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What drugs are nomally used for long term pain care?
My question for the group is what drugs are being given to yoiu for long term pain care. To let you know about me I have stenosis in my entire spine, ruptured discs in both cervical and lumbar areas with nerve damage, constant pain, on a scale of 1 to 10 always between a 6 and 10 . I have loss of feeling in my hands and the constantly shake. I am a fall risk due to constant loss of balance. I am also starting to loose feeling in my feet. Since I first was started on treatment for pain 8 years ago all I have been prescribed was Norco 10/325 4x a day. I have been questioning the pain clinic regarding this since Norco is a short term use drug. I just asked the doctor If I could be building up a tolerance he advised me it would take at least 20-30 years. So I am going to be firing him but would like to know what other people are getting prescribed so I know more when I get the new doctor.
My doc. finally called me yesterday about my above prior post. He stated I sould increase my dose of Dilaudid 4mg to four times a day. I was taking 4mg three times a day. I am still on Methadone dose of 2.5..also states I am supposed to get back to him in seven days to see how I am doing with this new change of increasing the Dilaudid to four times a day. Thank you for checking on me. I also had an appointment with the urologist today since I am getting up frequentlyduring the night with frequent voids.Started me on Detrol LA.(used to treat overactive bladder) Hope this works. I get very frustrated going to the doc every month. Hope everyone has a great week-end. Thanks again SMILES/HUGS Cindi
And, thank you for keeping us updated. When you write about things that are happening with you, it helps others with similar situations.
I know how scary it is when you can't fall asleep (I have had the same sleep issues). The body is sometimes a "contrarian." I found that if I "forced" myself to stay awake, my body would force me to sleep :-)
I decided that staying awake listening to a late night radio talk show at 10pm was more fun than sleep, and as soon as I decided NOT to sleep, my body forces me to fall asleep at 10pm!
I know how scary it is when you can't fall asleep (I have had the same sleep issues). The body is sometimes a "contrarian." I found that if I "forced" myself to stay awake, my body would force me to sleep :-)
I decided that staying awake listening to a late night radio talk show at 10pm was more fun than sleep, and as soon as I decided NOT to sleep, my body forces me to fall asleep at 10pm!
Thanks again for the info.. I am going to call my p/m doc this a.m. and ask him about a new regimen...I have been taking a 2.5 mg of methadone for the last few days..but my original order was methadone 5 mg. to take twice a day. I am going to ask him today if he wants me to go back to the original prescribed order of 5 mg. bid. I get scared and anxious at night when I cannot sleep for the first hour or two. (that is why I was taking Amitriptyline 10 mg for anxiety and help me relax.I will keep you updated. Thanks again SMILES/HUGS Cindi
Hopefully you're finding all this information interesting. It makes for interesting reading, for all of us!
I do feel it's important to add a 'general' statement here -- that although we are very happy to share our experiences, most of us are not medical professionals and we cannot give advice. So, please be sure to run things by your own doctor that you want to try.
One other thing I forgot to add: I think of "long acting" medications as belonging to 2 categories:
1.) Those that pharmacologically take a long time to feel the maximum effect ("time to peak") and have a long "half life" (technically, the half-life is amount of time it takes a drug to lose half of it's pharmacological activity... kinda like "how long it stays in your system"). Example: methadone.
2.) Shorter-acting medications that have been mechanically altered by manufacturing them with extenders like waxes, polymers, matrixes and whatnot so that the individual pill takes around a day to dissolve in your system. Example (as Philnoir mentioned): extended-release hydromorphone.
Long acting meds (in either category) have both pros and cons -- for example, long acting meds are nice and steady, no peaks and valleys (no waking up in the morning crawling to your pill bottle with your hands shaking). However, because they are long-acting, you have to be super careful with dosing. Until your optimium dose has been determined by your physician, it's not a good idea to take a pill, and then a couple hours later taking another pill because you think the first pill wasn't strong enough, not realizing that first pill is still "on its way up to peak," and then before you know it, you are in the middle of a long-lasting overdose.... The point is, to work closely with your physician on dosages, and to be patient (ha, no pun intended) with the initial low/conservative dosages in the beginning, as they actually build up in your system.
Another (over-simplified) way to look at it is the dilaudid you are currently taking has a half-life of about 4 hours. If you loosely divide that out, you can see that after a day (after 24 hours), a lot of it is out of your system. So, when you take your next pill tomorrow, you don't have much of that first pill left in your system. (The scientists call the steady amount in your system -- how much from yesterday, plus what you took today, etc., they call that "steady state.") However, if you take a methadone pill today, and then were to take another pill tomorrow, a lot of yesterday's pill is *still* in your system! So, that lower dose "stretches out," and might very well be enough.
