Pain Management Question

Folks,

My ONC prescribed Oxycodone to manage pain 2 - 5MG pills every 4 hours as needed for break through pain. The pain usually starts every 3 hours, I try and delay taking meds to between 5-6 hours. It seems my whole day revolves around taking medication to address the pain in my legs and hip. Does anyone know of other pain medications that doesn't have to be taken so frequently or is longer lasting?

Also nervous about addiction to pain medication....

Thanks much,

Ronnie

Hi Ronnie, there is no addiction when used to achieve a comfortable level of pain. It took me a long time to learn to stay ahead of the pain instead of chasing it. I take hydromorphone long lasting pain meds every 12 hours and sometimes breakthrough meds (dilaudid) when required. I think Oxycodone comes in long lasting form but I'm not sure. I've increased, decreased and so on over time. Your body will tell you when to stop or adjust.

Ronnie, take Tylenol or Advil along with the oxy. 5 mg of oxy plus 325 of Tylenol = percocet.

Check with your doc but adding the OTC drug is likely to make the pain relief better and last longer. At least it did for me.

And please, take your pain meds regularly. If you wait for the pain to break through, you'll need more meds to knock it back. If you take the pain meds regularly even if you're not in pain at that moment, you'll do better. There will be less pain in general.

I am sorry to hear you are dealing with pain issues. Below from my MBC Guide is a list of potentially helpful therapies.You (and others) are welcome to request a complimentary copy of the 126 page booklet by visiting the top of this page:https://community.breastcancer.org/forum/8/topics/831507?page=2#idx_32

Overview of Pain Medications

Pain medications may include one or more of the following.Patients may occasionally need to try one medication after the other (with their doctor's approval) until they find optimal relief. Physicians prescribing drugs for pain relief must also be made fully aware of all other medications the patient is taking. Before purchasing pain relievers, it is advisable to first check the ingredients to see whether the product contains Benzocaine.The FDA has issued a warning about the use of benzocaine, the main ingredient in some over-the-counter liquids and gels.Benzocaine is associated with a rare but serious condition called methemoglobinemia, which greatly reduces the amount of oxygen carried through the bloodstream.In the most severe cases, the condition can be life-threatening.

• Over the Counter Drugs (OTC)
• Weak Opioids
• Strong Opioids
• Antidepressants
• Anti-seizure Medication
• Muscle Relaxers
• Nerve Blocks (including Epidurals)
• Pain Pump

• Over-The-Counter (OTC) and prescription-strength pain relievers include Aspirin, Acetaminophen (Tylenol) and Ibuprofen (Advil, Motrin).
• Weak Opioids (derived from a drug called Opium) such as codeine

• Strong Opioids medications include Morphine (Avinza, Ms Contin, others), Oxycodone (OxyContin, Roxicodone, others), hydromorphone (Dilaudid, Exalgo), Fentanyl (Actiq, Fentora, Subsys [an under-the-tongue spray] and others), Methadone (Dolophine, Methadose) Oxymorphone (Opana), and Tapentadol (Nucynta).Tramadol (Ultram) is a painkiller similar to opioids. Some others painkillers are:

• Targiniq ER, which was FDA-approved in 2014, is a new opioid that is an extended-release/long-acting opioid analgesic to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate." Targiniq ER has properties that are expected to deter, but not totally prevent, abuse of the drug by snorting and injection. In addition, the Naloxone in Targiniq ER blocks the euphoric effects of oxycodone and helps circumvent the constipation that usually accompanies the ingestion of opioids.
• Zohydro ER is a new extended-release, oral opioid indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment.
• Hysingla ER is another strong opioid, which has the same active ingredient (hydrocodone) as Zohydro ER, the only other approved extended-release hydrocodone product.There are important differences between the two drugs.Hysingla ER has approved abuse-deterrent labeling, while Zohydro ER does not. Also, Hysingla ER is taken every 24 hours, whereas Zohydro ER is taken every 12 hours, and therefore comes in lower dosage strengths.

From: http://blogs.fda.gov/fdavoice/index.php/2014/11/additional-progress-on-reducing-the-abuse-of-opioid-pain-relievers/#sthash.DwMxtFrZ.dpuf

• Antidepressants. Certain medications called "tricyclic antidepressants" have been found to help relieve pain by interfering with chemical processes in the brain and spinal cord that causes a person to feel pain.Examples include Amitriptyline, Doxepin and Nortriptyline (Pamelor).Additionally, some people experienced a significant decrease in neuropathy-induced pain when they took a prescription antidepressant drug called Cymbalta (Duloxetine).

From:http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/treatment/con-20019948

• Anti-seizure Medications. Certain medications such as Gabapentin (Gralise, Neurontin) and Pregabalin (Lyrica), which were developed to treat epilepsy, may relieve nerve pain. From: http://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/treatment/con-20019948
• Muscle Relaxers:Muscle Relaxers such as Flexeril (Cyclobenzaprine) can help to alleviate painful muscle spasms. Potassium and magnesium supplements can also be helpful in relieving muscle cramps, as can Epsom salt baths.
• Nerve Blocks (including Epidurals): Specialized treatment involving the injection of a nerve-numbing substance may be used. This may help prevent pain messages traveling along that nerve pathway from reaching the brain.
• Pain Pump: A pain pump may be a viable consideration when oral and IV pain medications fail to control pain adequately.The pain pump is an implanted drug infusion system that releases prescribed amounts of pain medication directly to the pain receptors (nerves) near the spine.The entire system consists of a pump and a catheter. The pump, whose purpose is to store and deliver pain medication, is surgically placed in the abdomen. The catheter is inserted into the intrathecal (spinal canal) space surrounding the spinal cord. The catheter is then connected to the drug pump.The doctor fills the pump with pain medication using a needle. The pump sends the medication through the catheter directly to the spinal area where pain receptors are located. Patients return to their doctor for more medicine when the pump needs to be refilled.Before having the pump implanted, an epidural screening test provides a temporary evaluation period so that patients can determine whether the targeted drug delivery truly relieves the pain.It is worthy to note that the system can be turned off, or surgically removed, if eventually desired.One person with bone mets broke several ribs due to severe coughing and decided to have a pain pump inserted.She was also allergic to several pain medications, and has had no allergic reaction to the four the medications in the pump.After three years of living with the pump, she claims not to have experienced side effects such as drowsiness or constipation because the drugs bypass the digestive system, and the dosage is a fraction of the norm (since the drugs are delivered directly to the pain receptors). She has the pump refilled every two months and is able to administer an extra injection if necessary.In summary, she claims to be much more comfortable than she had been before she used the pump.More information about pain pumps is located at: http://www.medtronic.com/patients/cancer/device/what-is-drug-pump-therapy/Many of the above medications are taken orally, so they are easy to use. Medications may come in tablet form, or they may be made to dissolve quickly in the mouth. However, if a patient is unable to take medications orally, they may also be taken intravenously, rectally or through the skin using a patch.

Other therapies such as Acupuncture, Acupressure, Massage, Meditation, Physical Therapy, Yoga, and other relaxation techniques may also help to alleviate pain.

I take nortriptalene for pain due to sciatica and neuropathy.  Took a couple of weeks to start working but it did.  It also has been a great help with insomnia.