Breakthrough med questions

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Regular Member

Date Joined Mar 2007
Total Posts : 166
   Posted 12/18/2010 8:15 PM (GMT -6)   
Hello all!  I hope you all are doing greatttttt!  I have had a very tough transition from methadone to opana.  I was forced to change my long acting med because of legislators in FL (look at my previous post for explanation).  I have  noticed my breakthrough pain to occur more often on the opana than on the methadone.  I have tried other long acting meds but opana seems to be the closest to methadone.  For me the methadone works much much better than opana but I cannot take it here in FL so oh well.  I am taking the break through med more often.  When I was on methadone I would take the Oxycodone 1-3 a day.  Now on the opana I take it 4-5 or 6 times a day.  Also it (oxy 15) is not working as well as it used to.  My question is do you think I should ask my doc for a different b/t med or stay with the oxy and just go up in strength?  I have heard that PM docs very rarely prescribe the 30mg strength of the oxy ir.  The oxy has always worked great for me but as of late it is not doing the trick.  I have been on oxy ir 15mg for 4 yrs now for b/t pain with different meds for long term pain relief.  My pain levels are up more with the opana but it works with the least side effects.  I am just about at my wits end here.  It is hard for me to even type.  When I lift my left hand to type I get a shooting pain in my left shoulder that stays for a while.  I usually get a heating pad.   Anyway If any of you have any suggestions on my b/t pain question please let me know.  I have always been told that if you have to use more b/t meds then you need to adjust your long term med.  Problem is when I adjust the long term med I am still needed the b/t med for pain control.  I wish I could still take the methadone.  It worked wonders for me. 
Thanks to all of you and I hope your days and nights are as pain free as possible!!

Veteran Member

Date Joined Jan 2005
Total Posts : 9090
   Posted 12/19/2010 12:44 AM (GMT -6)   
Hi Shaw...

I'm sorry you're suffering with this med change. My insurance company at one point made me go from oxycontin to morphine. That was a terrible experience so I have empathy for you.

Absolutely you should discuss your pain control with the doc. When you are prescribed something new they can only guess at what dose will be right for you and your body. If you don't tell him how it's working or not working then he assumes he has the dosage correct. Those of us on pain meds do live in some fear and rightfully so. But you want and need a doctor with whom you can discuss pain control issues.

Let us know how it goes!
Moderator on the Fibromyalgia and Chronic Pain forums

“If you want to live a happy life, tie it to a goal, not to people or things.” Albert Einstein

Forum Moderator

Date Joined Feb 2003
Total Posts : 16417
   Posted 12/19/2010 1:50 AM (GMT -6)   
Hi Shaw, sorry to hear that you are still struggling with the medication thing. I am sort of leaning towards maybe changing the BT meds to something different basically because you have 4 years of it under your belt. I would think a change may be the right way to go, you could always go back to it if you had to. Many of our members drs change their meds up about every 2 years to avoid tolerance issues and it seems to work well. I understand the need of doing that too.

Lets us know what you and your dr decide to do and good luck.
Moderator Chronic Pain Forum

Veteran Member

Date Joined Dec 2007
Total Posts : 1235
   Posted 12/21/2010 1:12 AM (GMT -6)   


If you are taking your breakthrough pain meds that often, it is no wonder that they are't working so well for you anymore.

Breakthrough meds are only supposed to be taken when the pain levels are way over what your base line pain meds can handle. Not on a regular, daily basis.

It sounds to me like you might need an increase in your long acting Opana, and less of the oxycodone. If you are taking the oxycodone as frequently as you posted, it is not going to be effective in handling your  increased pain levels. The base line/long acting medication should cover most/all of your regular , every day pain levels, and the breakthrough meds are only for when you do more than you are supposed to, or something causes your pain levels to spike uncontrollably.

If you are taking oxycodone regularly, it just becomes a part of your base line meds, and because of that, it isn't going to be effective at covering any increases in activity or pain levels. Does that make sense ?

When you meet with the new PM doctor, I would explain to him that you recently changed from methadone which worked really well for your pain levels, to the long acting Opana, and you are experiencing more pain, which isn't taken care of by the Opana and ask for his recommendations. You will get further doing it that way than by questioning the conversion that the previous PM doctor did. Not all doctors/PM's especially are comfortable with the conversions, especially when it comes to methadone/to another opiod pain reliever. And the general rule when converting from one pain medication to another is what ever the total daily dosage of the old medication is/divided by the number of doses per day of the new med= new dose of med. Then cross tolerance is taken into consideration, and some doctors use a figure of 10% while others may use a figure of 25-40% when figuring for cross tolerance. Then they also want to wait and see how your pain is managed on the new medication- many times a lower dose of the new med will work as well as the higher dose of the old med for someone, and to see if you are able to tolerate the side effects before giving increases in the new med.

Hang in there, and just talk to your new PM doctor like I suggested and then listen to his recommendations.


spinal soldier
Veteran Member

Date Joined Dec 2009
Total Posts : 687
   Posted 12/21/2010 1:54 AM (GMT -6)   
hows it going? i second the idea of raising the OPANA ER, hopefully around 80mg per day in a divded dose. it is the only!!! opiate with a duration that long once you get it in you. i also think the oxycodone 15mg IR 5-6 per day is a not that much in the big scemme of things. until you titrate the OPANA right (that could be high) you will probably need a full dose-load everyday of breakthrough meds. i am a bigger fan of DILAUDID (hydromorphone) or MORPHINE SULFATE IR than any type of IR oxycodone for breakthrough pain and for a steady-state. i know everyone is different but techinally morphine has a better affinity to the CNS and brain opioid receptors. both are available in formulations for breakthrough pain. morphine has the brand name "MSIR" in 15mg,30mg.several generic products are avail. and some work good. my preference; Dilaudid (hydromorphone hcl) is a derivitive of morphine and has a more potent pain-killing effect by x7. it is avail. in tablet in 2,4, and 8mg. the brand name is a small bit better; it is made by PURDUE PHARMA who of coarse is the oxycontin store. there are some good generic tablets like Mallinkrodt and it's fairly cheap. adding a small dose of Soma (carisoprodol) or Vistaril (hydroxyzine)(50mg) to potentate the opiate drug. i'm gettin tired so i wiil saygood-night now.
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