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I would deffinitely look into rotation of baseline meds because obviously you build up your tolerance very quickly and switching between the meds such as kadian, oxycontin, opana would take advantage of incomplete cross tolerance. My choice of baseline med would be the oxycontin and breakthrough with the oxycontin i would choose dilaudid but if i was on a different baseline med than oxycontin like your kadian then I would want roxicodone (immediate release oxycodone). I wouldn't want to take the roxicodone with the oxycontin as I would get the best relief from the two different oxycodone preparations but they are both oxycodone and your tolerance will go up even quicker that way. I prefer the oxycodone then the dilaudid for breakthrough. demerol is rather weak orally (IV is a different story) so for breakthrough meds I would either stick with the dilaudid or look into roxicodone (it comes in 5, 15, 30mg strenghts). Morphine (ms contin, kadian, avinza, etc.) tends to make me too sleepy and lethargic which is why I would prefer the oxycodone for extended release

It isn't a common narcotic prescribed, but apparently from research I've done, all of two to four milligrams is enough for four to six hours of pain relief. So I gather it's a potent medication, hence my curiousity. I have called and found it in stock somewhere, but the stock is on hold for another patient. If it can do what I've read about, it would be godsend. The generic name for it is levorphanol. It's a synthetic drug like Duragesic or Demerol or Darvocet.

I have extensive damage throughout my back that is all inoperable and the pain is absolutely excrutiating. In fact, so much so that I get no euphoria or any of those kinds of side effects from my medication–likewise, I don't get sleepy, dizzy, feel nausea, etc., I simply benefit from pain reduction. It's strange, living like this: I'm sure you can relate. But my doctors are very competent and this as much as they can do, give me medication to ease the pain. I wish I'd never been in that car accident, I'll tell you as someone who knows the pain of wedge compression fractures, if you have one up as high in your back as me, with the wedge all the way to the spinal cord (a very lucky near miss) and the nerve damage that radiates throughout my back, plus the pressure of the wedged bone on the rest of my spine causing pain throughout, and to add to all that, scarred tissue from torn muscles, ligaments and tendons, you must be able to at least empathize. Our situations are obviously different. I was never given the chance at surgery and never will, so I suffer severe pain day in, day out. It will always be this way; I've grown to accept that (one must). I don't know what procedures you were lucky to have had that have allowed you to get by on four Percocets a day, but my situation really does warrant and require a high baseline and a high breakthrough set of drugs for my pain management. Once again, just from sitting here I'm in pain for having been sitting too long (over 15 minutes). I'll have to go lay down soon. Anyway, you are right, there will always be some pain...but four years is a great deal of time in the timeline of getting my health back on track, I think you got a sore deal and probably should be getting more pain treatment, but I don't know how you feel daily. I envy that you were able to get surgery, I wanted that from the get-go but it was a no-go...sigh. I don't sit around feeling sorry for myself, though. But don't worry, I'm in no danger nor overmedicated. My doctor is a damn fine physician and I'm lucky to have found him. 

Have you spoken to your pain management physician about an intrathecal pain pump?        

If you are not familiar with it is a pump which is impanted into your body usually in your abdomen and it supplies medications through a catheter which is placed in your spine.    You can also google it for more information.

 It is quite invasive but it could allow for much better pain relief with less medication.    

 It is also not without risks but for many they are a life saver.

 

 

 

 

 

 

 

 

 

 

barbary, I also am on 3 oxycodone (40 mg) and oxycodone for b/t for myself it was the best pain releiver that I have had. I tried the fentanyld patch but I  had a alergic reaction to it I have a history of  many allergies. I have 2 bulging discs along with a preety bad neck injury and other problems from a head on collision. I now have to switch to Morphine ER if this last drug store runs out of the generic Oxycontin. They did have it around the 13th of this month for it is a new drugstore that just opened. I myself am quite worried that I will not have the correct amount of Morphine, basically I am assuming  my doctor will start on   the least amount possible and I wil probably have to wait month to month until the correct amount works I absolutley hate this. As was mentioned maybe the switch will help me because I only had morphine when hospitalized. My Medicare D plan does not pay for brand names. I wish you the best for if these discs keeping getting worse I probably will have to think about surgury which was talked about briefly until I quickly changed the subject I also do not know if my doc will change the b/t medicine to morphine also,I will find out the middle of August. I have read many posts in here that orally Morphine is about 30 to 50  weaker than oxycodon-

I'm 32, so a decade younger, and I cannot BELIEVE that you don't have a pain specialist that will treat your pain properly. My doctor and the clinic he practices at have the philosophy that no patient, no person, should be living in undue pain.

