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    Old 11-28-2003, 11:22 PM   #1
    snoople007
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    Question Roxi or Dilaudid - Question from a n00b

    Hi all,

    I am new here, so please bear with me if I make a mistake.
    But my questions is very simple.

    I see a pain mgmt doctor for back pain every two or three weeks. Along with physical therapy and steroid shots, there is the drug management, my favorite part of the therapy by far (grin).

    I asked him about dilaudid, half-jokingly, saying "oh, that's like heroin, you guys don't prescribe that" and he goes "yes we do, it's not a street drug, it's just synthetic morphine"

    So that got me thinking, since it is such a strong drug, would it be longer lasting than what I am taking now -- Roxicodone 15mg 4/day? The oxycodone, lately, seems to run out of steam two hours after taking it, and I read somewhere that hydromorphone is supposed to last you up to eight hours.

    So I am wondering if anyone here will offer an opinion on the matter: shall I ask for dilaudid instead? The doc, from what I can tell has no prob prescribing it.
    And obviously, all joking aside, I really do want something that will work longer. We've tried morphine and duragesic, they are no good for me. Oxycodone works great, but not for long. They don't prescribe oxycontin because it's so controversial, incidentally. If they did, that would be the most effective one, I think.

    Thanks very much for any answers/suggestions you might give me. Hope you all enjoyed thanksgiving - I did!

    Snoople.

     
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    Old 11-29-2003, 08:29 AM   #2
    tyler7
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    Re: Roxi or Dilaudid - Question from a n00b

    Snoople,

    Well this is just further proof of how idiotic and reactionary the general public is. Your doc's place won't prescribe OxyContin but they will Duragesic. Because OxyC is so "controversial"... Um, newsflash - Duragesic (Fentynal) is THE MOST POWERFUL prescription narcotic that is available. Plenty above OxyC. But gee, as long as it's "controversial" and all, let's not RX it, but there's no problem dispensing the strongest synthetic out there. (don't get me wrong, I'm not saying I have anything wrong w/Duragesic, just that, at least in this context, the controversy is so ridiculous and uninformed)

    Also let me please say, it's good for all us CP people here to have a sense of humor about our predicaments, but I'm sorry to say how you've joked in particular gives me pause a little. Not because I'm offended, I just am somewhat wary of your intentions. Plus you say Duragesic "didn't work for you", do you mean its side effects or wasn't as good on the pain? Because that's another thing that frankly sounds odd. But, perhaps I'm way off here. Still, I'd choose your words a little more carefully.

    That said, as to your question of what's better, anyone here will tell you it all depends on the person. As I've stated before, the first time I ever had an RX for Dilauded it was 4mg, and it directly followed an RX for Percocet (oxycodone) 10/325, this is when I had kidney stones. I had gone onto the Dilauded, something my doc recommended, because even the Percs weren't strong enough at the time and he figured ON PAPER Dilauded was stronger, which it is. But in fact, the Dilauded worked no better than the Percs for me, actually a little weaker even. So there's no absolutes with meds. Sure you'll find a chart where everything's laid out in order of strengths, but you'll simply have to try one to see if it's stronger on you than what you took previously. Good luck and take care, and my apologies if I've misread the situation. Tyler

     
    Old 11-29-2003, 09:46 AM   #3
    inthezone
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    Re: Roxi or Dilaudid - Question from a n00b

    Duragesic is one of the longest acting pain med set-ups out there. It is good for 72hrs. longer by far than oxycodone or diladid. The one thing I have found out with Duragesic and even morphine (to a lesser extent) is that it has the ability to keep pain in control without giving you a buzz. I live in a lot of pain, but yet Duragesic has the ability to control that pain without pushing me into the Adverse Reactions part of the drug, sedation, euphoria, etc. When I was taking morphine I noticed the same thing to a lesser extent. Are you sure that you are not looking for a light buzz in your medication control (please don't take offense, I'm just going by what your post sounded like). If you are looking for a buzz, then Diladid will not be what you are looking for (unless you plan to shoot it up like a junkie, and it didn't sound like you were ready to do that). In normal theraputic dosages it has a lower buzz effect than morphine. None of these drugs, used properly, should give you a buzz that you will want to continue to seek out. Please be very careful with your pain mangement. What I have just told you will appear in NO PDR or the Prescribing Information for any of these meds. Addiction is very easy to fall into and very hard to get out of. I wish you the best of luck with your future pain mangement.

