Ranking of pain medications and their effectiveness

I was reading through some posts regarding interest in the ranking and effectiveness of pain medications but found it locked so I decided to approach this subject in a new post. The information given was very much on point in regards to what pain medications work and those that do not do as well. As discussed by other members it is a matter of what pain medication works best for you and your individual pain and chemical makeup coupled with metabolism. I have been on most pain killers as a result of 13 surgeries and in my own personal experience the following medication list indicates my progression through the different meds:

1. Percocet - following dental work
2. Vicodin - post op pain management
3. Lortab - same as above
4. Oxycontin - same as above
5. Morphine Sulfate - fractured elbow (fibular head)
6. Dilaudid - chronic pain management for inoperative lower back injury
7. Norco - same as above
8. Fentanyl patch 50mcg/hr - same as above

These are the main ones that I recall and have been on pain medications since I was 21 in the Army following many injuries and surgeries increasing my tolerance over the years.

Everyone is different and how your liver processes the drug and creates enzymes is particularly important as to the effectiveness of the pain medication. At one time Morphine was very effective but as my tolerance increased my medications had to be changed.

I personally found Lortab's very effective for a period of time but the side affects regarding the itching was not comfortable. After being moved up from Hydro 10/325 concern for my liver was greatly taken into consideration and I was changed to Dilaudid 4mg every 4-6 hours and for a time (with the itching very prevalent) was comfortable with its effects. As the pharmaceutical effects waned my doctor and I discussed changing to something different and a little stronger in the Fentanyl transdermal patches 50mcg/hr which I am very happy with because there is no up and down pain control - it is very balanced in its delivery and the itching is very minimal to non existent. I do not feel drugged and the pain although not completely gone manages it effectively and was prescribed Hydro 5/500 for break through pain as needed. The reason I am covered very well with liver panels done every 6 months is in efforts to keep the potential damage to my liver in check. Another reason I am followed so closely is that I am also on 1mg Xanax BID, Temazepam 30mg one night for sleep aid and Ambien 10mg the following night - they are alternated to minimize tolerance effects of my sleep aids, Fioricet for migraine HA's, and Cymbalta. I have had substance abuse issues in the past yet opiates were never my drug of choice, I am very fortunate to have a psychiatrist and Primary care physician who are not on the band wagon with many other physician's who find drug use so negatively, but after thorough counseling sessions it was determined that my substance abuse was secondary to my efforts to self medicate for PTSD that I was unaware of for many years and was not being treated for appropriately. Fentanyl patches work for me now and they are one of the strongest pain medications at this time.

I wish everyone in similar chronic pain situations the best and don't be afraid to try new meds and give them a chance at your doctor's discretion - I know that morphine, oxycodone/oxycontin, percocet, and demerol or not effective in my case but like so many others have mentioned and will agree - the many factors of your body's physiology greatly impacts what medications will work and those that will not. Our chemical receptor's in each of our brains are unique and different and finding the right pain management medication falls into trial and error especially in the case of other medications you are prescribed.

Don't get discouraged and just know that our differences are what make us so interesting and some things will work while others won't - just because research and a manual has been written can never explain the individual chemical makeups for us. Be patient, do your research, and trust your physician and pharmacists. Trust me I am on very potent medications in combination and I am glad that I am followed so proficiently.

Some can take 5mg of morphine IV and not know where they are at and others can take 8mg of Dilaudid and operate a vehicle better than most sober people.

Thanks Vickie for the welcome. I took the courage to join a forum like this in efforts to help others if possible so that I can also better understand and grasp the therapeutic concept of some of my own issues. I saw the chronic pain section and the interesting and diverse conversations prompted me to add my own perspective. I was asked by a member of my therapy team to start opening up about PTSD to gain insight and begin healing.

I also want to improve my skills in public postings, forums, and blogs. One of the better learning methods is to dig right in and immerse yourself first hand.

Sophia-

When you had dilaudid after your surgeries and in the hospital...was it through an IV?

