input about breakthrough pain meds

[emmalee187]

Hello All,
    I was hoping that I would be able to get some ideas on a new breakthrough med to suggest to my doc.  I am on fentanyl 175/48hr along with oxycodone 30mg.  I suffer from IC and have slipped four discs in my back in the last year.  Well, the problem is, I don't feel that my pain is well controlled, esp when I have any kind of flair up.  That is what I am going through now.  I have re-injured my back and what I am on is not covering the added pain.  Is there anyone out there that has any good suggestions?  Does diladdid(sp?) work well?

[tinman3266]

Hi my doctor has me on 10/325 oxycodone 4 times a day. I'm a stay at home dad do my schedule is 6am - 11pm
Mornings are hard pain wise and at bed time. What would you recommend for IR medication?  Opana, diladid or......... thanks I would like to give my pain doctor a suggestion

[femmy29]

Hi emmalee,

I'm sorry you are having such a difficult time with your doctor regarding your IR medication.  I deal with that same uphill battle with my doctor as well.  My doctor loves to offer titrations on the long acting med but not the short acting med.  I believe this is because the long acting med has less potential to release euphoria which is the main driver of opioid addiction.  What they don't realize is that with real chronic pain, there isn't any euphoria or very little which can be attributed to happiness that the pain went down versus the med producing it in and of itself.

At the end of this month I am finally getting a titration in strength on my breakthrough pain meds.  It is still less than I desired as sometimes I have to take two of my current strength to get the pain down and two of my current strength is slightly stronger than the strength increase I expect to receive later this month.

I don't understand why she would be against you trying something other than the 30 mg oxycodone for BT pain.  The 30 mg oxycodone tabs are the most sought after oxycodone med by addicts and because of that the DEA is closely watching all of the prescriptions for 30 mg oxycodone.

I really think that the 10 mg Opana IR would work well for your pain.  I don't believe that building up a tolerance to pain meds equals "you just have to deal".  When tolerance is reached, many doctors rotate the patient to a different opioid.  I am sure you already know that telling her you want to try Opana IR won't go over well as doctors are taught to consider that drug seeking behavior.  What I recommend instead is for you to tell her that you have been researching what are other possible options to overcome an opioid tolerance to a specific medication.  Bring in an article that discusses opioid rotation for her to read.  And tell her that the article suggests that patients tolerant to a medication can still achieve effective analgesia by rotating to a different opioid.  Then from there, show her an article that lists all of the short acting opioids on the market today and ask her if she thinks one of these other ones might work better for you.  Consumer BestBuy drugs has an online .pdf report that lists all of the opioids on the market along with their prices.  I'll try to find a article that discusses opioid rotation and include the website later as I ran across one awhile back on a website that I frequent.

The Consumer BestBuy opioid drugs report is at the website below:
http://www.consumerreports.org/health/best-buy-drugs/opioids.htm

femmy

[emmalee187]

Thanks so much to you both for the responce.  It is so nice to be able to talk about it.  I feel a frustrated b/c I talked to my doc today and it was a little like talking to a brick wall.  I explained that the meds I am on do not cover my flair ups and I feel that changing to a different IR may really help.  She said, No, I don't want to up the dosage that you are on of IR medication.... I then tried to clairify that I was not asking for more, just different.  The convo went like this for a few min.  Then I gave up.  The last thing that she said to me was," This is the down side of being on chronic pain meds, when you have extra pain, you just have to deal."  So... Onward and upward for now.  

[femmy29]

You can ask your doctor about as you said dilaudid (hydromorphone).  Opana IR is also a good breakthrough pain med.  It is quite a bit stronger than dilaudid.  The Opana IR comes in 5 mg and 10 mg doses.  The 10 mg dose is equivalent to about 20 mg of oxycodone.  It is a step down but you could combine a 5 mg and a 10 mg tablet to equal 30 mg of oxycodone.  Because of incomplete cross tolerance due to Opana IR (oxymorphone) being a totally different opioid, you could have great success with it as a breakthrough pain med.  Dilaudid and Opana IR are the only IR pills stronger than oxycodone on the market.  The next tier up would be the fentanyl lollipops or buccal tablets.  Good luck.  Let us know how things go.

femmy

[chriscross1964]

That is a bummer you are the second person to have to go off a good medicine because they are sooooo expensive, I too would not be able to take the meds if I didn't have insurance...That ***** and yes the rules in my state changed as well and all the doctors are on high alert.it really hurts all of us that are legitimate pain patients...well good luck and keep me updated....

[emmalee187]

I used to take 80mg O.C 3x per day with the 30mg IR for break through and it worked great! But, I lost my ins. and could not afford my meds.  I switched to the fentanyl patches about three months ago and thats when all these issues started.  it *****!  I dont really want to go back to square one.  I talked to my doc today, but she was not receptive, she kept saying that she didnt want to up my dose, eventhough that is not at all what I was asking her.  They have been cracking down in the state that I am in, lots of media attention on pain meds etc... She has been a little cold the last few times that I have seen her, so I want to have a plan of action the next time I go in.  I don't think that its personal, but it does make it hard for those of us who need the help tward a better quality of life.  Sorry, I went a little off topic there.  Thanks for the input.- EmmaLee  

[chriscross1964]

Hi there ,
Have u considered changing your ling acting meds I take oxycontin 80mg twice daily with oxycodone 30 mg for breakthrough and I have little to no problems....i have cervical and lumbar issues and the regimen I am on allows me to lead an active lifestyle...just my opinion....talk to your doctor...good luck