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Originally Posted by mr_colt  Thanks for the response,
I managed to bet onto Butrans after months of fighting for the medics to acknowledge that my pain is organic and not neuropathic. All the usual drugs like NSAID's, Trcyclics etc were tried with no effect.
Opioids are the only thing that have ever worked; but codeine, tramadol and DHC were barely effective on the pain. Buprenorphine has done the world of good in turning me from being almost bed-bound to housebound without door-to-door transport I suspose:
5mcg/hr is just not enough for any quality of life though, as I have mentioned in other posts. I have had to move counties to get close enough to an consultant who will script higher doses for someone my age (19) who isn't terminal.
So far it is looking like a trial increase to 10mcg/hr with Temgesic 200mcg sublinguals for breakthrough pain: From a pharm perspective is this a good combo to try? We were also thinking about oramorph for breakthrough but it only has a half-life of 4hrs and wouldnt bup's partial agonist-antagonist properties make it less effective?
mr_colt |
Mr. Colt: you are probably the most educated pt I've come across (assuming you're not a healthcare professional). From a pharm perspective, it is always good to treat chronic pain with a long-acting or "basal" agent and another for breakthrough pain, such as you describe. I would argue that all pain guidelines support this. However, not all practitioners are "used" to prescribing this way or "comfortable" with it. There lies the problem! There are also medico-legal issues with prescribing these medications if something should go awry. ANY breakthrough pain agent will not last more than 4 hours, no matter what the kinetics say! The key to treating pain is to adequately dose the underlying basal agent so that you will not require breakthrough agent. Unfortunately, some patients know this, abuse it and doctors are certainly aware of it. Oramorph here in the U.S. is an extended release morphine product. One would not use this for b/t pain. Partial agonist/antagonists are never used to treat chronic pain, period...If your pain is not neuropathic in origin, not sure why tricyclics tried. Not sure what type of chronic pain you have? Sounds somatic? Low back pain? Paraspinal? It is important to know to choose the right agent. Also if your dose is titrated upward, a titration of <30% is clinically ineffective. You can feel free to send me a private message and I'd be happy to look into your issues.