slow release morphine, opana??

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shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 4/23/2008 12:21 PM (GMT -7)   
Hello everyone, i am new to the site and have some questions.
 
I had a severe accident w/ a lawnmower that ran over my foot/leg when i was a young child. I had complete reconstruction of the foot, lost a toe, and had many compound bone breaks. I had severe nerve damage to the foot also.
 
It bothered me on and off over the years and was told by my old ortho and a new ortho that i should NEVER open that foot again to try to fix anythig for fear of making the pain worse. So, we just left it alone.
 
In 2001, out of the blue, i started having pain. I was put on percocet and lidocane patches by my PM group. Later, i started lumbar sympathetic blocks in addition.
Fast forward to now (2008). i am finding that i am having to use the percocet more, and need blocks more often. My PM started my on opana (slow release morphine). I am not excited about this new change, morphine usually makes me sick, and after starting yesterday, i have a bad headache and nausea.  I was wondering if anyone has used opana, and what side effects you had? Did it work well for your pain?
 
TIA, shannon

shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 4/23/2008 12:59 PM (GMT -7)   
Thanks for responding gramps! i am worried tho w/ the med swithc tho. I was on 5mg percocet 3x a day before the switch. Is opana a stronger med??? they said they gave me the smallest dose to take 2x a day. why not just up the percocet if that works?? Is it worry of abuse or addiction?? I have not felt addiction symptoms (thank goodness) even after all these years of using percocets...

i called the PM today to report my headache/nausea. they want to add a antinausea to the list of meds now....

i take meds for moderate ulcerative colitis, and am not thrilled to add opana on a daily basis when i was taking percocet on an as needed basis, however, w/ the pain increasing, i am needing to take it more often than not...i am also worried to aggrivate my UC by the med switch....

thanks again, i will report any lasting symptoms to the doc in a few days...if this does not work, would u know what else the PM's have to try???
thanks!

Disce Pati
Regular Member


Date Joined Apr 2008
Total Posts : 61
   Posted 4/23/2008 1:55 PM (GMT -7)   
Hi Shannon,

OpanaER is a newer around-the-clock pain med. I think it has only been out for the last year or so as a slow release medication. The advantages over your percocets is that it is a slow release pain killer that evens outs the ups and downs you get with percocet; plus because it is a different formulation there is a chance that it may work better for you than the percocets. An additional and probably one of the better advantages is that there is no tylenol associated with it like you get with percs - so you do not have to worry about liver problems that are associated with APAP (tylenol). So those could be the reason for the switch rather than just iincreasing your percs - you eliminate the ups and downs of the percocets kicking in and wearing off every 4 hours; you reduce the chance for liver damage by eliminating your exposure to APAP; and you may get a better analgesic response because it is a different compound than oxycodone (the narcotic in percocet). Another reason why you got this one as opposed to Oxycontin or Kadian, methadone, etc is that the marketing for this drug has been fairly strong - your doc may just have prescribed what she is more familiar with......

Theoretically, a slow release med like Opana ER reduces the likelihood of addiction because it eliminates the ups and downs of the four hour cycle - research has shown that this physical / mental anticipation can contribute to psychological addiction to narcotics. Plus some of these meds have an additive in it that when crushed or otherwise adulterated, the narcotic portion is blocked - so that if an addict would try to extract the narcotic or inject it, etc they wouldn't get the high they are looking for. Not sure if Opana is one of those types though.

All in all, my guess is that your doc figures it is time for you to switch to 24 / 7 medication to see if that can't settle things down. Usually a combination of a long acting drug with the immediate release for BT pain gives a person the best coverage. But it is all about trial and error. If Opana doesn't work, you have several other options to look at - each person is going to react to the meds differently so if you don't think it is helping than don't be afraid to let your doc know and you can give one of the other long acting meds a try.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 4/23/2008 2:13 PM (GMT -7)   
Hi, Shannon,
Welcome to the forum. I don't have much to offer, as I'm still on percocet, but I appreciate this thread as there's a lot of good info. for me as I start to consider the pros and cons of a longer acting drug. I was just paying attention over the past few days to when I get these overwhelming waves of tiredness and I think it's about 2 hours into the percocet (I take 2 pills most times). I'm going to pay even closer attention and if that is the case I'm going to think about other options.

Thanks Disce Pati for the detail on opana. I didn't know much about it.

PaLady

shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 4/23/2008 2:47 PM (GMT -7)   
Thanks so much everyone! I have been pretty upset about the change in meds....the doc wanted to change on my last visit, but i resisted.

I agree that 5mg percs 3x a day is little, and sorta thought it strange to move to morphinelike meds. Granted, i have been on percs for 8yrs now.

I was not offered tho, something for breakthrough pain, which any little thing will set it off (weather changes kil the arthritis in the bones, walking to much hurts it, ect).

anyways, i get a block again on tuesday, so i hope to be feeling better soon. thanks so much for all the help! im so glad i found this site!

