September 30, 2009 - 10:22pm
Hello All,
I am New to the Forum this evening. Firstly, I must say after 10 years in a Pain Management program I have never read anything like some of the posts in these forums. I have read entries that most seemingly came straight out of my head. It is hard to verbalize the agony and changes in life one must endure due to suffering from a chronic pain injury, and in these forums I have witnessed others who are experiencing similar issues and living similar lives. It has been a breath of fresh air to read some of these posts and feel a sudden burst of hope that I had lost long ago.
Now for my Story/Background: I was a Soldier in the US ARMY and suffered a severe injury whilst serving overseas with the 1st Armored Division during the 2000 to 2005 time frame. I suffer from Induced Muscle Compartment Syndrome for which I had 4 Fasciotomies, twice on both legs. I have been on Pain Medication ever since the 1st failed operation in late 2001, I was started on 5/500 Vicodin. Overtime I gradually moved from the 5/500 to 7.5/750 to 10/325. This went on for years during my visits to the VA where I could never get an answer and had to fight for my Meds every month. Then I was lucky enough to take a job with amazing healthcare and had the opportunity to make an appointment with a real Pain Mgmt Doctor. This is where I was introduced to Percocet (Endocet) 10/325, Ultram ER 100mg, Gabapentin 600mg, Fentanyl 50mcg, Oxycontin 20mg, Lidoderm patch (This was about 4 years ago). I have gone thru the whole show with Pain meds without much success. My Most recent "Cocktail" was a 50mcg Fentanyl patch a 20mg OxyContin x2 a day and 10/325 Endocet as needed for breakthru pain roughly 5 a day along with the application of a Lidoderm patch to both legs. I have also neglected to mention that I had a Spinal Cord Stimulator Implanted 9 weeks ago which I run high. The OxyContin was just not cutting it and my lovely wife who is my rock and confidant that gets me thru the tumultous life that the CRPS has led to discovered Opana in a Forum much like this one. I mentioned it to my Pain doctor who is a saint (I have his Cell phone number for emergencies) and he said sure lets give it a go. I asked to start out on the Opana ER at 5mg twice a day along with the 50 mcg Fentanyl patch and the 10/325 ENDOCET for Breakthru pain as well as the Stim, I have already noticed a differnece with the Opana at 5mg vs. the 20mg OxyContin. However, I am only getting 5 hours or so out of it and it's a bit weak. I would think I need to be on atleast the 20mg of Opana since according to the Opana website it is a 1 to 1 conversion from OxyContin to Opana. Does anyone have any idea how much different the 5's are to the 20's in stregnth and duration.
I look forward to speaking with all of you!! Godspeed in your journeys to a pain free life....
October 1, 2009 - 1:27am
#2
Opana strength
Patches_NY
I have been taking OxyContin for about 15 years for control of the pain associated with severe osteoarthritis. My highest dose was 4 of the 80mg pills every eight hours (12/day), with oxicodone 15 mg, 6/day for breakthrough pain. About a year and a half ago my (new) pain doctor suggested replacing half of the OxyContin with Opana. He had been uncomfortable with the large doses I was taking when I started with him and also thought the combination would give me better pain relief than increasing the OxyContin any more. As I had never heard of Opana and was having no problems with the OxyContin, I was not thrilled with the idea, but agreed to try it. Until I was forced to quit, due to the severe pain, I had practiced as a Physician Assistant in Cardiothoracic Surgery and my attitude was - stick with what's working. To my surprise, the combination did work better than the OxyContin alone! The only problem was the cost - $2200/mo. for both. So I could only stay on it as long as my insurance covered it. I am now on OxyContin and MSContin which, so far, doesn't work as well. As far as the equivalent dose - Opana is about twice the strength of OxyContin. So 40mg Opana replaces 80mg OxyContin and the immediate release Opana 5mg - 1 or 2 pills replace the 15mg oxycodone. There is a narcotic equivalent dose site on the net which will compute the doses between any two narcotics for you - I will try to find it, but wanted to get this off to you before it got any later.