Anyway, again, please don't take my ramblings as advice, it's not checked for accuracy, it's just a bunch of stuff I read and forgot most of (too much aluminum) and I'm not a doctor either (tried playing one on TV, but got preempted by a radio).
I do feel it's important to add a 'general' statement here -- that although we are very happy to share our experiences, most of us are not medical professionals and we cannot give advice. So, please be sure to run things by your own doctor that you want to try.
One other thing I forgot to add: I think of "long acting" medications as belonging to 2 categories:
1.) Those that pharmacologically take a long time to feel the maximum effect ("time to peak") and have a long "half life" (technically, the half-life is amount of time it takes a drug to lose half of it's pharmacological activity... kinda like "how long it stays in your system"). Example: methadone.
2.) Shorter-acting medications that have been mechanically altered by manufacturing them with extenders like waxes, polymers, matrixes and whatnot so that the individual pill takes around a day to dissolve in your system. Example (as Philnoir mentioned): extended-release hydromorphone.
Long acting meds (in either category) have both pros and cons -- for example, long acting meds are nice and steady, no peaks and valleys (no waking up in the morning crawling to your pill bottle with your hands shaking). However, because they are long-acting, you have to be super careful with dosing. Until your optimium dose has been determined by your physician, it's not a good idea to take a pill, and then a couple hours later taking another pill because you think the first pill wasn't strong enough, not realizing that first pill is still "on its way up to peak," and then before you know it, you are in the middle of a long-lasting overdose.... The point is, to work closely with your physician on dosages, and to be patient (ha, no pun intended) with the initial low/conservative dosages in the beginning, as they actually build up in your system.
Another (over-simplified) way to look at it is the dilaudid you are currently taking has a half-life of about 4 hours. If you loosely divide that out, you can see that after a day (after 24 hours), a lot of it is out of your system. So, when you take your next pill tomorrow, you don't have much of that first pill left in your system. (The scientists call the steady amount in your system -- how much from yesterday, plus what you took today, etc., they call that "steady state.") However, if you take a methadone pill today, and then were to take another pill tomorrow, a lot of yesterday's pill is *still* in your system! So, that lower dose "stretches out," and might very well be enough.
Anyway, again, please don't take my ramblings as advice, it's not checked for accuracy, it's just a bunch of stuff I read and forgot most of (too much aluminum) and I'm not a doctor either (tried playing one on TV, but got preempted by a radio).
Thank you for responding. I am so frustrated with this med regimen. Like I said as my earlier post,I just want this pain to go away and never visit me again. I know I will always be taking some kind of med d/t my chronic pain. I am so glad that you responded to my post...you make me feel better already. I did take a 2.5 mg dose this morning at 08:30 so far I don't feel any different..I also took a 4 mg. Dilaudid for b/t pain. I do appreciate any other information that you great people can post. I guess I will always be on this site for awhile for help and encouragement. I value any input.I hope I can sleep tonight. Do you think it will be alright if I would take an Amitriptyline10 mg this p.m.(I have been taking Amitriptyline since last week) it makes me feel less anxious and makes me relax so I can sleep? other Thank you again SMILES/HUGS Cindi
Methadone has saved my life. I have stenosis of the lumbar spine, degenerative disc deisease, 2 herniated discs 2 bulging discs and severe arthritis in the whole lumbar area. I used to take roxycodone 15 mg 3x a day with 5/325 mg Percocet for break thru. Over the years I kept needing more and taking all those pills was a nightmare. I switched to 30 mg of methadone 2x a day and I can live my life. I'm not saying my pain is completely gone but I'm free! There are days that go by where I hVe no pain at all! There are times where I'm sitting on te couch and I think to myself how beautiful it feels to be sitting here and not in so much pain. Now if I turn wrong or am on my feet for a long time or am just having a bad day then I can hurt pretty bad but I do what normal people do, I will take 800 ibuprofen and it actually helps! I'll get my heating pad, or do my stretches and usually I can get it under control. It's not perfect but before methadone I felt like the pills and the pain was controlling my life, now I feel free. You might have had those anxious symptoms bc the methadone wasn't a high enough mg to match what your previous medication was doing. Methadone is also great bc you don't get a tolerance to it! I have been on this same mg since I started 4 years ago. Give it a chance, if used correctly and responsibly this medication can change your life as well.
