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Old 11-28-2010, 07:04 PM   #1
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One size does not fit all

I don't have a PM Doc, just a PCP.

Does anyone out there know what type of pain medications work best for Abdominal pain and Immune related inflammation pain?


Codeine, Tincture of Opium, Morphine, Hydrocodone, OxyCodone, etc....?

I assume PM Docs are very skilled at matching pain type to med?

My limited experiences have been with Hydrocodone and Oxycodone. Hydro seems slightly better for the gut, less activating than Oxy. However, maybe Morphine or Codeine are even better... Or maybe Oxymorphone or Tincture?

I apologize for repeating myself, I've tried to get this information in another post that was worded slightly differently.

Any thoughts appreciated

 
Old 11-28-2010, 07:11 PM   #2
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Re: One size does not fit all

Generaly all the narcotics are created equal for pain, however, individuals sometimes find one better than another..... its more about individual variations than oxycodone being better for headache and Dilaudid being better for renal colic etc.

There are more or less three levals of narcotic pain killer

Low potency - codeine, tramadol

Mid potency, Dihydrocodeine, hydrocodone

High potency, morphine, oxycodone, hydromorphone, methadone, oxymorphone, tinct opium, omnapon etc

Generaly one starts with the mild ones (eg codeine or tramadol) and progresses upwards from there if needed through the medium potency ones, and finaly onto the highest potency ones in extremis.

Dose also has an effect, although codeine is rated mild and hydrocodone is rated moderate, in the doses usualy prescribed, there isnt much difference between them.

In chronic pain LA meds (SR tramadol, oxycontin, MS Contin) are preferable to short acting meds.

Combining a pain killer with regular doses of an antispasmodic might be worth investigating
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Last edited by jonnstar; 11-28-2010 at 07:13 PM.

 
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Old 11-28-2010, 07:54 PM   #3
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Re: One size does not fit all

Johnstar-

I agree with, and understand the strength scale. I thought that the conventional wisdom was that Morphine was most likely to cause nausea, that Codeine was (perhaps) best for GI issues, Dilaudid was extremely short acting and used mainly for acute pain. Some say that Demerol is the worst of all for side effects of all kinds, and that Hydrocodone works best with Acetaminophen.

Some of these characterizations may be more folklore than fact but ..... my point is, a skilled Doctor would need to know more than just which compound is stronger than another to correctly address a patients particular pain needs.

There are also more serious issues like respiratory depression, and cognitive impairment, interactions with other drugs, and dosing schedule.

An example of simple strength issue could be; Someone is taking 3, 5, or more of a 5/500 Combo drug every few hours. That individual is taking perhaps 100mg of Hydrocodone a day and way too much Acetaminophen. They need to be dose-equalized into Oxycodone or Hydromorphone.

An example of a quality issue is; A Hospice patient is given Oral Oxycodone but they have difficulting swallowing or metabolizing the medication in the GI tract, and Oxycodone causes them insomnia and anxiety, and their metastatic pain would be better contolled with a Fentanyl Patch.

Thanks for your input -

 
Old 11-28-2010, 11:04 PM   #4
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Re: One size does not fit all

Sure, very true, but those dont adress your point of specific drugs for specific pains..... codeien has a constipating effect might which might be of help in GI Issues.

Most of the narcotics are dosed 4 hourly, codeine, hydrocodone, dilaudid, morphine. Demerol is sorter acting, methadone is very long acting. Acetaminophen boosts the analgesic activity f any narcotic, though the effect is most obvious with the milder drugs such as codeine or hydrocodone. Ibuprofen, aspirin, naproxen etc all do the same.

If a person isnt doing well on a particular drug, then they change to another.... morphine makes you nauseous, then change to (say) oxycodone. if a person is in continual pain, long acting meds make more sense than short acting.

Dilaudid makes you restless, try morphine... you get the idea.

It isnt like a Monopoly board, "go straight to methadone, do not pass oxycontin, do not collect 200 dollars", its often educated guessed by the doctor, along with some element of trial and error.
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Last edited by jonnstar; 11-28-2010 at 11:19 PM.

 
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Old 11-29-2010, 10:28 AM   #5
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Re: One size does not fit all

Exactly J-Star,

I think we are on the same page. So, for my situation, many of my fellow post surg Ulcerative Colitis fellows have had good results from Codeine, and Tincture of Opium (Can't imagine the looks one would get from the Pharmacist when Opium is requested - I think it requires a Compounding Pharmacy and there is only one Distributor in the U.S.).

My pain and discomfort are definitely round the clock but I also have to work without being too cognitively 'affected'. Hydrocodone has actually worked fairly well but it is short acting which I why I'm starting to get anxious by limiting myself to one Norco a day. I tend to break it up into a bunch of chunklets so I can attempt to make it last throughout the day -ain't working well anymore.

Codeine I'm afraid might not be strong enough unless taken in higher doses, and I'm not familiar with the brand offerings available -Is there a time release version?

OxyContin wasn't too bad, except that I didn't really take it long enough to get fully acclimated to it -it seemed to hype me up compared to Hydrocodone.

A few others have said that Opana ER is tops in all categories, good for the gut, low euphoria, plenty of power. Though it is pretty spendy. Also MS Contin and Kadian seem to get good reviews.

I've got an appointment next week to hash this all out with my brain guy (Psychiatrist, Neurologist). My Prozac isn't working so I'd like to switch that up to perhaps Paxil since my anxiety is so high all of the time. I figure he might be a good one to handle the pain meds also, though we've never talked about them before......

 
Old 11-29-2010, 12:34 PM   #6
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Re: One size does not fit all

I tried the Opana maybe 3 years ago and I agree, it was much better than the Oxycontin, oxycodone, hydro... etc. For me anyway.
The Opana was a much smoother experience, if that makes any sense. There were no initial jitters or excitability, no drowsiness, lag or euphoria that you may get with some of the other meds at higher doses.
In fact, the only sensations that I got from it were a noted calming effect and considerable pain relief.

 
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