prefer one with a longer history of use and less withdrawal effects, as such, I only take it as a sleep aid, agains thteir commands, fuck them, I am not adding brain zaps to my withdrawal phase. That is just stupid. Plus they said it wouldnt help for sleep anymore as it wouldnt make me drowsie, why would I be taking it then? I am not actually depressed, just way over tired and very sore.

Max out all your supportive multimodal options along with your opes before upgrading to Fentanyl, the baddest of the bad.
  #7  
Old 06-12-2011, 19:18
Tigey Tigey is offline
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Re: advice on changing opioid meds for chonic pain managment

I think the point is that while fentanyl is indicated for chronic pain it's 'best' used in pain management which has a likely end-point (eg. death, surgery), while other opiods have less respiratory depression issues and fewer tolerance & cross-tolerance issues.

What issues are you using pain for? You say chronic, but chronic acute, chronic complex?

You could also look into Hydromorphone.

You can't get 100% of the patch contents out by wearing it, as it's designed to pull the correct amount for 72h - after which the patch starts giving less (depletion & patch/bloodstream fentanyl gradient issues).

If you're having tolerance gain issues, like I have, fentanyl is a bad idea imo. You asked for opinions, but looking over your posts, you seemed to want an opinion 'yeah, move to fentanyl. I understand that, but I've been in pain for years and while fentanyl is wonderful in some respects, it has a serious downside many doctors ignore.

While some patches have 8.4mg in for the 50mcg/hour and 4.2mcg for the 25mcg/hour, newer patch versions (generics) may have 58.1-60.2% of that amount in, as they have more efficient ways to get it into your skin for 72h. Reports of these patches are mixed, with many (including myself) preferring duragesic brand patches. Of course, insurance companies, PBS (in Australia) etc prefer the new generics as 40% less drug = 40% cheaper!

Tigey added 429 Minutes and 9 Seconds later...

Hi MindFunk,

I'll write more later, but the point people are making and which you're ignoring about Fentanyl is it's an end-of-the-line option. It reduces the efficacy of other opiate pain medication after you've developed a fentanyl tolerance, most people develop tolerance to it fairly quickly and it still stops taking the edge off, like everything else, eventually.

It seems that the problem is with your building tolerance to opiates, which is going to happen, unless you go into withdrawal to reduce your tolerance, which some of us have to do now and again. For instance, I've just WD'd off a total of 100mcg/hour fentanyl + actiq + morphine + 70mg more than I'm on of oxycontin + 200mg more than I'm on of oxycodone. That's been four months of hell.

We want you to have pain relief for as long as possible, at any level. Fentanyl often shortens the length of time pain relief at any reasonable dose works.

Post Quality Evaluations:
Excellent post that goes over some other options without jumping to fent, while still including your (similarly good, and short and sweet) post from earlier in the thread.

Last edited by Tigey; 06-12-2011 at 19:18. Reason: Automerged Doublepost
  #8  
Old 06-12-2011, 19:52
MindFunk MindFunk is offline
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Re: advice on changing opioid meds for chonic pain managment

the morphones have the worst side effects of all the opioids i've taken, they are seriously depressing, for mood.

oxycodone is the BEST #1.. but insurance/cost is a prob, morphine is in the middle of these two types, and the logical choice, and it's CHEAP! as hell

i hear yall about the fent, but i'm willing to bet any cross tolerance would be gone within a couple weeks/month with a switch, i never really got into abuse, so it might be something to look into for a rotation, or many not.. yall know more about it.

if i do use a rotation, which they indicated might be good for me, (go between 2 different drugs, few months back n forth..) maybe Oxycodone SR/IR for 3 months then morphine ER/IR for 3 months... back n forth, keep tolerance as low as possible.

have any of you tried this sort of rotation? or maybe that's another topic for discussion?
  #9  
Old 07-12-2011, 16:45
Tacticool Tacticool is offline
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Re: advice on changing opioid meds for chonic pain managment

Again ... Youve not spelled out your condition and problems and need for such medication.
  #10  
Old 07-12-2011, 22:51
MindFunk MindFunk is offline
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Re: advice on changing opioid meds for chonic pain managment

I have a painful connective tissue disease, it's something that progressively is getting worse as i age, and affects my joints, nervous system, muscular system, tendons/ligaments, internal organs...

