Ideas on 24/7 pain medication?

[Dr. Smith]

Susanne,

Oxycontin is expensive because it is still under patent, though it is supposed to expire (an extension was granted) soon. Time will have to tell on that one.

If you're already taking oxycodone, I wouldn't be too concerned about morphine. People get scared of morphine because they've heard more about it. Used responsibly as directed, it is one of the safest opioids.
Morphine is considered the gold standard (it's been around the longest, it's the best studied, and one of the least expensive). Oxycodone is considered to be approx. twice as potent, and harder to withdraw from. Fentanyl is many more times as potent. However some patients have found that morphine works on a near equivalent (less than twice as much) as oxycodone. It is considered to work very well for round the clock pain relief.

These equivalences are just guidelines so that doctors don't prescribe too much when switching from a particular dose of one to another -- everyone responds differently to these meds. There will still be a short titration period, during which some temporary side effects may be felt.

It might help to google or wiki these meds and learn about them to help you decide (with your doctor's help) which one is best for you.

Nothing is carved in stone, either. If one doesn't work (for whatever reason) your doctor should be able to switch you to another that does.

Please don't let fear prevent you from an improved quality of life.

Doc

[Susanne C.]

I do quite a bit of Internet research on all these drugs, and as we all know you can find contradictory information in medical papers, and really strident and crazy comments if you include forum and question and answer posts in the search. I also have a few books on chronic pain which advocate the increased use of opiates for neuropathic pain. I think this is a new trend in medicine, to be more concerned about under treated pain.

I don't want you to feel like I am too lazy to do my own research, I simply trust the opinions and experiences on this forum more than most sources! Some major sites still say CMT is not usually painful....
Thank you everyone. Every time something takes a turn for the worse I need a little reassurance and I know I will find it here. Your kindness means a lot to me.

[ger715]

Susanne,
Dr. Smith is a good source. He does quite a bit of research.
As far as the dose of meds I am on, I have been on the current dose almost 3 years. I started with Oxycodone 5mgs, 7 years ago. Still was in quite a bit of pain; especially when the neuropathy kicked in. My Pain Specialist added Oxycontin. He did 3 or 4 procedures undersedation which didn't help the pain. Each time he did a procedure that didn't work; he would add additional Oxycontin and upped the breakthru. I told him of my concern about too much Oxycontin. He told me at that time, he would help me come down from the dose and had anticipated my getting a spinal cord stimulator that would lessen the pain; thus less meds. I had an unsuccessful trial for an SCS, so no stimulator.

As far as my cognitive function.....my family is amazed that it does not seem to affect me other than a little more hyper. I am sensitive to many meds that way..including ones with added caffine. Over time, my body gradually became accustom to this dose.

Gerry

[mrsD]

I'd just like to add that Oxycodone has this side effect of "hyper" on some people. This is because it has a mild effect of stimulating serotonin release.

Morphine, however, typically does not do this as much. It is more sedating overall.

BTW... some doctors don't really understand opiate conversion from one
drug to the next.
Here is a handy site to help with that. You can print it out and give to
your doctor and save for yourself.
http://www.globalrph.com/narcoticonv.htm

The conversion from opiates to methadone is the most critical and dangerous IMO. So I keep this link handy, for other posters too.
http://www.globalrph.com/narcoticonv.htm

PO is "by mouth"
IM/IV/SC are injectable routes
The fentanyl patch is not on there or the BuTrans patch.