Please accept my thanks for your service to our country and let me know if there is anything else I can do for you.
face
October 1, 2009 - 9:47am
#3
Gratitude
Many Thanks for all of your kind words they are much appreciated 
. It is not often tht one gets thanked for such action. I am so thankful for my companies insurance program after hearing about the cost of this medication, I had no idea such a proposterous amount of money would be allowed to be charged for medication. In my eyes this is similar to the credit card rate issue in this country thier should be a ceiling for RX costs. I can not believe that the R&D required to create this Drug can validate its current cost more alarming is the ability for each pharmacy to choose its own price!!
From what I am reading it appears that Opana is much stronger than OxyContin but many have elduded to the fact that this is not true when taken orally? I think I must lean towards FACES comment above "Opana 5mg - 1 or 2 pills replace the 15mg oxycodone" It seems as if the 10mg Opana are aligned with a 15mg Oxy so based on that I am assuming that a more lateral transfer would be to go from 20mg OxtContin to 10mg Opana? Ideas?
3red3red - They Patch and the Opana see to be phasing out the need for Breakthru pain medication (10/325 percocet) - by this time I would have taken atleast 2 percocet when I was on the Oxycontin - as of now I have not taken any!!! So yeah for that -
I have also heard of Insuarnce comapnies suddly stopping the coverage of Opana - Has anyone heard of this as well?
Many Thanks in Advance as always -
October 1, 2009 - 6:18pm
#4
Increase the Fentanyl Dosage?
It's just a thought, Patch, but it's THE wonder drug for me. I have severe cancer pain that is caused by the life-extending hormone therapy that keeps my cancer somewhat at bay. I'm currently on the 72 hr 100 mcg p/h patch with the Fentora "fizzy" tablets (400 mcg 4 p/d) and OxycodoneIR 30 mg 3 p/d. This is the best "cocktail" that I've found by far. I will sing praises to Fentanyl for the rest 'o my life . . . when I first began using it my self-reported pain level dropped from 7.5/8.5 to 3.5/4.5. That was the first drop in 2 years! I have just started the Fentora and I'm not ready to make any statements as to it's efficacy just yet. Anyway, since I don't know beans about Opana I hope you don't mind my proselytising about Fentanyl.
Oh yeah, I'd like to add my Thanks to the others on this thread . . . you folks are the greatest. I only wish the politicos in D.C. would treat you as well as you all most definitely deserve . . .
Q
PS: Howdy JJ, glad to see you back!!!
October 1, 2009 - 6:48pm
#5
Agreed-
I have spoken with my Doctor about this before. Earlier we were going to increase the Fentanyl patch but I felt it was better to try to keep the Fentanyl low and try another pill. I have always read such horror stories about Fentanyl so I was nervous to start with it and cautious when using it. It has always been my goal to achieve the most amount of relief with the lowest dosage possible. I guess that is the whole philosophy of PM anyway but I feel I take a proactive approach to it. I ask my DR to always start me "one lower" than he would normally start. If its too low he just tells me to double if applicable or just to come back in and we can change it up. He really is a wonderful guy- At this point though I feel that raising the dosage of the patch may be the answer as well. Okay third week of Oct is my next monthly appt since I have to go every month!!! Ahhh I Hate that-I will ask him to bump it up then-.
October 1, 2009 - 7:12pm
#6
I hear you on the "keep it
I hear you on the "keep it low" thing, Patch, I hear you on the "Fentanyl horror stories" as well. I was worried spitless about switching to it after reading these extremely cautionary articles about it in Newsweek, The New Yorker, and Atlantic Monthly. Now those are all respectable magazines, it's not like I get my info from People and The National Inquirer. I had read several posts here from someone that had been using the Fentanyl patch for 4-5 years and she always praised it. This was a very articulate, down to earth, intelligent woman with kids and the whole normal life thing. Needless to say, I felt very confident in her opinions. She and I had a rather lengthy P.M. correspondence over about 10 days and she really put my mind at ease about the drug. I can't believe how the media can brainwash us . . . I've always thought that I was pretty immune to that. Boy, was I wrong! I hope that the increased dosage helps you, Patch. The 100 mcg that I'm on is perfect and I really don't see any need for an increase for several years. Enjoy the weekend . . . Q
October 2, 2009 - 9:57pm
#7
just to clear up what I said
Hi guys!
