Discussions that mention celebrex

Pain Management board


Hey Dana, Duragesic is actually Fentanyl, a much more potent opiate mg to mg than morphine, that's why it's measured in Micrograms.

Anyway, Has he tried any of the NMDA receptor blockers with Duregesic. I've read several articles claiming fentanyl actually binds to this receptor and can actually caused Hyperalgesia "increased pain , particularrly when his serum level drops, If he's changing every 72 hours that would likely happen, I had a friend that took part in the clinical trials for Duragesic to be used for non cancer pain. Only 3% lasted the full 72 hours. Most folks change them every 48-60 hours. If he's experiencing increased pain the last 12-24 hours it needs to be changed more frequently. That 3% that it lasted 72 hours for allows Jansen to claim "up to 72 hours of continous relief", that's exactly how it's worded too, "Up To" Doesn't gaurentee 72 hours.

The NMDA receptor is a receptor much like an opiate receptor , however meds that block this receptor, in adddition to opiates like meth , are believed to increase your threshold to pain , the oposite of hyperalgesia, it's also beleieved to slow tolerance and work particuallry well on neuro pain.

Methadone and levorpahnol have some NMDA blocking ability, Dextromathorphan can be used and is now made in a pure capsule called dexalone available OTC. There is also a new parkinsons med called Nemanda, It's also a very strong NMDA recpeptor blocking agent. These are things they are using at the clinic I go to. and can also be easily researched.

There is a product in clinical trials called morphidex which is a LA morphine product that has the dex included. When they compound LA hydro capsules, the Dextro is what makes the product long acting.

As far as anti inflamatories, you either have steroids like pred.. or you have the non steroidal anti inflamatories like naprocin, Ibuprofen, etc. The newest generation of anti inflamatories are called cox2 inhibitors, the cox 11 enzyme is part of the inflamation process. Bextra is the newest cox2 anti inflamatory. There is also Celebrex and I think another one has come out recently. If he's going t try one of the new NSAIDS he will have to stop the Naprocin though. Combined they would eat a whole in his stomach, But the Cox 11 NSAIDS are suposed to be easier on the stomach.

Everyone reponse to different NSAIDS is different. Bextra may be a wonder drug for one person and useless for another. So it probably means trying both Bextra and Celebrex to see which works better.

I know alot of his pain is being attributed to inflamation, that may be very true. There is also the posibility that his muscles are in such spasm or he my has such severe spastcity that the muscles are actually the culpret for pulling ribs out of wack and making a mess out of his neck and back. Muscles go into spasm or contracture to protect an injured area, It's the bodies way of protecting an inured area by contracting the muscle and bracing. Just like you would naturally brace if you saw you were going to be in a car accident. Only if the injury doesn't get better, you have to trick the muscles into releasing and that may be a huge component of his pain.

Xanaflex does have muscle relaxant qualties but is an older BP med, kind of like adding Clonidine to a pump or taking it orally to increase efficacy of pain meds. Robaxin, Skelaxin, flexerill,Xanaflex only have effect on the brain where valium also has an effect the muscle itself.

Personally I would want to see a real trial in the oposite direction and see if it's muscular rather than inflamatory. He wouldn't have to stop the anti-inflamatories, But there are other muscle relaxers stroger than Zanaflex. Just because it makes people sleepy doesn't mean it's relaxing spastic muscles. Baclofen oral or if he gets a pump is an option. Robaxin oral or weekly infusions may help.

I know a lot of docs prefer not to use Valium. It does cause dependnency similar to opiates, has a high street value and can cause the inability to form new memories at high doses. Too much and you pretty much black out from benzo's. But other muscle relaxers do not work on both the muscle and the brain, most simply work on the brain, reduce blood pressure and have a calming effect. Aside from Valium, Soma is the next best in my opinion but when it comes to muscle relaxers docs usually have one they prefer for whatever reason although everyone reponds differently.

But valium is the only one that actually works on smooth muscle tissue itself. It can cause increased CNS depression, but that side effect will deminish with time and so do all the others. If you could convince his doc just to give it a try for say a week or 10 days, He may find it works much better than NSAIDS, Steroids and Xanaflex.

