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   Strongest Pain Medicine? (Pain Management board)

12th December 2006
How would do you rank these three meds for pain relief?

Vicodin
Oxycodone
Morphine
Methadone

My friend is taking;

* Two 30 mg time released morphine daily
* Four 10/660 Vicodins daily
* Three 100 mg Lyrica daily
* One 10 mg Paxil daily

Pain level is in the #8 - #9 range every day even
with taking all those meds. It's neuropathy pain in the feet and legs
due to clogged arteries that made the toes turn black. Root cause
of this problem has been fixed, but the pain never goes away.

The doctor is not taking the pain issue seriously
so I need to understand what other meds can
we ask about.

Should I ask to replace Viodin with Oxycodone?
Should I ask to replace Morphine with Methadone?

Any other ideas?

Any tips are appreciated. :)

Edit typo.
12th December 2006
Hi lantern, Pain management is trial and error. Nobody knows how your friend will respond to any med. As far as what med is the strongest, that really doesn't matter, It's the number of mgs that counts. Just because oxycodone is 50% stronger than morphine it doesn't mean it will bring greater relief. It's also why they make higher dose long acting morphine than they do oxycodone. The strongest oxyC is 80 mgs, the strongest MScontin is 200 mgs. 80 mgs of oxy isn't stronger than 200 mgs of morphine. The strogest tab methadone comes in is 40 mgs, obviously you can take more than one tablet even though it's 3-10 times stronger than morphine.

So drug to drug comparison really doesn't matter at this point. There is plenty of room to increase his dose of morphine, but neuropothy doesn't repond as well to opiates as other types of pain. He likely needs something from the antiseizure class and anti depressant class for nerve pain in order to reach levels of pain relief he couldn't with opiates alone.. There are plenty of choices and newer choices than the ones he's taking, but that's trial and eror too. Cymbalts is the newest antidepressant that is also aproved for peripheral neuropothy. Lyrica is the newest anti seizuere but some folks respond better to oldies like tegratol. He's using paxil which is oone of the first SSRI to come out. The doc is covering all the bases.

Methadone does have the reputation of working better on nerve pain, but it would take weeks or months to adjust a meth dose and allow someoenes body to accomadate to the side effects. I hated the way it made me feel. The easiest thing would be an increase in morphine, but it may not be as effective as switching his anti D or the anti seizure med.Even doublking the morphine may not be enough opiate to mask neurpothy. Unfortunately it takes weeks or months to reach max effect from some of the drugs used in PM.

The more info he can give the doc the better off he will be. Keep a log or diary when an adjustment in med or dose is made, be honest in reporting and realize that even 5% better may let the doc know he's on the right track with a specific med. The hard part is adjusting all meds at once. You don't know what made the diference if you don't do one at a time, So it takes months or years to find out what works best when dealing with problems that will likley last a lifetime. CP for some never ends.
24th December 2006
I am Curious about pain meds also, what is the difference Between a 10mg Methadone and Lorcet 10/650? I know the Methadone is Stronger, But was Wondering How they Compare to Controlling Pain. Thanks in Advance and Merry Christmas to all and Hope Your Hollidays are as Pain Free as They Can Be:) :)
24th December 2006
Quote from bandit122:
I am Curious about pain meds also, what is the difference Between a 10mg Methadone and Lorcet 10/650? I know the Methadone is Stronger, But was Wondering How they Compare to Controlling Pain. Thanks in Advance and Merry Christmas to all and Hope Your Hollidays are as Pain Free as They Can Be:) :)

There's alot of variables at play here.

Equinalgesic charts are used to guage relative potency of narcotics against one another (e.g. Morphine, Methadone, Hydrocodone, etc). The "standard" by which all these types of meds (opioids) are measured is Morphine, usually at 10mg. I've seen equinalgesic charts that put Lorcet 10mg (hydrocodone) pretty much equal to Morphine 10mg (morphine is the standard by which all others are measured). I've seen others that indicate Morphine to be superior to hydrocodone mg for mg.

Also, most equinalgesic charts put Morphine 10mg equal to Methadone 10mg. All things being equal, this would tend to make Methadone 10mg pretty much equal to Lorcet (hydrocodone) 10mg.

But there's much more to this than just relative potencies.

The medical community is learning quickly that methadone is much more potent than once thought, and alot of this has to do with a person's experience with opioids.

If a person has little to no experience taking opioids then they may find these meds relatively equal in controlling pain, with the exception that the methadone may last a bit longer. However, a person who is now or was at one time using opioids for pain control will find methadone to be more potent, possibly considerably more potent than Lorcet.

So, if you are new to opioids then the two meds may seem close in potency. Over time the methadone will perform better. If you are used to opioids the methadone should prove more potent. And the more methadone you take the more potent it becomes, not just in mg but cumulatively as well since the body stores it in it's tissues and it gets released over time.
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