I found the equivalence charts and conversion calculators I mentioned:
- MedCalc Narcotic Equivalence Converter - Narcotic dosage conversion calculator with buprenorphine and 13 other opioids
- GlobalRPh's Calculator for Converting Various Narcotic Dosages to Fentanyl Patch Dosages - Calculator and table for converting current narcotic analgesic therapy dose to equivalent fentanyl patch dose
- GlobalRPh's Narcotic Dosage Converter - Calcuator for converting various narcotic dosages
- GlobalRPh's Equianalgesic Conversion Chart - Provides dosage conversion guidelines for common opioids/narcotics
- Equianalgesic Dosing for Management of Acute or Chronic Pain - Provides narcotic dosage conversion in instances where the management of acute or chronic pain is necessary
http://www.globalrph.com/narcotic.cgi (The 3rd one) Is the one I use and have found it to be very accurate. It includes a % reduction for incomplete cross tolerance which may come in handy in patients sensitive to the differences between products.
The 4th one is a pretty good chart for quick comparison, but always be sure you are comparing the same thing - same route (oral, IM, etc) and same action (immediate vs, long acting). These all appear to be immediate release products.
*****
Sorry, I should have been clearer that the "Opana 5mg - 1 or 2 pills replace the 15mg oxycodone" was for the immediate release pills. My experience with oxicodone is that the 15mg pill (Equivalent to 2 Percocet 7.5mg pills without the acetaminophen) is very small and cannot be accurately split. The Opana 5mg is splittable, but not really worth the trouble - I would choose 1 pill or 2 based upon the amount of breakthrough pain. The extended release Opana really are twice as strong as the Oxycontin. So you need half as much: Opana 40mg = Oxycontin 80mg. All of these doses are oral.
As far as insurance coverage - I have heard of companies stopping coverage of Opana (mine did), but a note from the doctor that nothing else was working gave me back the coverage. He also had to write a note in the beginning to get Opana when it was pretty new, because it was "off formulary", but it was never a bigger deal than writing a note or filling in a form they sent him, I think the companies just want to be sure they aren't paying out these huge amounts when an older, cheaper drug will do just as well. And you can't really blame them for that.
I did use the Fentanyl patch early in my pain history and was pleased with the pain control (although I usually only got 2 days, rather than 3 out of it), but it got to the point where my skin got so irritated from it that there was no place to put a new one, due to recovering rashes from the previous placements (plus the itching drove me crazy).
Finally, I agree with using two or three meds at lower doses, rather than maxing out one and then switching. There are far fewer side effects and many times the two meds act differently enough that they complement each other for better relief of the pain.
(edited)
October 2, 2009 - 9:57pm
#8
Thanks Q
.....you notice everything, don't you Q? No seriously, I am going to try and be a better Pharmer member.....promise
October 3, 2009 - 1:13am
#9
Man
Q, I hope I can recall this list in the future.