Disce Pati
Regular Member


Date Joined Apr 2008
Total Posts : 61
   Posted 4/23/2008 3:17 PM (GMT -7)   
I am surprised that the Opana is a replacement for and not an addition to the percocets. Usually when a person is switched to an extended release med s/he is given a certain quantity of immediate release meds - especially through the transition - and for the reason you mentioned shannon: what if they are not working as well? Plus, you need a few weeks, even months, to figure out the right dosing when you switch over. To some PM docs, the ideal situation is to get the patient on a dose of long acting meds so they rarely, if ever, have to use the BT meds but that is seldom accomplished from what I understand. Basically the idea behind the combination of long and short acting meds is that the extended release will give you a "blanket-like" suppression for the small variations that a person has during a day and that the BT meds are there to suppress the spikes. The idea is to find the fine line of giving enough long acting drugs to suppress the "baseline" pain without slowing down your mind or giving you too much sleepiness and then giving control to treat the spikes to the patient: on those days when you would rather not take the additional meds you can opt out; those days when you rather have as much pain suppression as possible even at the risk of getting a little "loopy" then you can do that. It is all about having some sense of control over your life. If you use your extended release to completely kill your pain you are risking being over medicated at the times when your spikes are more settled; plus you lose your sense of control. Which I personally feel is the key to learning how to live with chronic pain. But that may be my unique outlook.

As far as the nausea - for many people this is a side effect that goes away within the first 5 to 14 days of taking the meds - you can get tolerance to that, as well as headaches and wozziness, relatively quickly. The only side-effect that people usually do not get tolerant to is constipation, I have been told.

I am thinking that it is not so much the quantity of the percocets that you are taking / day that made your doc change to long acting but rather the fact that you are not managing your pain on that. Most research shows that chronic pain is best treated by a long acting med rather than the short acting ones - it gives you a better steady-state level in your blood. I think once you find a extended release med that works well, and you have been on it for a couple of weeks, you will notice that your body will not feel so tired out - from all that 4 hour cycling. But remember, it can take some time to find the right dose and the right med to get to that steady state.

Basically, I think pain meds are like any other medication that a person takes for a chronic condition: the more you can get an even level in your system, the better it is for your body; whether it is insulin for glucose levels, thyroid meds for your hormone levels, antibiotics for your infections, or blood pressure meds to keep you pressure even - the less you body fluctuates and has to react to the extremes the better it is for both your mind and body.

My PM doc had a nice diagram to show me the logic behind it....if there is a way to post images I can try to draw it out to share too. I think it would make more sense if you can see what I am talking about. The best that I can do is to tell you to imagine ripples on a pond - the peaks and troughs of the waves. Then think of what an oil slick does to the water (without thinking of the horror of the poor creatures stuck in it!) and then think of the long acting pain meds as the oil slick: it doesn't eliminate the peaks and troughs completely but it dampens them down - it causes the cycle to be muted - like putting a blanket over it. The trick is to find the level of long acting drug so that most of the peaks are suppressed or they barely poke through.......The BT meds then act to catch the waves that are able to poke through.........

I guess I see BT meds as the rock-and-roll version of pain meds: lively, reactive, intense; and the extended release as the classical music version: serene, relaxing, deep, soothing. Both have there places in the world and one makes the other even better....

shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 4/23/2008 4:26 PM (GMT -7)   
wow disce pati! thanks so much for all your info....i get exactly what u mean about reaching a threputic dose. I think i may call the doc to get some BT meds...

i am 35 w/ 2 kids (4 and 11mo), and keeping up right now is very hard. I just agreed to chaparone a field trip to the zoo, and now im scared to walk it w/o having the percocet to help me the night after (i KNOW i will be in alot of pain after). Tho, the PM keeps telling me that the opana is suppose to kick in by then (i have told him about my worries w/ the field trip). All i want is to be able to keep up w/ my family. Im sure u ALL know...

anyways, disce pati, u r a welth of great info! thank you!

shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 4/24/2008 9:25 AM (GMT -7)   
Gramps, thanks again for the response. I know that once my pain is under control things should be better. I have been on opana now for 3 days, and i still have NO pain response to it yet. My pain is proballly at a 8 or so, and i have had to cancel the zoo trip which has just broken my heart. The fact that i can't take my son to his first field trip due to the amount of walking is just killing me.

Anyone have any idea how long it might take the opana to kick in??? I am taking it twice a day, w/ no relief, and the headache/nausea is still there.

