Questions about BT meds with Duragesic - Pain Management Message Board

inpaininnv · 05-26-2005, 11:44 AM

Hi All
I have been having trouble finding a med that actually helps for Bt pain. I am on 50 ugh Duragesic every 48 hours. My dr is good about helping but as you all know you start small and work your way up. What meds works with the patch? I have tried the hydrocodones (sp?) and the percocets. I feel like the patch is so strong that nothing will help with bt pain. I saw my dr on Tues and she said we could try morphine or demerol and a few others. She did bring up Duiladid but she said that if I need more that 15 doses a month that I will blow my tolerance through the roof and that no other meds will be effective. Is that true? That scared me. My pain is from 2 failed back surgeries. I just do not want to be forced into another surgery because the meds are now ineffective.

My 50 ugh patch controls my pain, and I am happy at that dose. Plus it leaves room to increase if needed. BT pain in another story I need to know that a med is going to help ya know.

Anyhoo are any of you using Diuladid for bt with Duragesic? Does it work for you? I need some advice and support so I can make a informed decision and the meds. I have researched Duiladid online but I just do not know.

Thanks guys
Carla

P.S. I was forced to take the Mylan patches last month because no one would order name brand and I though I was going to die!! Not to mention if I did not REALLY tape the patch on good I would wake up in the morning and the patch would be stuck to the sheets

(Of course they would stick there fine)

Shoreline · 05-26-2005, 02:20 PM

Hi Carla, Oxycodone comes in 15mg and 30 mg tabs, your right it needs to be proportionate to your base dose. The name brand is roxicodone but here are 4 generic manufacturs.

As far a snothing being effective, that;s balogney, I know folks that use 6 100ugh patches. A single 50 patch is hardly the end of the road. Docs are just crackng down on BT meds, It's one more thing for the DEA to count against them. If you need to go to 75ugh to manage without BT meds and the meds aren't impairing you more than the injury, it sonds like your doc just has some mental limits or limits he thinks the DEA would get involvd in.

Obviously not everyone can get by on a 50ugh patch. Demerol orally is very weak and shouldn't be used long term unless you are into seizures. But I guess 15 doses a month probably isn't enough to cause a problem. 4mgs of dilaudid is no strnger than 30 mgs of MSIR, so how is dilaudid going to blow your tolerance. 30 mgs of oxy is like 45 mgs of MSIR and 8 mgs of dialiud would be like 60 mgs of MSIR or 45 mgs of oxy.

Fentanyl is measured in micrograms it's so potent, and he's worried about dilaudid. Personaly, I don't like oral dilaudid, very short half life and nothing like IV dilaudid you may have gotten PCA for post op pain. With a continous drip, half life doesn't really matter. Your doc has some interesting views and some obvious dosing limits when there really is no such thing. JUst his comfort limits.

Take care, Dave

inpaininnv · 05-26-2005, 03:38 PM

Hey Dave,

Well see thats what I thought about the patch. 50 ugh in no where near the end of the road for me dosing wise.Is there actually a roof on how much duragesic can be prescribed? I had thought originally that I would up the patch because I had needed Bt meds more often than not. I guess the dr was trying to scare me with Diladid. I just do not know why though, she made it sound like once I had a tolerence for it my pm is done with and its surgery time. Honestly I really do not want the Duiladid but I do need to know that when it is a real emergency that I have a med to "rescue" me. I had not thought about the DEA in my case specifically but maybe you are right.

So then what is the right proportion of bt meds to base meds? I had thought I had seen you post that it was 10 percent? Does plain oxycodone work better than Percocet? I understand that it is trial and error. I also know you can't just walk in and say this is what I want..it is so frustrating. Is it really that hard to match up bt meds for fentanyl?

I do not want to sound like a whiner...I have read lots of posts where there dr's do not even believe in using bt meds so I know it will just take time to figure it out. I have learned so much from this board. Thanks again.

LibraBalancer · 05-26-2005, 05:11 PM

Carla,
When I was on Duragesic, I was taking (only for a very short while) percocet for BT pains. It worked pretty well, no less than 10mg though. And yeah, what Dave said...I've read that Meperidine/Demerol is BAD in long term use. Dilaudid is cheapish and effective. My mom use to be on it for BT, although she was on MEthadone and not Duragesic, it's still potent and effective regarless of what your LA is. But listen to Shore, he's right about preportion. I've learned that from him and it's just common sense really! LOL

xo james

tkgoodspirit · 05-26-2005, 11:47 PM

Hey Carla,

I too am on 50mcg Duragesic. I only started the Duragesic in February so I'm still kinda at the "tweaking" stage. I was using Percocet as my main med, then my PM doc put me on the Duragesic (25mcg to begin) and Percs for b/t. Unfortuanately my insurance changed and I asked about a cheaper b/t med, plus I had been on Percs for a couple years at 10/325 4 times daily and I guess it began to lose it's effectiveness. It did help with b/t pain, it just didn't have enough oomph to last very long. Only a couple hours. So he put me on Methadone for b/t, no good, now I'm using Dilaudid for b/t, no good either. So, he said at my next appt we'd possible up my patch to 75mcg and I'm going to ask him about going back to Oxycodone, only without the acetamenaphine in it. As Dave stated it comes in 15 and 30mg. I think this will finally do the trick. Oxycodone works well for me as far as b/t meds, but the Percs having the acetamenaphine in it, the mg's weren't enough to last during a pain spike. While pure Oxycodone will do the trick for me I truly believe. Plus I don't need all that tylenol! I don't see my doc this time, I see the PA, they rotate appt's and it's my turn for the PA, but I'm sure she'll agree, since he told me at my last appt we'd change the patch if the Dilaudid wasn't working. It'll be my idea to include the Oxycodone for b/t. My goal is to not have to turn to b/t meds so often, only when my pain is really spiking, or I'm in a flare. With these other b/t meds on the 50mcg I am turning to them nearly every day, that doesn't make any sense. Too much meds for me! I would like to be able to turn to the b/t meds only when needed, like when my patch is near time to be changed, and not have to use the whole days dosage. You understand what I mean? Sounds like you want the same. I've been pretty fortunate with my PM doc so far, he's pretty much worked with me when ever I asked about a certain medication. He's been really great. So hopefully I'll get my meds fixed this Tuesday and I can find a good combo I can hang onto for awhile.

Let us know how it goes with you, and I'll do the same. My only worry is that the PA won't up the patch, and I'll have to wait another month to see the doc. If so, I guess, I'll do just that. I in no way plan on arguing over my pain meds with the PA, or the PM doc for that matter! LOL

Good luck,
tk