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Old 01-12-2005, 04:25 PM   #1
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breakthrough pain meds????? warning, long!!

i have been on different meds for some time due to 2 serious injuries and they just dont work as well as i had hoped. im thinking about trying a little something extra for breakthrough pain, and im wondering if you guys that have pretty bad pain get any more relief from adding these to your regular med regimen?

by the way, i fell off a cliff (26 foot) when i was 18 and broke a single vertebrae (L3) in different places (compound fracture), also i broke my right wrist in 3 places. the wrist was re-broke by a doctor and had a cast put on.

2 months later when it was time for the cast to come off, the doctors said it would not heal the way it was & had to rebreak it again. this time when the cast came off it was "okay".

i had alot of problems with my back, and about 2 years later i got into a severe accident & messed up my back pretty bad, fractured my skull, broke my right collarbone, busted up my face/teeth/knees pretty bad (bloody mess) and had to be transported to a hospital in tupelo, mississippi (im in alabama) because the hospitals here were afraid to keep/treat me because of the seriousness of it.

anyway, after about 5-6 months i could walk a little - sometimes with help/support. i was told to file for disability but i didnt want to, i wanted to heal up & move on with my life, i thought id heal & get back to work, some kinbd of work. a few years went by and i went through alot of different jobs trying to find one i could deal with, but the problem is i cant do any 1 thing for too long. if i sit a while then i have to stand....if i stand too long i have to lay down. even if im laying down too long i have to get up & sit or stand because of my back.

well more years went by and i kept losing jobs because of my back, either employers would find out about my condition, or i'd miss work & go to the hospital and get fired or have to quit. usually if i did start a new job (even 1 sitting driving & another sitting typing) id have to go to the E.R. after a day or 2 because of pain. through these years i'd daily take handfuls of tylenol/ibuprofen/anything else, sometimes the meds i'd get from the E.R. docs.

so 2 years ago i decided to file for disability before things get much worse (they were far beyond "bad" anyway). it took a long time because of my young age, they dont like to approve anyone young for that. but i did get approved and started seeing a doctor and going to the pain clinic a few times.

ive had an MRI at the pain clinic. they wanted me to come back every 2 weeks for an injection but i told them i cant - its too fart and i have no one to drive me that far. my doc gives me medicine and although sometimes i still suffer from pain/trouble getting up & down and walking, for almost 1/2 the month i can sort of tolerate the pain with my meds, as long as i take things very easy & slow.

i started on oxy 5mg, then went to 15, then 30 (these were all instant release). then i went from taking 3 30mg tabs a day to 4. then i tried oxycontin 80mg 2 times a day, but i didnt get as much relief. even though it may have been releasing doses all day (long lasting control), i dont think at any one time it ever released a dose equivalent to my 30mg instant release (it felt more like 15-20mg doses the oxycontin released and it just was not enough at a time for me). so i went back to 30mg IR 4 times a day for this month, but its not doing the trick. it does for a short while, then stops. thats why i am curious about meds for BT pain. my doctor is really great, she really works with me and helps me as long as i be honst with her (i am) and shes great, so i dont see a problem if i need something more.


what are some of your thoughts?


also, i have not talked with the surgeon yet to see if surgery is an option for downing the pain, but i did get the MRI results from my doc and my back is far worse than i though before. i have foraminal stenosis, and a diffferent problem with every vertebrae in my lumbar area (L1-L5) like spurring on 2, out of place something or other on 1, still visible fractures (im 28 this happened when i was 18), and a few more things i am not familiar with, ill know more feb 8th when i go back

Last edited by jujuhound; 01-12-2005 at 04:28 PM.

 
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Old 01-12-2005, 05:18 PM   #2
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Re: breakthrough pain meds????? warning, long!!

Hey JuJu,

Welcome to the PM board. No matter what Purdue says about q12h dosing for Oxycontin everybody that has used it knows tha it does not last that long. For me, about 8 hours was all it was good for. Theoretically the 80Mg should release 40Mg about 1 hour after taking it and (realistically) the other 40Mgs after five hours, so that you should maintain about a 40Mg dose over an 8 hour period. You might ask your dr about q8h dosing with the Oxycontin 80Mg or you might not be breaking down the time release binder completely. Some people just don't break it down completely. You might want to discuss other long acting meds., such Mscontin, duragesic or methdone. If you are disability and cost is a major factor, then methadone is the way to go since it is by far the cheapest pain med available. The thing to watch out for with any med change is the side effects that is unique to each one. It's always a pain (literally) changing meds. Trying to get the dosing correct while fighting the side effects and trying to figure out if you can handle the side effects at a doseage that is adaquate for relief. It is something that just has to be worked through slowly, evaluating each dose level over a two week period (that can be hell). But you've got to give it a fair trail. I also want to add that sucessful pain management is a 50% reduction in pain, giving you back at least some portion of your life not eliminating the pain altogether. For most of us totally eliminating the pain would leave us an incoherent zombie.