I am just looking forward to my block on tuesday and will report everything then to the PM.

thanks again to ALL of you! I am sooo glad to have found you all! shannon

Disce Pati
Regular Member


Date Joined Apr 2008
Total Posts : 61
   Posted 4/24/2008 10:23 AM (GMT -7)   
Hi Shannon,

This is just a guess here only...based on my experience with kadian, methadone and a short (one week) experience with oxycontin.....but I would think that if the Opana is working for you, you would have noticed some effect after the first dose (in the same time-frame as the nausea, headache maybe?) and that the cumulative (steady-state) effect should be reached within a couple of days or so. You may be one of those people that do not react to the pain-killing part of the drug but only to the negative, side-effects.

This is not uncommon with pain meds, (although I have no idea about Opana specifically). Opioids response in an individual varies greatly between people because of our genetic differences. What can work great for me, can have no effect on you and vice versa. If you are not getting any relief from this med it could be either that you are not getting a big enough dose, or that your body doesn't respond to the pain relief part of the meds and no matter how much you get, you won't feel any or much relief at all.

An example that I can give you is that a friend of mine gets good pain relief from Darvocet - but little or no pain relief from Percocet. Because percs are usually considered a "stronger" narcotic than darvocet, her reactions, to me seems to indicate that her cells somehow don't use the percocet like my body does. I am like that with meds that dentists use........He has to inject an "elephant" dose just to get a little bit of numbing and I metabolize what he does give me very fast - it wears off about 2 as fast in me than other patients he says. There are research labs now that are studying this with the idea of being able to better select the right drug for the right person based on their genetics: they are doing this for cancer drugs for instance, and they can test for pain killer too if they want to - but I think it is only at the research stage for that. For now, all we and the PM docs can do is the trial-and-error method to find the right drug.

So don't be afraid to tell the doc it is not working for you, if you think that is the case. All it may mean is that you need a different medication or a higher dose - it does not mean that you are being a difficult patient, etc. A good doctor recognizes that this is not uncommon, I would hope.

Morgoth
Regular Member


Date Joined May 2008
Total Posts : 177
   Posted 5/13/2008 5:36 PM (GMT -7)   
Shannon, did you ever see a doctor to determine the cause of the pain? In 2000 the bones in my lower left leg were shattered and my ankle actually desintegrated due to the force of the impact (after being hit by a car, a flew some 50' and came to a sudden halt when it turned out there was a steel container on my flight trajectory). Initially my left foot was partially paralyzed but my nervous system started to regenerate. It hurt like hell but eventually the pain slowly faded away and I'm now capable of moving that foot way better than before. I was on opium and various derivatives at the time (for intestinal bleedings) but it turned out these meds were not particularly effective against this kind of pain. Then my doctors tried various other medications till they came up with one that worked fine for me. Here in Belgium it is called Zaldiar. I was wondering whether a doctor actually determined the cause of the pain as it could be that better medication is available if a precise diagnosis can be obtained. I'm just giving my case as an example, the origins of that pain could be manyfold. Might be worth a try though.

Could you please keep me in the loop? I'm interested in your foot ...
Morgoth
 


shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 5/13/2008 6:48 PM (GMT -7)   
Hi Morgoth, i was run over by a ride on lawnmower when i was 5. Hit and then backed over it again as the child driving the lawn mower panicked... I was in the hospital over 3months haveing numerous surgeries to the foot. I had many compound fractures (bones that cracked and came outside the skin) in both my foot and my leg (left foot/leg). All the bones in my foot were broken or shattered. I had long pins put into the tops of each toe that went from top of toe to bottom of toe bone to try to piece the toes bones back together, they put corkes at the top of the pins that stuck out of the top of my toes. A nurse would come in each day and shake the pins to keep the bones from sticking (my mother says she had to leave the room as i would scream in horrible pain, tho i don't remember the physical pain). I had complete reconstruction of the foot, along w/ repair of other compound fracters to my leg put back together w/ surgical bolts. (both in lower and upper leg). I had numerous blood transfusions due to the loss of blood from the accident. The ortho orriginally told my mom that at the least i would lose my foot, and the most up to my knee. I had severe gangreen due to the dirty blade of the lawnmower. They ended up saving the foot, but i lost a toe in one of the many surgeries.

As i grew up and after physical therapy and years of shrink therapy, i had pain on and off, but nothing real severe. I was put in dance as recommended by my ortho for pt....I danced many years (ballet, and i might say i was very good and wanted to become a professional ballet dancer, but knew that i would never be able to do that , so i quite in my late teens as it hurt to much to dance anymore). Over the yrs, when the pain flared up, we did seek opinions w/ new orthos, as mine had retired (at the time, he was the BEST in my area, big city, miami, florida, usa). NO ONE would touch it and just sent me on my merry way.

The year 9/11 happened (im sorry, im a bad amarican, and can not remember what ur it was) was when, out of the blue i started having severe pain in the foot. The pain ranges from nerve pain from perminatly damaged nerves, to bone pain, to severe arthritis pain that comes and goes w/ weather. I have severe pain when i do any length of walking, can not walk in heals anymore (which i miss dearly, as im a shoe lover), and absoultycan not walk bearfoot at all, i must have shoes or slippers on at all times.

