Which pain meds are considered long acting?

[Joe]

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

[JohnnyBbob]

Fenanyl.... I was on it last fall, but when winter came, the heat from my blankets caused way too much of the medicine to enter my body.  My bed is next to a window in a 100 year old Wisconsin house, so my covers were quite thick.  I spent two weeks trying to figure out a way to keep the patch cool, but every morning I would wake up either shivering or so intoxicated and nauseous that I'd have to crawl to the bathroom.  Right now I'm back on Percocet, but I'm looking into trying Suboxone as an off-label twice-a-day pain med instead of a Percocet every 2.75 hours.

[WreckedKnee]

I've been getting oxycodone ir and vicoprophen for a knee injury but have the same problem as a lot of these people with how short they act. They work great for an hour or two before the pain comes back. My doctor just prescribed me butrans which is a buprenorphrine patch, once a week on top of the oxycodone, but they cost 100 dollars a piece and I don't have insurance. They make a buprenorphrine sublinguil tablet, subutex (Not Suboxone) that I have used before and it is much cheaper, but my doctor in Missouri says he can only prescribe buprenorphrine as a patch. I am hoping he will change me over to methadone. My personal experience with buprenorphrine is that it works alright for mild pain relief but if you have moderate to severe pain, like me, you still need something for breakthrough pain. Buprenprphrine does however help you make it to your next dose of oxycodone and it completely stops any feelings of withdrawal you might experience in between doses.

[italiano14]

Hi I'm a pain management patient and am taking tramidol and 7.5 norco but I have been on the meds sence my car accident almost 5yrs ago and am still waiting on my scrapyard insurance to approve a surgery on my back but honestly I'm tiered of have to take meds around the clock. Is there something that lasts at least 8 hours that would help me take less of the norco and tramidol please if there is let me know I see my doctor this coming wensday

[Bonnievz]

I've had chronice pain since 97, gone through oxycontin, that finally made me sick, and I was put the fentanyl patch.  I continued with oxycocet for 3 days until the fentanyl finally kicked in. I'm in Canada, pay for my own meds, but for 100, every 72hrs, is about $250 per month - huge difference. Why? who knows. I finally got to see a pain specialist who did a nerve block at C4-5 level, but didn't work well. Next he tried what they call a lidocain infusion. The lidocain is injected into a ballon , which is inside a protected plastic bottle, then a line is inserted into an area 3 or 4 inches below the collar bone. For 1200cc it takes about 6 hrs for the lidocain to be dripped into your body, but you can be at home & simply pin the  bottle to your clothes. Works for about 21 days & I've reduced the fentanyl by 50%, gradually, and hopefully rreduce more this yr. Cost about $140 per infusion, no side affects. I hate narcotics. Still take oxycocet for break through pain.  Highly recommend looking into this.

[Sirhan]

I am a 44 Year old health care professional.  I had a discography done on my low back by my PM Doc 2 years ago.  I was infected with Staff, spent time in the hospital, and have been unable to work since.  I had a Facet Fusion done last May(2010), I go to PT 2X a week, and take Roxicodone 30mg every 4 hours.  I really need help.  I cannot get out of pain, do not shower much, hardly go out, rarely have sex, feel like **** all day, and frequently curl up in bed with this feeling that my body is dying.  I have a good GP, good Neurosurgeon, good PM Doc, good PT's, and a good Shrink for Cog/Beh Therapy.  Can anyone help me?  I just want my life back.  That's all I care about and think about.  I hate taking pills mainly because they do not solve anything.  I'm in pain, take a pill, start feeling better, pill wears off, pain is terrible, take another pill etc...  Is this the way my life is going to be forever?  Please help me.

[lolliepop11]

I was hooked on it too. Took it 15 years for pain in my back due to kidney [only have a left one] . In the last few months my reg, doctor sent me to pain clinic cause I was calling her for refills two or three times a month. I was getting 120 at a time and that still was not enough. So one day she call me and told me of the pain clinic she set me up with. I said right she said really you and I both know you are hooked. So I went and he tested me he said I failed test. He said he could tell I was taking percert  just by sticking a test strip in my urine. I think he was lieing try to scare me. Does anyone know if that is true? Any way he swicthed me to the pacthes Fentyal 50 and gave me some clondine[for a month]. I had to take night time ninquil to sleep. But with the doctor giving me the two medinces and the night time, I was hapit free in less than a week. The first two days was the worst. I had been use to taking 12-14 a day. When he swicthed me I only had 10 pills left. So I took 2 at a time until I ran out, 2 days at the most. Then I knew I could go cold turkey or buy on street, Between God, doctor and me we got through it. It feels so good. Now I only take 25mg of the pacth and tizanidine, one at night for muscle spasms. IT FEELS GOOD TO BE UNHOOKED. Doctor told me last month all drug test showed up was the correct medince. He turned around to walk out of the room and turned back around looked at me and said see I told you it could be done! If I can do it anyone can.

