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    Old 07-01-2007, 09:12 AM   #1
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    compression fractures and pain meds...

    Hi everyone..I have a question regarding the different types of pain meds and which one works the best, side effects, etc. My Mom has 3 compression fractures in her spine and is in constant pain. She has tried everything and now the doctor would like her to try one of the following....kadian, avinza or fentanyl patches. Ok....I know they are an extended release of morphine sulfate, however I would like to know if any of you are taking any of these and how they work for you. Also, can you do the patch with the pills? I really don't have any knowledge of pain meds so thanks for your help in advance! Dana

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    Old 07-02-2007, 05:35 AM   #2
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    Re: compression fractures and pain meds...

    Hi Dana, Unless your mom has recuring compression fractures from OP, I don't really get why her doc would be pushing for a long acting med. LA meds are for chronic pain, not acute pain from something like a fracture or surgery that is expected to get better in a few weks or months. long acting meds aren't recomended for the short term treatment of severe acute pain. They take too long to adjust the right dose and physical dependence is unavoidable

    LA meds also don't gaurentee relief, you can be undermedicated on LA morphine just as easily as someone is undermdicated on 5 mg percocet or 2 mg dilaudid.

    Morphine is morphine and it al comes down to how much morphine she takes per day. Although 100 mgs of kadian may sound like alot, it's notthing compared to what taking 30 mgs of instant relese morphine every 4 hours would be like. So you could just as easily be miserable on too low a dose of kadian or avinza. Morphine is weaker than oxycdone and short acting oxy comes in strengths up to 30 mgs which would be equivelant to taking 45 mgs of morphine every 4-6 hours or up to 280 mgs of morphine a day.

    Putting your mom on 50,60 or 100 gs of kadian or avinza is no stronger than what you can achieve with short acting meds and heading down the road of long acting meds where a steady serum level of morphine is kept in her system pretty much gaurentees physical dependence. This isn't the same as addiction, but who wants to put their elderly parent through withdrawal when the fractures are healed in 6-8 weaks and she's now dependent on morphine.

    A 100 mg kadian or 120 mg avinza doesn't sustain 100 mgs in her sytem, it releases that many mgs over 12-24 hours, so it's not like it would be hard to duplicate this with a much less expensive version of short acting morphine that can be slowly decreased as she begins to heal in a couple of weaks or months. She will be pretty much stuck with whatever dose of lA med they give her and dependent on the doc to provide a proper plan to discontinue meds at some point when she does heal.

    Unfortunately most docs are better at writing scripts than actually developing a comprehensive plan to discontiue meds when she has healed. That's why the LA meds should be the last resort or do you expect her to be n pain and on opiates the rest of her life. That would be the only reason a doc could justify the use of LA meds.

    When treating acute pain you expect to get better, just because 5 mg vicodin or 5 mg percocet doesn't work it doesn't mean she doesn't have other chopices. If 5 mg percs don't work, the short acting version of oxy comes in 7.5 mg, 10mg, 15mg and 30mg. Personaly I don't get the logic. just because it's morphine, it doesn't gaurentee relief. Morphine is just the gold standard to which other opiates are compared and most opiates are stronger than morphione. People that use LA meds need their dose titrated or adjusted over time to find the right dose, it can take months of adjusting lA meds every 2 weeks to find the right dose so I don't really see how months of playing around with the wrong dose is going to benefit your mom when faster relief and adjustements can be made with short acting morphine.

    As far as your question, none of the LA meds live up tot their rep. Avinza doesn't last 24 hours, Kadian works better when dosed every 12 and statistialy more than 90% of the people using patches need to chenge them more frequently than the 72 hours they claim they work or they end up experiencing withdrawal on the third day. I guess I'm just trying to impress upo you that long term med are for long term problems, there are certainly strong enough short acting meds. Dilaudid comes in strengths up to 8 mg per dose, Oxymorphone comes in strengths of 5 and 10 mgs per dose which is roughly 3-5 times stronger than morphine, She does have lots of choices other than going to long acting meds that gaurentees physical dependence after you body gets used to having morphine in it 24/7 for several weeks.

    Everyone is thinking about now, but what about in 6 weeks when the fractures heal, nobody has a problem with mom going through withdrawal or spending the rest of her life dependent on opiates as long as she's comfy today?

    Is this a Pm doc that's prescribing LA meds for short term pain or a frustrated GP or surgeon that doesn't know what to do. They never get the dose right on the first shot, So just because they put her on 50 mgs of avinza or 20 mgs of kadian twice a day, the only thing gaurenteed is that she will become phsysicaly dependent and experience withdrawal when it's time to discontinue the LA meds. It takes months to adjust long acting meds to an efective level and it takes months for your body to accomadate to the side effects. She could easily start at 30 mgs of avnza a day and end up at 360 a day within 8 weeks. Shouldn't she be she healing in 6-8 weeks. and isn't having to figure out how to get mom off morphine a giant monster being ignored untill it's time to make mom sick.