I'm sure someone else will be along shortly to chime in and help you out. Good luck!
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Old 01-12-2005, 06:15 PM   #3
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Re: breakthrough pain meds????? warning, long!!

thanks for the reply, i appreciate it.

i dont know too many people that have to take strong pain meds, although i do know some "old friends" that would not let me alone if they knew i took this type of med, so i make sure i tell nobody about it. they were good friends at one time, but eventually got into drugs and would do about anything they could find. i rarely see them anymore though, so thats a plus.

i know ill probably never get most of this pain under control. what i was meaning is that some of the time with this medication (oxy IR) i can almost bear the pain and get around without much help, but i HAVE to baby myself. i have to get up & down extremely slow, i cant get very active at all, and just take my steps/movements pretty slow.


ive heard of methadone being perscribed for pain, even though most folks know of it as an "addiction treatment". i tried a pill one time, and it really did help. i have not told my doctor about it but i will next visit. i just wanted to try her methods first before actually trying to make suggestions myself.

is methadone any more dangerous than oxycodone in the long-run if taken properly? the reason im curious is the time i did take one, i felt some pain relief and it seemed to last a little longer than oxy IR, and not just that but at night when i laid down, i remember feeling a pleasant sensation right in my back where the pain normally is. it felt like it was inside my backbone, and it felt like it was "tickling" my pain areas. i dont know if thats normal, it may have been a side effect but it sure felt better than pain!

anyway, thanks for the welcome and its nice to meet you

 
Old 01-13-2005, 12:40 AM   #4
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Re: breakthrough pain meds????? warning, long!!

Something about your post does not make sense. If I'm reading right, you are taking Oxycodone and you want a bt med? Oxycodeone is a short term med and short term meds azre what is prescribed for BT. For example, I am prescribed up to 3 30mg Roxicodone for BT. My base med is a LA med. I take 60 mg MS CONTIN TID for a total of 180 mg.

The idea of a BT med is as a "emergency" pill to take when the LA med is not working and your pain is out of control at a given time. So as far as I can see, no Doc os going to give you a BT med to complement a SA med like you take.

And your taking meth behind your Docs' back is a flagrant violation of the contrac\t you might have signed. You could face instant removal as a patient. It was a foolish thing to do. If you are going to self-medicate, then you might as well look foir your meds on the street and please leave the PM Docs for us law abiding people in pain who follow the rules.

 
Old 01-13-2005, 05:20 AM   #5
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Re: breakthrough pain meds????? warning, long!!

Quote:
Originally Posted by wolftrades
Something about your post does not make sense. If I'm reading right, you are taking Oxycodone and you want a bt med? Oxycodeone is a short term med and short term meds azre what is prescribed for BT. For example, I am prescribed up to 3 30mg Roxicodone for BT. My base med is a LA med. I take 60 mg MS CONTIN TID for a total of 180 mg.

The idea of a BT med is as a "emergency" pill to take when the LA med is not working and your pain is out of control at a given time. So as far as I can see, no Doc os going to give you a BT med to complement a SA med like you take.

And your taking meth behind your Docs' back is a flagrant violation of the contrac\t you might have signed. You could face instant removal as a patient. It was a foolish thing to do. If you are going to self-medicate, then you might as well look foir your meds on the street and please leave the PM Docs for us law abiding people in pain who follow the rules.



calm down there fella, ive never taken anything without my docs approval. this was before i ever saw her for anything. when i applied for disability and even before then since i have had trouble walking i would take anything i could get for pain, but now i dont need to because the doc has been willing to work with me

the methadone i took -i tried 1 pill 1 day a few years ago, at least 2 years before i even started seeing a doctor about my pain. this was before i was taking anything other than handfuls of whatever OTC med i had at the time. a friend of mine was on meth for pain control and offered me one and i liked it.

i have never taken anything outside of what my doc gave me since i started seeing her in octoboer 2004.


i forgot to mention, i also have a script for 500 ultram 50mg, ive probably had 200 of them filled so far, so i have plenty left. the reason i asked about BT is mine is not working. i tried the oxycontin 80mg. but did not get the relief i get from oxy30IR, even though the IR is very temporary relief, and somethimes none at all.

i was really just looking for suggestions, thanks for the concern but im a big boy (at least thats what the ladies say ) and i wouldnt take something behind my docs back

Last edited by jujuhound; 01-13-2005 at 05:23 AM.