Hello philnoir..Thank you for the info. My treatment goal include to be without these peaks and valleys of these pain meds. Dilaudid 8 mg. I believe the last session I had with my p/m doc he said that he would like to switch me to Methadone and decrease my b/t med to Dilaudid 4 mg. instead of Dilaudid 8 mg. I would just like to be without this chronic pain and have a better quality of life. Yes, I know there are a lot of people out in our wonderful world that are suffering more than myself, but you just want NO MORE PAIN. It interfers with family, social and emotional well being.I want to let you know that I did take methadone 2.5 this a.m. I woke up this morning with a lot of anxiety,I usually take a Dilaudid 8 mg. four times a day.My p/m doc wanted to place me on methadone for the last few months, but I did not want everyone in my pharmacy to look at me with evil eyes due to the case I was taking methadone. Well I guess I will have to bite the bullet. I know I will always be taking meds for pain due to my chronic problems with facets degeneration and fibro and arthritis. I guess it is soon time for another epidural steroid injection from my pain doc. I had an ablation done for my pain in lower lumbar area two years ago,which did help my pain level for about 9 months.I get very frustrated with myself since I cannot do the activities as I used to. Well I want to thank you again for taking the time out to message me. Thank you for info. Hope to keep in contact Have or try to have a great day. SMILES/HUGS Cindi
Hah!
If only I could say what I need to say in two sentences!
Thanks for your contributions here.
Best wishes.
If only I could say what I need to say in two sentences!
Thanks for your contributions here.
Best wishes.
I'm afraid that your suffering from opioid withdrawal because today's conversion tables to methadone are too conservative.
For over 50 years, oral methadone was considered to be 3/2 the strength of morphine.That means that 20mg of methadone is equivalent to 30mg of morphine. (All opioid strengths are based on the so-called "gold standard" of analgesia, morphine sulfate.)
This means methadone is 150% the strength of morphine.
Recently, they've changed that ratio to a much more conservative number. At low doses of morphine equivalent, the ratio is 8/1 or 800%.
Methadone is not 8 times as strong as morphine.
The problem is untrained doctors were encouraged to prescribe long acting opioid medications. Some chose methadone, which has a very long half life, and many who received the medication that were opiate naive had overdose events. Some resulted in death.
Also, the pharmacokinetics of methadone in vivo is poorly understood. Even some opiate tolerant people using methadone 'woke up dead' and no one knows why.
Medical people are very afraid of methadone, and therefore very conservative in its use.
Too bad, because its a great pain medication. But not at 8/1.
There's a long acting form of hydromorphone called Exalgo. Have you tried this medication? Excellent drug, but expensive -- you need a good insurance plan.
Of course, I don't understand your treatment goals. Maybe you're trying to stop the opioids?
For over 50 years, oral methadone was considered to be 3/2 the strength of morphine.That means that 20mg of methadone is equivalent to 30mg of morphine. (All opioid strengths are based on the so-called "gold standard" of analgesia, morphine sulfate.)
This means methadone is 150% the strength of morphine.
Recently, they've changed that ratio to a much more conservative number. At low doses of morphine equivalent, the ratio is 8/1 or 800%.
Methadone is not 8 times as strong as morphine.
The problem is untrained doctors were encouraged to prescribe long acting opioid medications. Some chose methadone, which has a very long half life, and many who received the medication that were opiate naive had overdose events. Some resulted in death.
Also, the pharmacokinetics of methadone in vivo is poorly understood. Even some opiate tolerant people using methadone 'woke up dead' and no one knows why.
Medical people are very afraid of methadone, and therefore very conservative in its use.
Too bad, because its a great pain medication. But not at 8/1.
There's a long acting form of hydromorphone called Exalgo. Have you tried this medication? Excellent drug, but expensive -- you need a good insurance plan.
Of course, I don't understand your treatment goals. Maybe you're trying to stop the opioids?
I was scrolling thru these posts and I came across yours..quite interesting. I was on Fentanyl 100mcg every 48 hours for 4 years,and I (with help of p/m doc) titrated off of Fentanyl patch. I have DDD,fibro,arthritis GERD,and multiple muscle issues. I am under the services of a p/m doc for about a year now. I was and still taking Dilaudid 8 mg. 4 times a day. I was at his office for my monthly visit and he want to start me on Methadone 5 mg. twice a day and Dilaudid 4 mg. for b/t pain issues. Last week I took this Rx and I did not sleep at all. It also felt like my skin was crawling. The next am I had called his office and I told him about the above issue and he said to take Methadone 2.5(broke pill in half) and also said to take in a.m. and not in p.m. I am scared to do this b/c I don't want to feel like I did the other wk. I have two commitments this week,so I don,t want to put myself thru this and I have to have my head on straight. I do not do well without sleep.This is the reason I am posting you because I would like some advice on the Methadone. I did research on methadone the other day on the methadone site,but I would like an opinion about taking this med. Any advice would be appreciated. Thanks you SMILES/ HUGS Cindi
The most recent responder to your post "Philnoir," has a gift for being articulate and eloquent (he can answer in two sentences what takes me several paragraphs to write), so after he posts, there is usually nothing more to say.
