Pain Pills versus IV Pain Meds?

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Kaycie
Regular Member


Date Joined Jan 2006
Total Posts : 449
   Posted 3/25/2009 11:52 PM (GMT -7)   
Please help me understand this!

Right now, I'm under pain management via my colon surgeon and the ER because of very active Crohn's. I've failed just about every drug. I"m onto Tsyabri, a biologic, and if I fail it within 3 months, I will need a total colectomy.

Ok, that aside, I ache all over and have major gut pain. This visit to the ER, they gave me fentenal(sp?) in the IV 3 times before d/c. They said it was comparable to Dilaudid, but faster acting? I didn't really care just so long as the pain went away and I could rest so I could THINK straight. I have been on hyrdocodone since my hospital stay in July. I've built up a major tolerance to it, so it takes 21.5/975 every 6 hours to just take the "edge" off. But, since the manufacturer (one of them) was shut down, I can no longer get Norco and have to get Loratab, so it's only 7.5/500 and I can only take 2. The first ER visit they did write me a script for 10/500, but it didn't last long, unfortunately.

So, now this ER visit, they d/c'd me with 2mg of Dilaudid (which I thought was amazing....because the last doc told me if I needed ANYTHING beyond hydrocodone, I needed to be admitted). Ok, so, my question.. is the pill not as fast acting? I'm starting to wonder if my body is not digesting these pills? If I were to get this via IV, I'd be knocked out flat in a HEARTBEAT. The first ER visit a week ago, they gave me one dose of Dilaudid, and I passed out and slept for several hours after a long bout of pain. This time, they gave me fentenal, which didn't do much, but allowed me to sleep enough.

I'm calling my surgeon tomorrow...afraid they might admit me, but also partially thankful because if they do.. I would get IV pain pills and it would keep my pain under control at least...

Thanks in advance..and sorry to ramble
Kaycie - Age: 26
Crohn's - Dx Nov 05
Failed Remicade, Failed Clinical Trial ABT-874/Aisle 12, Failed Humira. Onto Humira. If I fail that, total colectomy.
IVF #1 (In-Vitro Fertilization) - Failed
IVF #2 - IVIg, Heparin, Baby Aspirin - TWIN GIRLS!!!
Reagan Dawn - 8/2/07 - Lived 1 hour 27 minutes due to Cloaca, NOT affiliated with my Crohn's
Addison Maria - 8/2/07 - 20 months old


Tirzah
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Date Joined Jul 2008
Total Posts : 2283
   Posted 3/26/2009 12:23 AM (GMT -7)   
Kaycie,
I'm not sure what they meant by fast-acting. Perhaps they got the term confused with short-acting?
Diluadid given orally takes about half an hour to absorb into a normal person's system. It usually last 4-6 hours. I'm not sure how Crohn's might affect the absorption. If you are getting knocked out from it, I would say that would normally not be a good thing at all unless you are under continuous medical supervision, like you would get in a hospital. It's one thing for it to take the edge off the pain and another thing entirely for it to knock you out. These meds can be dangerous, especially if all you're used to is Lorthttp://www.healingwell.com/community/volunteer.aspxab, and if not carefully monitored can cause respiratory arrest. If you are not alert enough to monitor whether you are breathing, you can't keep yourself safe or call 911 in an emergency. The IV formulation of Diluadid is called hydromorphone & it would be absorbed immediately & start to work within minutes.

Fentanyl, on the other hand, is a fast-acting medicine. Via IV, it would take effect almost immediately. It is available by prescription in 3 forms -- transdermal (Duragesic), buccal (Fentora) and oral transmucosal (Actiq). The Actiq & Fentora would take effect within about 10 minutes. It usually last no more than 4 hours. However, fentanyl is not usually prescribed to patients who have not been on long-acting narcotics, so I rather doubt your doc would write you for them. If the pain is post-op pain, they will almost certainly not put you on prescription fentanyl.

If this is all from your procedure, I would suggest you talk with your surgeon about the level of pain you are experiencing. Surgery is painful. I'm not doubting that at all. I imagine you do need something to manage the post-op pain, I just can't see why you would want to be on such dangerous, highly addictive drugs for what is a short term problem. That is a lot of risk to take on for pain that will lessen over the next couple of months.