I know you feel he's running out of options, But a 100ugh Duragesic is not the most he can ever take. THere is no ceiling on opiates other than side effects if you aproach the dose slowly and safely. I know people that wear 4 100's at a time.

There is also the idea of combining opiates. It's good he has a different opiate for BT pain because different opiates bind to different receptors. With multiple opiates you hit a broader range of receptors, by not using the same BT med as base med you don't make someone rapidly tolerant to the same med.

I know folks that can only get relief by combining opiates. The guy that wears 4 duragesic pathches also use Kadian and methadone. Along with BT meds. I know tolerance is an issue to watch, But whether it's 1 patch or 2, He' is just as physically dependnet, not addicted, just dependent. Addiction is an assortment of destructive behaviors and reasons for abusing meds. Dependnence is just a result of using these meds and that's the only real big trade when it comes to opiates. So he's dependent? why should it matter if he's using a 100ugh patch or using 2 100's. Or using a patch and taking methadone or another LA opiate.

If he's disabled, to the point of not being able to walk, stand, sit for any prolonged perriod. The only way to really manage that kind of pain is opiates and andjunt meds or combining different modalities. HAs he tried any of the antiseizure meds like Neurontin, Toppamax, Dilantin, or Lamyctyl. That's also the latest thing in neuro pain treatment.

I just see lots of folks that think there options are limited and usually they are only limited by the doc's comfort in prescribing and trying different meds and modalities. If his pain meds are not working, The doc needs to keep working at it. A single 100ugh patch is not the best they can do, It may be the most he can tolerate but there are other meds, Plenty of versioans of LA morphine, MSContin, and the generics, or Kadian and Avinza last from 12-24 hours. Oxycontin, methadone, Levorpahanol,

There a few drugs in clinical trial, one is OxyMorphcontin "LA oxymorphone/Numorphan" which is twice as strong as Oxycontin and at least 3 times stronger than morphine mg to mg.

Hopefully I mentioned some things that are worth trying if he hasn't already.
Take care, dave
Quote from Shoreline:
Hey Dana, Duragesic is actually Fentanyl, a much more potent opiate mg to mg than morphine, that's why it's measured in Micrograms.

Anyway, Has he tried any of the NMDA receptor blockers with Duregesic. I've read several articles claiming fentanyl actually binds to this receptor and can actually caused Hyperalgesia "increased pain , particularrly when his serum level drops, If he's changing every 72 hours that would likely happen, I had a friend that took part in the clinical trials for Duragesic to be used for non cancer pain. Only 3% lasted the full 72 hours. Most folks change them every 8-60 hours. If he's experiencing increased pain the last 12-24 hours it needs to be changed more frequently. That 3% that tit lasted 72 hours for allows Jansenm to claim "up to 72 hours of continous relief", that's exactly how it's wortded too, "Up To" Doesn't gaurentee 72 hours.

The NMDA receptor is a receptor much like an opiate receptor , however meds that block this receptor, in adddition to opiates like meth , are believed to increase your threshold to pain , the oposite of hyperalgesia, it's also beleieved to slow tolerance and work particuallry well on neuro pain.

Methadone and levorpahnol have some NMDA blocking ability, Dextromathorphan can be used and is now made in a pure capsule called dexalone available OTC. There is also a new parkinsons med called Nemanda, It's also a very strong NMDA recpeptor blocking agent. These are things they are using at the clinic I go to. and can also be easily researched.

There is a product in clinical trials called morphidex which is a LA morphine product that has the dex included. When they compound LA hydro capsules, the Dextro is what makes the product long acting.

As far as anti inflamatories, you either have steroids like pred.. or you have the non steroidal anti inflamatories like naprocin, Ibuprofen, etc. The newest generation of anti inflamatories are called cox2 inhibitors, the cox 11 enzyme is part of the inflamation process. Bextra is the newest cox2 anti inflamatory. There is also Celebrex and I think another one has come out recently. If he's going t try one of the new NSAIDS he will have to stopp the Naprocin though. Combined they would eat a whole in his stomach, But the Cox 11 NSAIDS are suposed to be easier on the stomach.

Everyone reponse to different NSAIDS is different. Bextra may be a wonder drug for one person and useless for another. So it probably means trying both Bextra and Celebrex to see which works better.

