Advice for breakthrough pain medication.

[cameronlanni]

I've never tried Roxicodone. Isn't that a liquid form of OxyCodone? But in all honesty, not only does Oxy not work real well for me, but it also makes me so drowsy sometimes that I have to leave work early, and that's something I can't deal with.

Even though the Fentanyl pops do sound like a good route, it definitely sounds like I should save those as a last resort. In 10 or 20 years years from now, I'm going to need a new medicine to upgrade/change to. So I'm still pretty much stuck without a good option now.

Oxymorphone is a combo of OxyCodone and Morphine, right? And what about HydroMorphone? I mentioned that I tried MSContin and it didn't work for me at all - but when I am in the hospital for my pain, they put me on a Morphine drip and that seems to work really well for me. Why is that?

Thanks again for your continued advice and assistance.

- Cameron

[forginon]

Regarding the drugs you mention, as for potency, it starts with morphine, then up to hydromorphone, then to oxymorphone. Although oxymorphone is the most potent of the three, it is poorly metabolized when taken by mouth, so the dosing is a bit complex. The oxymorphone drug on the market is Opana (may be others), and it comes in both short acting and long acting formulations. I haven't yet heard from anyone taking Opana SA for BT pain. Maybe someone will chime in who has used it.

Hydromorphone (Dilaudid) is derived from morphine as a semi-synthetic opioid. Orally, it is about 7-10 times more potent than morphine. A number of folks here use it. I've used it for acute pain and didn't like it much, and it didn't seem to work that well for me. In fact, I switched to hydrocodone (Vicodin-much less potent) and got better results. This all points to the fact that each of us is different and react to the various meds individually. Other folks here swear by Dilaudid.

The lollipops, which use fentanyl (100 times more potent than morphine), are very good BT meds.

Morphine is good as both a short acting med and as a long acting med. MS Contin (MS for morphine sulfate) is a long acting med and not appropriate for BT pain. In your hospital stay it was being used as a short acting med given on a regular schedule which you had some control over. Maybe morphine is better for you as a short acting med than as a long acting medication.

You've got lots of good info in this thread to think about.

Best of Luck!

steve

[conductor]

Not to bore everyone over and over with my stuff, but I use Fentanyl 75 mcg every two days. For BT, I use Actiq 800 mcg AND Dilaudid (hydromorphone) 8 mg--both as needed, of course. The Actiq and Dilaudid work very well as BT pain medications because they are potent. Fortunately, I haven't had to adjust the dose in nearly 10 years. For that, I am tremendously thankful.

As I've seen mentioned on this board, we must have a reasonable expectation of pain relief--that usually comes in around a 50% reduction in pain levels. My pain is a result from Systemic Lupus and the Lupus Anticoagulant. Finally, I don't like to admit to it, but it is a fact--I am on permanent disability due to this combination of enjoyable diseases. But, I have to remind myself to get a grip on a regular basis!!

Sincerely,
Jon (Conductor)