 
Old 01-13-2005, 08:42 AM   #6
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Smile Re: breakthrough pain meds????? warning, long!!

Hi Jujuhound. I'd like to share my experience with narcotics vs. methadone for pain control. I've been a chronic pain patient for about 5 years now. I have severe osteoporosis and consequently have broken almost every vertabrae in my back. I've had 8 spinal fusions, dual sacral-fusions. I've also had compression fractures in my left foot and have broken 4 ribs. These fractures are spontaneous. I don't have to do anything to get a break. Sometimes just turning over in bed or sneezing can cause a fracture. I'm 49 years old but sometimes feel like I'm 70. I have tried every narcotic medication that was available to me. I was in so much pain that I was never satisfied with the dosage that the doctors were prescribing for my pain. I freely admit that I didn't follow directions and I ran out early almost every month. I was breaking vertabrae about every 4 months, so I never really was released from my surgeons care. As a surgeon, he was used to operating, doing a 6 week follow up and then saying goodbye. He was not used to prescribing pain meds for his patients for up to 2 years like he was having to do for me. My tolerance grew and grew. He didn't seem to understand that the dosages were not adequately controlling my pain. He apparently received a letter from the pharmacy board (I think that's what he said) questioning the amount of pills he had prescribed for me. Well, that caused him to write me a letter saying that he thought my behavior of asking for higher and higher doses of meds was "drug seeking". I was devestated!! I felt like a criminal!! I wanted to shake somebody and scream, "Yes, you are right! I AM drug seeking!!! I'm seeking drugs to help me with this pain!." After calming down, I decided to get an appointment with a doctor at the University of Maryland Medical Hospital. It is the best thing I could have done ! The doctors there are so caring and understanding. They didn't treat me like I was a "drug seeker". I was totally honest with them about my history of pain meds and not taking them as directed because the prescribed doses just weren't working for me. The doctor put me on Methadone. At first I was shocked! I didn't think that Methadone was used for anything except as a substitue for heroin. Let me tell you, it is the answer to my prayers. It has helped my pain tremendously. I'm not saying that I have no pain. But I would say that my pain has been reduced by almost 70%. To me that is a miracle. I will be going back in early February for a checkup and to get some recommendations for physical therapy. I think you should talk to your docs about Methadone as a pain control option. I wish you well. Don't give up. There is an answer out there for you....I'm sure. KathyMac

 
Old 01-13-2005, 01:19 PM   #7
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Re: breakthrough pain meds????? warning, long!!

Quote:
Originally Posted by KathyMac
Hi Jujuhound. I'd like to share my experience with narcotics vs. methadone for pain control. I've been a chronic pain patient for about 5 years now. I have severe osteoporosis and consequently have broken almost every vertabrae in my back. I've had 8 spinal fusions, dual sacral-fusions. I've also had compression fractures in my left foot and have broken 4 ribs. These fractures are spontaneous. I don't have to do anything to get a break. Sometimes just turning over in bed or sneezing can cause a fracture. I'm 49 years old but sometimes feel like I'm 70. I have tried every narcotic medication that was available to me. I was in so much pain that I was never satisfied with the dosage that the doctors were prescribing for my pain. I freely admit that I didn't follow directions and I ran out early almost every month. I was breaking vertabrae about every 4 months, so I never really was released from my surgeons care. As a surgeon, he was used to operating, doing a 6 week follow up and then saying goodbye. He was not used to prescribing pain meds for his patients for up to 2 years like he was having to do for me. My tolerance grew and grew. He didn't seem to understand that the dosages were not adequately controlling my pain. He apparently received a letter from the pharmacy board (I think that's what he said) questioning the amount of pills he had prescribed for me. Well, that caused him to write me a letter saying that he thought my behavior of asking for higher and higher doses of meds was "drug seeking". I was devestated!! I felt like a criminal!! I wanted to shake somebody and scream, "Yes, you are right! I AM drug seeking!!! I'm seeking drugs to help me with this pain!." After calming down, I decided to get an appointment with a doctor at the University of Maryland Medical Hospital. It is the best thing I could have done ! The doctors there are so caring and understanding. They didn't treat me like I was a "drug seeker". I was totally honest with them about my history of pain meds and not taking them as directed because the prescribed doses just weren't working for me. The doctor put me on Methadone. At first I was shocked! I didn't think that Methadone was used for anything except as a substitue for heroin. Let me tell you, it is the answer to my prayers. It has helped my pain tremendously. I'm not saying that I have no pain. But I would say that my pain has been reduced by almost 70%. To me that is a miracle. I will be going back in early February for a checkup and to get some recommendations for physical therapy. I think you should talk to your docs about Methadone as a pain control option. I wish you well. Don't give up. There is an answer out there for you....I'm sure. KathyMac




