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Old 02-15-2008, 12:40 PM   #1
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ladyjayy HB User
Long acting pain meds..

Okay, I know this is a loaded question because everyone is different. Actually, I have a couple of questions. So here goes:

What are the different types of LA meds out there and what is the difference between oxy and morphine. Is Kaidan long acting morphine?

If I am already on percocet (I guess 22.5 mg total a day) would oxycodone 20 mg provide the same relief? Does that make sense?

Which of the LA meds are the least likely to make a person feel stoned and drowsy. I guess this is the loaded question because everyone is different.

I am on percocet 7.5 tid right now and this med actually ramps me up a little and does not make me sleepy at all. But I really am interested in LA meds to avoid all these ups and downs I am having. But I hate, and I repeat HATE feeling stoned and pukey. What I have found is that with the pain meds that make me sleepy and nauseous I end up just not taking them and being in pain because the side effects are just not worth it.

Basically, I think I need an "intro to LA meds." I'm still new at all of this.

I am not with a PM clinic at this time. My PCP is managing all my meds, which is great for me because we have a good working relationship. I just wanted to be as educated as I can when I come to her to discuss LA meds.

Thanks so much. Take care, many hugs,
Julie

 
Old 02-15-2008, 06:00 PM   #2
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forginon HB User
Re: Long acting pain meds..

I think that 20mg Of OxyContin (oxyc) daily, which would be two doses of 10mg tabs per day, one every twelve hours, would feel like less pain coverage than you get with the Percocet. The Percocet is short acting, meaning that you get the full dose all at once, and whatever painkilling effect it has is good for about 4-6 hours. Then you take another dose, etc. So you get the good pain coverage you wrote about for your waking hours. With the oxyc, the 10mg tablet will release 50% of the dose fairly quickly, then again in another 4-6 hours, providing fairly poor coverage compared to your current regimen. Then the same thing happens for the next dose and it's 12 hours. I imagine you'd get coverage similar to what you have now if you had 2 doses of a 20mg tablet. However, many find that the oxyc really only lasts for about 8 hours, so it might take 3 doses of the 20mg oxyc tablets in 24 hours. This should not make you feel drugged.

Other possibilities are MS Contin, which is continuous release Morphine, same basic idea as oxyc. However, MS Contin is about 50% less potent than oxyc so you'd have to adjust the dose accordingly. I use MS Contin three times daily and it works pretty good. Opana is continuous release oxymorphone, and I haven't heard much on this one. Oxymorphone is poorly metabolized, so even though it's more potent than morphine or oxy when used IV, the oral dose must be apropriately calculated to account for this attribute. There's the fentanyl patch, which has worked for many of us here. Fentanyl is a highly potent drug, about 100 times more potent than morphine, but it is dosed in micrograms to adjust for its potency. Then there's methadone, which I consider to be the best. It doesn't require a long acting formula since it already possesses this property. It's a complex drug for calculating dosage, but a good PM doc can do it just fine.

Of all these meth is the most sedating. I imagine that oxyc is probably one of the least sedating, and since you are already familiar with its major component, oxycodone, and it has worked for you, it's probably the next best choice.

Hope this helps,

steve

 
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Old 02-16-2008, 04:50 PM   #3
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Re: Long acting pain meds..

I can tell you my experience on being on the Oxycontin and percocet as breakthrough medication. When I went on the Oxycontin it gave me much less sedation, felt less "stoned" and drowsy. My doctor told me that would probably happen. Of course I was taking 4-6 Percocets per day for breakthough. I got up to 20mg x 2 = 40mg/day + 4-6 Percocets. It is pretty good for LA medication, although many people build up tolerance quick, alot of docs don't like to prescibe it, or if they do they don't like to prescribe high doses especially if they are PCP. But you will probably feel alot less sedation and "stoned" feelings with the Oxycontin and you may have alot more energy. Just be careful about taking it right before bedtime since it may keep you awake. But we'll come to that issue later if you do go on it.

Brian

 
Old 02-16-2008, 05:24 PM   #4
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lizzybrog80 HB User
Re: Long acting pain meds..

Hi,

I am pretty new to LA meds, but I'll tell you my experience so far. The first I tried was Avinza, LA morphine, a 24-hour pill. I was started at 30mg, which was ridiculously low (I was taking 10-12 percocets per day before starting it). I still used Percocet for breakthrough, and continued to need 10-12 per day. Needless to say, we increased the Avinza, first to 60mg (no change), then to 90mg. On 90mg the first day I had a great day and thought we had found it. But, it turned out to be a fluke, and the pain returned. Then we went to 120mg, which was slightly better, but I was still needing lots of BT meds, so it wasn't great. Finally, we went to 150mg, which I was only on for 2 days, b/c by that point my insurance told me they wouldn't pay for it.

Then we switched from 120mg Avinza to 50 mcg Fentanyl patch w/ Roxicodone for BT (Percocet w/out the Tylenol). Needless to say, it's not working great. I think part of the problem is that the oxycodone is not working for breakthrough pain. I'm so tolerant to it that it just doesn't work. So I'm still taking a LOT of Roxicodone for BT (3 15mg pills at a time, 2-3 times per day). I see my doc in a week, at which point we'll discuss the fact that it's not working, and I imagine we'll increase it. I just had an IDET procedure on 1/25/08, so in theory I should be having less pain, but, unfortunately, I'm not.

So I haven't had great success on LA meds yet, but I think it's just because I haven't found the right dose. Best of luck to you in finding a way to reduce your pain!

