long-acting meds

[mellie4]

Well, I did a lot of reading and thinking this weekend.  And after all that, I've decided (and sent an email) to talk to the NP at the pain clinic about switching me over to a long-acting medication for my pain.  I'm thinking it will give me better relief.  Even though I'm on a high dose now (45 mg. every 4 hours of oxycodone,) my pain seems to return after 2 to 3 hours.  And I did have a bad flare-up this weekend; most likely due to the fact I ran low on medication due to my script not coming in the mail.

Now it's a question of which medication???  The NP mentioned the Fentanyl patch, oxycontin, MS contin or methadone.  I've pretty much ruled out methadone.  And I think I've ruled out the Fentanyl patch as well, though it seems like a lot of people get get some great relief with this.  But I think that, for me, that may be for a later time if the pain won't come under control.

That leaves MS Contin and oxycontin.  Does anyone have any insight to these two?  Is one better than the other in any way or are the side effects of one less than the other (keeping in mind that everyone is different.)

Also, for those of you who are on long-acting medications, do you all need breakthrough meds, or do you find the long-acting meds to be enough?

Thanks for any help or suggestions.

[namnam46]

Hi Mellie, As you probably know I'm on the Fentanyl Patch. I LOVE it because it takes care of my pain and I don't have to worry about anything. I have to replace mine every 48 hours and 72 hours causes my pain to go thru the ceiling. I don't have any kind of w/d from it if I keep it on for that xtra day I just don't have ANY pain control. I think that the patch would be perfect for you and you would love it. NOW, having said that, I'm almost 64 years old and I'm not concerned about any type of addiction. First of all I don't have ANY type of an addictive personality, I stopped Tylox, after taking it for years, 4 weeks after my hip implant and had ABSOLUTELY no problem at all. Not even a cringe. There were many times that I would stop taking my Hydrocodone 7.5/500 when I still lived in TN, I'd been on it since 2003 continuously until January, 2010, and didn't have a single problem. I would stop for 5 or 6 days at a time just to test the pain. All I felt was the pain, NOTHING else. I'm VERY lucky in that perspective. My opiate tolerance isn't going up at all as it does for some that have written on here. So I don't have to worry about that. The younger you are, I think, the more concerned and cautious you need to be about what meds you take. I can definitely understand where you are coming from about waiting as you may need it worse later on. You will know when it is the correct time. Just DON'T BE AFRAID OF IT AT ALL!! Just use your better judgment!!

Good luck tomorrow..We'll be anxiously awaiting your post as to how it goes...Sherry

[mellie4]

Thanks!  I guess I was thinking the MsContin as I've been on oxycodone so long and I thought maybe I could do with less MsContin since it's new to me.  I'm on so much oxycodone (45 mg every 3 to 4 hours).  I'd think even if it made me drowsy initially that eventually I'd get used to it.

Luckily cost isn't a concern as it's a work injury and it's covered by that insurance.  I don't even have to pay co-pays.  They've been really good paying for all my meds.  They just paid for me to get a new compounding cream with all sorts of medication in it (neurontin, lidocaine, ketamine and several more).  It's over $200 for a small jar; much more expensive than the Voltarin I was on, but the approved it.  (And it actually gives me some relief in certain spots.)

My appointment is at 8 am tomorrow and I'll definitely talk to the NP about it in depth then.

[Tuckamore]

This is a personal choice and trial and error will provide you the best answers. In my opinion which medication will be most effective in treating your pain will only be determined after this trial and error period.

BP mentioned the difference in Ms Contin and OxyContin and is correct but these differences do not apply to everyone as our systems are all different. Additionally often our body adjusts to the medications and these "feelings" will dissipate in time.

If cost is an issue MS Contin is much less expensive. So do some research and begin with the one that you and your medical provider feel will be most beneficial for you.

Best of luck and please let us know what you decide.

~Tuck

[BP88]

The Oxycontin will make you feel more energetic whereas the MS Contin will make you feel a little drowsy.  The Oxycontin is roughly twice as strong as morphine in terms of pain relief.  I have tried both and am currently taking MS Contin since it's covered in my hospital's formulary.  If I were you I would choose the Oxycontin; it works VERY good.

[mellie4]

Thanks.  You make a really great point.  And I am definitely developing a tolerance to oxycodone; so maybe MsContin is the way for me to go at the moment.  

Are you newly on it and they're still adjusting your dose?  I am anxious in making changes but what I'm doing now isn't working.  I'm waiting now to hear about an appointment for this week so we can make the change.

[skmedlin27703]

I was on Fentanyl for 5 years until they made a change in the way they make the patch.  The matrix design (where the medicine is made into the adhesive) did not work well for me.  So, my dotor switched me to MsContin.  I still wake oxycodone (30mgs three times a day) for breakthrough pain.  I do need both but some people find they do not.  I chose MsContin over Oxycontin because I already have a tolerance building for the oxycodone and didnt want to choose something that wouldnt work well because of that.  Right now the MsContin is supposed to last 12 hours and feel like it is wearing off after 6hrs. I think once my dose is adjusted it will work well. Good luck.  Hope you find something that works for you.