If you have a long-term pain syndrome, I would recommend you see a Pain Management Specialist (PM). A PM would be able to put together a treatment program for you that would include non-medication treatments as well as medication, if needed. The PM would be specially trained to know what meds are absorbed when & how and would know what amounts would be appropriate for you to be able to live the fullest life possible. They could prescribe longer-acting medications so that your pain is kept at a steady level throughout the day. It will certainly not be a pain-free life, but hopefully could be a life where you could still participate in some kind of work/school and a minimal amount of social/recreational activities.

I don't know. I hope that helps. It just kinda concerns me that perhaps the hospital staff was not explaining to you the risks of these drugs. They can help people & do have their place, but it wasn't clear to me from your post that you understood that there are real dangers associated with them. I want you to get the pain control you need, but please be safe while doing so.

peace,
frances

Kaycie
Regular Member


Date Joined Jan 2006
Total Posts : 449
   Posted 3/26/2009 2:30 AM (GMT -7)   
Thank you Frances for you in depth post.

Just to clarify a few things...
1) This isn't post-op pain. The last surgery I had was a c-section nearly 20 months ago. No other procedures since. A colonoscopy a year ago, managed with no pain meds.

2)I have been on Loratabs since July. When I was admitted in July for severe pain (Literally was being dosed with Dilaudid, 2mg, every 90 minutes for 14 straight hours.) I was admitted and you could watch my blood pressure dramatically rise when the pain would become painful. In the ambulance on the way to the hospital (I tried to get into the car myself, but no such luck - DH had to call 911). I spent 8 days admitted on complete bowel rest with dilaudid for pain via PICC line.

3) Since my discharge in July, I have been struggling on and off medications for Crohn's.. Remicade, steroids, Aisle 12/ABT-874, Humira, and now Tsyabri. That is a LOT of biologics in my body, but I'm at a point of no return. If the Tsyabri, a biologic for certain auto-immune disorders is the only drug I have left. If that doesn't work, they WILL do a total colectomy.

4) Since the discharge as well, I have been on Loratabs and/or Norcos. Gradually increasing from 7.5mg/500 to 10mg/500. I have tried to wean off the pain pills more then once, and then I was hit with a Crohn's drug that was once again failing. I did fairly well (maybe 2 pain pills total per day) while still on steroids. But, unfortunately, the steroids shot my blood pressures up and the GI immediately took me off of them. Anyway, I basically was getting NO relief on the Loratabs (10mg/500) and that is what sent me to the hospital. I was 2-3 hours into the drug and felt as if it never took affect. I'm sure the reason (based on my understanding of fentanyl now) they gave me fentanyl was because I have been on Loratabs long-term at this point. But, to be 100% truthful..the fentanyl did not relieve the pain 100%, yet a week before, the dilaudid did.

I'm not asking to get IV drugs..I'm just not getting the relief from Dilaudid orally. I hate all these medications. I am calling my surgeon tomorrow... I have been up all night contemplating on whether or not he will put me in. Part of me wants to..part of me is scared to death of it. I'm very aware of the dependence and difficulties brought on by pain medication, but I'm truly stuck between a rock and a hard place. My ER doc this time actually has a sister-in-law & niece with this disease...and worked at Barnes Jewish where my new GI is (well, since summer). He seemed very knowledgeable about the problems with Crohn's for an ER doc.

I'm so lost and confused with all of these. Now, I get to wait on insurance AGAIN. It took them 3 weeks to approve Humira... I cannot go on like this for 3 more weeks.. I have got to get a drug in me and fast... which is why I worry about an admission... I firmly believe they might keep me there for 1-2 weeks until they can get this drug started...

Right now I'm exhausted, but would love some more input. I'm at a loss of what to do. OH, and wanted to note..Dilaudid via IV in the hospital is the only time I was knocked out flat from the drug (I literally fell asleep on it), but obviously, I was on a blood pressure and oximeter, so they knew I was fine. Again, reasonings why I still don't agree that they haven't admitted me. I have cried twice in the ER that I was not sure going home was the *right* thing to do... So, I'm going to rest, try and call the surgeon and see what he says....for now, the dilaudid pill form does NOT knock me out.. it doesn't even make me loopy what-so-ever. All it does is take a "bit" of the edge off so I can sleep... I have been using other non-medicinal forms of therapy as well. And, my surgeon has talked to me about getting a pain specialist to wean OFF the medications once I'm under control...

