Can someone explain in plain terms how different pain medications relate to one another strenghtwise? Specifically, how do Fentanyl, OxyContin and Lortabs relate the following way: 50mcg Fentanyl patch equals how many mg of OxyContin which then equals how many mg hydrocodone?

Also, is there any (Rx) muscle relaxers available that work exactly as Soma does only with longer-lasting effects? I have tried Flexeril, Skelaxin and Robaxin with no success at all and with bothersome side-effects including stomach and digestive upset and a dizzy or "cloudy" feeling, I have found that Soma is the only one that works for me with minimal side effects (mild stomach upset, slight reflux) but I find it very short-acting, effective for about 3 hours or so and I am only prescribed to take it 2 times per day (spaced approximately 12 hours apart, basically morning and evening). If there is nothing comparable to it, is it possible and safe to take Soma more than 2x per day? Don't get me wrong, I'm not asking if it's OK to break the rules and take more than prescribed, I know that is wrong and dangerous. I'm just asking if it's common practise to prescribe Soma more than 2x per day or if that is the max and I shouldn't bother asking the Dr at all.

Is there a common ingredient in the muscle relaxers I listed that might be causing me to get the stomach and digestive upset?

Hi! :)

I have been on opiates for a while now, after having been free of them (horrible withdrawal! ). But my pain is really just too much to bear without meds so I have gone back on. The problem is, I have been trying a few different things lately and have found one med that I like. My Dr apparently doesn't prefer this particular drug so he wants me to take other things, but I get bad side effects from these things he wants me on. Fentanyl is his favorite, but that gave me progressively worsening headaches up to the point that my vision was badly affected. I used OxyContin after that, which is the one I liked. Instead of continuing me on the OxyContin, he switched me to this morphine pill called Avinza (60mg/24 hr). I have been taking it for a week now, and after giving it plenty of time to work and get used to it, I just HATE it! I wake up with a pounding headache and a hung-over feeling and in a lot of pain. Every morning, it's like I have to "re-set" everything, meaning take the time to shake the headache and get to a more comfortable pain level.

When I talked to him at my last appointment, he basically disregarded my feelings and switched me to this Avinza. He seems to really hate OxyContin, I don't see why though. What's so bad about it compared to this other junk he wants me to take? From what I can tell, it's all basically the same stuff. Isn't it? So if I like one more than the other, I really don't understand why he wants to push this other stuff so badly. What exactly is the advantage of Avinza over OxyContin? Oh, and Avinza is a newer drug and is very expensive (there's no generic form of it yet). Thankfully I have insurance, the pills were about $300 for 30.

I don't have another appt till October, but I just have to call the nurse on Monday and explain my frustration, the headaches and pain is just too much. How can I effectively convey my dislike for the other meds and get the meds I prefer? I don't want to seem rude or anything. I know, the nurse at the Dr's office is very busy and gets a lot of calls per day, so I don't want to seem like I'm being rude or pushy, but I am so frustrated at this point! In this particular Dr's office, the nurse does the majority of the patient interaction and she would be the one I'd have to talk to about this, and then I guess she relays it to the Dr, so I need to find the most effective way to get the message across! I don't need an appointment for this, I'm just trying to do this over the phone. Since I've already been on these meds, I don't think there should be a problem, it's just a matter of getting the message across.

Maybe a nurse could give an opinion on how I should approach this?

Thanks for any help! :)

Fenatyl is a really nasty drug. It's local and powerful and can kill in a heartbeat. I'm surprised.

Oxycontin is extended release opiate and normally gives about 12 hours of relief. Everybody's maximum dose is different. Too much causes respiratory suppression. The drug cannot be cut although you can take three 10 mg tablets to get a 30 mg dose.
The prescribing info doesn't recommend it be taken PRN. Usually it's prescribes to get rid of pain for a continuous short period and then your off it. It has a notorious potention for abuse and getting high.

It's a morphine derivative which you can tailer the strength.

It looks like Avinza is essentially morphine by mouth and it combines a short acting and long acting versions together and it looks as though the concentration is somewhat steady over a long time. It looks like it's designed for long term pain management. http://www.avinza.com/pdf/Avinza_PI20081219.pdf

Knowing what I know about Fenatyl and morphine, both are really strong meds although some are, I guess what I would call allergic to morphine. Some may have headaches or have hallucinations when taking morphine.

I THINK he's looking for continuous pain relief with less of the abuse potential.

Hydromorphone is a long-acting opioid that might be worth a try which is long-acting. It's suggested to combine it with a short acting analgesic for rescue use.

What's probably missing from your treatment, only a guess, is your ability to modulate the amount of pain relief you get. True, if you need continuous, be on a continuous med. Sometimes you may need more, sometimes less and sometimes you might just need a boost. You will probably be happier and may not get caught up as easily in the needing more and more of one med to get relief.

