Which long-acting pain medication works (or has worked) best for you? Opinions needed

As much as anyone would like to help...it's impossible to say what is going to work for you. Even if we had identical "back" issues....everyone is so different with their overall health, metabolism, possible side effects, etc...

So, not trying to blow you off here...lol...but I just think it's best to speak to your Dr. and tell them exactly what you are saying here. That your pain levels are not being managed well enough each day.

I can recommend being as specific as possible though with exactly what type of pain you are having, where it is, and what makes it worse and what makes it better. Every Dr. wants to know that you are doing things to help your pain each day so that you aren't expecting just the opiate to be the only thing to make the pain less.

I thought I had read before that you were doing pretty well with your pain levels so if I may ask what are your levels now?

And I don't think you have ever had any back surgery? Or maybe it's just not listed on your signature.....

When is the last time you have had a round of PT, aqua therapy, or injections? Have you tried acupuncture? And do you also have a TENS unit that you use daily as well?

And lastly, what is the amount of exercise that you get each day?

These are all things that a good PM will want to know and I know I say it all the time but it's true, it's about using as many modalities daily/weekly/monthly to keep the pain at a decent level.

I usually just approach my Dr. and let him work out a "plan" for any raise in pain levels as it may not include having to up or change my opiate. It could be adding a different med or the other things I mentioned.

When is your next appt.?

It just may be that you've gone as long as you can and surgery is something that is needed to help stablize things.

Hey outammo, I have been on the fentanyl patches for five years. Recently I have noticed that they are not as effective. My pm doc changed up and put me on MS Contin. That worked great. It was like I actually had a normal life like everyone else. I had lortab for breakthrough pain andi didn't even need it. The only problem was, I have had gastric bypass and it made my stomach hurt so bad that I couldn't stand it. So, after two weeks I went back and they changed me to exalgo er. He gave me the highest doseage that there is in that. I didn't find it to work any better than the patches. Plus, it was real expensive. I took a prescription for exalgo to the pharmacy for 14 pills. That is two weeks worth because its a once a day pill. I went to a pharmacy that didn't take my insurance because I was hurting too bad to go anywhere else. I thought since it was a small script that I would just pay for it. When they called my name to let me know it was ready, the lady had a funny look. Then she rang it up and said," ok that will 674.00." I about had flipped!!!! Needless to say I ended up having to take it to the pharmacy that accepts my insurance...lol. Now I have had to go back on the patch and she changed my break through meds. My patches are a higher dose also. I try for two weeks and then go back. I still have a couple of others options I can try. They told me if I try other meds and then go back to the patch that just that small break would possibly make it to where the patches will work better. Hope this helps... Janet

My last MRI was in Sept. of last year. And I wouldn't say that my pain is higher exactly, its just that it has moved to different areas of my body, and while it isn't there 24/7, it comes and goes on a regular basis. I am not saying I want to change from the patch at the time, but when the pain comes it just makes me think that there may be a better way of doing things that could help it a bit more.

Also, my BT med listing is being generous. I am prescribed 40 pills a month. I can take 2 of them a day but I am not expected to take them on a daily basis. Just prn. I usually only take 1-2 every 2-3 days just so that I always have some on hand.

I am on gabapentin for nerve pain and flexeril for my muscle relaxer. I also tried robaxin but that one just gave me a nasty taste in my mouth, so I am back on flexeril.

To answer your question, I've used MS Contin, Fentanyl, and Oxycontin for LA meds, and so far the one that has worked best for me has been the Oxycontin.

Also, Exalgo is the name of the ER version of Dilaudid.

Hey Outtamo,

For me - fentanyl works the best for my pain issues. Unfortunately, I can't use the patch. I do use oral fentanyl and opana IR as my BT meds.

I'm currently on oxycontin as my ER med. As others have mentioned, there is also morphine, exalgo and opana.

If the fentanyl is working... and you don't have side effects.... I would suggest making adjustments in your BT medication, to see if that helps your situation. You could increase the dose of the oxycodone. You could try opana IR... dilaudid (have you ever used this?)... etc.