[gapper]

I am just wonderingi I have been on oxycodone 10/650 for a couple of years.  I have had a cycst removed from my siatic nerve, (leaving nerve damaged), had L5 fusion, have arthritis in upper back, have fibromyalgia (giving me frequeant migriaines) and have RA. (fibro and RA diagnosed within the last 3 to 4months) All this has occured within about 2 years.  I have tried oxycontine and doesnt work for me.  I am just wondering if there is any suggestions I can try, adding to my oxycodone for break through pain.
I have asked about this before with my Dr. but he just says I have to wait for my fibro and RA meds to kick in.  It is getting to the point where I can barley walk in the morning.  Takes me until about 2pm to get moving and then I am so sore by about 6 - 7pm I am ready for bed.

Any suggestions......

Dori

[rhinoking]

I have been on Oxycontin every 12 hours.. tried the patch and found I dont absorb it well (something with my skin makeup) also dont like things stuck to my skin.  It is great that there are these different choices for people like us in pain and that the patch has worked well for some of us, my thought and experience is that most of these will work for any pain if the right dose is achieved, however dont fool yourself that any one opioid is more or less addictive than another... they all work more or less the same way, binding with the mu receptors although side effects can vary from one opioid to another, some have different metabolites than others (found that out with a bad reaction to Morphine due to my kidney problems) and some cost alot more than others. The only one that I would say is different is Darvocet.. seems to be almost useless as a pain med for most people.

[Barbara]

AH HOW MUCH DOES IT COST AND CAN IT BE DONE WITH NO SIDE AFFECTS

[Frankinscense]

Laam is srictly a medicine for opiate addiction and available through clinics who offer it. As for as I know it is not offered for chronic pain. Buprenorphine is offered for pain relief and is becoming more popular as a medicine for chronic pain because it is a schedule five drug and it is availabe at your local pharmacy. Methadone is also available with a prescription.

[to doc dan from joe]

Dan,

Although my pain specialist can prescribe methadone, can I get it filled at the local pharmacy? how about some of the other long acting pain meds (LAAM, Bupremorphine etc) are they all available at the pharmacy or do I have to go to a clinic?

[Frankinscense]

Most all pain specialist can prescribe methadone if they feel their is a need for it. Reseach methadone with your favourite search engine. On the web their is lot of myths and untruths regarding methadone especially from non-research people. You will get a lot of untruths from other addicts and pain suffers. That is the main source of myths and untruths.   Dan..

[Frankinscense]

Are you positive about that dosage? That ratio could be incorrect. There are people on this forum who buy drugs on the street. If this dosage is wrong,you could be putting peoples lives at stake. I think everyone for this reason should not discuss various dosage ratios because it is not accurate science.Discussing dosages of narcotics may cause problems if you are not a pharmacist or physician. Buyer/reader of above post beware!
Dan..
                                                                   Post Script: Myself and someothers on this site are somewhat dosage savy. But keep in mind there are people here that are not well informed to the dangers of fetanyl. Fetanyl is a lifesaver to some. But it is a schedule II narcotic for a reason. Fetanyl is a very dangerous drug to someone who is an ocassional or recreational drug user and are not aware of its 72 hour pain relieveing properities. I think dosages of Fetanyl should not be discussed. It is as you say, a very potent narcotic. With this comes the danger of overdosing. Dan..

[From John B. to all]

It is getting down to the wire. I have 13 pills left and I see my doctor for my shoulder pain on Monday. Then I see my reg. MD on teus. I am going to try to get more percocets from the shoulder doctor and some more percodans from my other doctor. The only thing that I am afraid of is the pharmacy that I use mite question me. Bringing two scrips one day after the other. When I get back from my vacation I will ask my doctor about the methadone treatment. That really is tacking a risk being that I just don't know how he will react. I have read alot about methadone since you told me about it and there is a wide range of openions about it. My fear is my doctor (which I have been seeing now for 5 years) will just cut me off and I will be left in the gutter to blead to death. What a whole I have dug for myself.

  SUCCESS TO ALL OF YOU: John B.