     
    Old 11-29-2003, 10:23 PM   #4
    snoople007
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    Re: Roxi or Dilaudid - Question from a n00b

    So sorry all that my careless language and admittedly weak attempt at humour at the doctor's office gave rise to misunderstandings.

    Let me clear one thing up; no, not looking for a buzz of any kind, I am looking for the longest duration meds that I can get. Keeping that in mind, my choice in meds is rather limited.

    To the first respondent who wrote that the general public is reactionary and idiotic; couldn't agree with you more. Unfortunately I have to abide by their rules just the same. The meds I came up with in the post were two short term ones available to me. Fentanyl has not worked on me on three occasions, once as a patch, once as an epidural after surgery (painful does not describe it enough), and once IV during a procedure. Strange but true. I know it's strong stuff, I was not waiting for a buzz, I was waiting for the pain to die down. Instead it either resurfaced or never left.
    It is silly that OC should be unavailable to me even though duragesic is much stronger, and yet is available. All I know is I am bound by the constraints imposed by the clinic, for whatever reasons they may have.

    Let me explain a little something. I am from Holland, Europe. I had surgery just before I moved to the USA, and left that hospital with a huge, painful gash in my abdomen. No meds. Not even Tylenol. While I was in hospital, recovering, they gave me Tylenol and occasionally IBU. To give you a sense of the awareness of pain patients there, the IB had to be prescribed. In other words, I am from a culture that does not believe in pain meds, period. By the same token, if you are terminal, you will receive what you need, and there is no controversy about it.

    When I arrived here (USA) I did not know what Vicodin and Percocet were, but I received them for relatively minor problems. It has never been in my nature to look for pain meds. I never knew they gave a buzz. Whenever a person said "hey, X is addicted to pain medication", I thought they meant he couldn't stop taking Aspirin, for pain. Most Dutch, incidentally still believe it.

    And with that as a background, that made me joke about it, knowing that lots of Americans (how do I say it politely?) get a little freaked out, unnecessarily, when you mention pain meds. I thought of them as functional, but many people I talk to these days seem to think pain meds are first and foremost here to get us high, and secondly, to combat pain. Mention pain pills to anyone today, odds are you will evoke a knee-jerk reaction.

    I think the high and the diminished pain are somewhat connected or intertwined. And I admit, I get great pleasure from the fact that my back hurts less for two hours when I take a Roxicodone. But the evil Euphoria, that unwanted side-effect that we should all be trying to avoid, sometimes still makes an appearance, though not always. I am not spritual enough, still too much of a sinner, to stuff the euphoria away, so I will take it when it happens.

    But it is not my goal, and it is not the reason for considering hydromorphone. The reason is my belief that switching to a similar, if stronger drug, may trick my body into believing it is a completely new drug, so that maybe I can get more lifespan out of the drug. Maybe even six to eight hours as opposed to two or three.

    I certainly hope I haven't made my argument more convoluted now, but in case I have, let's summarise:

    - No offensive joke meant, just a harmless little rib based on our fear of drugs.
    - Switch to this stronger drug suggested for purposes of longer duration.
    - Not looking for a buzz, but I do enjoy it if I must have one.
    - I am seriously in pain. Not looking for a drug dealer.
    - I am not from a pain-med based culture. I never got preoccupied with them the way some people do (like, perhaps our conservative friend on the radio?)

    Thanks folks, for the answers, it's certainly very enjoyable writing to an intelligent board with some intelligent and helpful people for a change. I hope you will keep the answers coming, and am looking forward to continued correspondence on a variety of topics in the future. I certainly would like to be of help.

    Have a good night, and sorry for droning on, hope you're still awake after this!