I think there are too mean cooks (docs) in the kitchen right now!
Kaycie - Age: 26
Crohn's - Dx Nov 05
Failed Remicade, Failed Clinical Trial ABT-874/Aisle 12, Failed Humira. Onto Tsyabri. If I fail that, total colectomy.
IVF #1 (In-Vitro Fertilization) - Failed
IVF #2 - IVIg, Heparin, Baby Aspirin - TWIN GIRLS!!!
Reagan Dawn - 8/2/07 - Lived 1 hour 27 minutes due to Cloaca, NOT affiliated with my Crohn's
Addison Maria - 8/2/07 - 20 months old


LLPLUV
Veteran Member


Date Joined Mar 2009
Total Posts : 1158
   Posted 3/26/2009 6:13 AM (GMT -7)   
I think I know what your trying to ask.
 
Heres my take on it.
 
I have chronic kidney issues and at times the pain is so severe I have to go to the ER for IV pain meds.  There I know the IV meds are stronger.  They can observe my blood pressure and levels of pain.  IV pain meds are usually mixed with a nausa medication which can make you tired also.  While in the hospital they try and make you as close to pain free without causing your vitals to drop through the floor.
 
Meds you take at home will not be as powerful.  At home I believe most of us will admit never take the pain 100% away. We learn to grin and bare it. 
 
I think this is the difference you wanted explained.  Yes hospital pain control is the bomb..  turn    Its at least the few moments the pain is a bay.  At home most of us need to function.
 
I take 3 lortab 10's a day with my PCP until they get me an appointment with a Pain Doc.  Its not cutting it but I say again I grin and bare it.
 
I hope I got it right  tongue
 
Laurie
Chronic Kidney Stones, PKD (Polycystic Kidney Disease), Chronic Kidney Failure, Severe Hypertension


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2283
   Posted 3/26/2009 8:39 AM (GMT -7)   
Kaycie,
I really didn't mean to upset you. I did try to answer your question as well, but perhaps failed at that.

A PM would work to get you off of pain meds whenever possible once your pain is controlled. Controlled does not mean gone. **However, if your pain cannot be controlled to the point where you can minimally function without medication, the PM's role is to continue managing your pain with medication for as long as necessary.** Perhaps the PM your surgeon knows doesn't follow that policy, but there are many PM's out there who do. I cannot speak for all PM's, but I know mine has a number of Crohn's patients & almost all of them seem to be very happy with the pain control he provides. He works closely with GI's and does require his patients follow all of the behavior changes from the GI, plus sometimes some additional requirements of his own, but as long as they do their part, he works very hard to keep their pain properly managed. Sometimes that is with injections, sometimes with medication.

I have heard that meds are often absorbed differently in Crohn's patients than in healthy patients & a PM could better explain that. Anything that is given orally could potentially (though not necessarily) be affected by Crohn's. There are meds given via alternative routes to accommodate for that -- buccal, transmucosal, transdermal, nasal, IM. I really would think it worthwhile to make a few phone calls to some PM offices to see whether they have any experience treating Crohn's patients and whether they are willing to medicate to control pain when all other treatment options have failed (as sounds like your case).

good luck,
frances

Becoming undone
Veteran Member


Date Joined Jul 2007
Total Posts : 927
   Posted 3/26/2009 9:36 AM (GMT -7)   
certain pain meds also work differently on abdominal pain (which can be tricky to treat...just cause the way the nerves and the muscle inervate). Things such as morphine don't work as well as some of the other conjugate such as fentanyl. Also we crohn's patients may have adsorption issues.

When I go to the ER, fentanyl IV works great, but is short lived, morphine IV... it makes other pain go away, depresses my heart rate, and makes me feel kinda "out of it" but not so good at taking away the ab pain.

me...vicodin work pretty well, dilaudid...not so much. However, those are breakthrough meds. I am on the fentanyl patch...for the reasons state above...I have gotten some of my life back.

Pain Management docs know a bit more about this that the GI or surgeons. It may be helpful for you to look into a referral to a PM doc...
"The earth laughs in flowers"


Morgoth
Regular Member


Date Joined May 2008
Total Posts : 177
   Posted 3/26/2009 10:21 AM (GMT -7)   
IV and IM are better for patients with intestinal problems as then there is no question about how much medication was exactly absorbed. Crohn's can seriously mess with your absorption and the only way to find a scientifically useful average is by conducting month long trials. Been there, done it. Result was IM anyway.

