Opinions - What is the best opiate medication of these for pain?

Discussion in 'Opiates & Opioids' started by I_8_my yellow crayon, Jan 12, 2010.

  1. DF118-Dihydrocodeine 40mg Immediate Release

    1 vote(s)
    9.1%
  2. DHC Continus 60,90,120mg-Time Released Dihydrocodeine

    0 vote(s)
    0.0%
  3. Co-codamol 30/500-Codeine phos 30mg/Paracetamol 500mg

    1 vote(s)
    9.1%
  4. Perdureta's-50mg-8 hour Time Released Codeine

    0 vote(s)
    0.0%
  5. Vicodin 5/500- 5mg Hydrocodone/500mg Acetaminophen

    2 vote(s)
    18.2%
  6. Tylenol with Codeine #4- 60mg Codeine/325 Acetaminophen

    0 vote(s)
    0.0%
  7. Teva 60mg Codeine Phosphate Tabs(pure)

    0 vote(s)
    0.0%
  8. Percocet 5/325- 5mg Oxycodone/325mg Acetaminophen

    7 vote(s)
    63.6%
  9. Darvocet 100/325-100mg Dextropropoxyphene/325mg Acetaminophen

    0 vote(s)
    0.0%
  10. Tramadol-100mg Immediate Release Tablets

    0 vote(s)
    0.0%
  1. I_8_my yellow crayon

    I_8_my yellow crayon Palladium Member

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    As some of SWIM's friends on here know, I am a pain sufferer. He deals with daily pain. I had aproblem once with the heavy opiates like Hydromorphone, Oxymorphone, Fentanyl, and such. So he strays away from the potent narcotics.

    I have 4 plates in his arm and a pin in his shoulder.The pain is also a type of pain that isn't persistant for all 24 hours of the day, but is present everyday. It just depends on the day, some days I need to take pain medication all day long, and some days he only has to take one dose. But it does flare up atleast everyday, and is unbearable:cry: when it does, which is why a chronic type opioid medication is not needed, and breakthrough pain medications are more suitable.

    Right now I do not get sick if he doesn't take his pain meds, because he doesn't take them all day long everyday, as said before, some days are better then others. The medications listed are what I have access to, and everything else is out of the question. Thanks.
     
    Last edited: Jan 12, 2010
  2. desertimplant

    desertimplant Newbie

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    I didn't vote in the above survey primarily because he's moved pretty far beyond the specific meds listed...but it's a good poll and provides a good basis for some great discussions\learning for all. SWIM's concern is that if one must use really any of the meds listed for a period longer than say...6-12 weeks then it may be advisable to really look more closely at a time-released version of one of them as well as a B\T higher power type....
    Based on the drug list provided, which has You previously used with success?

    Here's SWIM's observations as a chronic pain sufferer for going on 9+ years

    SWIM also is a chronic pain sufferer and knows exactly where You is coming from...
    I have got the bi-level problem as well...ie; there is always a background ache that is up and down in severity...but also has those literally drop-to-your-knees and cry type of pain spikes that even dying starts sounding like a better option...
    I have no magic advice but does keep a nice pre-mixed plug for those occasions...plug of choice is 24mg of hydromorphone or oxymorphone which are relatively pretty equal via anal administration (orally both suck as You knows compared to oxycodone). The one fear I have is that one of these days it won't be enough so he's worked pretty hard at keeping his Fent patches\dose at the same level for 1.5+ years. And so far it has been a pretty good combination....but lately the 175mcg standard prescribed dose is starting NOT to be as effective as it once was...so he may be having to bump at least another 12.5-25mcg...there's nothing between so only 2 options...He's thinking start small..see if 12.5mcg patch will be enough...
    The pisser is that hairy I am running out of places to stick the damn things...he's worried that if goes outside the norm (patches worn) and starts experimenting with gel directly that bad things may happen...ie; either too much and SWIM starts posting from 6' under...or it works but jacks his tolerance so much he can't find a steady place like he's had. So for SWIM the Fent patches have been a life saver and keeping his primary pain-level well controlled ...with the plug there to give him that big blast when things get bad (real kickn' pain spike). I have tried a few Fent plugs with 1/2 pea sized to pea-sized blobs of gel from a patch already worn for its full 72 hours (trying to be a s safe as possible and not die) which has worked well..but also nearly dropped SWIM to the ground on 1 occasion..so long term he decided the crushed, dissolved Oxy\Hydromorphone was a safer alternative..at least its much easier to know exact dose rather than an educated guess...trying to guess at something measured in a millionth of a gram just too risky in the long run

    I think You actually has an advantage of at least not being in such a bad way he's gettin sick\WD's often just from not keepin a certain level (of opiates)...but agreed...if You has to start usin more frequently then that may happen.

    Maybe either Oxymorphone or hydromorphone in a concentrated plug could be the best option...both have relatively short half-lives (as compared to something like Methadone)...and You can knock the pain out quick then back off quickly to stay away from the physical part of the dependency...and provided it is more rare

    Question:..what does it take normally for You to keep his steady pain at "comfortable\manageable" level?
    Question 2: Normally..when You has a bad spike...what does i take to get the pain spike under control?
    If I had an idea it may make easier to suggest a better or at least different breakthru\short-term plan when the really bad ones hit....

