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Old 08-20-2008, 07:22 AM   #1
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I'm changing from Mscontin to Oxycontin, need a little help please

I went to my pain management Dr last week and explained that the Mscontin 30 mg's I take 3 times a day is not working for my pain and never really did work that well. After explaining that I had been on Oxycontin 20 mg's 3 times daily after cervical fusion surgery almost 2 years ago, actually worked better than this Mscontin ever did and could we switch back over to the Oxycontin again.

We didn't go through the whole discussion of the conversion or anything about having problems switching from one drug to the other, but now that I'm about to start the Oxycontin I fear having terrible withdrawals and perhaps not getting enough pain relief!!

Could someone be so kind to explain all this to me and if the conversion to the Oxycontin 20 mgs is a good choice or should I have had a higher starting mg's as I wean off the Mscontin? I'm just very confused now and would like some help with this please.

Oh, and when my pcp wrote out the script he decided I didn't need anymore breakthrough meds, which were Oxy Ir's 5 mgs 3 times daily! It's my pain management Dr who tell's my pcp Dr what to write out and follow through with, seeing in our state the pain Dr doesn't write the scripts but just advise's what my pcp should do. But I think my pcp Dr just didn't want to write out for any breakthrough meds and just let me suffer. But I will call my pain Dr over the b/t's later and see if I should stay on them or not.

Any help someone could give me would be very much appreciated~
Thank you,
Have a sparkling day to all,
Shelby

 
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Old 08-20-2008, 09:39 AM   #2
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

Shelby,

If I remember correctly, Oxycodone (Oxycontin) is 2x stronger than Morphine Sulfate.

As far as the BT meds go, who actually has the final say? Your GP or your PM? Has your GP ever disputed or refused to write any other meds/doses that your PM has recommended?

It sounds like your GP is looking at this as enough of an increase in LA meds, so he isn't thinking the BT will be necessary. But I'm not sure that he is taking the amount of BT you have been using into consideration, or including it in the overall conversion.

If you were previously taking your max dose of BT meds, you'll probably notice some differences in pain coverage, and (I'm not 100% on the overall conversion) you might have some mild withdrawl symptoms. If you only took the BT on rare occasions, then there probably shouldn't be any problems.

I would definitely contact the PM, if you think this is going to cause w/d symptoms. Maybe he can convince the GP that you'll need them, at least occasionally. Best of luck with everything. Please let us know how it goes. CMP/MM

Last edited by cmpgirl; 08-20-2008 at 09:40 AM.

 
Old 08-20-2008, 09:58 AM   #3
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

Quote:
Originally Posted by cmpgirl View Post
Shelby,

If I remember correctly, Oxycodone (Oxycontin) is 2x stronger than Morphine Sulfate.

As far as the BT meds go, who actually has the final say? Your GP or your PM? Has your GP ever disputed or refused to write any other meds/doses that your PM has recommended?

It sounds like your GP is looking at this as enough of an increase in LA meds, so he isn't thinking the BT will be necessary. But I'm not sure that he is taking the amount of BT you have been using into consideration, or including it in the overall conversion.

If you were previously taking your max dose of BT meds, you'll probably notice some differences in pain coverage, and (I'm not 100% on the overall conversion) you might have some mild withdrawl symptoms. If you only took the BT on rare occasions, then there probably shouldn't be any problems.

I would definitely contact the PM, if you think this is going to cause w/d symptoms. Maybe he can convince the GP that you'll need them, at least occasionally. Best of luck with everything. Please let us know how it goes. CMP/MM
Thank you so much for responding my dear!!!
I've been waiting for someone to help me with this and you came through...thank you again!!!
As for the PM Dr, he did tell my PCP to keep me on the breakthrough's, but my PCP is a little leary of them for some reason. I do take 3 tab's, 5 mg's a day for b/t, so that isn't really alot of medication. When I left the PM office, the nurse said to stay on the b/t's, so what I'll do is have her contact my PCP and tell him to do just that, as he will follow what my PM recommends.

I was just concerned with the change over of med's and if there was a big difference of how they were compared. I had always heard that Mscontin, even though its morphine, that it never was as strong as Oxycontin for some reason. All I know is Oxy works better in my system and with my pain at the lower level dosage, so more power to me if it works, seeing we all will be on these long acting meds for the rest of our lives.....so why increase if its not necessary yet.

