I'm currently seeing a Pain Management doctor for my chronic back pain. I was researching long-acting opioids and opiates and have only found a few i.e; Oxycontin, MS Contin, Methadone, Fentanyl Patch and Oxymorphone (which my insurance doesn't cover). I think I'm going to ask to try a Fentanyl patch if my doctor will let me. I know that MS Contin is the Gold Standard but I just want everyone's opinion. What about breakthrough pain? Does anyone without cancer use Actiq for breakthrough pain or any other short acting drugs? Please Help. Thanks :)
I'm starting opiate/opioid therapy for chronic back pain. What's the best long acting narcotic?
Added 1 Feb 2010:
Thanks you everyone. I have decided that not one narcotic is the best for an individual person. People differ from one another and don't respond the same as others do to the same drug. I have therefore decided to try what ever narcotics that I discuss with my doctor to see which works best for me personally. So far the Fentanyl patch has been working great. The only side effect I experience is sweating which is not that bad. However the sweating causes the Tegaderm patch that covers the Fentanyl patch to bubble up do to the sweat that accumulates under the patch. It only seems to work for 2 days as well because the third day I experience withdrawals. I will talk to my doctor about this and will probably try an oral long acting narcotic such as Morphine Sulfate (MS Contin most likely.) I'll keep you all up to date on what happens. I see my doctor on the 8th. Thanks for all the comments.
Methadone gets my vote. I tried a whole host of meds before my doctor put me on methadone. He started out giving me 1 - 10mg every 6 hours for a total of 4 per day. But I was on a lot of oxycontin. 80mgs 4-6 a day. You might not need as much as I did. I don't have break through pain and I don't get loopy or high. I am a functioning person today because of methadone. But like you said, ask more than a couple of people. Best of luck to you..happy holidays Kimmie1
Subuex is garbage & most doctors can't even write it because they have to have a different license because it's considered a " detox drug" just like Methadone the doctor has to write "for pain" on it to write it for a pain drug. I've been on Duragesic,didn't help. I've been on oxcycode,didn't help. Finaly I was put on M.S Contin 100mgx2 daily with 5 4mg dilaudid for break through pain,and that worked for along time. If cost is an issue Metadone are the cheapest. My insurance lapsed for a minute and I found out that 113 Diladid,brand(I've found the generics to not work nearly if at all was 256$!!! Ooch!! I changed from the M.S Contin to all dilaudid and two 100mg M.S Contin when converted turned out to be 8 8mg tabs a day! Surprised me alot. I thouht I might get 2,mabey 3 more 4mg a day,but it works for me. Depending on what mg M.S. Contin you'll makes a big decision on what,or what you can get writ.
Ask your doc if you can try different combinations that's what I would try. But not to knock the subutex,avoid that if you could even get a scrip for it. Where I live there's a huge waiting list because of the lisense the doctors must have is small,and I live in a big city. Good luck
Just to let evryone know pumps and stimulators are the future, maybe not because of the effectivness, but more because they are controlled. The goverment sees a pandemic and is dumping reasearch money into pump research for pain. While this is a nice idea seeing as they can try to limit the amount of narcotic released to each pt without watching them. They fail to see that oral and inject. meds can still be used by the pt, without doctors knowledge. This is their idea of gaining control over the communities drug problems. I don't think this will work for the reason I left previouly in this statement. On the other hand working in the medical field I have seen pumps work well with pt's.
I have severe lower back pain. I had a spinal fusion a bone graph and a 10 inch bar in my back with four screws. The only thing that I have found to relieve my pain is MS Conten (morphine sulphate). I have been on this medication for ten years. Once you build a tollerence for this medicine the only effect you feel Is pain relif. I have no trouble with break through pain. It does take some getting used to because it is extremly strong but it has worked well for me. It is best to go to a pain control Doctor to continue getting this medicine prescribed for you. It is a tripple script medicine and only for severe pain. I wish you the very best and hope you get your pain under control very soon. I know how being in pain can effect everything in life. The very best of luck to you and I hope this helps in some way.
It seems as though any opiode med. that I took for my back pain became ineffective therefore i am banned by the gov. from taking them because of the subocone contract. Does anyone no of a strong pain med. similar to morphine.oxycotin,fentinol,ext. that would help in such a situation but would get me around the suboxone guidelines. If there is it could the answer for many of us.