[Brian Stevens]

Duragesic is a wonderful time released product.  10mg of Fentnyl is like 150mg of morphine.  So you can figure that out pretty easy.  There are draw backs as it isn't indicated for people with colitis for irritable bowel syndrome.  But I have that and it still helps immensely.  Talk to your Doc.  oxy is not the way to go, it's way to addicting.  The patches get changed every 48 to 72 hours.  Thank you Brian

[Frankinscense]

Hey man sorry about the above post.
Anyway depression is directly caused by short acting opiates such as percodan and vicodin. They effect neurotransmitters such as endorphins that help fight pain and depressions. Continual use of opiates for twenty years can cause a syndrome known as endorphin challanged. This probably could be a direct cause for your depression. Taking A/D to treat your depression when you are taking strong narcotics could IMO counteract their effects.
Their is only one medicine to counteract the effects of long term narcotic use and that would be a long acting opiate such as LAAM or methadone. These medicines should only be used when abstinence continues to be a failure. Methadone/LAAM will be what will replace your endorphins that have been effected or depleted. Methadone is great for depression and almost works imediately.It will stop your cravings for percodan/vicodin and give you back your life. Its hard to detox off of. But why would anyone want to detox off something that gives you back your life. Look at methadone or Laam as medicine. Not as a replacement opiates. These medicines are much like insulin is to a diabetic. Or dilantin is to a epileptic. MMT has done wonders for my life and many other pill addicts. Best of LUCK John B. My peace I give you-my peace I leave you..
Dan...

[From John B. to all]

Sorry for posting the same post. I just needed to know that you read it so you know where I am. Thank you so much for tha advice. I will read up on that drug. Is this somthing that a doctor will agree with? Do you think that I will have trouble geting this med. from him? I is all knew to me. I can't believe I have let it go this long.

  SUCCESS TO YOU MY FRIEND: John B.

[Frankinscense]

Gosh Man can't you write something different. You keep giving us the same post word for word >> over and over again. I do not understand. Are you the same? Have you made any improvements? What gives John B.? This robotic message is getting monotonous.
Dan,,

[From John B. to all]

I thought I just would sent you my first post please read the rest of then. Thank you John B.


All of you sound like you have this drug thing figured out. And I can relate to all of you. I have been taking pain meds on and off(more on than off) now for almost 20 years, and befor that a pot smoker. For the last 3 years I have been taking percodan. I have cut way back on them now partly because I was fearful my doctor would cut me off and partly because I know what they are doing to me. I do suffer from migrains but very few, much less than I tell my doctor about or my wife. About a year ago I stopped taking them as much. I was taking about 120 pills a month. Now I take 50 about every two months. When I get them I will go through them in about two weeks. Then stay strait till my next doctors visit(in about 7 weeks)I have found that the bigest catch with these drugs are that they give you a way to feel, a way to stimulate your mind, and all you have to do is put a pill in your mouth. It is human nature to want to stimulate you mind somehow, to feel a certain emotion. Without drugs this takes reall work.

Without drugs- To fell a sence of accomplishment. One might take up a hoby, or seek a rewarding career. With drugs you can just take a pill and sit back or do something small around the house. That is just one of many examples.
After you take them for a long time you loose the ability to become self-motivated. The only way you know to feel anything is to just take your pill of chioce. Thats why when you stop them you don't feel anything, you just want to lay around the house and not face up to anything. When quiting drugs it is a whole reshaping of how you conduct your life. You have to learn how to feel happy, concerned, interested, motivated feel love. Any emotion you can posibly think of has to be relearned, all over again or sometimes even learned for the first time. It is a hard battle but I can say this. When you achieve happyness on you own rather than with drugs it is a deeper feeling, a feeling of treu happyness not the fake happyness from some drug.

My precription will come in 3 weeks and I will take it again. I am just now doing things without the drugs and doing well, but I look forward to that next fix. I hope some day I will get sick of this rollercoaster ride and quit but I am just not ready yet.

Success to all of you

[Frankinscense]

MMt is an option to people with addixtion/pain issues. Bupre./NX will not solve any pain issues tom. And futhermore with naloxone in the formulation will stand a chance of any med needed for occasional breakthrough pain will not work because of the blocking and I mean downright blocking that NX offers. It is put in the formulation to where if a opiate such as oxycodone,morphine and heroin and will provide ZERO effect such as analgesia,euphoria,respiratory depression and etc. It can cause a major problem. If Tom(YOU) has a traumatic injury that requires an agonist pain killer for sufficent pain RELIEF,forget it you will suffer until the long acting NX wears off. I would not EVEN consider, under ANY circumstances taking naloxone for any reason other than a overdose on agonist opiates. Also,long term use of naloxone is not recommended because of liver problems that occur.  Lastly I am not sure bupre/NX is a maint medicine. I think it is only for a short term  such as a year or so tops. AT least with Laam/methadone you can have pain relief. A person Like you and me might be on methadone for the rest of our lives. If not, I have a protocol from Dr. Payte MD that will offer an almost pain free detox using his technique to get off methadone. The average MMT patient does not know this technique. I have been using this technique and have dropped from 120mgm methadone to 45mgs very little problems with discomfort. Seriously, tom
IMO methadone is simply the best for pai/addiction problems.
Dan...
ps: write me for any more private questions. I was not able to proofread my post b/cuz I am running late for my job. See ya'll later. God Grant Us HIS mercy! Dan

[From John B. to all]

Please read my posts under Vicoden addiction/physician over perscibing. I have been talking to JB and he has been a great help. But he said I should talk to you.

