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medication options after fentanyl and dilaudid pump.
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medication options after fentanyl and dilaudid pump.

After 15 knee surgeries, 4 herniated discs, Chronic osteomyoletis ( infected right knee) and to top it off i have chronic RSD,also in my right leg. I have maxed out on an dilaudid intrathecal pump for chronic pain. For the breakthrough pain i take fentora 800mcg one every 2 hours. i was on actiq 1600mcg one every two hours. needless to say my tolerance is pretty high. These meds help somewhat now, but i,m concearned in a year or two when my leg gets degenerativly worse due to RSD and the bone infection. I have a great pm doctor, not a miracle worker. any advise.    
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Avatar_n_tn
Your about where I am.  I have been taking Subutex as well for the past 3 years but the chronic pain is usually so bad, I don't stay sober, and next thing you know I'm back on the oxy's or whatever is available.  I wish I knew the answer.  I cannot believe that with all the millions of Americans suffering with chronic pain the drug companies cannot come up with something better.  I personally think they make too much money how things are now, and don't want to give it up.  I wish I could offer you some decent advice, but that's why I'm at this fourm looking for myself.  Best of luck to you!!
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Avatar_n_tn
thank you for your response and wish you all the best. i'm 31 so my age is also a concearn. my worst nitemare is suffering the next 45 years brcause i can,t get pain relief. i also considered to have my leg amputated, but there is a vrty low success rate in getting pain releif. do to my chronic osteomyoletis, no doctor will stick a needle in my knee, let alone operate out of fear the infection will get in my bloodstream. anyone else who is in the same boat i would love to hear your response.  
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Avatar_m_tn
To everyone and anyone who can help me, I'm a male 45yrs old and suffer from 3 failed spinal/disc fusion surgeries.I have taken all the pain pills that are out there and now have a pain pump w/dilaudid but it does not help at all with my pain issues.One Dr. said I was opioid intolerant so a new pain Dr. I have is trying fentanyl in my pain pump this week.Will the fentynal help me better than the dilaudid I'm really desperate for relief ? Which is stronger and better for pain? Any comments would be appreciated !
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Avatar_f_tn
Unfortunately there probably really isn't an answer as to which is stronger or works better.  Different medications work differently for different people.  Myself for example dilaudid works great for controlling pain.  Drugs like Morphine for example don't work at all for me.  Different meds work differently for different people and different types of pain.  We all metabolize medications at a different rate as well.  You may just have to try a few different ones based on your doctor’s recommendations and find what works the best for you.  Opiate tolerance is probably what you meant and that does present a big challenge when it comes to treating chronic pain.  The more medication that is taken over a number of years the less effective it becomes in many cases.  Hopefully the fentanyl your doctor tries will be the key for you.  Good luck to you and keep positive

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Avatar_n_tn
When a pain pump has to be takin out after several complicatons. What are the options left for pain relief?
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Avatar_n_tn
Once a pump is removed, There is no amount of oral meds that will equal the potency of the pump. 300mg of iv morphine is equal to 1mg of morphine in the pump. I would recommed the fentanyl patches. Then if you were on oral breakthrough pain meds, I would stay on them or start taking something if you were not before. By far, Fentanyl is the most potent pain medication . This would also prevent withdrawal.
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Avatar_n_tn
I was wondering how the fentanyl works in your pump, compaired to dilaudid. I have been told by a few pain doctors that a great pump medication is sufentanil and ketamine. This works great for RSD and CRPS Type 1. The Ketamine has an effect on the opioid, that you won't develop a tolerance, but the ketamine makes the sufentanil 33% more potent in the intrathregularecal pain pumps. Sufentanil is 10x as potent as fentanyl. There is also a sufentanil in an inhaler form anto treat breakthrough pain and a sufentanil patch for chronic pain.
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Avatar_n_tn
i suffer from chronic back pain. My dr has me on methadone and dilaudid. He only gives me 60 4mg dilaudid and 60 methadone 10 mg per mounth. The dilaudid is the only thing that helps and he will not put me on just dilaudid. he gave me opana last mounth and it did nothing to help. please tell me what i can do to get what works for meThe dilaudid works fine but he will not give me enough to get thru the mo.  please advise   61 and in pain since 1991
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547368_tn?1332173665
This ia an old thread. I advise you to begin a new one for best response. I haven't seen Kicker on the forum for some time.

Peace,
Tuck
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Avatar_m_tn
Fentanyl is much stronger.  Its should work a lot better.  I had the fentanyl pump very good for pain.  It is the strongest pain med on the market in the US overseas they have pharmacutical heroin.
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Avatar_f_tn
Reading all your stories makes me feel sane and unified with you guys. I had 3x knee surgeries and developed chronic crps. I had a spinal cord stim implanted which worked well but my body rejected it about a month later (rare but it happens).  I'm getting a pain pump ( fentanyl) implanted tomorrow! Dilauded and fentanyl is what works for me. I've tried methadone which didn't  help me at all and I had horrible withdrawal from it when switching to fentanyl. If you aren't getting relief u need to find a pain dr that is flexible and doesn't give all patients the same medicine. I have had bad drs, and it makes a huge difference when u find a dr that listens and tries new therapies. Ps I was on ketamine for 6 months too, and built a huge tolerance to it fast, and it didn't increase opioid pain relief (I was on 100-150mg lozenge 3x day), hope this helps, try different drugs, try different doctors, and hopefully you will find a spot where ur pains tolerated.
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Avatar_n_tn
I took fentanyl patch and I also thought it was best pain relief cuz it relived the burning pain.  However, it made me weepy, cried all the time and after a month or more became suicidal.  Lots of suicidal "ideation" that did not seem to come from me.  I had to ask friends to sit with me because I was plotting to kill myself in three months.  I stopped the meds and the suicide ideas immediately stopped.  So I know the drug caused it.  My questtion is, is it possible the pump would work better than the patch.  I wonder sometimes if the delivery system is what our body considers so toxic--i notice I negatively respond to ER when I'm ok with the immediate release version and wonder if it is some drug in the ER or the patch that makes it so toxic.
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