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Pain Medications IR vs ER

I am sure that you have read posts that talk about Immediate release and extended release pain medications.
Not every one understands the difference. I know I did not until I started using them and better understood their purpose.

The ones most of us know about are the Immediate release kind. That is the perocet, Vicodin, etc that many doctors prescribe when they first get involved with patients with spinal problems. These medications are designed to give you immediate relief, for first time users, they can get that 'high' initially. This takes your mind off the pain,it happens quickly, but it doesn't last long.

Then the extended release medications (ie Oxycontin) are designed to provide a patient with an even amount of pain relief during the course of a day. Thats why most prescriptions are written for 1 or 2 dosages a day, perhaps 3. Taking this type of pain medication does not provide you with that immediate relief nor will it generally provide any type of 'high' feeling.

I see a big problem with the Immediate relief type of medication. You (not meaning any one individual) take it, you find good relief, but several hours go by and the pain comes back and you look to take another pill, even if its before the prescribed time.
You grab for a pill, does that make you a drug abuser? a drug seeker? No, it just means that you are in pain and you are looking to find some relief. I do believe that this type of pain medication can get easily abused.

I dont see as much a problem with the Extended release. I recall so many times when I was taken this type (probably about 2 years straight), I never felt good, but I never felt bad either. It was more a less a calm. Then depending on the dosage of the extended medication and your condition, a breakthrough pain medical (Immediate relief) may be prescribed.
Those you take in between the time periods of the ER medication.

If I could graph both types of medications here, this is what it would look like

Immediate Relief: Up/Down Up/Down Up/Down Up/Down Up/Down

Extended Relief: Ok -------------- Ok -------------- Ok ---------------------- Ok

and for some

Extended Relief Ok -------------- Ok ---- >IR ----OK -------->IR--------- OK

The IR means when you need breakthrough medication to help.

No doctor wants to see their patients in pain, there is no question about that. The do want to make sure that they are prescribing the correct medication for their patient. Now, there will be times when the doctor and patient do not agree.
I will probably hear screams about this, but I would side with the doctors being correct. They are the trained one, they can read the diagnostic tests and from clinical examinations determine how much pain a patient is in. I have personally witnessed patients that just want to be pain free, so they keep asking for more medication, higher amounts, etc They just dont want to deal with the pain... And I cant blame anyone for not wanting to deal with the pain.

But nothing is always black and white.

Ron DiLauro Spine-Health System Administrator
I am not a medical professional. I comment on personal experiences
You can email me at: rdilauro@veritashealth.com


  • Ron thank you for this post. I have printed it out to take to someone who has just been diagnosed with a rare untreatable cancer and is in a lot of pain. He has never taken any kind of medication in his life. They haven't given him anything for break through pain so maybe he will ask for something as he needs it. He doesn't understand why slow release medications don't work immediately and have tried to explain but this will be better as he can read something that he can understand. So thank you, this is so timely for me.
  • do start to deliver their medications in an hour, but are made to deliver the medication, steadily throughout the dosing period. If you are supposed to take one tablet every 12 hours, then by the end of hour one, the medication is being delivered to your blood stream and will continue to be delivered over the next 11 hours. Once you are into a regular dosing schedule, you will not notice the ups and downs in blood plasma levels that come from the use of short acting or immediate release medications.
    The difference in a few extended release or long acting medications are those contained in a patch form- bupenorepinephrine, and fentanyl patches. Both of them, when first applied can take somewhere between a few hours to a few days to build up to a steady plasma level in your blood stream. This is only for the first time that you put the patch on. Once you have been through a patch change (fentanyl) or bupe patch change, you will continue to have a steady blood plasma level in your body and the pain relief will continue, even through the patch changes.
    Breakthrough medications ( immediate release or short acting) are not meant to be used at every little increase in pain that you may have, despite the amount you may be prescribed per day. Every patient should discuss the use of breakthrough medications with your doctor to make sure that you understand how he wants you to use them, but in most situations, they are meant as a "rescue" medication only. For those times when the pain has flared significantly over your normal pain that should be reduced by your long acting medication. Try other pain reducing modalities first, ice, heat, heating pad, pain relieving creams available over the counter , and resting, hot showers. If none of that reduces the pain enough, then it might be time to consider taking a breakthrough medication. Since they are immediate release, you may be able to try half a dose to see if that helps to relieve some of the pain, and wait an hour. If needed then take the other half. Again, this is something that you need to discuss with your prescribing doctor to clarify how he/she wants you to use your breakthrough medications, however , if you start taking the breakthrough medications with any type of regularity- assume you are prescribed 4 doses per day, and you find that you are taking them halfway through your long acting dosing schedule several times a week, your body will quickly become adjusted to your doing that and that will tell your body that you are experiencing withdrawal or the pain levels have escalated on the days you don't. It also leaves you with nothing to manage the real onsets of exacerbated pain levels on those days when you overdo it or something causes a significant flare of pain,, Use them wisely.
  • thoracic spine painthoracic spine pain Posts: 566
    edited 12/16/2013 - 12:31 AM
    Deleted post - guess you didn't read my post - I know this isn't a site for cancer but kinda assumed u had read my post. I guess I think people should be able to live and die with dignity. Was a tad upset after putting my dog to sleep. It was such a peaceful death - would be good if everyone including animals could die peacefully.

    I was taking the information for someone who has cancer so guess we both got our wires crossed. Anyway the outcome for me was that he read Ron's explanation and it was really helpful especially for people who have never had to take strong drugs in their life. Thank you for the condolences for my 18 year old dingo.
  • sandisandi Posts: 6,343
    edited 12/14/2013 - 4:15 AM
    I am not sure what you are ranting about since I didn't say anything about cancer patients or anyone not getting pain relief.
    I think you need to re-read my post and not read things into what I said. I am sorry for the loss of your dog. It's heartbreaking.
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