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Long acting pain meds
I've tried many kinds of pain meds through the years for failed back surgery, spinal stenosis. The extended release meds don't work as well for me as the immediate release ones do. With my last doctor, I got him to replace the two 100 mg ER tabs with two 30mg of IR because they work better for me. Has anyone else had similar experience with ER meds?
I only wish most doctors would read this article. I know many, many people who are lucky to get ANY meds, let alone breakthrough meds. My pharmacist would probably have a fit if I were to come in with 2 prescriptions.
I'm not sure what you're saying...
If you were on only baseline medication, without a breakthrough dose, then yes, I imagine you needed some IR. Every chronic pain patient needs BT dosing.
The average is about 25% of the baseline dose. So if I'm on 100mg of long acting opioid daily, I'd need somewhere around 25mg of BT opioid to get through the pain peaks.
https://www.ncbi.nlm.nih.gov/pubmed/16885015
But if you're saying that replacing long acting opioids for IR dose, I don't understand how this can possibly work, and it isn't good medicine. First, the IR pill is going to quit on you much sooner than the IR -- within 4 hours, and fast acting opioid is going to more quickly increase your tolerance.
Are you saying your 30mg pill covers 12 hours of pain?
If you were on only baseline medication, without a breakthrough dose, then yes, I imagine you needed some IR. Every chronic pain patient needs BT dosing.
The average is about 25% of the baseline dose. So if I'm on 100mg of long acting opioid daily, I'd need somewhere around 25mg of BT opioid to get through the pain peaks.
https://www.ncbi.nlm.nih.gov/pubmed/16885015
But if you're saying that replacing long acting opioids for IR dose, I don't understand how this can possibly work, and it isn't good medicine. First, the IR pill is going to quit on you much sooner than the IR -- within 4 hours, and fast acting opioid is going to more quickly increase your tolerance.
Are you saying your 30mg pill covers 12 hours of pain?
I guess I don't understand what your question is. Most doctors won't prescribe the instant release meds anymore other than for breakthrough pain, and those are usually in much smaller doses, no one's going to prescribe 30mg oxyxodone anymore, except maybe for cancer pain.
The ER versions provide constant steady pain relief rather than the ups and downs of the instant release. One thing to remember is that, in chronic pain, you will never be pain free, a doctor will consider a medication a success if you get 50% relief from it. You have to use other modalities to help bring the pain down as well and learn other coping mechanisms. Good luck to you.
The ER versions provide constant steady pain relief rather than the ups and downs of the instant release. One thing to remember is that, in chronic pain, you will never be pain free, a doctor will consider a medication a success if you get 50% relief from it. You have to use other modalities to help bring the pain down as well and learn other coping mechanisms. Good luck to you.
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Of course, I've had pharmacists ask (when reading my Rx), "What is BT pain?"
Chronic pain is not taught in medical schools, except as a side. Perhaps we need a new word -- when people see "chronic pain" they probably believe its like the pain of a broken bone, only it lasts longer.
I have no idea what kind of education a pharmacy PhD grad receives on the disease state known as chronic pain.
But folks need to understand that opioid medications just don't work for chronic pain like they do for acute pain.
Back when I was opioid naive (such a long time ago), when I had severe pain from a tooth abscess, 2 Percocet tablets removed 90% of the pain, for 4-6 hours, just like it said on the bottle.
Chronic pain doesn't work this way. Long acting OxyContin can be delivering the same 10mg of oxycodone to my bloodstream every hour, but it does not remove 90% of chronic pain -- it can't, because my nervous system never stops generating pain signals.
Some want to call this "opioid induced hyperalgesia" but the hyperalgesia is there long before any opioid comes into play.
This is chronic pain, and pain spikes are also a regular part of the syndrome.
This is an education problem, a public relations problem, but we're dealing with one of the most self-satisfied and arrogant professions in the world -- the medical profession. Unfortunately, many practitioners believe they know everything -- a group of old dogs that can be extremely difficult to teach new tricks.