Combination therapy (long acting and a separate short acting rescue med) is probably better in the long run than a single long or single short-acting med. For both lesening depndence and increasing the quality of life.

I do like the sound of combination therapy. I'll mention it next time I see the Dr.

But as for in the short term, from now till October, I'd really just prefer to switch back to the med that I liked and didn't have problems with. I don't think I can handle these headaches and stuff until October!

I really just want this to be simple, just do this over the phone. I have baan to the Dr's office probably 4 or 5 times rather recently because of some bloodwork and other testing I had to do, so the expense (co-pays, gas) and time and travel (40 minute drive each way) with 2 screaming little kids... uggh! I'd rather just try to get him to switch my meds over the phone and we can discuss things further at the next appt in October!

Oh, and yes, I do need a continuous painkiller for possibly long-term use. It's possible that I might need another surgery, so after that surgery I might be able to get off the meds altogether. Or at least free from regular use, I might need something for once in a while use, like hydrocodone (lortab).

He is most likely reluctant because it is a very addictive narcotic and long term use is highly contra indicated for that drug.

He has to answer to a board that look at how many narcotics he prescribes and give valid reasons for doing so.
I personally would rather have hydrocodone or vicodin than Demerol.Demerol and Morphine make me ill.

If you are not asking for a higher or more potent narcotic because you just want a buzz than he needs to pay better attention to what you are telling him.Tell him its not about that .Doctors are so afraid to talk about if they think you are abusing a drug.Get the conversation going.

Headaches is a serious side effect.

I have never had any kind of fear when it came to a doctor and I always went in there informed and told the truth.
I have told a doctor I am not leaving here until I understand what you just said to me.

You are paying for their service.If a plumber or a mechanic was giving you the brush off you would tell him who was boss.

Have the conversation or or find another doctor.
Good Luck!

I didn't even see headaches as a listed side-effect in my prescription information. Do you really think it's something I should be worried about? What could it mean?

Morphine doesn't seem to "click" with me. I have had it IV a few times while I was in the hospital, and I really didn't feel that it did much good for me as far as pain relief and I do remember getting headaches then too.

I read somewhere about an enzyme that has to be present in the liver to properly use morphine, and rarely some people are missing it. Maybe I'm missing it?

Quote:

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Originally Posted by passmeby

I didn't even see headaches as a listed side-effect in my prescription information. Do you really think it's something I should be worried about? What could it mean?

Morphine doesn't seem to "click" with me. I have had it IV a few times while I was in the hospital, and I really didn't feel that it did much good for me as far as pain relief and I do remember getting headaches then too.

I read somewhere about an enzyme that has to be present in the liver to properly use morphine, and rarely some people are missing it. Maybe I'm missing it?

---

I never heard that about the enzyme but I don't doubt it.
I find certain narcotics work for me.
I would not say having a headache is dangerous but common sense dictates that it's a sign of something not jiving.
Why replace one pain with another?
Its friggin ridiculous.
I would tell him what works for you,that's it .
If he thinks your playing him he just won't do so an honest open discussion is what you got to do. IMO

Hey, if your talking about that sheet that you get at the pharmacy. Forget it.

Take a look at www.rxlist.com, Drugs.com | Prescription Drugs - Information, Interactions & Side Effects or drugstore.com Online Pharmacy - Prescription Drugs, Health and Beauty, plus more and/or use Google and type with the quotes like:

"Avinza physician prescribing information"

Well, he's the one who prescribed the stuff to me in the first place, so I don't exactly know why he's all of a sudden wanting to change it up. I didn't ask for any of this stuff specifically, he's the one who decided what to put me on on his own. I was using the OxyContin for a good while, over 2 months straight doing just fine, until all of a sudden he insists I take morphine. I don't know...

And yeah, I did look at a drug website, drugs.com I think? To see the side effects they listed because I know that the pharmacy print outs aren't very complete, just a general kind of reference. Part of the problem might be that this drug Avinza is new-ish so some side effects might not even be reported yet.

Quote:

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Originally Posted by passmeby

Well, he's the one who prescribed the stuff to me in the first place, so I don't exactly know why he's all of a sudden wanting to change it up. I didn't ask for any of this stuff specifically, he's the one who decided what to put me on on his own. I was using the OxyContin for a good while, over 2 months straight doing just fine, untill all of a sudden he insists I take morphine. I dunno.....

And yeah, I did look at a drug website, drugs.com I think? to see the side effects they listed because I know that the pharmacy print outs aren't very complete, just a general kind of reference. Part of the problem might be that this drug Avinza is new-ish so some side effects might not even be reported yet.

---

You know you better than he does and you have to be firm and tell it like it is.
You are paying for him to give you a service,not the other way around,
Good luck!

Many Drs do not like prescribing Oxy's because they are highly addictive and sold as a street drug. They are one molecule away from heroin and called hillbilly heroin.

