My doctors and I have found IV and IM injections of Dilaudid work very well for me in controlling post-surgical pain, but NOTHING I take by mouth - Vicodan, Percoset, Dilaudid - give any relief at all. Someone suggested to me that it is because of a "first past" metabolic issue - that eventually the drug, whether IV, IM or oral, hits my liver, but with the IV/IM route, I have already received the pain relief before it is broken down and, at least in the case of oral meds, poorly metabolized. Does this make sense?
Seems you know whats going on but there is also the food issue, food absorbs medications. The thing is is that IV medications gets into the blood almost immediately and spreads around the body to the brain as fast as the heart is beating. Oral medications have to combine with the liquid in the stomach then get absorbed into the blood. And the rate of absorbtion from stomach to blood would be slower than an IV. Some would stay in the digestive tract. I would imagine that if you got a high enough dosage orally it would help your pain symptoms oh and take it on an empty stomach. Also check out fentanyl patchs they may help you more. Good luck B
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