    Snoople

    Last edited by snoople007; 11-29-2003 at 10:32 PM. Reason: Typographical errors

     
    Old 11-29-2003, 10:34 PM   #5
    tyler7
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    Re: Roxi or Dilaudid - Question from a n00b

    Wow Snoople, Holland, huh? Ya know I worked as director Paul Verhoeven's assistant for two years a couple years ago, something of a local hero in your neck of the woods. That man has some scary strong resolve, I'll tell ya.

     
    Old 11-29-2003, 11:13 PM   #6
    wirry1422
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    Re: Roxi or Dilaudid - Question from a n00b

    I just lost a rather long post, which is very frustrating, so i apologize for being brief. You may want to try the once daily, 24 hour dosing of Avinza, which is morphine. Also available is 12 hour dosing mscontin, also morphine. Now even though you are on oxycodone, which is stronger than morphine, since the morphine acts on different pain receptors, you may be able to trick your body into "resetting" its tolerance level. Also available is methadone, which is long acting, but since i have never been on that, you will have to find out more about methadone from another poster. BTW, dilaudid, even though it is more potent than morphine and oxy, has a very short half-life and thus a very short duration of action, so that is not a good choice if you are looking for a long acting med. Actually oxycontin would be the best for you since you are on roxicodone, but its too bad the clinic had gotton brain-washed. Oh well, good luck.

     
    Old 11-30-2003, 07:31 AM   #7
    inthezone
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    Re: Roxi or Dilaudid - Question from a n00b

    Sorry if I offended you snoople. Wirry, Oxycodone is not more potent than morphine. Altough is takes less mg's to equal the same amount of pain relief as morphine, in the long run the morphine has the ability to kill more pain than oxycodone. Not by much, but by a little (so little in my opinion that it is not worth mentioning). But you are right about the long acting morphine meds like MSContin and Kadian. Once these are titrated properly they work very well on any type of pain, and have no limit to how much they can effect this pain.

    It may take you several days of continues use to get your blood plasma level up to the full amount offered by these drugs. I know from personal experience that when I was taking Kadian that it took almost 3 days of dosing every 12 hrs to reach the full effect from this pill (Duragesic took over a week for this to happen). Like wirry, I have never done methadone so I cannot speak from personal experience and so will leave someone else to speak on that. If long action is what you want, then you will be forced to go to one of the time release medications.

    I personnally try to stay away from the euphoric effect of these drugs, as I know that I have an addictive personallity and it is in my best interest not to wake up that side of myself. Once you look at OxyContin, the time release Morphines (which they have quite a few), Duragesic (Fentanyl) and methadone you have pretty much run the gautlet with long acting meds. I also don't thing Dilaudid (hydromorphone) is the answer that you are looking for, as you would find no more than an extra hour of relief over the Oxy (which in itself is a long acting med as compared to IR morphine). Good luck. Welcome to America where you can get the most potent drugs in the world so long as it is not controversial. What a Joke!!

    Last edited by inthezone; 11-30-2003 at 09:31 AM.

     
    Old 11-30-2003, 03:43 PM   #8
    wirry1422
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    Re: Roxi or Dilaudid - Question from a n00b

    By potency i meant quantifiable comparison. As you stated, inthezone, it takes a larger dose in mg's of morphine to equal the same efficacy as an amount of oxycodone, 50% more to be precise. So in that sense, oxycodone is 50% more potent mg for mg than morphine. As far as either drugs efficacy in any person in particular, that varies greatly from person to person. So indeed morphine may very well be stronger for some, while oxycodone may be stronger for others. Sorry for the cunfusion.

     
    Old 11-30-2003, 07:41 PM   #9
    inthezone
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    Re: Roxi or Dilaudid - Question from a n00b

    Sorry for the misunderstanding, we were both looking at different points. When I think of potency, I think of the intrinsic limit of the med in pain reduction. Sorry for the mistake.

     
    Old 12-01-2003, 08:07 PM   #10
    snoople007
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    Re: Roxi or Dilaudid - Question from a n00b

    Thanks again for all the replies! I feel I am well-armed for my visit to the clinic tomorrow.

    I took no offence from any of you here, I value all the advice. I tried morphine in several of its incarnations, and morphine is just not a drug that works well for me. I feel side-effects, including strong euphoria, but just not great pain relief.