I know alot of his pain is being attributed to inflamation, that may be very true. There is also the posibility that his muscles are in such spasm or he my has such severe spastcity that the muscles are actually the culpret for pulling ribs out of wack and making a mess out of hisneck and back. Muscles go into spasm or contracture to prevent an injured area, It's the bodies ay of protecting an inured area by contracting the muscle and bracing. Just like you would naturally brace if yo u saw you were going to be in a car accident. Only if the injury doesn't get better, you have to trick the muscles into releasing and that may be a huge component of his pain.

Xanaflex does have muscle relaxant qualties but is an older BP med, kind of like adding Clonidine to a pump or taking it orally to increase efficacy of pain meds. Robaxin, Skelaxin, flexerill,Xanaflex only have effect on the brain where valium also has an effect the muscle itself.

Personally I would want to see a real trial in the oposite direction and see if it's muscular rather than inflamatory. He wouldn't have to stop the anti-inflamatories, But there are other muscle relaxers stroger than Zanaflex. Just because it makes people sleepy doesn't mean it's relaxing spastic muscles. Baclofen oral or if he gets a pump is an option. Robaxin oral or weekly infusions may help.

I know a lot of docs prefer not to use Valium. It does cause dependnency similar to opiates, has a high street value and can cause the inability to form new memories at high doses. Too much and you pretty much black out from benzo's. But other muscle relaxers do not work on both the muscle and the brain, most simply work on the brain, reduce blood pressure and have a calming effect. Aside from Valium, Soma is the next best in my opinion but when it comes to muscle relaxers docs usually have one they prefer for whatever reason although everyone reponds differently.

But valium is the only one that actually works on smooth muscle tissue itself. It can cause increased CNS depression, but that side effect will deminish with time and so do all the others. If you could convince his doc just to give it a try for say a week or 10 days, He may find it works much better than NSAIDS, Steroids and Xanaflex.

I know you feel he's running out of options, But a 100ugh Duragesic is not the most he can ever take. THere is no ceiling on opiates other than side effects if you aproach the dose slowly and safely. I know people that wear 4 100's at a time.

There is also the idea of combining opiates. It's good he has a different opiate for BT pain because different opiates bind to different receptors. With multiple opiates you hit a broader range of receptors, by not using the same BT med as base med you don't make someone rapidly tolerant to the same med.

I know folks that can only get relief by combining opiates. The guy that wears 4 duragesic pathches also use Kadian and methadone. Along with BT meds. I know tolerance is an issue to watch, But whether it's 1 patch or 2, He' is just as physically dependnet, not addicted, just dependent. ADdiction is an assortment of destructive behaviors and reasons for abusing meds. Dependnence is just a result of using these meds and that's the only real big trade when it comes to opiates. So he's dependent? why should it matter if he's using a 100ugh patch or using 2 100's. Or using a patch and taking methadone or another LA opiate.

If he's disabled, to the point of not being able to walk, stand, sit for any prolonged perriod. The only way to really manage that kind of pain is opiates and andjunt meds or combining different modalities. HAs he tried any of the antiseizure meds like Neurontin, Toppamax, Dilantin, or Lamyctyl. That's also the latest thing in neuro pain treatment.

I just see lots of folks that think there options are limited and usually they are only limited by the doc's comfort in prescribing and trying different meds and modalities. If his pain meds are not working, The doc needs to keep working at it. A single 100ugh patch is not the best they can do, It may be the most he can tolerate but there are other meds, Plenty of versioans of LA morphine, MSContin, and the generics, or Kadian and Avinza last from 12-24 hours. Oxycontin, methadone, Levorpahanol,

There a few drugs in clinical trial, one is OxyMorphcontin "LA oxymorphone/Numorphan" which is twice as strong as Oxycontin and at least 3 times stronger than morphine mg to mg.

Hopefully I mentioned some things that are worth trying if he hasn't already.
Take care, dave


LOL I'll just print this up and show my doc LOL I got totally confused and thats a lot for me to write down so will print it and show my doc your ideas. but thanks anyways. I will do research on all that stuff as soon as I can hopefully later today. Thank yu very much. You have been veryu kind in here. :angel: