Question on Painkillers

[BrownBagger]

I'm far from "narcotic naive," having had more than my share of surgery and other procedures requiring painkillers, but I don't really understand the difference between them and why a doctor would prescribe oxycodone over hydrocodone or dilaudid or oxycontin or fentaynal. I've had all that stuff--and more--over the years, and it all seemed to work OK. Since I now have bone (rib) involvement, I assume I'll be needing some more narcotics at some point, in addition to pallative radiation (and hopefully, surgery). I'm also aware that most oncologists are not pain management specialists, so it might not be a bad idea to know what I should be getting in the way of narcotic painkillers.

So, can anyone explain why one might want dilaudid over oxycontin, for example? Is it just a matter of trial and error to see what works?

[Lee]

I know I can't take morphine, I get itchy skin with in 24 hrs. I always tell my surgeon this prior to any procedure. Guess that could be one reason why they prescribe one medication over another.

Lee

[CRguy]

The quick'n dirty here bro' is often it will come down to trial and "error" or a docs personal experience... and patient response.
Getting a pain pro is a great idea BTW ! They may be wanting to treat "bone" pain differently than visceral / organ / soft tissue pain.

basically the opioids will affect different pain receptors / pathways with differing intensity / binding strength / duration of action and consequently will have differing treatment profiles and side effects.

Like you, me = NOT naive !
in hosp, morphine was a waste of an IV line for me so I was switched to Toradol ( think mega NSAID on steroids ! )
other times I've had hydromorphone (Dilaudid), codeine, oxymorphone ( Opana, Opana ER, Numorphan HCl, Numorphan .... Oxycontin is oxycodone)
never had fentanyl for pain (but used it lots in Vet Med and had it IV as part of scope dope !)
it is often used in the transdermal patches and IS potent
( aside : the new toxic street drugs are often laced with fentanyl, carfentanyl, sufentanyl which have been used to knock down large wildlife = elephants and water buffalo ! )

oxymorphone is the one I've had most with good success and virtually no side efx.

get some input from the docs up front

Cheers
CR

[BrownBagger]

One of my hospital roommates last year--a young guy in really rough shape--was getting Methadone. I assumed that he was a heroin addict who needed the stuff to avoid withdrawl, but a nurse later told me that they use it for pain relief as well.

Fortunately, I'm not on anything other than Tramadol at the moment, which is a non-narcotic (Ultram) that I use to address permanent pain in my rib cage thanks to two thoracotomies, but they've been giving me oxycodone lately for post-op pain. I try to stay away from Percocet, however, as I like to have the "occasional" drink and the acetaminophen in Percocet scares me. Despite all my other problems, my liver remains in good shape. I get the itchies from morphine too, Lee, and from oxycodone if I'm on it for long enough.

All that said, some days, like today, I feel like I've got a few more good years in me. I got no bone pain, my bronchial tumor doesn't feel like it's growing (feels like it's shrinking, actually), and I've been dealing with a few lung thangs for the past 8 years with no real diminution in lung capacity or other lung-related issues. If it wasn't so windy, I might consider a short bike ride. Got my new teeth and a pocket full of change from some recent freelance work, so I feel like I'm ready to roll on.

[Maia]

I can't answer about painkillers but I just wanted to leave this here, without bothering you too much, I hope. I don't know if it's feasible, but just in case:
FDA Approved Non-Invasive, Non-Ionizing Radiation Therapy to Treat Pain from Bone Metastases: MRI-guided Focused Ultrasound Surgery

At Fox Chase Cancer Center Philadelphia, PA https://www.foxchase.org/news/2013-05-2 ... metastases

333 Cottman Ave., Philadelphia, PA, USA
Contact: Sandra Ashby Sandra.Ashby@fccc.edu.
215 728-5641
Treating physician: Josh Meyer, MD


https://www.youtube.com/watch?v=x4lA-M3zbdU

Treatment centers:
Fox Chase Cancer Center, Philadelphia, PA
University of Virginia Health System, Charlottesville, VA
Medical College of Wisconsin Froedtert Hospital, Milwaukee, WI
Stanford University School of Medicine, Stanford, CA
University of California San Francisco, San Francisco, CA
City of Hope, Duarte, CA
Mayo Clinic, Rochester, Minnesota

http://www.insightec.com/us/clinical/oncology
https://www.fusfoundation.org/the-techn ... sites/list (need to chose "Bone metastases" as indication and USA as location.
More: viewtopic.php?f=1&t=51602

[CRguy]

Nice find Maia.....worth taking a look at !

Checking out your other topic Eric and I am sayin' homie be layin' down some good WORD here and there !

methadone for pain = yes, we've had some folks here as I recall.
the Tramadol may be more of a low level "background" pain relief and they often add in heavier stuff for break through pain so you're not on the big guns at higher doses all the time ( multimodal balanced approach = often much better results with less side effects )

the acetaminophen = shall never pass CRguy's lips ... useless for me, toxicty issues for many
and like you, I'd rather have a single malt or good red wine for my self medication !

Cheers all
CR

[Lee]

. . . I'd rather have a single malt or good red wine for my self medication !

Yep me too .