    So I feel I should stay with the Roxicodone. I am a bit worried about Methadone, since I understand it is so very addictive. I even read a post on this board where a poster stated a person could wean off the Methadone to a dose of 1mg/day, and then still go through w/d Hell trying to get off altogether.

    So Oxycodone is it, and even though I can only get the short-acting type, I count myself fortunate that I am getting them from a doctor who understands that pain needs to be treated. That's a far cry from my previous doctor who gave me Flexeril and only occasionally 5 mg Vicodin. Mostly, however, it was Celebrex or IB for pain. I can honestly say that that did not work for pain, even though I gave these drugs more than a fighting chance, rather than dismissing them outright.

    Thanks again for the messages. and no offence was taken.

    Night!

    Snoop

     
    Old 12-05-2003, 12:43 PM   #11
    HockeyCrystal
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    Re: Roxi or Dilaudid - Question from a n00b

    I don't have time to read all the replies to this message, but I just wanted to say that Dilaudid (i'm on 4mg right now, 1-2 every 3-4 hours) does NOT last up to 8 hours. If it did, I wouldn't be forced to take my meds every 3-4 hours...Just because it is supposedly stronger than percocets, does not mean it lasts longer... I believe it lasts longer than the 2 hours of relief I got when I was on percocets, but the dilaudid's only last around 4 hours at the very most.... Hope someone else has mentioned this, but if not i wanted you to know it isn't a long acting med, so don't be mislead just because it's supposedly so strong mg to mg...

    Hope you get some better relief soon!
    Crystal

    Last edited by HockeyCrystal; 12-05-2003 at 12:44 PM.

     
    Old 12-05-2003, 08:10 PM   #12
    inthezone
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    Re: Roxi or Dilaudid - Question from a n00b

    Yes, I did mention it earlier in this post. It only lasts a little longer than percocets which in it self is a long acting drug. Read the last paragraph on post #7. Fill me in on wheather you agree or disagree on my statement on that part of the subject. You seem quite knowledgeable about this particulair subject, so please express your opinion on my words.

    Please let your opinion be the truth, an opinion that is not truthful is worthless. I'm a big boy, I can take reality. May not like it but can take it....Bear or ITZ.

    Last edited by inthezone; 12-05-2003 at 08:13 PM.

     
    Old 12-06-2003, 05:22 PM   #13
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    Re: Roxi or Dilaudid - Question from a n00b

    ITZ,
    I'm not sure exactly what you are asking me to give my opinion on? I read the last paragraph several times, but I don't know exactly what you want my opinion on...Can you be more specific?

    Lots of love,
    Crystal

     
    Old 12-06-2003, 09:18 PM   #14
    inthezone
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    Re: Roxi or Dilaudid - Question from a n00b

    Crystal: If I would have written it better you could have understood it better and probably answered it. The point I was trying to make was that Snoople was taking oxycodone which, in itself, is a somewhat longer lasting pain killer compared with many of the other Cll drugs. And I was also agreeing with Wirry that Dilaudid was not the proper drug Snoople was looking for as a long acting medication. After reading that post I must have been messed up on some of my B/T and an additional dose of my base/pain medicines. I'm Sorry

     
    Old 12-07-2003, 07:03 PM   #15
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    Re: Roxi or Dilaudid - Question from a n00b

    Well, I thought snoople said that he/she is on Percocet? That's not a long-acting med...Neither is Dilaudid. Sure oxycodone comes in a long acting form, but that's oxycontin, not Percocet. Percocets don't last very long. Neither should be used for a long acting med, because neither of them ARE long acting... MS Contin, OxyContin, Methadone and the duragesic patch are about the best ways to go in terms with a long acting med. I'm sure there are others, but these are the only ones I know are long acting....

    I am sorry if I'm still misinterpreting what you want my opinion on, but I don't believe Dilaudid is the med this person is looking for mainly because it's purely short acting, until they approve the long acting form of dilaudid that I heard was trying to be approved (I think that's what was going on, but I'm not sure...I heard about it quite a while ago)....

    Gotta go do homework!

    Much love,
    Crystal

     
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