Need help deciding on breakthrough meds - Pain Management Message Board

cptpooface · 03-13-2007, 03:55 PM

Lately I have started to have severe breakthrough almost every day. It can last from two to three hours, or it can last all day. I am on 60mg of MS Contin, which seems to work really randomly, sometimes it will help a lot, but sometimes it doesn't help much at all. I was on Oxycontin but it started to give me euphoria so I got off of them as quickly as possible. I think the Oxycontin would keep the breakthrough pain away, but I don't want to have those side effects. So I have been talking to my doctor and he gave me 20mg of MS-IR (Instant release morphine). I have tried MS-IR before (last spring) but at a much lower dose, and it wasn't effective. I was hoping that with this higher dose I would get relief, but when I take them it feels like I never took anything at all.

I was wondering if maybe the instant release morphine doesn't work because I am taking MS Contin, and I have developed a big resistance to the morphine. Since I started taking MS Contin, developing a resistance has been a huge problem. I don't like upping the dosage and neither does my doctor. This was the reason I tried Oxycontin, my doctor said that since they are different I wouldn't have a resistance to Oxycontin. He was right and the Oxycontin worked great, but the side effects caused me to stop taking them.

I have a doctors appointment tomorrow, and I need to get some information so I can discuss this intelligently with my doctor. If I take morphine for both long lasting and breakthrough pain will the medication be less effective? That is what I think the problem is, and I think if I take morphine for long lasting pain, and something different for breakthrough it will work muc better. What do you think? Would it be better to take the MS Contin and switch to a different breakthrough medication? I also would like to know what effective breakthrough meds anyone has taken. I don't really know the names of any breakthrough meds, and I don't know what the primary medication in each one is. The primary medication in MS-IR is morphine, the primary medication in Oxycontin is oxycodone (I think). I know that sometimes it can take a long time to get the dosage and medication right. So I would really like it if some people could tell me what has worked really well for them.

I really appreciate all the help I have gotten on this forum. I also appreciate any input on this thread. Thank you very much for any help you can give me.

BrittleBones · 03-13-2007, 07:32 PM

Hi CPT! I'm experiencing the same sort of problem that you are having. I've been on Methadone, 120 mgs. a day, for my long acting pain medication and on oxycodone, 30 mgs., 4 tablets a day for breakthrough pain. I've been on this combination for quite some time and recently have been experiencing a big increase in the amount of "break through" pain. The oxycodone is not really effective anymore and I'm really not too keen on asking for an increase in the Methadone. I'm scheduled to see a new pain management doctor this Friday. He is taking the place of my long term doc who just left the practice late last month. I'm hoping that he'll be willing to let me try a different "break through" med. At one time I was taking Dilaudid for my break through pain and it was very effective. I needed to take at least 8mg. of Dilaudid to get relief, but it was a good med for me. After awhile it stopped working as well. The other medication that was a great bt med for me was Actiq "lollipops" or lozenges. If you are not familiar with that drug, it comtains the same medication that's in the Duragesic patch (Fentanyl). Unlike the patch which allows the medicine to be administered through the skin over a three to five day period, the Actiq is a very quick (but short) acting way to get the med into the bloodstream for rapid results. I'm going to see if he's willing to let me try that again. So all in all, I would suggest the Dilaudid first as an option for you. Have you ever tried that before? Good luck. I hope you find something that can give you quicker relief. All the best - KathyMac

TraveltoSL · 03-13-2007, 07:47 PM

Hey KathyMac,

Maybe I am totally not getting what other people are on so if you could help with your plan then maybe I can understand better since I just quoted something and may be wrong....

Are you saying that you are on Oxycontin...pure Oxycodone without Tylenol....the one's that last from 8-12 hours.....for B/T pain....4 times a day?

Or are you actually saying another name for Percocet....30mgs total a day...which equals 4 tablets a day???? I am totally confused.....

I didn't know that Oxycontin was used for B/T pain since I am on 20mg, every 8 hours (since it doesn't last the 12 hours it first was made for) and then Percocet 7.5/325, 1-2 every 4-6 hours...but no more than 8 in a 24hr period......only take them when needed actually....

So, when I just posted above, I want to make sure I am saying the right thing....

Not saying that people aren't on two forms of long acting medicines....Just haven't heard Oxycontin used for B/T since it is a time released medicine and not fast acting like Percocet or other B/T's....

This way, we can all be on the same page for those new to the board and asking about medicine.....So for me....I always call Oxycontin....Oxycontin or Oxycodone......this way people know it's the straight Oxycodone with nothing added....then Percocet....I say the name brand or call it Oxycodone WITH Tylenol....and usually has the Oxycodone mg....like 7.5 and then the Tylenol listed with the / and then the mgs....like 325.....

So, if you could respond to explain this to me it would be very helpful so if I'm saying the wrong thing I can shut my trap....HAHAHA.....

Blessings,
Ingrid

cpapp31 · 03-13-2007, 09:33 PM

Hi Ingrid!

Sorry to butt in on your post to Kathy. There is a breakthrough med called OxyIR, it releases oxycodone fast and does not have any tylenol in it.

Also, I wanted to agree with Kathy about the Dilaudid for breakthrough pain. I am on the Duragesic Patch for my chronic pain and use Dilaudid for breakthrough pain. It really helps with my pain.

Take care,
Cpapp31

TraveltoSL · 03-13-2007, 09:50 PM

OHHHHH....that's right...Thank you

Maybe for people like me, could we try to use the brand name with the generic or info in parenthesis so everyone can learn the medicines as well??? Just a thought....Thanks for "butting" in...

Kathy, is that what you are talking about when you say Oxycodone for your B/T?....

CTPoo...(i laugh at that screen name every time...!)LOL....Anyway, maybe you can ask for that but if you had bad reactions to the Oxycontin, it is the same medicine so maybe switching to something new all together would help....

Maybe on one quick post, we would be allowed to describe where we all came up with our screen names....it would be fun!!! But don't know if Mods would be ok since it's off topic....But just one little post???? Please??? Mods????(Tee Hee)....with all these pain we need some fun once in awhile....

Blessings,
Ingrid