Zohydro users?

[Cjharms]

I'm looking for others experience on Zohydro?
Is it managing your pain better than the shorter acting meds?

We have been increasing my mg, but I don't seem to be getting any more relief. I almost feel like the shorter acting meds did a little better, or maybe I'm getting the opiate hyperalgesia (?)

[philnoir]

Your experience of greater efficacy with short acting hydrocodone over Zohydro can be a combination of two phenomena.

First, when you take a medication like Norco containing 10mg of hydrocodone, the entire 10mg of hydrocodone is dumped into your bloodstream within an hour or so. That entire 10mg is available to the many opioid receptors in your spine and through out your body at once, providing a greater analgesic response.

When you take a 20 mg Zohydro tablet. It is designed to release hydrocodone slowly into your intestine over a 12 hour period, giving you the same amount of hydrocodone as taking two Norco 10 every 6 hours, but your body is not receiving the full analgesic effect of that 10mg at any given time.

Some people need that full analgesic effect to kickstart the pain relief response.

Also, with a full 10mg of hydrocodone in your serum, more is available to cross the blood-brain barrier, and trigger the psychoactive effects of the medication. This is the warm sense of well being felt viscerally in the chest and abdomen that many opioid users feel, and most opioid misusers crave.

While this feeling is labeled with negative terms like the "high" or the "rush",  it can be beneficial to the analgesic process. Animals relax almost immediately and completely when given a subdermal injection of opiate pain medicine. Generally they go to sleep, because that warmth allows them to relax completely -- their blood pressure drops, their capillaries let go and they become very warm, and they just surrender to this feeling. One reason that animals don't usually require large doses of pain medication in spite of severe pain is because of this surrender to the relaxation  response.

Human beings are more complex -- we have to think our feelings through, and this requires a bit of energy that we could be applying to analgesia. We're busy -- our pain medication allows us to "get things done."

Anyway, don't get hung up on the fact that Norco may have given you a "kick" that Zohydro can't supply. I've found that special opiate feeling is an essential part of the treatment of acute pain. But chronic pain and acute pain are different phenomena, neurologically.

Yes, Tuck is correct. The current thinking in medicine is that the inner glow that opiate users receive with IR medication can cause addiction -- this may be true in some people, but certainly not in a majority of people.

ER medication is believed to have benefits -- your serum level of medication is constant, so that your opioid receptors always have a supply while medicated.

Personally, after living on ER opioids for over 20 years, and after giving this subject a great deal of thought, I believe that ER opioids accelerate dependence and tolerance, and therefore, reduce opiate efficacy. I believe that there's only one long-acting opiate family that is appropriate to the treatment of chronic pain, and hydrocodone, oxycodone, nor morphine are in that family.

I know that an individual's degree of dependence and tolerance to opioid medication profoundly affects analgesia -- this isn't news to pain doctors. But I also believe that people who are opioid naive should be kept that way for as long as possible, and that tolerance and dependence is accelerated with the use of ER opioids.

Many medical doctors do not share my opinion, I might add.

I hope my musings added something to your musings.

Best wishes.

[Tuckamore]

Hello Cj,

Welcome to MedHelp's Pain Management Community. I am glad you found us and took the time to post. I'm sorry to read that your pain does not seem to be controlled better with Zohydro ER.

Zohydro ER (hydrocodone bitartrate) is probably one of the newest  extended-release opioid. I haven't heard much about it from our members or my medical friends. I do know that I had a discussion with my PMP regarding it's effectiveness. He said he wasn't impressed with it.

I know this may bring a lot of controversy and debate but I tend to agree with you. A LA opiate doesn't seem to control my pain as well as a SA one does - but here's the rub. It doesn't mean that that's correct - meaning for the majority of ppl their pain is better controlled or should be better controlled with a LA and SA opiate.

I believe finding the right combination of opiates takes time and a caring PMP that's caring and will to work with his chronic pain patient(s). When it comes to opiates - one size does not fit all.

Too often PMP have their preferences. One PMP will refuse to RX this or that opiate - often for a personal reason or as I said as a personal preference. Unfortunately their preferences are not always what's best for the patient.

Zohydro ER may not be the right LA med for you. Ask your PMP if you can try another. Hopefully he/she will work with you.

We may have a member that has personal experience with Zohydro ER  - watch for more comments. I wish you the very best and hope you'll be active in our community.

Take Care My Friend in Pain,
~Tuck