I have read many people's attempts to answer this, but no one seems to completely answer my question. I have been on Hydrocodone for many years for chronic pain from Scoliosis and Osteoarthritis in my neck, low back, hips, and hands. It is getting to the point that I have to walk with a walker all the time now. Due to the Scoliosis, my left hip is about 4" higher than my right hip, and I tend to lean to the left now when I am sitting or walking. I have been taking four (4) 10 mg Hydrocodone each day for a long time, and was on Tramadol until recently (2 tablets 3 times per day). The doctor gave my Oxycontin ER, but it didn't do anything. So he has increased the Hydrocodone to 6 per day. I asked him about the Oxymorphone or Oxycodone, and he just brushed me off. I also have a lot of muscle spasms due to the Scoliosis pulling my muscles all to pieces.
What I want to know is the millegram equivalent between a 10 mg. Hydrocodone and a 10 mg. Oxycodone. Does anyone know? The 50 mg. Tramadol is equal to a 5 mg. Hydrocodone. So what is the equivalent to a 10 mg. Hydrocodone if you switch to Oxycodone?
Oxycodone is so much stronger then hydrocodone. Oxymorphone is stronger then oxycodone. 10 mg of oxymorphone is equivalent in pain control to 45 mg of hydrocodone. 15-20 mg of oxycodone is equivalent to 45 mg of hydrocodone. A long acting medication is better for chronic pain because it controls the pain better then waiting until you have severe pain then taking something. For you equivalent to 60 mg hydrocodone a day is 25 mg of oxycodone or 13 mg of oxymorphone/ day.
The converter that I use is different from Kaismamas conversions. I am getting 10mg of hydrocodone is equal to 6.7mg oxycodone and 3.3mg of oxymorphone. This is a direct conversion with no adjustments for cross tolerance. The problem with converting from one opioid to another is that they DONT convert equally. The reason for this is that many opioids are metabolized by the body very differently and this can be different from one person to another (Ever wonder why one person is completely snowed by codeine and another person gets no relief at all from the same drug, in the same amount? It is a complex matter of different ways the body breaks down drugs.
The Cytochrome P450 monooxygenase system is one of the most important ways drugs are metabolized-you may have seen things about CYP enzymes? This is just a part of a complex system that scientists are just beginning to understand-perhaps one day they can tailor pain relief to ones metabolism.) Conversions should ONLY be done under a Dr's supervision and usually reduced slightly for cross tolerance. Just because you are tolerant to hydrocodone doesnt mean you have the same tolerance to oxycodone or oxymorphone (because of said CYP enzymes and other factors) so a direct conversion can lead to overdose. Most docs will reduce the dosage for cross tolerance by 25-50% then titrate upwards as needed. Chronic pain should be managed with a long acting medication. If you are on 40mg hydrocodone a day, this comes out to around 26.7mg oxycodone so you would take that and divide by two to put you on Oxycontin. They would likely reduce the dose slightly for cross tolerance and put you on Oxycontin 10mg twice a day then titrate up as needed. Oxycontin is going to feel much different then hydrocodone. Hydrocodone is an immediate release, short acting drug and as so it floods the brain's opioid receptors with drug. This leads to a euphoric "rush" and the brain eventually becomes conditioned to equate this "rush" with pain relief. Oxycontin, on the other hand, releases much more slowly, so instead of feeling a rush of medication in 10-20 minutes, it takes about an hour for the medication to start relieving pain but rather than peaking in 2 hours, it will sustain that pain relief 8-10 hours. You do not have a rush of drug across the receptors so many people think the drug isnt working because they dont "feel" the effects of the drug the same (or the "high" in other words) With a long acting drug, it takes a few days to develop a "blood level" of the medication. Once a blood level has built, your pain should lessen. Long acting drugs stay ahead of the pain rather than chasing it, like short acting pills do. Chronic pain is much better served by using a long acting drug.It has to be taken "on the clock" rather than "as needed" for it to work correctly, for example 8am and 8pm no matter what your pain levels are (Hydrocodone and acetaminophen, on the other hand, are taken "as needed" or when the pain becomes severe). Oxymorphone is going to be too big a jump from hydrocodone and I doubt your physician will try that and oxycodone IR (immediate release) is not given too often anymore because it is so frequently abused (and he probably wouldnt give it to you anyway since you stated the oxycontin didnt work-it is the same thing, the only difference is they way it releases, so if the long acting didnt work, it is doubtful the short acting will either) Has he suggested MSContin at all? Perhaps it would work better for you. Just remember that a long acting drug isnt going to "feel" the same as an immediate release drug. You are not going to feel a euphoric rush of drug, only pain relief. I doubt that the rush is what you are looking for, you may not even realize it is what you are expecting, but you probably dont feel like the drug is working for you because you cant "feel" it in the way hydrocodone has conditioned you to think of as pain relief. That is not your fault and you likely do not even realize it has happened-chronic pain shouldnt be treated with short acting drugs for more than a few weeks, at most. Once pain is "chronic", it should be approached with a long acting drug to prevent this "conditioning" of the brain from happening. Another possible option is Zohydro ER which is a new long acting hydrocodone product, new to the market. Instead of taking 4-10mg tablets per day, you would take 20mg twice a day. What strength Oxycontin were you on and for how long did you try it? It may be that you either were not on a strong enough dose, you didnt take it long enough or didnt take it correctly (On the clock rather than as needed). One thing I have learned is that chronic pain definitely takes a great deal of trial and error to find what works the best for you. What works for you will be different than what works for anyone else. You have to find the right combination of medications that work with your particular metabolism. https://www.drugs.com/pro/zohydro-er-capsules.html
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