    You sounds like he has his situation well thought out and as long as he keeps up his good self control there's got to be something You can do to keep it managed...hang in there you

    Apologies for drifting somewhat and writing a novella... just wanted to get everyone clear on SWIM's point of view
     
    Last edited: Jan 12, 2010
  3. diffs

    diffs Silver Member

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    I have tried all on the list except for darvocet. He would say that oxycodone worked best for his pain needs (although it wasn't actually prescibed to swim). The body works in a strange way. Sometimes the strongest pain-killer isn't always the best solution to ones pain needs. I remember years ago getting more releif from 30mg of codeine than he did from 60mg of dihydrocodeine, even though DHC is meant to be stronger. Unfortunatly now neither really help with swims pain and are just used for "fun".

    Personally I would go
    1)oxycodone
    2)hydrocodone
    3)dihydrocodeine

    but as I said, each individual is different and strongest isn't always the best solution.

    Tramadol is a funny one. I have never really had any effect from tramadol, yet he has some friends who swear by it and say its the best thing ever invented.

    My advice would be to keep trying different meds until You finds the best solution for them. Good Luck
     
  4. I_8_my yellow crayon

    I_8_my yellow crayon Palladium Member

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    My doctor gives him a lowsy 50 Tylenol 4 per month. But that's not SWIM's fault; I was getting Hydromorph Contin 24mg and 4mg Dilaudid for BT. I got addicted to them and started using them to feel better mentally instead of physically. SWIM ended up in rehab and cost his family alot of money, so they forbid him to ever take that drug again, and if he does, they say they will never speak to him and that I amn't their son if he chooses to go back on pain meds. SWIM's father is the community health director and is very good personal friends with SWIM's doctor. Also, SWIM's girlfriend is in her last semester of schooling to be a registered nurse, and she doesn't approve either, since SWIM put her through so much. But she isn't as hostile as SWIM's parents, and doesn't give him grief over taking the medications listed above. Basically codeine/DHC types.

    SWIM's doctor will give him the Hydromorph Contin Back, and the Dilaudid, but only half the dose and I am required to do pill counts and will get his prescription by week, not by month.

    It sucks because SWIM called the doctors bluff when he gave all of these rules and sure enough, the doctor followed through. It kinda sucks because I live within a 45 second walk of the doctors office:(. I did this for three months and couldn't stand it anymore, being called when he was having a nap, and having to piss right in front of him, so I said hell with it.

    I have never tryed percocet, or hydrocodone. I live in Canada and they don't have it here. To be honest, I go to the doctor, collects his measly 50 Tylenol 4's every month, and orders the rest of his meds online. If I have a bad day, he will take 12 of those T4's(<(recommended dose 2 every 4 hours as needed) , so 4 bad days per month equals no meds left. I had no choice but to turn to the street or online, so he chose online, and found a great place that takes care of his needs, and nobody knows about it but him and his gf. Enough about that though. Please note, SWIM listed no sources.

    As for the question about consumption. I takes all of his Tylenol 4's within the first 2 weeks of the month or less. Normally what he uses when all else fails, is he takes 4-5 DF118's at once, so thats 160-200mgs of dihydrocodeine. But they hardly work anymore. Maybe I need to go buy some lube and a turkey baster:laugh:........and pop his own cherry:eek:
     
  5. ponehacker

    ponehacker Silver Member

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    For less than severe pain that is inflamation-related, I would have to say that hydro/oxycodone & paracetamol combinations have always worked extremely well for him.
     
  6. desertimplant

    desertimplant Newbie

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    i8myc makes some good points. True enough some pain clinics\docs are really hard to work with. I understand to some extent but why after being good for a long period did the doc continue to apparently punish You is sad for sure. I have always managed to keep his requests on schedule and even had to endure WD's for a day or so to prevent that trust from being questioned. At least SWIM's doc only asks for the urine tests maybe once annually and doesn't have to have the doc watch. One would think that after the "trials" are over they'd stop the constant hassling. Good luck on it anyhow and I am glad to hear You found an alternative to being probed, prodded, questioned constantly just to get a little relief. And to follow-up swi-ponehacker ideas (good one) in many cases the opiate\NSAID combo does do a good job as it attacks both the source of pain directly as well as the receptors in the brain. SWIM's liver is in such sad shape that is no longer an option for him but certainly recommends it if one's liver is decent shape. The street is always an option but the big downside is never knowing quality\reliability...kind of a moving target in many locales.
    SWIM hopes You uses CWE when possible on the T4's...speaking from personal experience once the liver gets thrashed there's not many options left...
     
    Last edited: Jan 12, 2010
  7. Gdriussi

    Gdriussi Newbie

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    to the poster below, i just wanted to say that i hope You are doing cold water extractions w/the tylenol 4s -- i guess a doctor would know better, but that seems like too much tylenol - it's really hard on one's liver. and god forbid You ever escalate (as I did) and start IVing, and contracted Hep C, you'd want as healthy a liver as possible. a lot of pain meds online have tylenol in them too, so look for it. also -- i related to your story totally - SAME thing. I had legit rx for dilaudid and methadone, then started abusing them.....then rehab *sigh* -- luckily i've had some successful surgeries and my pain is mostly tolerable. right now i manage it w/Krantom, though i've thought about getting something stronger for emergency's

    to the original OP: i would suggest hydromorphone for break thru pain: they are extremely potent and fast, w/short half-life, but you should know their oral bio SUCKS. i don't know the exact numbers, but i remember doing the math when I was shooting them and figuring out she'd need 6 oral to equal 1 IV - plugging wouldn't be as high as IV, but certainly much higher than oral, and of course, much safer. for long term, chronic pain i'd just trying good 'ol methadone. it's got a ridiculously long half life, and is less "fun" than other opiates, therefore less likely to trigger abuse behavior.

    i hope that helps
    g

     
    Last edited: Nov 7, 2011