[winnie.1963]

I'm so glad I have found this site & thank anyone in advance for their answers.
Long story cut short:- I have been on large doses of tramadol plus pethidine every day (plus lots of other drugs) for chronic pain following major spinal damage in an RTA.

I started to find the tramadol & pethidine was no longer strong enough. My pain consultant suggested a change to hydromorphone to increase pain relief so at least I could have some relief, especially at night. I have been given "palladone" (which says hydromorphone hydrachloride on the box) in both slow release and quick release form.

I'm struggling with the pain 'though. Is HH stronger than tram plus peth?

Can anyone tell me if this is usual, I am up to 2 doses of 10mg slow release and a total of 13mg of the quick release hydromorphone hydrochloride. Is HH an opiate...I'm hurting and confused...can anyone make any suggestions please?

Thank you

Winnie

[Businessman1]

Hydromorphone is an opiate and one of the stronger ones too. I had it IV when I had back surgery and then in tablets when I went home.

I never found it that effective orally either (it was very strong as an IV). I could hardly feel it even at 3 times the prescribed dose.

After a week I asked to be changed back to Oxycodone. It isn't as strong but has a higher bioavailability when taken orally. You probably know this but Oxycontin is the slow release version and you can get generics for the instant release.

The other alternatives are Opana (oxymorphone) and morphine. Both come in slow and instant release. I haven't tried either but I'm sure your doctor can advise if you tell them that the hydromorphone isn't working for you.

[winnie.1963]

Thank you for such a helpful answer, I'm so glad I found this forum as i have a real case of professional clash with me in the middle. It helps to talk to real people with real experiences rather than text book ones.

Would you think me rude to ask what dose of hydromorph you were on? My GP felt the dose recommended by my pain management consultant was too high so started me on 4mg of the slow release twice a day with 1.3mg quick release to be used up to 8 times a day. The dose has been increased gradually but I'm still waking in agony during the night with spasms. I finally managed to get the GP to talk to the consultant yesterday & he said my GP had done more harm than good and put the dose straight up to 16mg twice a day plus the short releases saying i could increase if necessary to 30mg twice daily plus the quick release if needed.

I've asked if I can try something different but my GP won't prescribe anything & I can't get hold of the consultant (just a message from his secretary to let him know if the 60mg didn't work)

Now you have given me some very helpful advice from your own experience I can go back to the GP with a couple of things I can ask if I can try (of course I won't say who I've been "talking" to.

The problem I have is that my consultant thinks my GP is a "whimp" and my GP doesn't like the consultant. They're entitled to their opinions but I'm stuck in the middle.

Thank you for a very informative response, it's very hard to be stuck in the middle with no backup. I'm going to ask if any of the drugs you mention would be helpful.

Kind regards,
Winnie

p.s. if anyone else has any more comments or suggestions I'd be grateful to hear them

Originally Posted by Businessman1

Hydromorphone is an opiate and one of the stronger ones too. I had it IV when I had back surgery and then in tablets when I went home.

I never found it that effective orally either (it was very strong as an IV). I could hardly feel it even at 3 times the prescribed dose.

After a week I asked to be changed back to Oxycodone. It isn't as strong but has a higher bioavailability when taken orally. You probably know this but Oxycontin is the slow release version and you can get generics for the instant release.

The other alternatives are Opana (oxymorphone) and morphine. Both come in slow and instant release. I haven't tried either but I'm sure your doctor can advise if you tell them that the hydromorphone isn't working for you.

[Businessman1]

My dose won't help you because everyone is so different but as an FYI, I was taking about 30mg/day of the hydromorphone but was prescribed around 10mg. I also took oxycontin as well - a total of around 100mg/day.

I personally didn't like slow release pain meds because I think they give you too much in the first hour and then not enough in the following 11 hours they are meant to last. Also, my tolerance was building up fast and didn't want to get meds in my sleep.

I asked to go back to instant release oxycodone. I liked instant release meds better as they let me control my pain more precisely. I didn't find it a hassle to take pills more often - lets face it, its not that much work... My doctor preferred prescribing me oxycodone after hearing how much hydromorphone I was taking.

I would change your GP if you are not happy. In my albeit limited experience, doctors don't like you to tell them what to prescribe you. Plus they may see it as "drug seeking behavior".

As one other FYI, when I increased my hydromorphone, it didn't always improve the pain relief but on occasion it did make it hard for me to breathe. I had the same problem with hydrocodone too sometimes.

[winnie.1963]

Thank you for another helpful answer.

I totally agree with the *each individual is different* approach but reading your experience has helped me put things into perspective. The assumption of "drug seeking behaviour" is a very sad one and IMHO usually comes from someone who has never suffered from severe acute or chronic pain themselves.

I found that no-one gave me any "credit" for the amount of medication I had reduced voluntarily when I didn't need it but started to get the *tut*s of disapproval when I relapsed following a fall and needed to increase my medication again.

I'm also pleased that you happened to mention your opinion of the effectiveness of slow release medication. I have been feeling the same but thought it was just me being negative (I'm usually a very positive person but this new medication seems to have thrown me completely).

Thank you for taking the time to help a stranger, wishing you well,

Winnie

[bristolqueen]

Since palladone was removed form the market several years ago -I am curious. Was the Pallidone prescribed?