Posted 2/16/2013 12:07 AM (GMT 0)
you must divide that question into two. is cost(money) an issue or do you have great coverage and/or cash to pay for the newer better ones that they make a killing from, enough to where Purdue Pharma. had no problem paying multiple billions in fines or court settlements and still have a huge profit margin. we are about same age with same pain problem. i am 34 but in my 20s it was rough due to very hypocritical people who could not put themselves in anothers shoes. it is still that way but no near as bad and because many of those "friends" where struck down with chronic pain and then i hear, "i don't know how you have made it through 10 plus years of this", i did not understand until at 22 and very in shape an immediate transition to can't hardly walk and horrible pain changed my way of thinking. keep in mind most doctors do not understand. to question, point #1, cost an issue, you are limited to about 20% of meds on market: (should say tried all of them and when hurt 3 years into degree in pharmacology and now practical experience) in this apprx. 20%: Morphine Sulfate Controlled Release tablets 15, 30, 60, 100, and 200mg also i think generic capsule version like Avinza or Kadian may be on market: 30, 60, 90, 120mg. unless like Avinza which has a portion of immediate beads and slow release beads i would not want it. Methadone is prob the cheapest but powerful if it is good on your system, (i get nightmares), 5, 10, 40mg tablets. Methadone can be used in combo and help because it does things like control or lower tolerance by NMDA antagonism. after that you may have the best bet for "the lower price, ha), Fentanyl is a great! pain killer, the problem is it is so lipid or fat soluble the oral route is not possible and i hate the darn patches and the tegaderm covers to make sure it stuck the 2 or 3 days, i think it restricts movement but they stick to some people. last time i had the fent. patch it was 2 100mcg/hr patches changed every 3 days, they work just won't stick, for breakthrough pain i think it was oxycodone IR 30mg qid = 4/day prn=as needed. they where still up in price; 200.00-300.00 a month, generic! then OpanaER generic which has been out there for maybe 1.5 years sucks, comes in: 5,10,20,40mg, maybe 7.5mg and 30mg and 15mg. all suck. Purdue won court case so no generic Oxycontin (i think), even so the brand name OxyContin changed the formulation more similar to OpanaER without a large blood level within the first 1.5hrs, older OxyContin was like a big bang then controlled release, they took that out. so i tried new OxyContin brand: 80mg 3/day every 8hrs. and it was no good for me and very expensive. one off chance; if possible at least try it, Levorphanol, brand name Levo-Dromoran is "on back order" for 5 years. never tried it but heard much about and researched it, it may be the best single opioid analgesic in America. one way to get it; find a local compounding pharmacy and ask if they can make you 2mg capsules, (4mg made but not perscribed much), it does everything! NMDA antagonist, SNRI properties like tapentadol, has strong affinity for most all opioid receptors in central nervous system, and kicks in fast and is very long acting, off hand i think 48 hr half-life. you get advantage of dose accumulation like Methadone. also seems to help nerve pain better than more morphine like opioids, Levorphanol is 100% synthetic, when i got price quote for 100 2mg compounded capsules it was under 20$. i am taking a stretch break and then the expensive long acting opioids. if you have the means that is prob way to go. as long as dose is titrated to effect and as long as you have the right breakthrough pain/activity pain medication you should be able to level off and if need be take dextroamphetamine or Provigil to stay alert, wakeful, and motivated with good cognition ability you can put this horrible chronic pain into remission. that also means is muscle spasms occur or anxiety/insomnia, depression or apathy occur aggresively treat them. i can relate with you. Wellbutrin along with pain meds pulled me out of fog before, it increases dopamine and norepinephrine in neuronal space that can be used. your age is your advantage. you can come out of this some what. has any doctor talked about surgery and if so what kind(s)? Nick