NOT FUN!

so obviously i will be taking these sort of meds until some other major sort of therapy is available. I do have hopes for the far future, but for now this is what is available, medication and constant physical therapy.

take care fellows
  #11  
Old 09-12-2011, 17:13
MindFunk MindFunk is offline
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Re: advice on changing opioid meds for chonic pain managment

well, i changed to morphine = dose to 60mg oxymorphone, and it's much better for me, it's been a couple days now, and i'm sleeping sooooooo much better, and my pain is far better controlled.. i don't have all those side effects, even my abdomen is feeling much much much better.

this is absolutely superb in comparison, thank god for morphine i say.
WoW.. absolutely much better! i can't stop typing it..

thanks for the support you guys, i'm so glad i didn't switch to the patch..

how is morphine compared to the patch in the ways that you guys were talking about fentanyl? is morphine like fentanyl in it's long term effects? if i have to switch drugs in the far future will it be bad like switching from fentanyl?

tigey? tacticool?
  #12  
Old 09-12-2011, 19:52
kailey_elise Gold member kailey_elise is offline
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Re: advice on changing opioid meds for chonic pain managment

I was wondering why there hasn't been a combo suggested. If the morphine is too cloudy during the day, is it possible for the doc to give you one dose a day of morphine & one dose a day of oxymorphone? So you could take the Opana during the day & MS Contin at night?

If you "enjoy" your meds at all, in addition to pain relief (not saying they have to be abused in order to feel mental enjoyment, btw), Fentanyl isn't for you. It has nearly NO euphoric aspects at all, esp once you've been on it for a bit. It just doesn't hit all the same receptors, it seems.

I'm glad the morphine seems to be working for you. If the doc is open to it, a low dose of methylphenidate or amphetamine might be an idea, to counteract the cloudiness. It also has a bit of synergy with the opioids, if I recall correctly.

Anyway, point being, Fentanyl really is best for the end of the line kind of stuff, because it zooms the tolerance so goddamn fast!

I personally liked methadone quite a bit for my chronic pain issues, and used low-dose oxycodone for breakthru pain (until that didn't work, and I was switched to hydromorphone for BT). Again, it's not as euphoric as other meds, so a suggestion might be to stick with the morphine/oxymorphone for a while, and then if the amounts are starting to become prohibitive, move to methadone, then to Fentanyl.

You want to give yourself as much "wiggle room" as you can for as long as possible, esp if there's no cure for your condition & the idea is that you're gonna be on opioids forever.

~Kailey

Post Quality Evaluations:
Good to suggest a combination of things, and perhaps adding a stimulant to the mix to combat "cloudiness" (as well as the bit of synergy with opiates). Thanks for putting it in laymen's terms for the OP... leave as much wiggle room as long as you can
  #13  
Old 10-12-2011, 07:49
Tacticool Tacticool is offline
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Re: advice on changing opioid meds for chonic pain managment

I just lost TON of txt i typed on this damn Ipad so ill try to make it brief.

I was on various amounts including months without Percocet for two years before my surgery ( anterior , artificial , total disc replacement. They gutted me thru the stomach moving my emtire insides around to cut out my disc , jack up my spine and Inerrt the prosthesis Aka artificial disc. ). I took about 11 10mg peroccets in the late afternoon to around 3am ish the night befoe my snip and saved about 7 extra 10/325s for sfter surgery JUST IN CSSE - u have no idea what you'll be on. Bit my tolersmcd to oxycodome was gettin pretty high I realized and they were gonna have to do something.

After surgery the doctor prescribed " pethedine" shots I later came to kno was demerol. It was demerol and vistiril. They were painful IM injections that did NOT help the pain. And the other stiff was a sedating antihistamine which just knocked me loopy. I mmwdiately tried to ask the surgeon for pain relief he flatly denied me. Th nurse was AWESOME she twice asked him to change his plan she told me once he was snotty and once he shouted jed down. Again I asked him to do something and please give me that pump thing where I can help myself when I need it he coldly and snotty laughed at me.

So I suffered for all we'd and thurs with sinful painful demerol piercings until on Friday mornin one of the interns checked me out and asked hw my pain control was and I said it hasmt been good tar doctor isn't budging his stance. The kid says " yeah but you'd say your pain of course with our care haz been ( * I'll never ever forget gh part *) WELL CPMTROLLED ROGJT ? s" and he touches one hand to my Stomach where the foot Long cut was , and one on spine where the new disc was and it was so terrible I screamed blue bloody murder. Mean I am talkin about a scream of pain that brought like 10 nurses 2 doctors and very interested civilians visiting their frieds and family.

The kid new doc is like THAT'S FCKIM IT. I HAVE TRIED NICELH. IF HE REFUSES TO ADJUST UT PAIN MED BASED ON THESE OBVIUS EVALUATIOS BY MANY STAFF MEMBERS ILL GO OVER HIS HEAD TILL I REACH OBAMA!! Sure enough a feW hours later my surgeon visits and is like "hey guy I hear ya not feeling too hot ,,, poor poor kid why ya not TELL me !! Im like brrr he saysimma slap a patch on ya '. Having no idea what that was I say ok will thsg help ? Bc Plz I am dying! He says oh yeah !

Well them I got my first patch ever which was ( i guess old a leftcpover ?) a Real Duragesic gel patch 25 mcg/h. Andmhe said it would take 12hrs ( this was like 9 am say ) so for everhu 4 hours i was allowed 10 Mg perc.

