help with knowledge of long acting meds for chronic pain

[anangelsmommy, ADN, BSN, RN]

I started a thread in another forum and someone suggested I look here and of course this is a perfect place! I was working on a care plan for a patient that has chronic pain and is concerned about advancing her opiate medications. She had originally started out on muscle relaxants combined with very small doses of percocet and or vicodin. There was a whole list of muscle relaxants - and some arthritis drugs like celbrex. but she developed severe esophagitis, had reflux and had to stop all changed to percocet, added prilosec. now she is building tolerance to opiate meds and concerned. someone here said there are some opiates that act longer so you do not get the up and downs and you get better pain management and less likely to need to advance on dosage. The only one that I know of is oxycontin but I was wondering if there are others and do they even start in doses equal for someone that only takes 7.5 mg of percocet, tid? and how to equal out - is the oxy dose the same? I am not sure if she would be open to it because part of her concern was actually trying to reduce her meds but if it actually kept her from increasing, it might work.

angels mommy

[anangelsmommy, ADN, BSN, RN]

ok, found it. up at the top of the forum. http://www.endpain.org/dosage.html. is there any difference real or percieved between vicodin and percocet other than how one responds to it?

angels mommy

[NRSKarenRN, BSN, RN]

see:

pain, chronic; assessment and management of (guideline)management

key to chronic pain management is identifying type of pain and what meds used in past and adding adjuctive meds and other modalities to treat flareups. some poeple can not tolerated nsaids due to gi effect: esophagitis, gastritis, ulcers so narcotics used. long acting narctoics preferred as less peaks and valleys through the day.

is there any difference real or percieved between vicodin and percocet other than how one responds to it?

the active ingredients in vicodin are hydrocodone and acetaminophen while the active ingredients in percocet are oxycodone and acetaminophen. they may vary such as 5 mg hydrocodone/500 mg acetaminophen or 7.5/500, etc... both narcotics have similar length of action.

[Jmas7]

There are a lot of new things coming out that I'm seeing a ton of in my work, like Opana which is a long acting Oxymorphone, and Kadian/MS Contin which are long acting Morphines, and I recently have dealt with Nucynta which is a long acting that is similar to Percocet & Vicodin. There are a lot of options other than Percocet & Vicodin but the problem is they are still pretty new sooo pretty expensive.

[Munch]

I know this thread has been started a while ago but Jmas is right, Opana ER is extremely expensive because it doesn't have a generic. MScontin is a bit cheaper because now a generic version is available. Also a very low dose of methadone could be an option. I'm talking like 5-10mgs. Methadone is DIRT CHEAP and is a VERY effective long acting pain killer. Also oxycontin comes in a 10mg version so the patient wouldn't have to worry about such a high increase and oxycontin isn't THAT THAT expensive if you have insurance...I would say it's in the middle as far as cost goes. Of course the cost of all of these meds depends of if you have insurance, what kind of plan you have, if you have prescription coverage or if you have insurance at all...Just my

[tewdles, RN]

You are on the right path. A long acting opiate coupled with an immediate release option will likely provide your patient with improved control and quality of life.

As you can see from the responses there are a number of options. I prefer to pick the brains of the PharmD and collab with the MD in attempts to improve the POC. Certainly the willingness of the patient to try an new POC, as well as compliance history will factor into recommendations.

Good luck...yours is a path worth investigating.