Personally I love Motrin for pain. For me it's the best stuff out there, prefer it to prescription pain meds any time. For both my surgeries, while in the hospital, I would take what they gave me, butt once I'm home, I'm on Motrin. I would always talk to my surgeon prior to my surgeries to make sure it was ok. Both times it was never an issue. And yes, I always take it with food in my stomach.

Butt I think BB, your situation is different.

Lee

[BrownBagger]

the Tramadol may be more of a low level "background" pain relief and they often add in heavier stuff for break through pain so you're not on the big guns at higher doses all the time ( multimodal balanced approach = often much better results with less side effects )

The best thing about Tramadol, at least in my experience, is that I don't get a tolerance to it. I've been on the same daily dose for years and it still does what it's supposed to. And yes, it handles the background pain very well. My biggest beef with pain is that it's distracting--top of mind. Anything that can relegate it to the background is what I'm looking for. I don't mind knowing it's there--after all, we hurt for a reason, and it's a reason worth paying attention to. But I can't work if I'm distracted and I'm miserable if I can't work, so that about sums it up for me.

[ozziej]

Hi Eric
So good to hear that someone else has had a similar experience with Tramadol. Have been on the same dose for 11 years and I certainly find it works well as a background medication. I have stepped up to oxycodone for breakthrough pain with good effect. My pain guy talks about how important it is to get pain under control quickly in order not to prime the system. IMO well worth adding a pain specialist to the team.
Wishing you less pain and more time to do the things you want.

[PainInTheAss]

I'm so sorry you're experiencing this! I'm getting a bone scan for a weird pain I started getting in my rib and a CT to check the liver since its on the right side. He doesn't think it is mets, but we want to be sure. Blah!

My daughter is on Fentynal patches (for autoimmune damage related pain) and has done all the rest you mentioned including slow release morphine (and methodone). From the top of my head, hydrocodone is less potent than OxyContin, so it's something a dentist would give for a root canal, for example. I took that for post radiation/chemo crampiness and that's all I needed. She went to slow release morphine when the OxyContin wasn't working, so pretty sure that's stronger. Dilaudid is right there with Fentynal, I would think. I got it after my surgery and it lasted a lot longer than morphine which seemed to work better for breakout pain I had immediately after waking from surgery. Fentanyl is an opioid, but in a time release patch. It's so powerful that if a child were to handle the patch, they could OD, so much stronger than OxyContin. Fentunal is keeping her pain free and functioning, but the slow release morphine did, too. She has a friend who has been on Fentynal patches for many years, so no danger of ODing if you aren't stacking other opioids on top of it, but I think she has some OxyContin for days with extra pain. You just have to take everything exactly as prescribed since most of these are opioids. Tramadol didn't work well for her and was like taking hydrocodone.

Methodone blocks the pain receptors so no other opioids will work while taking methodone so I wouldn't recommend it if you aren't sure how severe the pain might get. It's a bitch to get off of, too, and causes withdrawals when taking high doses.

I hope that helps!

Btw, for the longest time, I thought Brownbagger meant you like to pack your lunch until you explained it one day!

[Ron50]

Hi Eric,
Between high doses of steroids over a long period of time as well as psoriatic arthritis and long term osteo arthritis , not to mention severe neuropathy from the hips down , I was on Targin for three years. I was on 80 mg a day. That is 40mg oxycodone /20mg naloxone. The naloxone is supposed to prevent opiate induced constipation. It didn't for me and every dose I had to take 2 dulcolax and 2 colxyl. It turned into a nightmare and eventually the opiate was generating more pain than it stopped. They would not increase the dose as 80mg daily is considered the highest dose they want to go to in Australia for chronic pain. I could take nothing else because of nephrotic syndrome of the kidneys. I gave the targin away and withdrew from it over 34 weeks mid last year. Not a fun journey. Some days I think the pain is going to kill me but it is better than the opiates in my opinion. They say pain is natures way of letting you know you are still alive....Well I must be living the high life. best wishes Ron.

[BeansMama]

As my palliative care doc explained to me there are different levels. First you have tramadol (which didn't work for me unfortunately) then hydrocodone which can cause problems because of the Tylenol it is mixed with over time, then morphine which is more natural and as she put it 'dirtier' I don't know why. Then you go into the synthetics, oxycodone, then fentanyl, then dilauded, then methadone. As far as medication strength. Some meds work better for someone than others. Oxycodone does nothing for me at 20mg but I get relief at 40 MG.

Personally I am on the 100 mcg fentanyl patch with 40 MG of oxycodone for breakthrough pain. Previously I was on 125 mcg of fentanyl and 3 MG of dilauded for breakthrough but I asked for a reduction because I felt it made me sleep too much. I switched to that combo from 130 MG of er morphine and 2 hydrocodone every 6 hours for breakthrough. That definitely made me sleepy.

I find with the patch it controls my pain well and I am not loopy like most opiods made me. If I need to take the oxycodone it still isn't too bad. I can still function.

This combo seems to give me the best QOL without too much pain.

A palliative care doc is well worth it. It is about QOL versus just throwing meds your way. They actually spend the time to find our how you feel and work with you for the best result possible.