So.... even w/ the fentanyl... you are at a daily 7-8 on the pain scale? You said up until this last month, it had been working.... so the changing every 48 hours isn't making a difference? Just wondering....

Take care... --Tina

It just made me sick and I couldn't handle it. My body just did not like it at all. I don't know why.

I guess my point is that you wouldn't be asking for "more" BT meds but just a stronger strength to take when needed. So you can tell them that you only use "x" amount per month...but if they move to the 10, 15, or even the 30mg then it would actually work for the BT.

So, you could even ask them for only 20 for the month and tell them you don't want to be taking it every day...Just to have something work for a day when there is a big flare..

I just think that because you are on Fentanyl...none of the other meds that have been mentioned will be strong enough for you and you would have to be on a very high dosage of those which may make them even more uncomfortable..

I would be getting an appt. with your Neuro to make sure you don't have something else going on as it's unusual to be upping the meds (which yes, for most people it would have made a difference from 72 to 48 hours) and not working at all...

Or as I mentioned, it just may be time for surgery as it's really not feasible to continue going up in medication every few months for years to come...

Keep us posted..

Matt: The only thing that I have changed is my exercise routine. I have been trying to exercise more often to lose some extra weight (I need to lose about 25 lbs or so to be in my normal range). My doctor and physical therapist have both told me if I lost some weight then my pain might be reduced in the long run, and I also have high blood pressure.

I also returned to school, and going back full-time when I haven't taken any college courses since 2009, and at the same time trying to take care of my son 50% of the time when he isn't with his mother. I suppose this may have something to do with my stress and anxiety level. I never really thought about it but it does take a larger toll on me than what I had going on before.

I will ask about my BT med at my next appt next month and see what they want to do. I will re-iterate my new pain in new areas and see if another MRI would be a good idea.

Thank you all.

I know what you mean. My son turns 3 in April, so ours are pretty close. Definitely a handful.

We are all different (obviously), our pain varies (obviously), and pain medications affect us all differently (hat-trick!). However, sometimes we can learn something from others' experiences - so here's mine!

First, you may have already answered this, but what mcgs. are your Fentanyl patches? When I was using them, I was on the 48hr regimen almost from the beginning. Whether it was my metabolism or whatever - I had little to no pain relief by the 3rd day, and experiencing w/d symptoms too. I don't take a long-acting medication anymore. With my current issues, I get much better pain control with short-acting medication. That being said, when I was taking a l/a pain med, I had decent pain control with the Duragesic 75mcg and also Oxycontin 20mg. My b/t meds were Percocet 5/325 and oxycodone IR 15mg. (2 separate combinations - not all 4 of these at the same time! Lol). I was also on the 100mcg for awhile and needed very little b/t meds. Now on the other hand, my fiance does well with just a l/a med (morphine 60mg ER). Actually, he is just starting a reduction to the 30mg.

I agree with you - surgery should be a last resort - for several reasons (medical, financial, emotional, family/work issues, etc.). The doctors that I have dealt with through the years usually agree that all minimally invasive treatments should be exhausted before more invasive treatments are tried. Always do what is best for YOU. I hope you start feeling better soon! Have a peaceful day.

Post Edited (Splashdancer) : 2/11/2013 7:28:10 PM (GMT-7)

Have you tried Oxycontin Janet?

Splashdancer- My BT meds are the same, Percocet 5/325 and Oxy IR (except I use the 10mg dose instead) also different combinations, not at the same time. My pain level has been much better with the addition of the second BT med.

I also discovered that using all the same type of pain med makes a huge difference for me in terms of side effects. Since I've switched to strictly Oxy (Oxycontin, Percocet, and Oxy IR) I havent had such horrible nausea and vomiting and everything else.

I think my BT meds seem to be my main problem then. It just seems that when I have large flare ups I have nothing to counter it with that seems to control it in any way that allows me to function as normally as I can. I think I will give my doctor a call tomorrow and leave a message regarding this and see if we can talk about adjusting my BT meds.

Thanks to everyone for their help, it has given me more insight and more information to discuss with my doctor the next time I go in.