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Old 01-25-2013, 06:42 AM   #1
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Which meds do you think work better

Currently have been on Fentanyl 25mcg (Mylan) patches q48 for about a month for DDD. I had a lengthy discussion last month with my PM doctor about alternatives as I'm a little worried when summer rolls around I'll have issues with it falling off and possibly getting too much b/c of the heat. As well, I've been struggling with some side effects. Finally, after only 2 months on the patch I think I need to go up on the dose as my pain level seems to be inflated from prior months.

My doctor has suggested all of the below meds and discussed them all with me.

So, if you had your choice, which would you go with.

Continue on the patch q48.
Change to Kadian
Change to Opana
Change to Dilaudid

 
Old 01-25-2013, 07:43 AM   #2
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Re: Which meds do you think work better

Everyone reacts different to medication. Years ago I was on Kadian. My pain doctor switched me to ms contin as it was much cheaper. After being on that for many years doctor decided it was time to switch as ms contin wasn't as effective after years of being on it.
He first prescribed opana. I had horrible side effects. Panic attacks trouble breathing. I tried it for a month. Side effects did not ease. Next he put me on nucynta. This medication was a miracle for nerve pain. However, it made me nauseous. Not just a little but severely nauseous. Next he tried exalgo. This medication also made me very sick not to mention the cost. My insurance only covered 40% because it wasn't generic. Now I am on oxycontin. So far the side effects have been minimal and Purdue has helped with the cost even though I have insurance.
I am evidently sensitive to many medications. Before this switch I had only tried morphine. Every time the doctor prescribed a new medication I gave it a month to be sure the side effects would not subside. The last few months have been rough.

 
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Old 01-25-2013, 09:17 PM   #3
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Re: Which meds do you think work better

Everyone responds differently. Assuming you haven't tried any of these meds (in any form) before, my personal opinion is that you are most likely to respond to the Kadian. When you are on a lower dose is a good time to be on a morphine product. Plus, its now generic. Both Kadian and Exalgo are typically does every 24 hours, but the Kadian can also be dosed every 12 hours (not sure on the Exalgo).

Opana is more hit & miss on pain relief. Dilaudid (long acting would be Exlago) is still brand only. I also had various issues with the patches. I found them much more difficult to deal with than pills (which is why a lot of people say they want to try them).

Plus, anecdotally, they do seem to increase tolerance quicker, and unless you use multiple patches, a larger dose increase than needed may be taken at one time. You want to stay at the lowest dose the longest time you can. I've tried some form of all three of these (although some only short acting).

Any med change can be rough. Its nice when doctors can have you follow up after a shorter period of time, such as 1-2 weeks, although yes its good to stick it out for a month if you can, as often side effects subside and relief increases. Hope you find something that works well for you. Everyone is so different (methadone is what works best for me). Best wishes.
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Old 01-25-2013, 10:08 PM   #4
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Re: Which meds do you think work better

Fentanyl is a heavy hitter for DDD. Your doctor would be the best person to make the decision based on your medical history and his examination in suggesting a different medication. I am surprised that you are having increased pain with fentanyl. That is not the usual case, since fentanyl is one of the strongest if not the strongest medication for the treatment of pain.
It is not known for increasing pain. In fact, it is known for the opposite, for handling pain that other pain meds don't.
All of that aside, you must keep in mind that pain management is about managing the pain, not eliminating it completely. That is impossible when it comes to treating chronic pain- you want to keep your daily pain levels within livable limits- most pm doctors prefer a patients pain levels to be around a 4-5 for the treatment level to be considered successful.
Most people can function in their work and daily activities at that level, so that should be an attainable goal...
Talk to your doctor. He must have some medication in mind for you to consider. He knows your medical history and reactions to the various medications that you have tried up to this point.

 
Old 01-25-2013, 10:16 PM   #5
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Re: Which meds do you think work better

Fentanyl is a heavy hitter for DDD. Your doctor would be the best person to make the decision based on your medical history and his examination in suggesting a different medication. I am surprised that you are having increased pain with fentanyl. That is not the usual case, since fentanyl is one of the strongest if not the strongest medication for the treatment of pain.
It is not known for increasing pain. In fact, it is known for the opposite, for handling pain that other pain meds don't.
All of that aside, you must keep in mind that pain management is about managing the pain, not eliminating it completely. That is impossible when it comes to treating chronic pain- you want to keep your daily pain levels within livable limits- most pm doctors prefer a patients pain levels to be around a 4-5 for the treatment level to be considered successful.
Most people can function in their work and daily activities at that level, so that should be an attainable goal...
Talk to your doctor. He must have some medication in mind for you to consider. He knows your medical history and reactions to the various medications that you have tried up to this point.