The best drugs for severe, incapacitating, intestinal problems is morphine and/or heroin. Of course, no doctor is going to prescribe those without very good reasons. And if they do, and you get permission to use them at home, you most likely won't be allowed to drive a vehicle any longer. Positive thing is, morphine/heroine slow down your metabolism, thus limiting intestinal bleedings, lower your heart rate and BP, and seriously reduce diarrhea;even to the point where a colectomy might no longer be necessary.

Beware however, morphine is not a pleasant drug (neither is heroin by the way), and if administered in serious dosages, you'll most likely feel sick at first. The beauty of morphine however is that it actually works as medication and not just as a painkiller. Most countries allow patients with severe intestinal problems to administer the product at home. Crohn patients on morphine will have to take the drug for the rest of their lives of course, another serious matter to consider.

Should there be anything you want to know in particular about morphine treatment, don't hesitate to ask.

Take care.
To stand and be still at the Birkenhead Drill is a mighty bullet to shew.


Kaycie
Regular Member


Date Joined Jan 2006
Total Posts : 449
   Posted 3/26/2009 3:02 PM (GMT -7)   
Frances - You didn't upset me.. I just don't think you understood some of what I typed, which I think was my fault just as well! I really appreciated your info, honestly.

Everyone else - THANK YOU for your in depth responses. The *goal* is to maintain pain control until we can get this flare under control with Tsyabri. If it gets under control, then I will either wean myself, or be weaned by a doctor off the medication. But, if it doesn't work, then we'll do a total colectomy and then wean off pain meds.

I truly do not want to be on pain meds, but I have a DEEP amount of respect for those that DO live on them. I am not *me* when I'm on them. I have not been able to return to work since last week. I tried going back one day this past week and I showed up late and so only worked for 5.5 hours and then was back in the ER that evening. I had a horrible spell this morning with my CD as well. The good thing is my GI has given me a prescription for Levsin, which is a FANTASTIC anti-spasmatic that helps calm the gut while the pain meds help take away the pain.

Morgoth - Yes, that was my true question I guess. I was wondering if my Crohn's was prohibiting the adequate pain relief from the oral dialudid. I wasn't expecting miracles, but I literally feel crippled. But, I should add that Humira is known to cause severe joint pain and I may (even though I'm not supposed to) see if the GI will let me take a SHORT term steroid for about a week until Humira clears out and I can start Tsyabri. I figure 2 weeks would not be enough to penetrate my system, but it would be enough to help get the relief of SOME of the pain. And, then maybe I could move from the Dilaudid back to Hydrcodone and it would be efficient.

LLPLUV - Thank you! Yes, there is an OBVIOUS different between IV meds and oral, isn't there? I never knew this until I was in the hospital in July and they would not discharge me until I was able to tolerate oral steroids versus IV steroids. I just wasn't *sure* that pain meds were the same? The ER doc was super nice and told me to come back if I was having trouble. He truly understood my pain. He even joked with me about going to one of the best hospitals in the country (because that's where he came from!). So, anyway, I'm trying to talk between all the docs and see what we can do.

To everyone though, thank you for the wealth of info. I think I might call around to pain management docs to see if they would work with me short-term. I am VERY hesitant to get off the pain meds by myself and I have accepted that I might just need help in that. I'm not addicted, but my body is dependent. It's a very surreal and scary feeling, especially when I dealt with a brother that had a drug addiction. A lot of times, I will underestimate my pain just because I'm scared of the drugs...but I'm now at a point I cannot function, so I'm at a loss. I'm just hoping the Tsyabri works. It's a 3 month minimum. If at 3 months I'm better, they will continue with it.

