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Intolerant to most pain meds and IN PAIN

stockbrokersstockbroker Posts: 464
edited 06/11/2012 - 8:32 AM in Pain Medications
"Gosh. I am s-o-o-o-o lucky" she said, sarcasm dripping from her every syllable. I have a damaged L5 nerve, suffer chronic pain and am intolerant to most pain medications. The only drug I can take with NO side effects AT ALL is Dilaudid. Recently, I had a spinal cord stimulator implanted and while it helps my pain a good deal, it is not the be-all and end-all I had hoped it would be, which is to say, I will not be able to wean off of my meds completely. It turns out, it is really unusual for people to be able to get off of their meds with a SCS. I was so disappointed, I actually slipped off the precipice upon which I've been balancing, and fell into depression. I had, however, been able to reduce my Dilaudid from 8mgs 4X day to 8mgs 3X a day. I guess that is something. I mentioned to my PM doc that a few days, I was able to get by with just two doses of Dilauded (or total 16mgs.) The PM doc, like others before her wants to get me on a long-acting drug. I have tried Oxycontin, Avinza, Fentanyl, and Kadian. The first two made me very, very nervous, almost panicky. The Fentanyl made me nauseous. The Kadian was the best of the lot but I did develop severe abdominal pains which were attributed to the Kadian. My current PM just put me on Opana ER, saying it was a long-acting Dilaudid. When I went to pick up the prescription, the pharmacist asked me about it, because oxycontin and oxycocone are listed as medications I can't tolerate. My research tells me Opana ER is more closely related to these two meds than it is to Dilaudid. So, I took the 10mgs. of Opana and 1. I felt nervous and 2. it did nothing for my pain. Additionally, this doc prescribed Dilaudid 4 mgs. for breakthrough pain. I don't see how that's going to do the trick. When I was trying to wean off the drugs, I got down to 8mgs Dilaudid 3X daily and tried to go to 6mgs Dilaudid 3X daily and the 6mgs didn't cover my pain. I surely see the benefit of a long acting drug but if all of them give me bad side effects, what is the harm of just staying on the Dilaudid, from which I have NO side effects. I feel absolutely normal except my pain is relieved. Is Opana like long-acting Dilaudid? My body doesn't think so. Any thoughts, comments re: Opana ER and re" 4mgs Dilaudid for break through would be appreciated. Susan.


  • hi, im no dr or nurse, nut have experience with pain meds. i believe diluadid is hydro-morphone and opana is oxymorphone, you can get both in er and ir forms, for me the oxymorphone is a little stronger than hydromorphone. just like oxycodone (percocet) is slightly stronger than hydrocodone (vicodin). i hope this info is helpful and you get conyinued relief. remember always get med advice from your dr. your treatment depends on it.
  • Most PM doctors prefer long acting pain medications as the base medications because there is not the constant up and down blood plasma levels that come with using shorter acting pain meds, like dilaudid, vicoden, percocet etc.
    Nervousness is not necessarily a "bad" side effect unless it becomes disabling, considered more of a nuisance than one that prohibits taking a certain pain medication. Almost every medication out there in the market and in development has some side effect to it, many of them have a lot of side effects and it becomes a matter of learning to live with the side effects, waiting for them to subside some and they usually do once you are on a steady dose for a period of time, or if it is unbearable, then stopping the use of that particular med.
    The other issues with the other medications not relieving your pain is probably , in large part due to the low dose of them. With a change in any medication in PM, doctors use a conversion chart, taking your daily intake of medication, and then converting it to the new type of medication, dividing it into how many doses per day you will be given, and then reducing it a percentage for cross tolerance issues. Medications will need to be titrated up or down , to see what dosage will cover your pain needs, while minimizing the side effects that you experience.
    Opana is a good medication, and once you have been titrated to the correct dosage, you may find that it offers you similar relief to what you are getting with the dilaudid.
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  • Thanks for your comments. After a day on the new program, I think its going to work. Between the small dose of Opana (10mgs) the small dose of Dilaudid (4 mgs) and the stimulator, I seem to be doing okay after all. I guess my doc knows what she's doing. Imagine that! Thanks again.
  • oxymorphone (14-Hydroxydihydromorphinone) is more derived from morphine while oxycodone is from codeine (14-hydroxydihydrocodeinone).

    Kadian and Avinza are both morphine just one is 24hrs and 12hrs respectively.

    hydromorphone (dihydromorphinone)is also derived from morphine.

    Fentanyl (N-phenyl-N-(1-phenethyl-4-piperidinyl)propanamide)is actually not derived from any natural opiate but is synthesis from 4-piperidinone hydrochloride.

    So if one of the morphine relatives gives you problems you would usually switch to the codeine and so forth. If the morphine relatives give you different side effects for each pill but not the same it must be some other inactive ingredient that they use in the pills/patches.

    Maybe a little too technical but I studied chemistry for a long time and thought I might try putting it out there.
  • im pretty sure that oxymorphone and hydromorphone are two different meds. diluadid is hydromorphone and opana is oxymorphone, thats from the manufacturers info packet.
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  • Sorry the stim isn't working like you thought it would. Everyone wants to see the best scenario take place...one with no need for medication. I will be having a morphine pump installed soon, and even with that I was told I still will need oral medication. I probably will get off the the MS Contin gradually and keep taking the oxycodone for breakthrough pain.

    It's also a good thing that Opana is helping you now. As you know, there has been extensive debate about whether or not it works. Some people think it's worthless while others say it helps with their pain.

    I did switch from Fentanyl 100mcg to MS Contin 180 mg's daily, and I know the dose was calculated a little below what the conversion chart says to take. I'm sure it was for safety reasons because I never took this much morphine before, only in injection form from a hospital for various reasons. So far I tolerated okay, but it doesn't last the full 8 hours in between doses (3 pills a day).

    Hang in there, and I hope the Opana does the trick. Take care
  • I've actually spent quite a miserable weekend. The Opana feels like I'm taking Nothing and the 4mgs of Dilaudid is half of my usual dosage. I've got my stimulator cranked up but I've slipped back into that dark place called depression. She started me out on 10 mgs of Opana for two weeks and then I'm to go up to 20mgs after 2 weeks. How am I to live with the pain for the first two weeks. I don't get it.
  • Very sorry to hear that. I have been through that myself. It took me a couple months to get to the right dose of Avinza with perocet for breakthrough pain. I was miserable. Started on 30mg and now take 90. I tried doing the lease amount of work possible, and laying down whenever I could. I even threw in some anti-inflammatory but nothing seemed to work until the avinza dose was right for me. Good luck and hope u feel better soon. I did notice someone post earlier that avinza was a 12 hour med??? Mine says its a once a day and thats what im prescribed. Am i confused on this?
  • Like you, I'm intolerant to pain meds...well to almost all meds really. What I've found is that my body really needs longer to adapt to the medication being introduced in most cases. How long are you giving the meds? Is there a way to start out slow and work your way up into a stronger pain med? Perhaps this would help broaden your possibilities.

    Just a thought,
  • The doctor is starting me out on a low dose: its 10mgs Opana ER for two weeks and then 20mgs. My problem is that the 10mgs is doing squat for my pain and my usual Dilaudid has been cut way back so now I'm almost always in pain. Since I recently have become pretty significantly depressed, this increased pain is very hard to deal with.
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