At the time I was happy o was FINALLY, GIVN MED strong to help

BUT - I came to realize. I was never given a PCA Pump. Skipped it entirely. Skipped simple morphine medication. Not a shot .. Nver a morphine tablet. Skipped over morphine and also decent sized oxycodome. Even tjo I was known to yolerste oycodome well z, I wasmt given Amy comtinuous OC nor 30 or even 15 mg Oxy ir. No Dilaudid ( hydromorhpme) very common in IV shots , IM hydromorphone shots , Dilaudid tablets , ahydroorphome commit etc nor Opama. Oxymorphone. Cut rights to fentanyl patch , the strongest of the strong.

I did not realize but WITJIN A month percocet would have no effect whatsoever for me. Beneficial percocet no longer viable. Tolerwmce mow 300mg oxycode would literally just cost a lot. I get jydromohpme tablets. If I were looking to have fun ,A bottle might last two days imstradof 30. I'm gonna have to try Opana cause what else is there. Fentanyl RUINS ur receptors. And its NOT for euphoria. Irs for pain receptors and will sedate u big time ( kill u possibly ) ppl just think oh its xwhag i need f my pain !!!! Maybe even had a sucker or two of fentanyl pops or tablets. Its NO JOKE LOO OL
ok emd ranting.

Post Quality Evaluations:
completely incoherent due to txtspk and typos
  #14  
Old 11-12-2011, 03:09
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Re: advice on changing opioid meds for chonic pain managment

Quote:
Originally Posted by kailey_elise View Post
I was wondering why there hasn't been a combo suggested. If the morphine is too cloudy during the day, is it possible for the doc to give you one dose a day of morphine & one dose a day of oxymorphone? So you could take the Opana during the day & MS Contin at night?

If you "enjoy" your meds at all, in addition to pain relief (not saying they have to be abused in order to feel mental enjoyment, btw), Fentanyl isn't for you. It has nearly NO euphoric aspects at all, esp once you've been on it for a bit. It just doesn't hit all the same receptors, it seems.

I'm glad the morphine seems to be working for you. If the doc is open to it, a low dose of methylphenidate or amphetamine might be an idea, to counteract the cloudiness. It also has a bit of synergy with the opioids, if I recall correctly.

Anyway, point being, Fentanyl really is best for the end of the line kind of stuff, because it zooms the tolerance so goddamn fast!

I personally liked methadone quite a bit for my chronic pain issues, and used low-dose oxycodone for breakthru pain (until that didn't work, and I was switched to hydromorphone for BT). Again, it's not as euphoric as other meds, so a suggestion might be to stick with the morphine/oxymorphone for a while, and then if the amounts are starting to become prohibitive, move to methadone, then to Fentanyl.

You want to give yourself as much "wiggle room" as you can for as long as possible, esp if there's no cure for your condition & the idea is that you're gonna be on opioids forever.

~Kailey
Hi Kailey, thanks for the reply, i was wondering what do you think about "wiggle room" for Morphine?

also, on oxymorphone i feel like it's a prison sentence, it's so depressing i HATE it. i absolutely HATE oxymorphone (opana) makes me feel like crap. Oxycodone, Morphine... TOTALLY different, it helps the pain and does not have serious psychological effects. I mean i felt like i just didn't want to be alive while on opana, thats how serious that crap effects my mood.

MindFunk added 4 Minutes and 27 Seconds later...

oh i didn't say, went from 60mg Opana to 180mg morphine, it is 3:1 conversion.. so it's just a straight up change over. 20mg opana er to 60mg morphine er, 10mg oxymorphone ir to 30mg morphine ir tabs, and it's the best change without a doubt, i needed to get off opana, i was so depressed, and it was ALL the Opana, not my fault. i feel so much better right away, like night and day. i'm not saying opana is bad for everyone, but for me it's like take a pill, and want to shut the shades and be totally alone. and theres nothing i could do but change meds. right away i feel better.

thank god!

Last edited by MindFunk; 11-12-2011 at 03:09. Reason: Automerged Doublepost
  #15  
Old 11-12-2011, 12:21
kailey_elise Gold member kailey_elise is offline
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Re: advice on changing opioid meds for chonic pain managment

Well, in that case, morphine sounds like a much better fit.

I think morphine leaves a good deal of wiggle room, esp if you're only taking it orally. That leaves, say, morphine IV, Dilaudid, Fentanyl & a few others available in an acute situation or whatever. Also leaves room for more long-term chronic pain, including upping the dose & then potential switchovers if needed.

Glad it's working for you!

~Kailey

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analgesic, chronic pain, demerol, dilaudid, drugs, euphoric, fentanyl, hydromorphone, methadone, morphine, narcotic, opana, opiate, opiates, opioid, opioid therapy, opioids, oxycodone, oxymorphone, pain control, pain relief, percocet, tolerance, withdrawal

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