Quote:

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Originally Posted by N0help4u

Many Drs do not like prescribing Oxy's because they are highly addictive and sold as a street drug. They are one molecule away from heroin and called hillbilly heroin.

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Hello:

Bingo!!

Doctors are more concerned with HOW it's going to LOOK to the DEA, instead of how to control their patients pain...

Another example of our failed Drug War..

excon

excon's answer is the right one. Fear of the DEA.

If you had a "nice doc" then you could possibly do it over the phone, BUT...

The prescription must be in the pharmacist's hands with 7 days or postmarked within 7 if using a mail order pharmacy.

If the psysician is part of a large organization like a hospital, this can add significant transit time in he mail. He also has to provide the stamp.

Some docs can really picky with these meds. They may either require an appointment, only give enough for a month, and/or require you to physically pick it up.

What looks good is getting it from the same pharmacy prescribed by the same doctor for a reasonable length of time and that you would have no leftovers. He needs to ensure that say, you have an appointment every 3 months.

I do the oxy through the mail all the time. I use it as needed (PRN) which would be an "off label" use.

Say you normally require 20 mg a day, but some days you could use 10 and other's 30 or even 40. That's being able to change based on the amount of pain, but it doesn't solve the ability to handle something acute, lie adding acetminophen or aspirin to the combination. When you add Acetominophen your essentially making Percoset.

You didn't say what kind of injury we are talking about, but drugs such as Soma (muscle relaxer) and Neurontin (kin of a nerve deadener) should really be used as a first line of defense.

Another rule with pain is that if you medicate at the slightest hint it will get worse, then a smaller amount of medication will be necessary to get relief.

A simple example of this:

You burn your finger. It's not hurting. Place in cool water immediately. It will hurt less and not blister as much.

You hit your head. Ice pack immediately. The swelling will reduce and it will hurt less.

And the final one. You stomach hurts and you drop a rock on your toe. The toe now hurts and the stomach doesn't.

Yeah the problem is you DID have an addiction so the doctor knows you are prone to addiction. They will not prescribe something that is highly addictive if they know it can lead to problems. Plus many people that have had or do have addictions are not only taking their meds but combining them with alcohol or drugs. So the doctors have to take all this into consideration when they prescribe meds.

I think these posts should be combined. One gives insight into the other.

https://www.askmehelpdesk.com/medica...er-370058.html

Can you tell us exactly what your pain is from?

IDK but I know when I have pain what works for me (and I have had somas a couple times in my life) is I break them and take pieces at a time so that I am not getting too much at once and then it wears off and I have to wait.

I don't know if you need the entire pill at once for your pain or if that would even work for you but it works for me but I don't get severe pain,

Just a thought you might try.

Some of what you ask for for equivelency is in the prescribing information, I think.

Hdrocodone, I believe is not available separately. It's mixed with varying strengths of Aceteminophin (APAP) in the brand name Vicodin. Acetiminophen has limits due to liver damage and that's what all the hoola has been about recently.

Soma http://www.soma250.com/pdf/full_prescribing_info.pdf
is available at 250 and 350 mg strengths and I know can be taen 4x per day. The half life is less that 2 hours, so the effects are totally gone in 10 hrs

Absorption: Absolute bioavailability of carisoprodol has not been determined. The
mean time to peak plasma concentrations (Tmax) of carisoprodol was approximately
1.5 to 2 hours. Co-administration of a high-fat meal with SOMA (350 mg tablet) had no
effect on the pharmacokinetics of carisoprodol. Therefore, SOMA may be administered
with or without food.

Soma has been used for long-term relief (years) despite what the prescribing info says.

Intestinal upset can be a tolerance thing. A typical diabetes drug took me a month to get to 1000 mg/2x per day. I started with pieces of the tablets and took until my body tolerated it and then gradually increased it.

Stomach upset can usually be relieved by taking with food and/or milk. Some things like antibiotics are rendered less effective by taking calcium.

Threads merged

NoHelp, yeah I was addicted to the pain meds, but I was legally prescribed them. The physical addiction came from the long term use, not from any kind of abuse. I took the meds as prescribed. I used the meds for a very long time, so I think anyone using it for that long would become physically addicted. But anyway, my GP Dr doesn't know this, this script was from my Neurosurgeon. All my GP knows is that I was seeing a Neurosurgeon, had surgery, surgery has since failed badly. I told him what meds I had been on, and instead of having me on Lortab, he put me on a roud-the clock opiod treatment. The damage I could've done to my liver from taking the acetominophen so much like I had been was what he wanted to eliminate. SO, I am no longer taking any acetominophen, which is great. He did a LFT (Liver function test) to make sure I hadn't done any damage. My GP knows nothing about me being physically dependent on any meds, I have only been seeing this GP since fairly recently. At the time when my Neurosurgeon dropped me, I had no GP.

As for my need for the meds, it's a neuroligic issue (spinal) and another issue that I am not really comfortable talking about, as I haven't really come to grips with it yet myself.