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MedHelp Member's Question

Which pain meds are considered long acting?

by Joe, Dec 04, 2000 12:00AM
Dr. Steve,



Awhile ago I posted a question to you concerning my fluctuating pain levels cause me to have withdrawal symptoms several times a month.  Your reply was to have my oxycodone switched to a longer lasting pain med to help with the withdrawal symptoms.  My next appointment is comming up and I was wondering what pain meds are long acting so I can suggest some to my pain specialist. Someone on the thread also mentioned that oxycontin and ms contin are not considered long acting pain meds even though they are slowly released into the system because the active drug is only a short acting one itself, is this true?



Thanks,



Joe
Member Comments (33)

by Brian Stevens, Dec 04, 2000 12:00AM
I'M also a chronic-pain client, You should talk to your dr. about Duregesic patchs they contain fentnyl a very strong pain medication that is put on like a patch that last between 48 to 72 hours.  Usually you space them like the largest is 100 mcg to the lowest 25mcg.  I use a 100 on Monday, a 50 Tuesday and another 50 on Wednesday, then back to a 100 mcg.  I've had good success with thistransadermal patch. and then i use something else for the break through pain.  I hope this helps you it has been a God send for me.

by to doc dan from joe, Dec 04, 2000 12:00AM
Brian,



Thanks for the responce, I was wondering, if I switch from an opioid pain med to the fentnyly patch will I still have withdrawal symptoms during the switch?  Also I've read on this forum that doctors are reluctant to give scripts for the patch because it is very expensive is this true?

by vickyvortex, Dec 04, 2000 12:00AM
I know I am banned from this board, but I had to look up fentanyl to see what it was.  I happened to run across this site:  They are giving out meds to worms!!!!  check it out:  http://www.opioids.com/fentanyl/subjective.htmlv

by interested in fentenyl, Dec 04, 2000 12:00AM
just type in www.opioids.com/fentanyl.  This seems to work better, but do not be fooled by the notice that this page does not exist on the previous site posted.

by tom to thread, Dec 04, 2000 12:00AM
thank god I have never needed the fentanyl patch, but this is what I learned watching a PBS special on pain management for cancer patients. From what I learned on this show, plus a little net research, the Fentanyl patch is probably the single most effective treatment for chronic pain going. Yes, it costs a bunch -- apparently several thousand per month. But patients who weren't getting sufficient relief from even aggressive MS contin (morphine) and Dilaudid therapy were transformed by the patch: They were both lucid and out of pain for long durations. As far as withdrawal when switching over, I sincerely doubt it. Fentanyl is as hardcore opioid as you can get. They call it "designer heroin" on the street. If I hws facing ultra-serious, long-term pain, it's what I'd ask for, no doubt about it.



oh, hi v-vortex, good to hear from you!

by J.B. to Brian and Vicky, Dec 05, 2000 12:00AM
This is interesting, "designer Heroine".  About a year ago I was at the hospital here and talking to my favorite addiction therapist about his mother's cancer.  He was considering taking her to Mexico for her last days(she was terminal) for pain management.  I was dumbfounded when he said that she would be better off on heroine than morphine or Dilaudid.  He stated that heroine is less sedating allowing the dying person to be lucid during their last days.  Apparently, doctors in Mexico are allowed to use elixors containing heroine and cocaine which are strictly illegal in this country as schedule I narcotics. Personally, I'm all for it and told him so. Just pondering again!



Hope all is well with you, tom.  Take care and be well!

by Frankinscense, Dec 05, 2000 12:00AM
Fentanyl is just another very strong opiate. There are no mysterious designer opiates. Wait,maybe I do not know the definition of designer drugs. Opiates are opiates. They are either synthetic or of natural origin. The "designer" drugs are generally always a very strong synthetic>>fetanyl. Fetanyl is literally a hundred times as potent as morphine. 0.05-0.10 mg. is equivalent to 10-30 mgm's. morphine. This super strength per mg makes it ideal to use in an transdermal patch. Joe, there is a GAP in time that you must allow for the formulation in the patch to work. I cannot remember the specifics on how much time must past before the patch starts working. Ask your doctor or phamacists. I am sure they will have that information. I had a close relative on the patch and she was give oxymorphone suppositories until the patch started to work. (she suffered cancer pain)

  The other question was in reference to a long acting opiate. There a few short acting opiates that are in a slow release formulation,but they have all the disadvantages of short acting opiates. These medicines IMO are very good pain relievers but  they are very disturbing to the endorphin neurtransmiters. That is the main reasons for withdrawals and cravings. These disturbances that short acting opiates have on the neurotransmiters is what make these(IMO) undesirable for long term or chronic pain relief. All opiate/narcotic pain relievers cause this problem but long acting opiates do not spike the neurotransmitters  as short acting ones do.

                                                                  An example of a long acting opiates are methadone,LAAM, and buprenorphine. I only know details concerning methadone. IT is IMO one of the best medicine for chronic or long term pain management. Methadone has been studied and researched probably more than any other medicine. It has been used for 30-40 years w/out any negative medical concerns. Other than it can cause dependency like all opiates. (price speaking, it is very inexpensive)

                                                                  Buprenorphine sounds like THE IDEAL pain medicine of the future. Analgesia compared to morphine without as much sedative effects that morphine causes. And does not produce addiction on the same scale as morphine,hydrocodone,oxycodone,codiene and others. If all that is written about buprenorphine is true and accurate, it will be the pain medicine of the FUTURE. Pain medicine of the future will probably produce an antidepressant effect,produce analgesia,cause no sedation or nausea, and be non-addictive.

Wow! What a concept.

Best of Luck to you JOE,

Dan...

by to doc dan from joe, Dec 05, 2000 12:00AM
Thanks for the reply,



Can my pain specialist perscibe the meds your mentioned or do I have to go to a detox center?

by Shiny, Dec 05, 2000 12:00AM
I just read the messages about short-term pain meds and have a question.  I am having cosmetic surgery (I am know to this board hense really do not want to give my name, kind of embarrassing (sp)) anyway I'm having a breast augmentation.  I am now on Lortab twice a day and oxycontin 20m nightly.  I have been told that the surgery is quite painful the first couple of days.  My problem is what kind of pain meds I should ask for.  I will make sure I tell the doctor who gives me pain pills cause I don't want a fuss at the pharmacy.  I will probably  want a short-acting pain pill but something stronger then the 10m Lortab. What should I ask for?  I don't think I should have to use my current pain pill supply for this but don't want to get in trouble with my pharmacy.  Would MScontin be a good choice?

by Brian Stevens, Dec 05, 2000 12:00AM
yes Duragesic is very expensive, 5 100 mcg patches are about $368 dollars a box.  The lower the dosage the lower the price.  But we have to remember that Jansen Laboratories makes Duragesic and when it's patent runs out the price will drop like a rock off the empire state building.  The cost of this medication is worth the money for me.  I broke my neck in a auto crash in 1982 and things are starting to fall apart, my back is disintergrateing and the pain is unbearable especially while I'm back at college pursuing my degree, something that I could never do without this medication.  Most insurance will pay for this medication and your pain specialist should know that there is a time frame of about 12 hours for the patch to start working so you will need PO medications for a day.  And sometimes you will need PO medication for breakthrough pain.  I've been blessed with the physicians who know me and treat me like I should be treated.  No person unless there recreational users and then they don't need a Doctor.  You can get anything heroin etc on the streets of our bigger cities and don't think that it isn't around in small towns.  Thank you Brian Stevens.