       Please help me: John B.

[J.B. to Brian and Vicky]

Go tom go!  If anybody can get it all figured out and decide on the best program, you will.  Tell Bobbie Merry Christmas for me!  Hope you are all doing well.  J.B.

[Bob to Dan re: dihydrocodeine Bitatarate]

Dan, Just as I was ready to post this long and windy post I was disconnected.  Probably just as well.  Please let me introduce myself.  I am a registered nurse with a back-ground in addictions tx, pain management (mostly HIV+), and psychiatry.  I've been lurking on this BB for a month and like what I see.  I hope my little contribution will be helpful.  I should add that I also have chronic pain from several motorcycle accidents I no longer ride) and botched knee surgeries but manage without narcotics most of the year.  This cold, however, is killing me.  Dihydrocodeine Bitartarate (Contugesic or codicontin) is marketed as Europe's answer to oxycontin.  The strength there is 30 mg to 120 (!) mg whereas Synalgos and DHCplus are both 16 mg., far too low for effective pain control.  Also codeine doesn't work for everyone.  I find Contugesic in the 60 mg - 90 mg range one q6h to control my arthritis pain very effectively especially when a NSAID is added.  Unfortunately the medication is not available in the USA.  Hope this helps. If I can ever be of assistance, please don't hesitate to ask.

[tom to J.B. and Dan]

First, a big Hello to my friend, J.B., hope you and Marty are doing well. Especially hoping that the new breast anti-cancer drug (tamoxifin?) is giving her the help she needs and deserves. She has been through so much already. If you're relationship with Marty is anything like my relationship with my wife, Bobbie, you must be heartsick over her continuing ordeal.

For J.B. and Dan:
For my part, I'm still weighing the pluses and minuses of methadone or ORLAAM vs. buprenorphine. There's a research and treatment group operating out of UCLA called MATRIX that has opiate-addicted individuals both detoxing and maintaining on buprenorphine. I'm supposed to get a call at home tomorrow night from the director of the program, first to see if I can get into the program, and, second, whether I can pay for the treatment (don't know the figures yet, but it's sounding more and more expensive every time I speak with them). I should know tomorrow. The protocol goes something like this: abstain from opiates the first night, then, when withdrawal really sets in, inject the buprenorphine subcutaneously (not IV or deep muscle- they're calling it "skin popping" which the heroin users are all familiar with but something this strictly oral narcotic junkie, me, will have to learn how to do); same routine second morning; same routine the third morning. After that, they evaluate you and determine where you go from there with the buprenorphine (I think maintenance consists of taking a buprenorphine/naltrexone pill every day, but I'm not clear on that - perhaps my good friend Dan has a more accurate description).

Anyway, I haven't by any means ruled out methadone maintenance as a solution for me. There are a lot of pluses compared to the minuses for this option. But it looks like buprenorphine is on the verge of legalization as an addiction treatment in California. Check out these sites:
http://www.matrixcenter.com/researchers.html
http://www.csam-asam.org/index.htm

It's just that I want to make the right decision.

I hope Dan also reads this and checks out the sites and posts his opinion. I'm wondering if any physician that's a member of this CSAM org could just as well treat me with methadone as buprenorphine (still lots of details to iron out). I have this bug in my mind about becoming dependant on the existing methadone clinic system. I would rather be treated in a way that gives me more options and mobility, because I know that once I'm on methadone, I'm really, really ON IT, if you know what I mean. I'd like to be able to get detox and/or maintenance therapy from any addiction doctor, rather than just from the methadone clinic system as it exists today. Perhaps I just need to walk into one of these clinics and see for myself what they're like.

One big problem with the MATRIX program is it's in downtown LA, making a regular commute quite a problem (although they do have an Orange County [my county] office that might be able to provide the same services, but early indications are that MATRIX only does the buprenorphine program from their LA office. At least I have two methadone clinics available to me in Santa Ana, Orange County (So Cal), which is far more do-able than the LA locations.

So, anyway, I'll keep ya'll posted and look for both your replies. Peace and good health to both my good friends.
tom