    Why put her through weeks of withdrawal end the LA morphine when stronger short acting meds could be used now and then slowly decreased in strength over the next few weeks or months without the level of dependency that will develop from round the clock morphine or Fentanyl. Yes orals can be taken with the patch, but since there is no other oral version of fentanyl to slowly decrease her dose, she is at the whimof the doc making 50% decreases to get her off the stuff at some point down the road.

    If she has long term chronic pain and isn't expected to get better, then pain management with LA meds makes a little more sense, but something that will generally improve in 6 weeks doesn't call for the longet acting meds. The same serum levels can be achived with short acting meds at the right dose and would be miuch easier to discontinue down the road when she starts heling. There is a consequence for every action and the consequences for using LA opiates are pretty severe unless you don't ever expect her to be able to function again without narcotic medication.

    Obviously I don't kow all the details, but if it were my mom and I know it's hard to watch someone suffer, but this pain won't be anywhere near as traumatic as going through withdrawal after spending 2 months on LA morphine or a fentanyl path.

    Fractures do heal or surgery on severly compressed fractures can be surgically resolved, but nobody gets complete pain relief unless over medicated and the price of phsyical dependence is prety substantial in my book. Often folks have no problem trading freedom from opiates for pain relief untill the opiates are discontinued, then you get posts about how can the doc put me through this terrible withdrawal and not listen to me when I say my fractures still hurt 3 months later.

    Good luck, Dave

    Old 07-02-2007, 06:05 AM   #3
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    Re: compression fractures and pain meds...

    Hi Dave....thanks for the reply. My Mom has osteoporosis and evidently has reoccuring compression fractures. She sneezes and theres a fear that something might have broke. She has been on prednisone for over 30 + years for Crohns disease and that has made her bones worse than swiss cheese. She's like a porcelan (sp?) doll. She is not eligible for surgery to fix anything because of her conditions. Not only does she have Crohns, Osteoporosis but she also has COPD/Emphysema. Sooooo....they have tried many pain pills and now they have come to trying one of these pills. Thanks again....Dana

    Old 07-02-2007, 07:03 AM   #4
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    Re: compression fractures and pain meds...

    Hi Dana - I am a 51 year old woman with severe osteoporosis, copd, various auto-immune diseases and a chronic pain patient. I would have to disagree with Dave on a few points. I have experienced too many compression fractures in my spine, arm, foot and hips to count and I suspect that your mother and I are living very similar lives at this point. You don't say how old she is and 51 is a rather young age to be suffering from the degree of osteoporosis that I suffer from, however...I lost my estrogen at age 22-23 and without any hormone replacement therapy and the use of prednisone for the past 15 years, I too have bones like swiss-cheese!! I can say that I do suffer chronic pain as a result of compression fractures - there is the initial pain, of course, that sometimes occurs when bones break (although I've been told of a few breaks on xray that I never realized I had!). Dave is right when he says that acute pain like that does get better with time, but it seems that bones that are chronically breaking and not being repaired surgically really do cause a long-term pain, at least they have in my case. It's hard to say sometimes where the pain is coming from - it depends on whether or not your mom has had surgery to repair her compression fractures and if the surgery was successful. I have a history (and perhaps she does too) of having vertabrae fused during an operation only to have the next vertabrae(s) in line fracture shortly thereafter. I currently have fractures at L3-L5 that are causing me some extra pain. I could have them surgically repaired, but after more than 10 surgeries I don't think the solution is worth the complications that I could experience at this point. But, I won't say never and if the pain continues I may have to look at it again. OK, enough about me...this is about your mom. If she is really experiencing chronic pain she does deserve to be treated by an experienced pain management doc who can weigh the pros and cons of long acting meds for your mom. I am currently using the fentanyl patch (Duragesic) with oxycodone 30 mg. for breakthrough pain. This has been working very well for me, but I am hoping that sometime in the future I can have a trial with the pain pump. I've been very impressed with the results that others have had with it, including Dave (Shorline). It would be great to have all the pain relief without the narcotic buzz and fuzziness that sometimes comes with the higher doses of these kind of drugs. I would also like to endorse methadone as a really good pain medication. I was on it for several years and only switched when I felt like I was spending more time "gazing into space" than actively living my daily life. Anyway, that's all I can offer. Again, as somebody who has experienced compression fractures in the past and still deals with them currently, I think the pain can be both acute and chronic. Good luck - KathyMac

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