Meds can't *totally* alleviate the pain, but they certainly can go a long way to making your life more livable. I used to walk with a cane when I didn't get the right doses of medication, and thankfully like the paralysis of limbs of that's history. Of course, I did physical therapy for a while. I slack on my exercises, but I try and do as much as I can remember to. That helped, and so does light exercise like walks or bike rides. I just feel lucky that I didn't end up quadriplegic...just a few millimeters more and I'd be in a wheelchair. But the flipside is that I have great amounts of radial nerve pain, as mentioned. I wonder sometimes that if I had become quadriplegic if I'd be in constant pain?

I know it's morbid, but sometimes it feels like...well, you know I bet. I am disabled. I am on SSDI and SSI, it's all official. But since people can't see my disabilities, they seem to assume I'm fit for duty for any and all things. Even my family seems to forget that I'm disabled. Do you ever encounter that mentality with people? When you became disabled, did you notice people one-by-one sort of disappearing from your life? Boy, I have.

I often feel very alone with all of this; enough so that I go to a shrink too and have my whole set of drugs from that. I've got stomach problems too, so I have a specialist for THAT too.

My freakin' medicine cabinet is like a pharmacy. Some clonazepam here for anxiety, some hydromorphone, Soma and Kadian there for pain (plus my Lidoderm patches), some Protonix and some Donnatal for my stomach, & some Abilify and Lamictal for mood stabilization. I even have trouble sleeping, believe it or not, so I've got temazepam for that. So automatically, bars and the like are basically out of the question. My liver and such are under enough attack, haha. Ain't them vehicular accidents a peachy thing? 

Back to Medicare, though (for anyone who's on it), I have a number of those meds filled as brand name. Medicare is tricky like that; that's partly why I mentioned my personal pharmacy. Anyone on Medicare should always call their provider and find out if certain brands are covered. You'd be surprised. 

...just slowly, well, actually come to think of it only within a matter of about five months, oxycodone eventually just quit working as well as it had in the beginning. Maybe now it would work proper again, but my high dosage of Kadian (I'm on Medicare and that's brand name, it's covered depending on who your carrier is; mine is AARP and they're great) is comparable to the two 80mg twice daily of oxycodone. I'm intrigued by oxymorphone in spite of the reviews of it I've read here. I think I will ask my doc his opinion of it. He's a well-informed doc and does the conversions to almost perfect accuracy. I really don't know how I'd handle one of those pumps, though. I like to control my medication, and since that's so invasive and like fentanyl, it controls and regulates itself (unless you have those oral fentanyl pills that dissolve under your tongue, or the lollipop...but I'm certain those are both reserved for cancer patients). I don't know, a few people have said that oxymorphone works well with them; and that doctor that posts here backed it up. I just know that when the clock hits such-and-such time, I always (daily) feel the pain coming back full force; and when I'm doing well with my meds, that doesn't happen so much. I don't find myself clock watching for when I can take my next batch like it's a full-time job [groans and laughs at the same time]. That's also why levorphanol appeals to me, but I have not read one post from anyone save the fellow that posted the chart that even knows what it is besides me. You haven't heard of levorphanol have you? It's also called Levo Dromoran. What are your thoughts on Opana ER?

 I have had all types of people giving me a hard time for a long time..I got my Medicare card when i was 23...I take 12 diff pills daily...slightly over 20 pills daily....I have thought about switching drs for a few years...when i feel rough mostly...but i do see where my dr is coming from due to my age..to young to be on way high doses for this chronic pain...he has talked of patches but went with the kadian with the new diagnosis of the arachnoid problem...anyway take it easy...

 

I am not a Dr. I just play one on TV.

 

 

 

 here is a link...please take a good read...and yes you could get this...i try to warn people here about injections in and around the spinal cord...all though you can get this from other reasons...I remember a couple times I had shots in the cord...that the dr really had to contort me in crazy ways to place the shots..once he did a shot that really tweaked my left leg...now its showing itself in my left leg  pretty good..

check the link

http://en.wikipedia.org/wiki/Arachnoiditis

 

I am not a Dr. I just play one on TV.

 

 

 

 I also have severe back and neck troubles (along with almost every other joint in my body). Hydromorphone does work for bt pain that is moderate to severe and the actiq works for the severe bt pain. You do not need to have cancer for these to be perscribed, but you do have to work your way up to them with trials of other combos as well as building tolerence to other meds first. Yes, they are expensive 120 a month runs between $5,000 & $6,400 w/o insurance. I am not sure how medicare D works, they may be stricter on only covering these for cancer patients, but I don't have a problem with my ins.. They will only cover a quantity of 120 per month though. I wish you luck and never give up, there is a combo out there that will make life more tolerable.

yes, the suckers are fentanyl and yes they come in generic and yes they work.

Yeah, it looks like I'm a prime candidate for contracting this. My doctors have told me that over the years my spine will continue to compress where it's wedged, thus pinching the nerves there further. I guess all I can say is that sucks you've got it, I won't be getting any epidurals again, no implants and I hope to high heavens that I either a) never get it, or b) get it later in life. I'm still so young.