HI chaddy, I've never ben impressed with oral dilaudid, It's just not as effective as it is when delivered IV like in a PCA after surgery. It also has a shorter half life than morphine and oxycodone, so duration is shorter.

Your BT meds should be proportionate to your base meds. Just looking at the Avinza your BT med would need to be 30% of one of your doses. MSIR comes in 15mg and 30 mg tablets, but liquid versions allow you to dose whatever you need or you can simply take 2 30mg MSIR at a time or whatever you need of the liquid version.

10mgs of oxy is extremely low compared to your total opiate intake. BT meds need to raise your opiate serum level at least 20% to be felt or make a difference. Roxicodone/Oxycodone HCL comes in plain 5mg, 15 and 30 mg strengths unles your outside the US. Canada has it's own strengths of meds. There are also liquid version of oxycodone with 20mgs per ml that can be used to create whatever dose you need whether it's 50 mgs or 100 mgs at a time. I use 30 mg oxycodone tabs because it has the longest half life of all the BT meds. It's prescribed 1 or 2 tabs twice a day, 30-60 mgs per dose. Although often I just use what I need, If I take more than 15 mgs in the day it pretty much wrecks the day as far as being productive, I have never taken 2 whole 30's at a time although one isn't enough in the evening, that's how I ended up with the orders of 1 or 2 tabs. The tablets are scored and I have a splitter so I can take can take 15, 30, 45 or 60 mgs at a time depending on my need at the time.

The thing to remeber about BT meds is not to incorporate them into your daily routine. IF I took 2 pills twice a day as prescribed every day for the last 2 years. IF I had a huge flair today, the BT meds wouldn't be any more effective than any other day I took the max dose for the last 2 years. By only using what I need for each occurance of BT pain they are still very effective 90% of the time, some days are bad and everything sfeels like a dud, but I can get through a bad day when I loo back at everything else I have gotten throguh. I have never taken 2 whole pills at a time, so there is still a dose of oxy that I have never taken should I have a huge flair or need a higher dose of BT meds than what I'm used to. You will get just as used to taking BT meds every day as you do the long acting meds, so try to find something that works, that you have control over the dose and only use what you need. Realize if you take the max amunt of BT meds every day, if you have a major flair up, the BTmeds aren't going to be any more effective then the days your took the max dose for less pain. The liquid version of oxycodone is called Oxyfast and there are generics, I can't think of the liquid version of Morphine but both come in a couple different strengths, 5mgs per ml and 20 mgs per ml.

There is something stronger available for BT ain but it's aproved for malignant cancer pain oly. Docs do prescrib e it for chronic pain but it would scare me once I reached the max dose of the most poetent take home med available. The med is called Aqtiq and is a Fentanyl sloli pop. Howver the highest tolernce patients I have ever met are always those using Aqtiq. It just seems too easy to start at a 200mcg pop and work your way up to the strongest pop which is 1600 micrograms, 16 times the strength of what a 100ugh patch delivers only it delievers it imediately and last about 2 hours. It would concern me that there was nothing stronger available outside of a hospital. I do know that pain can increase and we do grow tolerant. What do you do once a 1600 mic Aqtiq pop no longer works, use 2?

What happens if we grow tolerant to the most potent med available and then develop malignant cancer. The pain wouldn't be manageble outside of a hospice with IV meds. There simply isn't anything stronger and I haven't figured out the logic in a doc prsescribing a BT meds 16 times the strength of their bases dose of long acting med.

It seems someone would only be satisfied when their serum level is at the peak created by the use of Aqtiq, if their serum level drops to 1/16th of what a 1600 microgram pop delivers how can you can you be content without a pop in your mouth. The bright side is I have never met a patient that wasn't happy with the relief they got from Aqtiq, but that just makes sense when there is nothing stronger and one dose is 2-16 times stronger than a 100ugh patch. It does come in 200, 400, 800, 1200 and 1600 mcg strengths. But I have never seen tolerance grow like it does with Aqtiq.

There is a pharmokenetic reason, Fentanyl actually binds to the NMDA receptor which causes Hyper algesia, increased tolerance to opiates and decreased tolerance to pain. Many adjunct meds in PM target blocking the NMDA receptor to decrease tolerance to opiates,and increase tolerance to pain. A drug like fentanyl that binds to it will cause wind up once the drug wears off and fentanyl has a half life of just minutes when given IV and not much longer once the pop comes out of the mouth. That's why the patch is used to maintain a constant dose, when it drops off the patient is in trouble.

IMO it should be the last resort, although I'm sure some Aqtiq users would disagree or feel it was their last resort. But when you compare their aqtiq use to their base med, BT meds 10 times stronger than their total daily base med just doesn't make sense to me. I would hate to see what happens if they develop malignant cancer or need post op pain control after their body becomes tolerant to something that strong.

You still have a lot of room to find a dose of morphine or Oxy that works, whether you have to take multiple 30 mg pills or use the liquid versions to customize a dose that works.
Good luck, Dave