October 3, 2009 - 7:19am
#10
My experience with Opana
My experience with Opana suggested to me that a 40mg Opana(Oxymorphone continuous release) was equivalent to about 80mg Oxycontin(Oxycodone continuous release). Ok so basically Opana(Oxymorphone CR) is one of the strongest painkillers available in the U.S. other then Fentanyl-Fentanyl being stronger on a mg to mg basis. Let me explain Fentanyl comes in 25, 50, 75, and 100 mcg. Now 100 mcg is equivalent to 10 mg of Fentanyl that way we can compare the 3 drugs i am going to discuss on an equal scale. I have a few ideas on how we could get you on a better breakthrough pain management system.(1) First of all I think you should talk to your doctor about getting off the Endocet because the Endocet has a 10mg Oxycodone to 325mg acetaminophen(tylenol) ratio and if you didn't know taking to much acetaminophen is really bad for the liver. My suggestion would be to ask the doctor about getting on the the 5mg Oxycodone immediate release(which have no acetaminophen) or he could put you on the 15mg Oxycodone immediate release tablets which also have no acetaminophen.(2) Now since he has you on 40mg of Oxycontin(Oxycodone CR) a day instead of you taking your Endocet or some of the alternatives that i mentioned he should probably just bump you up to 60-80 mg of Oxycontin. (3) Now you mentioned that the Opana(Oxymorphone CR) seems to be having better breakthrough pain than the Oxycontin which comes to no suprise to me. For one like I mentioned earlier its more potent mg for mg, and two sometimes when you take the same opiate for an extended amount of time you build a tolerance for that specific opiate. So alot of times doctors actually encourage you to either alternate or switch opiates because the effects will usually be more profound because your body isnt used to taking the other opiate and of course in some cases like in yours the oxymorphone happens to be stronger than the oxycodone. Theres one more opiate i think you should know about that i think would also help you with some breakthrough pain and opiate is called Dilaudid(Hydromorphone), its potency is probably right in between Oxycontin and Opana leaning more towards Opana in strength so its also stronger than Oxycontin mg for mg. It sounds like your going through some real pain and it sounds to me like your going to be doing this doctor thing for awhile so I thought I'd share some of the knowledge I know to help make things a little easier for you, I hope everything goes well with you and your family and wish you nothing but the best-God bless, the OxyKing
October 26, 2009 - 8:03pm
#11
Hooah!
Patches_NY
I too served in the Army, and was wounded overseas. Thus my ordeal with pain meds. I can say from personal experience that the Opana ER works if you give it a chance. It does not give you that burst of energy and feeling that you can do anything that Oxy does, but it works. And if you have ever had those nights where you are in bed crying in pain, you will see that the Opana takes that away.
October 28, 2009 - 9:12pm
#12
OxyKing, here's a simplifier . . .
Let me see what I remember from my high school math 40 years ago. One gram is equal to 1,000 milligrams (mgs) and one mg is equal to 1,000 micrograms (mcgs). That would make 10 mgs equal to 10,000 mcgs, not 100 mcgs equivalent to 10 mgs, am I right?
There is a conversion table in the PI for Fentanyl that really helps out when you switch from a different opioid to Fentanyl. In my case, I switched from OxycodoneIR and I'm a lot happier as well as pain reduced because of the change. It lowered my self-reported pain level from 7.5-8.5 on Oxy to just 3.5-4.5 . . . that was the first drop in over 2 years despite continual increase in dosage.
I'm on the 100 mcg p/h patch which converts to a daily total dose of 157.5-202 mgs of Oral Oxycodone, 39.1-51 mgs of Oral Hydromorphone, 315-404 mgs of Oral Morphine, and 105-134 mgs of Oral Methadone. I hope this helps anyone that is thinking about switching over
One thing that I always try to emphasize when I talk about Fentanyl is the fact that it is not a euphoric. Many posters have dissed it because they rate their analgesics on the strength of a side effect, euphoria, and not on the actual reduction of pain. A wrong-headed method to say the least. Enjoy the evening . . . Q
First of all, let me thank you for your service to our country! In today's vast diversity of opinions about the war, too few of us take the time to thank the men and women who protect our rights as Americans, to think, feel and say what we want.
I can't answer your questions about conversions; there are far smarter persons with better knowledge. I can though speak to the praises to Opana, ER and IR. Both have given me my life back and for the first time in many years, I am as close to being pain free as one can be when your spine is referred to as a "spider-web". Through five failed surgeries and titanium rod, I too ran the gambet of drugs - most had little impact on the pain itself. I've been on the 20mg ER and 10mg IR for four months. (I am surprised you are on the patch and the ER).......anyway, yes these are very expensive, $873.50 this month; to me, worth EVERY penny. If you search this forum, you can find differing opinions as to the effectiveness of the Opana's. As with all other pain meds, there are the lovers, the haters and the abusers.