Correct Meds For Long Term Pain

Vicodin and oxycontin are not good drugs for long term pain because as your tolerance rises so does your use.  For long term pain, my pain doc has me on Fentynal patches and immediate release morphine sulfate.  I have been on them now for about 4 years without upping dosage.  Younger pain docs are best as this has only been a speciality for 20 some years.

[femmy29]

Oxycontin is a good long-acting opioid medication for long term chronic pain.  Not sure where you are getting your information from but I would love to have a link to the research study that shows tolerance increases at a faster rate when using certain types of opioid medications over others.

Vicodin is a short-acting opioid medication that is prescribed frequently for acute pain (pain that is expected to last less than 3 months) and for chronic pain either as the main opioid medication or as a breakthrough pain medication.

What may work for you, may not be the solution for another person.  Everyone's reaction to opioid medications is different as well as the development of tolerance is different from one person to the next.

There are many other effective opioid medications for pain management other than Fentanyl, Morphine, Vicodin, and Oxycontin.

Lastly, let us not forget that not everyone can be prescribed Fentanyl as the patient needs to be on at least 60 mg of morphine equivalent for 1-2 weeks to be opioid tolerant enough for Fentanyl; otherwise, the respiratory depression is likely to be fatal or require a trip to the ER.

The choices in medication for pain management should be left up to the patient and their doctor.  It is always okay to recommend a medication but to tell others that certain medications should be excluded without providing evidence to assert the claim, makes the statement misleading to others.  From what I have read and researched, a tolerance is developed with all opioids.  How soon tolerance is developed varies from patient to patient.  Just because your medication regimen has worked for the last 4 years without a change in dosage, doesn't mean the same medication regimen will work for another person for that duration of time.

femmy

[MedicDan]

Oxycontin is a very effective medication for long term pain management.  I would be hesitant to put a pt on Fentanyl AND IR Morphine that seems a tad excessive, but different providers have different opinions.  Further, you will build a tolerance to ANY opioid over time so I am not sure where your getting that information from.  Also Vicodin, OxyContin and Fentanyl all have different uses, hydrocodone medications are generally for short term, fast acting, post op use.  There are ER versions but they are not used as often as the IR versions. I know many providers, myself included who will prescribe hydrocodone meds PRN to pts who may use it for breakthrough pain. OxyContin is an ER medication and is used for round the clock pain management, it is generally prescribes 1 tablet po q 12 hrs MDD 2. Often times pts on OxyContin are also prescribed a PRN med such as Vicodin or Percocet for breakthrough pain.  Fentanyl is a HIGHLY addictive and very dangerous medication.  I have seen cases where pts. chew the patch, or insert it into their anus or vagina for faster absorption and it can very easily cause a fatal overdose. I would feel more comfortable prescribing OxyContin than Fentanyl, especially since OxyContin was reformulated it is very had to defeat the time release function and makes its safer.  Finally just because something works for YOU doesn't mean that it works for ALL!

-Dan
DNP, ANP, AEMT-P

[mosaicjayne]

I apologize, I meant to type Oxycodone rather than Oxycontin in my earlier post.

All opiates are addictive, but for those who suffer from chronic pain, short acting opiates such as Vicodin or Oxycodone are more likely to be abused as they are not meant for long-term pain issues and users frequently have to keep increasing their dose.

But Vicodin and Oxycodone are short-term, not long-term, pain medications. Methadone, Fentanyal, Oxycontin and others are preferable for long-term pain.

Wasn't trying to prescribe,and certainly not for everyone, but I had just read a bunch of posts from people who were on Vicodin or Oxycodone for chronic, long-term pain and who complained that the medications they were on were either not working anymore and they were suffering or that they were taking enormous amounts.

The post was meant to suggest options for patients to discuss with their doctors.  Long-term pain is agonizing to live with and I meant to help.

Hope no one who reads these posts abuses Fentanyl as mentioned by MedicDan, I wasn't writing for recreational? drug users or abusers but for people who had serious, chronic pain issues.

Mosaicjayne

[mosaicjayne]

Meant to type Oxycodone, not Oxycontin, in my earlier post.  Oxycodone is usually used for short-term pain  and Oxycontin is for long-term, chronic pain.

[femmy29]

Thanks for the clarification.  Your original post was definitely taken out of the context that you implied for it to be taken in.  Oxycontin contains oxycodone in extended release form.  As you stated, oxycodone does come in immediate release form with or without percocet.  

I agree with many things that you wrote.  I believe prescribing only a short term pain medication for chronic pain is suboptimal for the patient as short term pain medication fizzles out before 4-6 hours, which is before one is supposed to take another for pain and because it has a profile that ramps up very quickly and ramps down quickly after it peaks, it leads many chronic patients to want to take more of the medication to avoid the valleys.  

A long-acting medication with a short-acting medication for breakthrough pain is really (I believe) the optimal solution for chronic pain.  I know many physicians force their patients to choose one or the other.  Many (including myself) find that being on just a long-acting medicine is insufficient as pain typically breaks through the long-acting medication regardless of dosage at least once or twice a day.  Because of this, many patients choose the short-acting medication when presented with an option thinking they will have more control over the pain.  When doctors tell patients to make a choice between short-acting and long-acting, that leaves many patients to make a decision that really shouldn't need to be made as research shows combining both a long-acting and short-acting medication provides the best treatment for chronic pain.  

I will probably end up on Fentanyl at some point in time during my quest in avoiding a 2 level spinal fusion.  I was told today my spine orthopedic specialist that if I take my MRI films to any surgeon, they will book me immediately for surgery.  I am currently taking Opana ER with percocet for breakthrough pain.  I am glad that the Fentanyl continues to work very well for you after being on the medication for four years.  That gives me hope that even once I begin Fentanyl, I will still have many years of effective pain control.  

femmy :)

[mosaicjayne]

I'm glad we got everything clarified!

I have the Fentanyl Patches, as stated, and Morphine Sulphate Immediate Release (MSIR) for breakthrough pain. Once my pain doctor and I got my correct dosage established, and that took some trial and error, I have been doing great...and for years now!

Sincerely hope that your pain will be controlled with medications...a 2 level spinal fusion does not sound like anything to look forward to and I for one would most likely do everything I could do avoid it...I wish you well!

Mjayne :)