That being said, I want to suggest that you research these 2 long acting opiates. (There's a lot to consider, so to properly research these should take weeks and months, not just a day or two.)
1.) Suboxone
2.) Methadone
You can start by using this forum's own "Search Function," and also google them using phrases like:
"methadone experiences"
"suboxone pros cons"
suboxone chronic pain
methadone suboxone addiction
getting off of suboxone
getting off of methadone
Read only from reliable sources, and then you can make an educated decision whether you want to find someone in your area to discuss these in person.
That being said, I want to suggest that you research these 2 long acting opiates. (There's a lot to consider, so to properly research these should take weeks and months, not just a day or two.)
1.) Suboxone
2.) Methadone
You can start by using this forum's own "Search Function," and also google them using phrases like:
"methadone experiences"
"suboxone pros cons"
suboxone chronic pain
methadone suboxone addiction
getting off of suboxone
getting off of methadone
Read only from reliable sources, and then you can make an educated decision whether you want to find someone in your area to discuss these in person.
I too have spine disease, both cervical and lumbar, including disease of the joints and disc. My diagnoses include cervical and lumbar cord and foramenal stenosis at multiple levels, spondylosis at multiple levels, degenerative disc disease, and lumbar scoliosis. I've had spine disease for over 30 years.
I've been using opioids to manage pain for over 30 years, and have been maintained on long-acting opioid preparations since 1994, with breakthrough / rescue doses of opioids approximately 25% of my daily dose.
To fight tolerance, my opioid Rx has rotated from one to another every year or two. This means I change from oxycodone to morphine to hydromorphone, etc. when tolerance causes my dose to creep up too high, too quickly..
In these last 20 years I've used these long-acting opioids: Duragesic (fentanyl) patch, OxyContin, methadone, ms contin, and Exalgo (hydromorphone), along with short acting / immediate release opioids oxycodone, hydromorphone (Dilaudid), and morphine.
Your pain doctor is either ignorant, a fool, or a liar -- opiate tolerance occurs within the first 6 months to 1 year of chronic opioid use. Although the studies are limited, chronic pain patients do better on long-acting opioid analgesics because they do not experience the peaks and valleys in opioid serum level.
Have you been offered any alternative treatments? Have you been referred to a pain psychologist?
Mutimodal pain treatment should be part of every chronic painers regimen.
Do yourself a favor and find a real pain doctor with compassion for people in chronic pain, who is board certified in pain management, and is not afraid to prescribe real pain medication.
I've been using opioids to manage pain for over 30 years, and have been maintained on long-acting opioid preparations since 1994, with breakthrough / rescue doses of opioids approximately 25% of my daily dose.
To fight tolerance, my opioid Rx has rotated from one to another every year or two. This means I change from oxycodone to morphine to hydromorphone, etc. when tolerance causes my dose to creep up too high, too quickly..
In these last 20 years I've used these long-acting opioids: Duragesic (fentanyl) patch, OxyContin, methadone, ms contin, and Exalgo (hydromorphone), along with short acting / immediate release opioids oxycodone, hydromorphone (Dilaudid), and morphine.
Your pain doctor is either ignorant, a fool, or a liar -- opiate tolerance occurs within the first 6 months to 1 year of chronic opioid use. Although the studies are limited, chronic pain patients do better on long-acting opioid analgesics because they do not experience the peaks and valleys in opioid serum level.
Have you been offered any alternative treatments? Have you been referred to a pain psychologist?
Mutimodal pain treatment should be part of every chronic painers regimen.
Do yourself a favor and find a real pain doctor with compassion for people in chronic pain, who is board certified in pain management, and is not afraid to prescribe real pain medication.
for severe pain narcotics are usually the only thing that works and as long as your under the doc supervision and taking them the way youre supposed to and your doc is checking your blood for any changes you shouldnt really have anything to worry about, but for moderate long term pain theres tramadol its specifically made for long term use but like i said usually work just for moderate pain
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