I have RSD and was wearing 2 fentanyl patches and taking morphine(ms contin) and it didn't take the pain away ,it did at first but then my body got adjusted very quickly and i needed higher doses of morphine for break through pain. i take suboxone and tramadol this combo. has been working well for 2 yrs. now i take other meds. for my condition as well.i don't think doctors prescribe fentanyl patches for back pain even severe back pain. this type of medication was only approved for patients with cancer or RSD and maybe in other extreme cases but not for severe back pain.i'm not a doctor but this is what i was told and read,do you take any muscle relaxers? maybe you should consider a muscle relaxer with a pain med. again i'm not a doctor but i have severe back pain as well b/c i have full body RSD. and have taken many combos of meds. i use to take oxycontin for years before fentanyl but again even though the meds are long acting your body starts to adjust.
when i was taking oxycontin i would have break through pain as well and then i was prescribed methadone with the oxycontin.it's just a cycle of more meds. and never ending pain. so i've found that a long acting med. like suboxone and tramadol as needed with a muscle relaxer seems to work well for me but everyone is different.
i am a paraplegic,from a car accident at the age of sixteen it will be 35 years next month. I had harringtonrods with spinal fusion after my accident, I got married and had a son at 23 and had many years without pain until the rods starting topoke through my skin so they were removed and the dr, did not put anything back to keep my spine stable.After years of the wear on my spine my spinal cord had gotton so bad my disc were shot DDD 2006 had anterior posterior fusion with cadaver bone and still having severe pain, my back is full of hardware and very ridgid, I have been on fentanly patches oxycontin, hyro, so may I can't even remember, The fentanyl was by far the worse med I have ever been on, I could not stay awake eat or did I care I lost so much wieght and I am a short small framed girl to begin with, I stopped the patche cold and had bad w/d this was before you heard of meds that would help with the w/d and a poor excuse of a dr. didn't help. Now I am in pain mangt.
and just this week asked to be changed from hydro. for a while they helped for a while but just wasn't helping, Now I on percocet 7.5 4xday and xanax and it helps if I take half of xanax with the perk, I have very strong muscle spasms so that helps to control them. I don't want to get high I just want to have a little slice of life. I know alot of you guys understand and I have found this site to be very helpful. My prayers are with all of you and I would not wish this type of pain on anyone.
I strongly advise, that anyone beginning a painkiller regimin, use extreme caution!!! It always starts so innocently with a few here and there, getting more, & getting more. Then, when that's not enough, a pain management "dr/drug dealer" that gives more & stronger. Then, if you live through that and it's not enough, street drugs. I am speaking from my own dysfunctional ex-love affair to narcs. I'm not that far along in my recovery. Anyway, I hope you understand addiction, tolorance, side effects, & listen to some of the people who have been addicted to them.
You need to start off w/ subutex, and then go on to the suboxone!! Never do what I did and start on a methadone treatment plan... in which I just substituted on high for another. Now 3 years later and many of thousands of $$ later, as of yesterday I am no longer using methadone. I just recently started detoxing from 60mg a day-going down 10 a week until 20 and then straight 2 mg a day, I left my clinic at 14 mg, and today woke up feeling withdrawl symptoms, but almost a relief because I didn't have to go pay 125$ to dose at 12mg... took 4mg of subutex..(suboxone would have caused me to be deathly ill because of the naloxone in it). I have done my research and I am looking foward to feeling sooooo good for once, without taking something to make me feel that way!! They say it's safe to use the subutex for 2 weeks so you dont get addicted, yet you don't feel sick, and u lose the cravings! YOU HAVE TO BE READY TO DO THIS THOUGH!!! Good luck!!
I too have chronic and terrible back pain. I've used the basics: hydrocodone 10/325, Fent. patches 50mg, Oxycontin 60-80mg per day (180mg in the past per day), and briefly tried methadone for pain.
The fent. patches were the only meds that made me feel sick. The generics would fall off, and didn't to work. I went to the Duragesic brand patches which are much better for sticking and pain control. Though as I said, they made me feel sick and ill.
I find low dose oxycontin to be most effective. I prefer to take 1 20mg pill, 3 times per day, or 2 in the morning, 1 at night. Keeping another instant release med around for bad BT pain is also a good idea. I'd reccommend hydrocodone 10/325. Percs. are too much to add with ER oxycodone.
Also be sure to check the medication interractions as narcotic anelgesics do interract with some other non-opiod meds.
Good luck. Chronic pain is difficult to deal with, and takes it's physical and emotional toll. I also went through a shoulder surgery in Sept, and I still havn't recovered. It was and still is very difficult to manage both bad back pain and shoulder pain (after 5 months, my shoulder still kills- much worse than before surgery).
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