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Newcomer here but veteran chronic pain sufferer

AnonymousUserAAnonymousUser Posts: 49,900
edited 06/11/2012 - 8:26 AM in Pain Medications
:H Hello all. I stumbled on this blog sight as I was researching pain meds. I empathize with you all and know what you're going through. I have had two cervical spine surgeries, two knee surgeries (one on each knee), one elbow surgery, and two for carpal tunnel on the right hand.

Currently I am in pain management. I take two 80mg CR morphine capsules a day and 40mg of oxycodone ir as a rescue dose (breakthrough pain). Three years ago I moved from NJ to NC. While in NJ I was taking 40mg oxycontin tid and up to 20mg oxy ir as a rescue dose. I have been on chronic pain meds since July of 1999 and have been suffering with chronic pain since March 1991. I had my first cervical spine surgery on Jan 30th, 1992. It was an anterior bilevel fusion using allograft bone tissue C5-C7.

My pain was never resolved after this, and in fact, got much worse over time. Because this was a workers comp related injury my complaints of worsening pain unfortunately fell on deaf ears, however, not being the type of person to pack it in and give up I continued fighting for further medical care even after my case had been adjudicated.

From late 1992-1999 a psuedo-arhtrosis had been suspected of being at least partially responsible for my continuing pain. Finally, I found a doctor that knew his spine surgeries who ordered a CT scan with 3mm overlapping cuts. This indeed revealed a pseudo-arthrosis at both levels of the previous surgery. In my pursuit of getting proper medical care for the condition, it was unfortunate that my attorney of record did not agree with my legal position on the matter. I had to argue my case against my own attorney, and in fact, I wrote my own legal brief using case law to support my position. This eventually convinced my attorney to proceed with the matter in the manner I wished.

I am happy to say that I won the case and my former employer was forced to pay for my continuing medical care, and to this day is still doing so. I suppose the point I'm trying to make to all of you is, NEVER GIVE UP! THERE IS A GOD! THERE IS HOPE! AND LAST BUT NOT LEAST, THE TRUTH WILL EVENTUALLY PREVAIL!

All of this being said, I would like to mention a few things regarding some of the posts I've read here. Bioavailability has absolutely nothing to do with blood serum drug levels. Bioavailability refers to the amount of molecules of a specific chemical which is expected to reach the central compartment ( central nervous system). This has to do with essentially how many passes the drug makes through the liver metabolic system, how many metabolites the drug is converted to, and how many of these metabolites pass through the blood /brain barrier.

Someone had cogently indicated that medications formulated in higher overall dosages usually indicate that that particular medication has a lower bioavailability which in general is true but not set in stone. For example, morphine has approximately a 40% bioavailability, while oxycodone hydrochloride is around 80% (all of this is at least partially dependant on the individual patient as well). Typically, it can be surmised that oxycodone is approximately twice as strong as morphine.

Additionally, other factors directly effect the bioavailability of a particular drug. One of the most significant factors effecting this is the route of administration. For example, most opiod medications have a higher bioavailability when administered intravenously, a little less when administered intramuscularly, little more less with subcutaneously, and then the least when ingested orally. This is believed to be as a result of receptor sites being located throughout the smooth muscle tissues in the digestive system. The more smooth muscle tissues that are avoided during the administration process, the fewer molecules will bind to the receptors in the smooth muscles, the more will bind to the receptors in the central nervous system. Also, the rate of absorbtion is directly related to the efficiency of the medication as well.

The faster the medication is absorbed the faster it is distributed to the receptors the more of the dose takes effect at the same time. In other words, when taking medication orally it takes more time for the drug to be broken down and absorbed, and as a result the molecules are distributed at a slower rate to the receptor sites which means that by the time the last molecule binds, other molecules previouslty bound will leave the receptor sites, as as a result will not be having an effect at the same time as the last molecule. I hope all of you feel better and meet with success in finding relief to your pain!
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Comments

  • Your explanation regarding the bioavailability of medication was interesting. Now, if I can just find a way to administer my meds intravenously! :)
  • :) hi and welcome to the forum! :H we are here to offer you support and answer what questions we can. as you are familiar with the forum please continue to drop by anytime. <:P i hope your pain issues are resolved a bit for you. good luck! =D> Jenny :)
  • Welcome to Spine Health :H I'm happy to hear that you won your case and were able to overcome all those osbstacles. You and I (as well as many here) are suffering despite having surgeries. All my pain comes from L4-S1 and I have had both levels fused over 7 months ago for severe DDD, recurrent herniation, retrolisthesis, nerve impingement, and I have facet problems too. My back pain and sciatica are chronic and I take the meds listed below for it.
    What you wrote about bioavailability was very interesting. I'm trying my best to understand it. I was wondering if Fentanyl patches are strong as Oxycontin, since I read that Fentanyl's bioavailability is 90%.
    I'm sorry that your pain has worsened after your surgeries and I hope there will be some treatment that will bring you relief.
  • Welcome to Spine Health! I'm sorry your pain is ongoing but glad you won your case! Thanks for the information on bioavailability - interesting!

    Cheri
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