hello, KathyMac

its nice to meet you.

i may talk w/ my doctor and see how things go with that.
i almost always tske my meds as directed, but evey now & then i show up a week early at the doctors office and she is understanding and knows sometimes i have to take more. sometimes they last me the full 4 weeks, and sometimes not. but ive never been able to take less than perscribed. see, right now im still in the titration stage, trying to find something that works. the long acting oxycontin 80mg gave me less relief than the 30mg instant release, maybe i have trouble breaking the med down inside.

anyway, its nice of you to share this with me, thats basically why i decided to join & post this here as i am curious about this medicine and the more information i get the better. i am not a "street meds-seeking junkie" as the other poster made it sound, i tried a pill of methadone about 2 years ago (before i filed for disability or had a doctor) because i was going to the ER frequently and not getting any relief, and you know how they are - they say go see your doctor when this script is gone! i should have filed long ago but i wanted to try to work and i tried from 19-26 with no real luck at all. so i tried that meth when a friend offered it to me and the relief i got was better than what meds ive been trying lately. i just didnt mention to my doctor that i had tried methadone in the past, because she was experienced in pain management and i wanted to follow her course of action because i am nott well educated in all the different pain meds (well some) and i thought she may know something that would work better.

but she is very helpful and understanding, and will help me any way she can provided i keep following the "deal" we made (i wont start "doctor seeking - will use 1 pharmacy, wont overdue my meds unless needed, etc.) and i am sticking to that so she's been great so far.

thanks again for the insight

 
Old 01-13-2005, 03:56 PM   #8
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Re: breakthrough pain meds????? warning, long!!

Hey JuJU, The roxicodone is a short acting med, I use it for Break Through pain. If your in enough pain to need 30mgs of OxyIR then you should be in enough pain for a doc to mange your pain correctly with long acting meds and use the oxy for break through pain. If oxyC didn't work, There are plenty of other meds, There are several version of LA morphine, MSContin and generic forms last about 8 hours, Kadian and Avinza are 24 hour versions of LA morphine but maintain a steadier serum level when taken twice a day. Kadian maintains a moother serum level wth BID dosing. I'm Not sure about the Avinza , as far as their stand on once a day dosing. But I really haven't heard people complain about Avinza not lasting 24 hours, It actually has some imediate release morphine to get you started each day, BUt the idea is to maintain a constant level because it's easier to keep pain in check than to bring a high level down.

Docs are also less concerned about abuse with LA meds because they don't kick in the way short acting meds do. I took Kadian for abot a year and never felt a dose wear off or kick in. Just smooth coverage and I alternate my break through med from oxy to MSIR and dilaudid to prevent tolerance to the BT med.

Duragesic patches are an option, and methadone is an option.

Meth works very well on pain but has some significant side effects on personality, labido and motivation, It sort of takes the color out of life. Some folks can handle it and some can't. It's all trial and error, there isn't a quick answer to finding the right dose or right med. Most docs start low and work upwards untill you find a level of relief that's livable. If you have reasonable expectations you can sustain on the same dose for seveeral years, Tolerance does develop but anelgesia is ther last thing you become tolerant too.

I pretty much tried them all, spent too many years on meth feeling blah and had an IT pump implanted in june that's giving me better relief and a clearer head than I have ever had.

But another short acting med doesn't make sense, Particularly since the only thing stronger than a 30 mg Roxicodone is 2 30 mg roxicodone.
Everything is compared to Morphine in strength, It's the gold standard of pain relief but hardly the strongest pain reliever. Oxy is 50% stronger, Dilaudid is 7 times stronger than morphine. You would need 45 mgs of morphine to come close to a 30mg roxi,and the largest morphine tab is 30mgs. 8 mgs of dilaudid would be about the same as 30 mgs of oxy, but dilaudid has a very short oral half life.