The liquid (IV) form of dilaudid is very different from the pill form in that the amount of medication your body actually receives after breaking the pill down is not very much. Aka the pill has poor bio availability, especially in comparison to the liquid form which enters the blood stream directly so is absorbed completely.

Just didn't want you to be disappointed if you end up trying the pill and it doesn't give you the same results.

Lexi--- yeah it was in the IV. I have never had any tablets of it or anything stronger than oxycodone. Thank you for the info that is helpful. Do you have any other suggestions.

|Disabled vet yes thank you for this thread. I would like to know if you have any suggestions also.

Hey guys.It's not incouraging to see that the med that a Pain Management has me on isn't listed.Nucynta 150.But I guess I already have figured out that it is not really a true opiate.And Suboxone has 0%.Right now as I type this I've had abouut 1 milligram of a Suboxone strip,for my stomache and will take Nucynta after I eat something.

Going back to the Doctor the 24th.I'm seriously thinking about telling them to chunk this Nucynta.

I didn't know there were fentnyl tablets.I'll bet they're pretty effective.

Post Edited (tidalmouse) : 7/13/2013 7:06:23 AM (GMT-6)

I've actually tried the patch.It's actually a little strong for me.

I think they put me on the Nucynta because I did mention it.I should have kept my mouth shut it looks like.After being on various pain meds for the last decade I think I may be still feeling some withdrawals.I started on the Nucynta about 6-7 weeks ago.

My stomache has gotten pretty bad on this Nucynta.I knew the Suboxone would settle it.I'm been taking phenergen also.I know Nucynta is a Sched 2 but isn't it what some people call "Super Tramadol"?Since I switched from Hydrocodone to Nucynta I've kind of felt like crap.It may be that I need to take a smaller dose of Nucynta.

David I'm not QT but can answer this for you. Fentenyl sold under the name Onsolis I believe that's how its spelled is a transmucosal strip. Meaning its instant release and dissolves usually in the cheek. It's given in much smaller doses as it's absorbed rather quickly and it's also one that requires special prescribing for cancer patients only at this time.

As for placement of your patches it's absorbed thru the skin and enters the blood stream in this way so getting it in the area of your pain doesn't guarantee better direct relief other then some areas of the body are better for rate of absorption, skin is thinner and pliable and filled with blood vessels.

You wouldn't want to put it for instance on your hands or front forearm as these are areas where your skin is usually tougher.

Logical questions no reason for laughing. It's how we learn.

Hey you guys! Sorry it took me so long to respond! Thanks Vickie for having my back and answering for me. :0)

it's cool, QT, I got a good answer to my question

Just a few additional comments on oral fentanyl (be it the "lollipop" (Actiq), buccal lozenge (Fentora), buccal film (Onsolis), etc)....

It's definitely not a medication that one would want to use until everything else has been exhausted.... it's only meant for opiod-tolerant patients, etc. Yes, it's definitely a "powerful" medication -- that being said, I consider fentanyl in all forms to be strong and to be used w/ caution. (But, if you really think about it, that goes for all narcotics).

That being said, it does have a place in pain management. While it's meant "on label" for cancer pain, numerous medications are written "off label".... oral fentanyl being one of them.

It's also a very expensive med to get an insurance company to pay for...but there ARE those that will cover it... or, as a recent member shared - she pushed on and on and did eventually get her insurance to approve it.

For me - it's the one medication that truly helps my pain. If I'm having a migraine (which used to knock me out of commission for a day or two... and use to include endless trips to the ER for fluids/meds) - this gets rid of my migraine (in most cases) within 30 minutes. It also helps reduce the severity of my back issues and other pain issues.

So.... as I shared, it's definitely not a "starting point" medication.... I do consider it an "exhausted all other avenues" type thing.... but I just wanted to share my experience w/ it.... and that it's not completely impossible to get scripted for severe pain management.

--Tina

Loretta, I like it on my forearms ,because I really don't have any hair on the part of my arms, less painful pulling them off, plus, they are out of sight even if I am wearing a T-shirt.

This has been a very educational and interesting thread to me, for sure.

David

I put the patch on a little on the outside, but on the front. I hope you can get the picture of what I'm trying to say. lol

Loretta