-Beth
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Discograms 11/16/06 & 7/10/07
End. Discectomy - July 2007 (L4/5)
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Old 02-16-2008, 06:18 PM   #5
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Re: Long acting pain meds..

lizzybrog<
I would definitely suggest increasing the patch. I hope that no more patches have fallen off and you took one of my suggestions for keeping them held down. If you increase to 75mcg make sure its brand (Duragesic) or Sandoz (generic). Hope you feel better soon,.

Brian

 
Old 02-17-2008, 05:40 AM   #6
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Re: Long acting pain meds..

Lizzy:

Please make sure before you switch to Sandoz or Duragesic that you see the thread about the recall of defective patches by them. Someone else just posted that they returned a 50mcg patch that was defective as well, so there may be another recall in the next to near future.

I hope you get your issues resolved. And, boy oh boy, am I EVER glad that I am off of these things now!!! I went through a few tough days switching over, but I was switched primarily because the wholesalers in my area couldn't/wouldn't offer to the pharmacy(s) Sandoz, and I'm so relieved that I chose NOT to pay for the Brand name. Otherwise I'd be a "wreck" right now.

I'm offering those of you who are using either Sandoz or Duragesic 25mcg patches up in prayer that this will be resolved in short order with no discomfort for anyone.
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Old 02-17-2008, 06:34 AM   #7
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Re: Long acting pain meds..

Hello,

I am pretty sure that it is time for a LA med for myself!!! I am so sick of the ups and downs and huge debilitating flare ups.

I am currently taking 8 10/325 percocets a day and I take 2 at a time and it only lasts for a few hours.

I took the big leap of faith and when I called the Doc for a refill last Friday so I could pick it up in the office in my town and drop it to the Parm, I explained about how many I am allowed to take and how I have the huge flare ups and that my pain is up and down all the time every day.

I never know when it is going to just go into a huge flare and I am quite frankly sick of it.

So I asked the person on the phone to please as the doc if he could prescibe something longer acting and the percocet for BT pain.

I went to pick the script up and it was the same ol thing. I will see the doc on Friday of this week.

I know I have a tolerance because I have been taking them for months and even before this neck injury I was in PM for another prolem and I was actually on Methadone for a while.

While Methadone worked well I just could not stand the side effects.

I have tried so many different kinds of medications. Nerve drugs you name it. I was put on a fentanyl patch one time that made me itch so bad I had to take it off.

I dont know what the darn soulution is anymore but I am for sure very tolerant to many meds.

I thought that this thread had some good information in it and I will be speaking to my doctor on Friday.

No one should live on the rollercoaster of constant ups and downs and huge flare ups.

Chrissy

 
Old 02-17-2008, 11:44 AM   #8
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lizzybrog80 HB User
Re: Long acting pain meds..

Quote:
Originally Posted by brianpain33 View Post
lizzybrog<
I would definitely suggest increasing the patch. I hope that no more patches have fallen off and you took one of my suggestions for keeping them held down. If you increase to 75mcg make sure its brand (Duragesic) or Sandoz (generic). Hope you feel better soon,.

Brian

Brian,

I have not had any more patches fall off, which is good. I see my doc this Thursday, so we'll see about increasing the patch. And I'll try to see what I can do about getting the brand or Sandoz. I have been using tape to hold the patches on. Thank you for all of your help!!!

-Beth
__________________
Back pain since March 2005
2 ESI's - Feb. 2006
Discograms 11/16/06 & 7/10/07
End. Discectomy - July 2007 (L4/5)
3-level Foraminal Inj. - Jan. 2008 (L3/4, L4/5, L5/S1)
IDET - 1/25/08 (L3/4)

 
Old 02-17-2008, 12:39 PM   #9
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Re: Long acting pain meds..

Quote:
Originally Posted by bgsigns View Post
Lizzy:

Please make sure before you switch to Sandoz or Duragesic that you see the thread about the recall of defective patches by them. Someone else just posted that they returned a 50mcg patch that was defective as well, so there may be another recall in the next to near future.

I hope you get your issues resolved. And, boy oh boy, am I EVER glad that I am off of these things now!!! I went through a few tough days switching over, but I was switched primarily because the wholesalers in my area couldn't/wouldn't offer to the pharmacy(s) Sandoz, and I'm so relieved that I chose NOT to pay for the Brand name. Otherwise I'd be a "wreck" right now.

I'm offering those of you who are using either Sandoz or Duragesic 25mcg patches up in prayer that this will be resolved in short order with no discomfort for anyone.
Hi,

Are you saying that you're offering prayers for those taking brand or Sandoz b/c of the recall issue, or something else??? I thought maybe you were talking about them being incredibly addicting, or something... just wanted to clarify what concerns you most about this drug, since I'm obviously taking it Thanks a ton!!!

-Beth
__________________
Back pain since March 2005
2 ESI's - Feb. 2006
Discograms 11/16/06 & 7/10/07
End. Discectomy - July 2007 (L4/5)
3-level Foraminal Inj. - Jan. 2008 (L3/4, L4/5, L5/S1)
IDET - 1/25/08 (L3/4)

 
Old 02-17-2008, 01:01 PM   #10
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SpinalMalady HB UserSpinalMalady HB User
Re: Long acting pain meds..

Beth,
Sorry for the confusion...
The prayers are for anyone who might encounter problems with filling or replacing their Sandoz or Duragesic patches that have been recalled.
__________________
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12/10/04 MicroD & Hemi Lami 100% Success
09/05 Re-injured post Katrina
06-07 In Pain Mgmt. trying to deal
3/9/07 2 Level PLIF due to CES

 
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