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  • Long acting pain med that is least "drowsy"?

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    Old 09-11-2010, 10:19 AM   #1
    wrenegade
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    Question Long acting pain med that is least "drowsy"?

    Hi, everyone,

    It's been a really long time (years) since I posted on here. In the meantime I had tried getting off my meds, but was in so much pain I had to get back on, but at a lower dose. That was 2 or 3 years ago. I also underwent microdisectomies, nerve ablation, foraminotomies, etc. . . all arthroscopic. I had a very small amount of relief, but glad for what I did get.

    I have a grade 2 (possibly 3) spondy at L5-S1 for the last 33 years. Also have some osteoporosis now. When I got back on pain meds, I stuck with hydrocodone and am now at the highest level for that. I requested something longacting last time and got back on the OC 10mg twice a day. Thing is, it costs $30 a month and I cannot afford it so I asked PM doc for a less expensive replacement. He rx'd MS Contin, but it makes me soooo sleepy. I have to work full time and believe me it's a real challenge. I am also taking 2 college classes a semester. Lately, I've been thinking that I just need to quit trying so hard (I'm 52) and try to get on disability. I am in so much pain and so tired all the time.

    I never thought I would consider a fusion, but I've been thinking about it now. My last MRI showed the disc at that level mashed out all over the place and the last x-ray you can clearly see that the L5 bone is resting on the S1 bone. I'm thinking that at least the "cage" would lift that bone up if nothing else.

    But, I regressed. My question is have you found a long-acting med that does not make you so sleepy that it's hard to function and is affordable? What about Opana? (That's one PM doc suggested)

    Thanks,
    Karen

     
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    Old 09-11-2010, 10:46 AM   #2
    dave490
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    Re: Long acting pain med that is least "drowsy"?

    If your dose is appropriate, the drowsiness should go away after a few days. I think it would be good to ask your doctor if you can start out on the lowest dose possible, even though it might not be enough, then slowly increase the dosage to a level that keeps you comfortable. Even the lowest dosage will provide some relief, and you'll give your body a chance to adjust to having pain meds in your system again. Almost all pain medication that tackles severe pain will cause you to be drowsy at first.

     
    Old 09-11-2010, 12:33 PM   #3
    janiee08
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    Re: Long acting pain med that is least "drowsy"?

    I believe Opana is rather expensive as well..Hopefully others will chime in....janiee

     
    Old 09-11-2010, 01:54 PM   #4
    maltluver
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    Re: Long acting pain med that is least "drowsy"?

    Medicines react differently with different people. It might not make one person sleepy but may knock someone else off their feet so it's hard to recommend something. However, you make get used to this med and it won't affect you so much.

    It is perhaps time to do some serious talking with your surgeon about whether a pain management specialist can help you....it could be that surgery is going to be all that is left.

    Do let us know, okay?

    Carol

     
    Old 09-11-2010, 09:50 PM   #5
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    Re: Long acting pain med that is least "drowsy"?

    While I found Opana to be similar to oxycontin in pain relief it caused pain to my wallet! Opana is also a name brand medication and at least for my insurance co. it was more expensive than the name brand oxycontin. This may not be the case for you and/or your insurance coverage but as others mentioned maybe you could try to tritrate the dose more slowly to avoid the sleepiness. Good luck.

    KG

     
    Old 09-12-2010, 12:24 PM   #6
    Toonces1
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    Re: Long acting pain med that is least "drowsy"?

    Someone will correct me if I'm wrong, but I THINK Opana has morphine in it??? I take Kadian as my long-acting pain med and I do not get drowsy from it at all. It is so slow releasing that I really can't tell "mentally" that I've taken it, I just know if my pain is reduced. I'm not on a tiny dose either, but I don't think we can post our doses.

    However, I have never gotten sleepy from morphine when I've been in the hospital post surgery and they've given it to me, even in high doses.

    I would guess that everyone reacts a little differently to different meds, but I would agree that the sleepiness should wear off if you can give it some time for your body to get used to it. I used to get really sleepy from my break-through medication, but now it does not affect me at all, except for reducing my pain of course.