We finally went to some ofthe major teaching hospitals here, (university of miami, ortho and to jackson orthos) tests were run, and on top of all the obvious injurys, i also have bone spures that are growing down towards the ground at the ball of my foot. NO ONE is willing to open the foot to correct this for fear of mucking something up.

So, i was sent to myPM group. I was originally put on 7.5mg percocet along w/ lidocane patches to apply directly to the site of pain. I also began lumbar sympathatic blocks. They worked really well at first. But i have been doing them for years now, and am not having long lasting befifit from them anymore. I am still on percs, and honestly don't forsee a time that i will be off meds. The meds and the blocks are the only thing that got me out of the wheelchair when my pain originally came on so fast. I was unable to walk on my foot for close to 3mo.

The PM group has started talking about maybe cutting or freezing the nerve that runs to the foot , but i worry about losing complete feeling in the foot, what if i stepped on glass and didn't know it kind of thing....they have also talked about some type of nerve stimulator implantation, which scares me to, not to mention that not all my pain is nerve related.

My original ortho told my parents and put in my records that i should NEVER have surgery again on that foot, and that his thoughts were that even tho he saved the foot, his thoughts on my future, my be w/o the use of my foot in the yrs to come. Sadly, we did have a lawsuit and settled out of court w/ the neighbors, but i got the money when i was 18 and like a young kid will always do, i spent it....so, as it was ment to help take care of me later in life when i could not walk....i now dont have that to fall back on. I have two young kids now and not walking is NOT an option for me, i don't care if i have to try every drug in the book and every crazy thing the PM recommends. I sorta feel like this is the best it's gunna get. My back is in pain due to the fact that the reconstructed arch is so high on the foot and my walk is sorta offf kilter, so i have back and hip problems now to.

Phew...LOL...I will research zaldiar, i have never heard of it. I can say that i do get good relief from the percs, but am becomming used to the dose and think i need something stronger, but am afraid to ask for fear of looking like im drug seeking (its sad to feel like tha when i have such an obvious injury). I also want to discuss w/ them getting off the tylanol part of the med..i have been on it for yrs and would like to keep my liver if at all possible! lol

anyways, im glad to hear that you did regain some of the nervous system again, for me, the nerves will never regenerate, i am now 35 and had the accident when i was 5....so, that is not even a thought for me.

ok, sorry for the book....im glad that u r getting some relief and glad that u shared w/ me! i usually see alot of peps here w/ back injuries, and not really what im dealing w/ so it's nice to see someone who is pretty much in my shoes (tho i wish neither one of us were, i would rather be in my ballet shoes)! lol
take care morgoth! and keep in touch with your progress, shannon

blizzardlizzard
Regular Member


Date Joined Feb 2008
Total Posts : 23
   Posted 5/15/2008 10:50 AM (GMT -7)   
I have been on Opana ER 20mg. 2x's a day and have been given Opana 5mg. 4x's a day for about 3 months or so and have had no nausea or headaches which I had with other opiates. It worked great for my pain until this past week or so. Needless to say I've had problems getting it at certain pharmacies, however Rite Aid agreed to order it a week before my prescription was due. Hope everyone is having a lpd.
CRPS 1 in the right leg
Spinal Arthritis
Anxiety Disorder

One day at a time


shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 5/16/2008 9:35 AM (GMT -7)   

hi blizzard. thanks for the reply! i did end up getting off the opana, i took it for close to a wk, but did not have any relief from it and my nausea/headache did not go away until i got off it. Im sooooo glad im not on it anymore! lol

i was able to get it very easily at my hospital pharmacy (incase ur still having trouble finding it). sorry to hear that it has just stopped working...any idea why?

good luck, shannon


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 6/27/2008 11:48 PM (GMT -7)   

inpane4reel
New Member


Date Joined Mar 2009
Total Posts : 1
   Posted 5/15/2009 11:16 AM (GMT -7)   
has anyone had trouble with getting the right dose? i have been on 15mgs. for 2months and it seems that it just stoped working.opana-er is a new med from the info. i have read.also it makes me soooo tired.

coloradogirl81
New Member


Date Joined Nov 2009
Total Posts : 1
   Posted 11/11/2009 3:50 PM (GMT -7)   
I've been on Opana for about a year for Chronic pain, They also have me on Vicodin for breakthrough pain. The nausua will go away after a while, it's annoying but it's not abnormal. It took a few weeks for it to start really doing what it was supposed to do, but it's been a life saver for me. I still have pain, but I'm able to be more comfortable. Hope you find some answers!

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   Posted 10/20/2013 2:20 PM (GMT -7)   
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