Thank you again for helping me understand some of this~
You have a sparkling painfree day my dear,
Shelby

 
Old 08-20-2008, 10:30 AM   #4
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

In general I think oxy is 1.5 times stronger than morphine. But, everyone is different. I don't think you will experience major withdrawls but it may not cover your painwell enough. Most doctors start low on a new med and titrate upwards so hang in there and tell them when things are working.
Good luck getting your bt meds back. I had the same problem except it was my pm that didn't give me any bt meds and my gp said,"That's ridiculous! Everyone has days with more pain!" and she promptly wrote me a new prescription.

I hope this works out for you.~Mush
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Last edited by trowftd3; 08-20-2008 at 10:31 AM.

 
Old 08-20-2008, 10:37 AM   #5
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

I can't really help you. I have never been on MS contin - I am allergic to morphine which is why I have not responded to you. The only other medication I have taken successfully is percocet and demerol for pain relief. Everything else I am allergic too that we have tried.

I saw your note in my thread and thought it might be easier to respond here. I just recently was blessed with a wonderful pm doctor. I was severely undermedicated and suffered for months. If you want you can do a search on my story. By selecting the Advanced Search button and searching by my name.

The only thing, I can think of is you might ask a pharmacist for his opinion.

If you have any back questions those I can answer. I have had 4 spinal surgeries (38 hours total) - two fusions, laminectomies, and revision (removal of one side of the hardware).

Welcome to the board and I pray that you will receive the answers you need.

 
Old 08-20-2008, 08:50 PM   #6
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

Quote:
Originally Posted by shelby3195 View Post

As for the PM Dr, he did tell my PCP to keep me on the breakthrough's, but my PCP is a little leary of them for some reason. I do take 3 tab's, 5 mg's a day for b/t, so that isn't really alot of medication. When I left the PM office, the nurse said to stay on the b/t's, so what I'll do is have her contact my PCP and tell him to do just that, as he will follow what my PM recommends.
As we've discussed on these boards many times over, most GPs really don't understand PM....Just look @ Diet's case. I think your GP is probably a little leery because he thinks you're already going to be taking OC and doesn't want you to take anymore Oxy. However, it's obvious that he doesn't understand the role of BT meds.

Quote:
I was just concerned with the change over of med's and if there was a big difference of how they were compared. I had always heard that Mscontin, even though its morphine, that it never was as strong as Oxycontin for some reason. All I know is Oxy works better in my system and with my pain at the lower level dosage, so more power to me if it works, seeing we all will be on these long acting meds for the rest of our lives.....so why increase if its not necessary yet.
Your concern is very valid....Anyone switching should be concerned and you're asking good questions. As a general rule, Oxy is 2-3 times stronger than oral morphine. Oral morphine has poor bioavailability....Around 30%, thus, you lose about 70%. Conversely, Oxy is about 70%. Oral morphine works well, you just need a lot of it. IV morphine is a different story and works very, very well and that is why it's the DOC in most hospitals for severe pain.

Hope this helps, and good luck. I'm sure the conversion will go fine.

Regards,

Ex

 
Old 08-20-2008, 08:53 PM   #7
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

I think that the 3 to 2 conversion is about right - as far as the "textbook" goes, but everyone responds differently. My concern is that your BT meds weren't included in the conversion, so I think it's a little low. Hopefully you can call your doctor if you run into problems with withdrawal. He should prescribe something more if you go into withdrawal. Just try not to start it on the weekend when he can't be reached! If you have mild withdrawal, your body will probably adjust over a couple weeks.

I, too, responded far better to oxycodone than I did to MS Contin - I don't feel like the MS Contin has ever worked very well for me. I know you've already made the switch, but it might have been worthwhile giving Kadian or Avinza a try if you can get brand name. Always a possibility if the oxycodone doesn't work out.

I forgot to mention that the doctor probably reduced the dose for "incomplete cross tolerance" -- if you've been off oxycodone for a while, *less* oxycodone is usually necessary. In other words, your doctor doesn't do a straight conversion but converts and then reduces the dose because you will get a better response with a new medication. That may be why he dropped your b/t meds. If he hadn't there wouldn't have been an adjustment for this factor. It doesn't mean you won't need BT meds though...Sometimes it takes a couple weeks to a month of fiddling with a dose after changing meds to get it right. Oops, just reread your post and see that you've been taking oxycodone as a BT medication and that your GP is doing the change - he may not know anything about incomplete cross -tolerance. Since your're taking a small amt. for BT pain, I'm not sure what that does to incomplete cross-tolerance - again, he may not have factored that in...I do hope he understands that withdrawal is a normal response to not having a dose that is high enough.