     
    Old 09-12-2010, 12:36 PM   #7
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    Re: Long acting pain med that is least "drowsy"?

    Opana is oxymorphone, which is in the morphine class, but it's a high-potency drug. The difference between oxycodone and oxymorphone is in the metabolism by your body. One of the problems with the oral morphine-class drugs is that the live clears up to 50% of the drug on first pass. This is why you must take a higher dose of oral morphine-class drugs than you would need either IM or IV. It's okay to list your dosages, so long as you're not advocating that dose for someone else.

     
    Old 09-25-2010, 06:20 AM   #8
    wrenegade
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    Question Re: Long acting pain med that is least "drowsy"?

    Thanks for responding, y'all!

    Dave, you said, "Even the lowest dosage will provide some relief, and you'll give your body a chance to adjust to having pain meds in your system again." Sorry if I wasn't too clear. I've been back on the pain meds for a couple of years, but have been taking it much slower as far as trying to keep my increases to a minimum. I've been on the maximum dose of hydrocodone for quite a while, but, of course, it is no longer working so well. The OxyContin worked really well, but I could not afford the co-pay. I did go to my pain management doctor this week, and we decided to go with the short-acting oxycodone until we decide what to do about something long acting. I'm happy to say that I am getting better pain relief.

    I did find out that the Opana would have been over $200 for 60 (10 mg)
    (I hope it's okay to post that) Def out of my price range!

    The MS Contin was the lowest dose; maybe I didn't stick with it long enough. Like someone said, maybe the drowsiness would have worn off after a while. I had some bad dreams when taking it, too? Anyone else ever experience this?

    Someone mentioned Kadian. I may ask about trying that.

    I am putting off having surgery because in a little over a year, I will be vested for retirement where I work. I don't want to mess that up in case something went wrong with the surgery. It's very difficult working full time and being in pain. It's a very high stress job, too, but it has great benefits and I'm thankful to have a job.

    Another question I have is about depression. I read an article in Reader's Digest several years ago that talked about how pain uses the same chemical receptor sites that regulate our mood hormones. It said that many people with chronic pain become depressed because of this. Do many of you take something for depression? Does anyone know which hormones are used up? Is it serotonin, norepinephrine, dopamine or all of them? Or does it vary with individuals?

    I've been thinking about requesting something like this. But I wanted to start on the right one. I've heard they can take months to kick in. Would my PM doctor prescribe or would I have to go to someone else?

    Sorry for the lengthy post and all the questions. You are a great bunch. It's nice to have support and a place where people understand.

    Bye for now,

    wren

    Last edited by wrenegade; 09-25-2010 at 06:21 AM.

     
    Old 09-25-2010, 06:57 PM   #9
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    Re: Long acting pain med that is least "drowsy"?

    Well I can help you with part of your last post. I've been a chronic pain patient and on the heavy meds for 7 years. For me as some others I've built up a tolerance the sleep side effect works in reverse, the meds actually "wire" me, so I have to be careful taking them at night. I actually have to take ambien with my night meds or I would literally never sleep. With the ambien I only sleep 5 hours a night and it takes about 2 hours to kick in.

    On the depression meds question. I am also Bi-polar and have dealt with psych meds for the last 21 years, so can give you some input on how they work, how fast etc. It really depends on what you take, there are literally dozens on the market now. You don't have to go to a psychiatrist to get them, any doc will prescibe them. There are 4 major type of depression meds:

    1. Trycilic - these are old generation, some of the first made, they work on both norephenephrine and serotonine, they generally have the most side effects.

    2. MAOI's - These are 2nd generation, once again lots of side effect, lots of food interactions

    3. Selective Seratonin Reuptake Inhibitors - Newer meds, great results, not as many side effects. Work on changing the amount of Seratonin in your brain, several diff. kinds but generally very effective.

    4. Serotonin and norepinephrine reuptake inhibitors - Newer meds, great results, not as many side effects. They increase both norepinephrine and seratonin in the brain.