Oxy actually has the longest half life or duration and is the most efficiently metabolized when taken orally. There is nothing wrong with using a long acting morphine product and stickng with the oxy for BT pain, different opiates hit different receptors. By mixing opiates, one plus one may equal 3 when you combine a different short acting med with a different LA med.

In 12 years of PM, I've never seen a doc use two short acting meds, calling one a BT med and the other a base med. The SA meds have very high street value, create more euphoria, tolerance grows faster because it's too easy to associate the way it makes you feel with pain relief. SA meds work like a roller coaster, your pain levels go up and down all day rather than maintaing a constant level of relief.They also leave you clock watching and trying to cram activity into those few hours they are effective.

If your shooting for 100% relief, your not being realistic and will never be happy. Even with LA meds, morphine pumps or SA meds 40-50% relief is considered a great success and takes some of us years to obtain that if it's even possible.

If your docs just a pill pusher and keeps you coming back for more, you can probably get whatever you want. If you simply want pain relief. Find a real PM doc that has more up his sleeve than a script pad and one that understands how to manage long term pain.

You don't have to feel anything to get the anelgesic effects of a med. You don't need to feel it kick in, you don't want to feel it wear off, They simply relieve pain once you have become used to the initial drowsiness or whatever feeling you want to call it. There just isn't any reason to stay on SA meds if you in that much pain. Using nothing but the most potent short acting meds goes against every PM protocol I have ever read or seen.

If your unwilling to try other LA meds, It may appear you like the SA meds with the kick a bit too much when your pain could be managed and controlled with a LA med with less potential for abuse and rapid tolerance. SA meds have their place, but not for long term 24/7 pain.

Talk to your doc abut your goals and make sure your on the same page. But even with a morphine pump delivering meds directly to my spine, at best I get 50% relief and it took 12 years of pain management and 3 failed surgeries to get there. 50% relief is considered a succes with the pump. IF you medicated yourself to manage your worst pain at all times you would be a blob on the couch.
I hope you found something helpful or something to talk to your doc about.
Good luck,Dave

 
Old 01-13-2005, 05:33 PM   #9
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Re: breakthrough pain meds????? warning, long!!

thanks for all the thoughts


like i was saying, im nott well educated in all the pain meds, i just know what ive taken.

when my mother had cancer she let me try on 1 of her duragesic patches. i did notice alot of pain relief, but when i took off the patch (day 3) there was a rash on my leg. i still have this rash (about a year old). if i put first aid creme on it every day for a week it will go away, but later on - a few weeks or a couple months my leg will get itchy, ill itch that spot and the rash comes back. even when its gone you still see little "spots", tiny dots in that area. i told my doc when she suggested duragesic, so she decided not to try that again.


i guess i should have worded myself different. i dont think she'd increase my meds more than 4 times a day (what i take now). the oxycontin didnt work (80mg) so maybe i can try something else, ill talk to her next visit.

i was more or less curious how your breakthrough meds help, when you take them on top of your "base meds" (is that what you call them?)

thanks again for the replies

 
Old 01-14-2005, 07:29 AM   #10
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Re: breakthrough pain meds????? warning, long!!

There are long acting pain meds like oxycontin and mscontin,and there are the short acting meds like percs and vicodin and the oxy IR that you are currently taking.you are not currently ON any long acting meds like alot of us are.we take ,as in my meds, i am on oxycontin 60mgs every eight hours along with oxy IR for BT pain.in your case, you are basically already on the breakthrough meds but you are not on any long acting meds,therefore,any meds that you take that are more than what you are already on,are just a bunch more short acting meds.

Breakthrough meds are meds that are taken for when your long acting med is just not enough(like when you have a sudden pain flare?)then you would take one of the oxy IR.Just for that "breakthrough" pain.I, like shore stated, have never heard of any doc who Rxed 'breakthrough"meds when you are already ON breakthrough meds.If you have not tried MS contin you should try that and see if it works for you.Your doc would also probably Rx you real BT meds to go along with that.I believe you also mentioned that the methadone helped you awhile back?i would ask your doc about that too as a possibility.You wouldn't have to mention that you already tried it as you did not have an Rx and they could look upon this negitively.Just tell them that you have done research on it and it sounded like somethng you wanted to try.I hope you find something that works for you.Marcia
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