 
Old 01-31-2013, 01:30 AM   #6
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Re: Which meds do you think work better

Hi Chris. I find for me the patch is the way to go, for a couple of reasons. First, I have memory difficulty due to a TBI (traumatic brain injury) and remembering to take meds is a complicated affair. I wear the 75mcg/hr. At one time I thought I was allergic to the adhesive, so I switched to Morphine ER. I went back to the patch, and no more rash. It just works out better to not have to forget to take a pill, have the pain go up, and then battle that. Your doctor is the one who will make the ultimate decision, but for me, the patch is the way to go. Remember though, everyone is different, and what might work for me, may not be the best for you. Good luck.

 
Old 01-31-2013, 07:57 PM   #7
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Re: Which meds do you think work better

Quote:
Originally Posted by dave490 View Post
Hi Chris. I find for me the patch is the way to go, for a couple of reasons. First, I have memory difficulty due to a TBI (traumatic brain injury) and remembering to take meds is a complicated affair. I wear the 75mcg/hr. At one time I thought I was allergic to the adhesive, so I switched to Morphine ER. I went back to the patch, and no more rash. It just works out better to not have to forget to take a pill, have the pain go up, and then battle that. Your doctor is the one who will make the ultimate decision, but for me, the patch is the way to go. Remember though, everyone is different, and what might work for me, may not be the best for you. Good luck.
Fentanyl worked great for me but I had to change them every 36-48 hours which I did not like usin so quickly. Recently had good results with Nucynta ER. But each of us are so different.

 
Old 02-01-2013, 09:00 AM   #8
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Re: Which meds do you think work better

Thanks for all the replies. With that being said I have another question. IF we were to add a breakthrough/rescue med, which would be the better option? Percocet or strait Oxycodone w/o the APAP? What benefit do I get from the APAP? Is one better than the other in your opinion?

I'm really questioning whether I should, upon doctor's recommendation, add a BT med or go up to a 50mcg patch.

The constant pain hasn't gone up, just in non-consistent "waves" if you will.

Last edited by SoonerChris; 02-01-2013 at 09:09 AM.

 
Old 02-01-2013, 09:06 AM   #9
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Re: Which meds do you think work better

Quote:
Originally Posted by backhurtz View Post
I am surprised that you are having increased pain with fentanyl. That is not the usual case, since fentanyl is one of the strongest if not the strongest medication for the treatment of pain.
It is not known for increasing pain. In fact, it is known for the opposite, for handling pain that other pain meds don't.
I wasn't saying that the pain is increasing I was saying I still have pain. I think it's simply a factor of the conversion from my prior meds (i.e. too small dose of Fentanyl). We all know docs want to start out as small as possible.

 
Old 02-01-2013, 09:53 AM   #10
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Re: Which meds do you think work better

Just to add my 2 cents, I am very sensitive to all the pain pills I was subscribed for low back and shoulder OA pain, even Fentanyl drove me crazy from extreme fatigue, nausea, and dozey feeling all the time. Went up to 50mcgs and then back down to 12's but couldn't tolerate it at all. I couldn't tolerate any of the opiates . I lost 20 pounds and my constant pain dissipated. I still have mobility pain and issues, but that nagging pain is gone, so I came off all the opiates. Been trying to deal with the withdrawals from coming off, over the past 3 weeks, but am feeling so much clearer headed. He is now suggesting IV pain management, of which I know nothing about.

 
Old 02-02-2013, 06:23 AM   #11
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Re: Which meds do you think work better

One of he meds not on your list was methadone. The last thing I tried was the patch. I loved it. The pain control, no side effects and my family was thrilled. Then they started falling off. And to top it off I was allergic in some way to the adhesive. It tried to eat throw my skin and them my muscle. That is when my doctor introduced to methadone. Not the pink liquid given to herion addicts, but pills designated for pain management.
Now I am sure just he name methadone probably unnerves you (and scores of other). It doesn't always have the best reputation. But at this point I was willing to try anything. When I went into withdrawl from the patch, I wanted to die. I have never felt anything it before or since.
This was the best decision I ever made about my pain management. I have been on it for 3 years with one increase based on an accident with increased my pain twofold.
Anyway, something to consider. If you don't announce your meds and what they are to anyone, no one to lay judgement (not that they have the right).
I sincerely hope that you fine something that will reduce your pain to manageable levels. We pretty much all agree that around 50% or a pain scale of 4 - 6 is manageable and liveable with other modalities for dealing with pain. Anyone looking to make chronic pain "go away" is either deluding themselves or don't care that level of meds would most likely turn them into a drooling mess.
Whatever meds you and your doctor choose, I wish you the best of luck. No one deserves to live with the kind of pain the good people of this forum are forced to lilve with.

 
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