    If you think your meds are causing depression, the best thing to do is talk to your doc about it. I'm sure he/she has experience with this in other patient and probably has a set med that he/she likes to prescribe. Usually they start with a certain one, then if that doesn't work or there are intereractions they kind of just go down the list. Hope this helps.

    Good luck.

    Kat

     
    Old 09-25-2010, 09:56 PM   #10
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    Re: Long acting pain med that is least "drowsy"?

    Opana ER worked very well for me. There is a manufacturers discount card that I believe limits your co-pay to $25 or maybe $50, but while I was still working it was a great asset. Now that I'm not working I reverted to MS Contin as I can be drowsy if needed :-)
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    Old 09-26-2010, 08:57 AM   #11
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    Re: Long acting pain med that is least "drowsy"?

    i just wanted to mention something about the anti depressants here? these meds are something i would NOT go onto unless youy really HAVE TO? only becasue they can be a really hard thing to come off of for some, like taking months to titrate down and off? i know of a few people on these boards,and who i know personally who were on them, then went off after only maybe six months,and DID have some rather profound side effects while during the titration down then 'off' phases? i am on lexapro and it really seems to help, BUT whenever i had been on another SSRI or the SNRI like cymbalta and we did ANY switching, i was always ON something that we lowered and then i went 'directly" onto something else, which is very different than going completely 'off' of them? only becasue of my ongoing severe recurrent depression and what is also a more 'situational" depression too was/is still there?

    just about ANY iof the anti D meds and just the ways they work upon our brains just can impact a persons brain a wee bit more than other meds can, and create some pretty profound side effects while being on them and going off as well. it all depends upon how YOU respond to them and how your brain reacts when they are possibly stopped too?? just make certain if you DO go this route, it is not in the more "prophalactic" way to try and "prevent' a depletion of seritonin/depression(not everyone will even FELL this loss and regain everything at some point too?), but ONLY if they truely are very much needed. thats a huge difference in reasons to even START esp the SSRIs? they just are one of the harder meds for most people to actually 'get off of' once they are not needed anymore? they just can impact our brains THAT much overall. just PLEASE keep that in your mind here in making THAT decision. its not one of those decisions to make lightly, trust me there.

    when they ARE truely 'needed" to try and treat what can be debilitating deperession, thats one thing, but if you take these and do NOT even yet have any symptoms of depression, they could 'create" problems for you since your seritonin is simply really okay and you are adding it anyway(seritonin syndrome is always a possible when too much is within our brains than should be too)? just be careful with these meds hon, and only go onto them if they are seriously a real 'need". and not wanting to try and prevent something you may not even have or ever have either? everyone is just THAT different when it comes to depression/seritonin depletion and how we will individually even react to narcotics too. just always make ANY decisions to go onto any meds taking all the good real reasons for the need, along with ANY potential side effects they can simply 'have" into account.

    by the way, considering everything here, i DO think doing things the way you currently are with simply taking the SA meds during your day is probably best for you right now when considering the overall cost of the OC was for you? my brand name co pay with the OC is actually 35.00 a pop. but for me its worth not having to worry whether or not my OC even contains enough active med if i went generic? been down THAT road before and kept waiting for that generic OC to simply be felt where the BN always hits me first, within my c spine? never actually occured with the generic version. so for you, this does sound like a good plan until you can figure out what truely 'needs" to be done eventually with surgical intervention.

    you just really DO have something going on there that will eventually need to be intervened upon surgically. this is going to come down to how long you can tolerate the pain and symptoms and trying to do this within YOUR hopeful time frame. i hope you can hold out there til you can be fully vested. i DO know how much THAT really does mean to the individual. i was not able to make that with my job myself and it killed me too both emotionally and financially. HAD to simply go onto disability an did NOT want to have to give up the job i loved soo much either? hope the multidosing with the SA oxy actually works til then for you. just be VERY careful about ANY anti D decisions til or unless they truely ARE simply 'needed" and not wanted? everyone is simply very different in all ways pretty much esp when we have to take any meds and how OUR bodies will even use them. please keep us posted, marcia
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