Does you GP know that you might experience some withdrawal if the dose isn't high enough? Some GPs don't really understand the physical dependence part of regular treatment with meds. If he doesn't know that you are physically dependent on the meds, I would be careful about using words like withdrawal if you experience it since it's possible that your GP might equate physical dependence with addiction [hopefully, your GP has more experience and is more enlightened than some other GPs. In all fairness to them, they get very little education on pain management in med school - they don't have to do a rotation in it and they are used to prescribing it on a short term basis for temporary injuries.

I think the switch will probably go well [the numbers basically look good -- again, everyone is different though].

Last edited by Confused089; 08-20-2008 at 09:12 PM.

 
Old 08-21-2008, 07:19 AM   #8
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

Quote:
Originally Posted by Confused089 View Post

I, too, responded far better to oxycodone than I did to MS Contin - I don't feel like the MS Contin has ever worked very well for me. I know you've already made the switch, but it might have been worthwhile giving Kadian or Avinza a try if you can get brand name. Always a possibility if the oxycodone doesn't work out.
I switched from the patch to Avinza earlier this Spring / Summer and I have to say that the Avinza is working quite well. There was some issue with the change, but we got all of that worked out. Most of the people I've interacted with re: MsContin say you need 3 x day.

Good luck,

Ex

 
Old 08-21-2008, 09:53 AM   #9
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

I quess I'm responding to your post dietdrpepper because I read your bio and totally understand and have so much empathy for what you've been through. After a not so good night of sleep and much pain, I came back here to see if I had anymore response's..only to see how all of you have compassion, understanding, support, and knowledge of chronic pain issues. And you took your time out of your busy day's to answer mine is amazing!! Thank you all so much!!

Back to what really brought me here, as I'm sort of in the same boat as you dietdrpepper, with the main pain issue right now being my back with the same as you had with spinal stenosis and a huge herniated disk at level L5/S1, along with two other disk's that need surgery of some kind. But each Dr I've seen have told me it would be like repairing the whole back, which would be impossible at this stage of my life. Whatever that mean's I'm not sure, all I know is my immune system is very run down, so nobody will touch me until I put some weight on and build up my immune system.
I also have fibromyalgia, rotator cuff problems with a frozen shoulder, limited motion after my cervical fusion surgery not quite two years ago, one failed knee replacement and now needing another one, oh heck, just too much to put here in a post...hehehe..

But I do agree with all of you about the Mscontin and the Oxycontin and how it will work well for me. I haven't started it just yet, I start Aug 23rd, and that's why I wanted some info before I do the change over without my added stress over the lack of knowledge on the difference of the two. Again, thank you all for your responses of knowledge to that!!! Priceless!!!

A little update about the b/t Oxy Ir's: I talked with the PM nurse this morning and she agreed that I stay on the b/t's for awhile anyway at that dosage, or until I feel comfortable enough, but also as the time goes on, I should have them around to take as needed for any type of breakthrough pain. So, in other words, always have a script filled just in case....which to me anyway, added pain is bound to happen even while on any long acting pain medication. So what she or the PM Dr does is notify my pcp to write the script out and gives it to me without question, seeing it sort of cover's my pcp's DEA report's he has to file with any chronic pain patient he handle's....it let's him off the hook so to speak...lol!

Anyhoo...I hope I didn't go into too much detail for a post for all of you to read...if so..I apologize...but I had to at least reach out to each and everyone of you that responded to help me through this period of adjustment. I just hope sometime I'll beable to help someone else like all of you have helped me through this dilemma, or to just give someone comfort and support!!
Thank you all once again~
Everyone have a sparkling bright painfree day,
Shelby

 
Old 08-21-2008, 11:31 AM   #10
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Re: I'm changing from Mscontin to Oxycontin, need a little help please

Shelby,

Please let us know how it goes.

I am glad you will retain the BT meds. One should never switch opioids w/o having BT meds on hand. You should not experience any WDs at all. You are going to a higher dose by switching to oxy, even though the numbers appear lower, so, if anything, your pain coverage should be better.

Best Wishes.

steve

 
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