Thank you all again!
Kaycie - Age: 26
Crohn's - Dx Nov 05
Failed Remicade, Failed Clinical Trial ABT-874/Aisle 12, Failed Humira. Onto Tsyabri. If I fail that, total colectomy.
IVF #1 (In-Vitro Fertilization) - Failed
IVF #2 - IVIg, Heparin, Baby Aspirin - TWIN GIRLS!!!
Reagan Dawn - 8/2/07 - Lived 1 hour 27 minutes due to Cloaca, NOT affiliated with my Crohn's
Addison Maria - 8/2/07 - 20 months old


Boxerlover
Regular Member


Date Joined Dec 2006
Total Posts : 274
   Posted 3/26/2009 5:47 PM (GMT -7)   

I have also heard that chrone's patient's don't absorb the same but in addition I have head that Dilaudid is not a good med by mouth. For me personally, Dilaudid I.V. works great but Dilaudid by mouth does nothing.  I wonder if the fentenyl patch would be good for you since it's absorbed into the skin.  Just a thought.

Melissa


Kaycie
Regular Member


Date Joined Jan 2006
Total Posts : 449
   Posted 3/26/2009 5:58 PM (GMT -7)   
Boxerlover said...
I have also heard that chrone's patient's don't absorb the same but in addition I have head that Dilaudid is not a good med by mouth. For me personally, Dilaudid I.V. works great but Dilaudid by mouth does nothing. I wonder if the fentenyl patch would be good for you since it's absorbed into the skin. Just a thought.

Melissa


I just spoke to my surgeon's nurse about 3 hours ago, and that was sort of her opinion on the matter too. She's quite concerned they d/c'd me with dilaudid. So, she is speaking with a different doc tomorrow to see what they are going to do. I told her I'm not getting near the pain relief I need at times and I'm actually very nervous about being home on THIS strong of a pain med, as if she. So, they are going to converse tomorrow and call me in the morning....
Kaycie - Age: 26
Crohn's - Dx Nov 05
Failed Remicade, Failed Clinical Trial ABT-874/Aisle 12, Failed Humira. Onto Tsyabri. If I fail that, total colectomy.
IVF #1 (In-Vitro Fertilization) - Failed
IVF #2 - IVIg, Heparin, Baby Aspirin - TWIN GIRLS!!!
Reagan Dawn - 8/2/07 - Lived 1 hour 27 minutes due to Cloaca, NOT affiliated with my Crohn's
Addison Maria - 8/2/07 - 20 months old


Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 3/26/2009 6:51 PM (GMT -7)   
Frances, Kaycie, and all.

Please keep posting. I learn so much each time I read posts from you all.

Greatly appreciated.
Wife: Liz
Dogs: Koshka & Chomp


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 3/26/2009 9:43 PM (GMT -7)   
Hi Kaycie,

I don't know much about Crohn's and pain meds (although we do have people with Crohn's on this board, so maybe one of them will come along & help you out), but I can tell you that different people react quite differently to different pain medications. It all depends on your body physiology & pain. What helps one person will not necessarily help someone else with the "same" pain. It is somewhat of a game of trial & error at first to find the right med. I've been taking pain medication regularly for only about 5 months now & I am still not satisfied with the relief that I've gotten from anything that I've been on so far. Right now I take oral dilaudid, and it has been the most helpful, however I have to take significant amounts of it just to get a very small amount of relief. My body has proven to be very very resistant to pain medication. I've never had IV pain medication, except a couple of times in the recovery room post-op, so I can't add anything about that. Frances did a good job explaining the action of the med. Hopefully you can find a real PM who can help you to find some relief in a safe, controlled fashion.

Skeye

Post Edited (skeye) : 3/26/2009 10:47:54 PM (GMT-6)


Becoming undone
Veteran Member


Date Joined Jul 2007
Total Posts : 927
   Posted 3/27/2009 11:51 AM (GMT -7)   
I knew I had read it somewhere...spent a while finding this...It was not the same article I had read, but there were a few others..."Oxycodone may be more effective than morphine in treatment of visceral pain - New research suggests"
http://www.medicalnewstoday.com/articles/29683.php
just a bit of food for thought...
"The earth laughs in flowers"


Becoming undone
Veteran Member


Date Joined Jul 2007
Total Posts : 927
   Posted 3/27/2009 12:09 PM (GMT -7)   
and if you're really interested and nerdy (like me)..."Translational pain research: Evaluating analgesic effect in
experimental visceral pain models" World J Gastroenterol 2009 January 14; 15(2): 177-181
http://www.wjgnet.com/1007-9327/15/177.pdf
it's pretty new as seen in the publish date...
"The earth laughs in flowers"

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