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Meds for breakthrough pain??

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  • Meds for breakthrough pain??

    Hello everyone,
    I'm looking for recommendations on short acting pain meds for breakthrough pain. I experience chronic pain which is caused by a perineural cyst, bulging disk and tethering on my cervical spinal cord. My doctors are reluctant to operate as I've already had three cervical laminectomies. I've had in intrathecal pump since 2006 and while it does help (especially my spasms), I am still experiencing some very intense breakthrough pain. From the pump I'm getting 54.02 ?g of Lioresal daily and 4.05 ?g of hydromorphone daily. I can get a bolus of 12.60 ?g of Lioresal and 0.945 ?g of hydromorphone every four hours.

    Up until a few months ago, I had been taking 800 ?g of Fentora five times a day for breakthrough pain. Late last year the pain started getting even worse and I had to start taking 30 mg of oxycodone as the Fentora wasn't always doing the job. I had to switch to a different PDP for 2014 and the new plan doesn't cover Fentora so my doctor switched to oxycodone as my primary medication for breakthrough pain, I was taking 30 mg three times a day. The oxycodone alone wasn't helping very much so my doctor also prescribed methadone, 10 mg three times a day but that hasn't been helping much either. I have to go for a pump refill this Thursday and plan to ask my doctor what other medication besides methadone she might recommend (as well as asking for a bolus increase). I'm also throwing that question out to the group.

    What do you all take for your breakthrough pain? Anyone else here ever tried Fentora and if so did it help you? I found the Fentora a better medication as it was much faster acting than the others with less side effects. Anyone know what the best replacement for Fentora would be? I have used Actiq in the past but that too is not covered by my drug plan. The only reason my doctor prescribed methadone was because I had mistakenly brought it up and a phone conversation, I meant to ask about morphine. When I got the prescription for methadone, I had it filled as I was desperate to try something different. From what I've read, methadone is better than morphine for treating pain but unfortunately it's not helping me.

    Thanks in advance for any info you all can provide.
    Dan G. in CT

  • #2
    Is that a fentanyl patch? There are folks here on them. Mostly with love/hate relationships to it with the constant withdrawal symptoms rearing their ugly head.
    Man, you are in a tough position. I hope you find some non drug options to help you get through the day with some element of sanity. You could alway increase the methadone dose but you might be ending up with paradoxical opiate pain. Ugh. Been there. Had to take a medication holiday, which is hard when living with others who don't want their heads bit off by someone grumpy. It helped.

    Sorry I can't think of a miracle treatment.
    Good luck.



    • #3
      thanks for your reply. Fentora contains Fentanyl but its an oral med taken sublingually. I tried the patch many yrs ago and while it helped it also really impaired my breathing. Still working w/insurance co. and the mfg on getting Fentora again at a lower cost which in my case is $45k for a 3 mo. supply!
      Dan G. in CT


      • #4
        I use morphine with percacet for the break through pain, plus gabapentin to help with the burning pain. Never tried fentora, but did the fentanyl patches, and they just didn't work. It's hard when you find something that works, and then the insurance companies refuse their use. It is hard enough just finding the right combo of drugs, and then you find you can't afford them.....that's tough. Good luck finding a solution.


        • #5
          Standard cocktail: Nucynta 100mg every 4 hours, Oxycontin 80mg 2x daily. For breakthrough, it's hydromorphone 4mg-12mg...

          Seems to work quite well for me...
          Andria - T6/7 Transverse Myelitis - My Chariots: Ki Tsunami Titanium w/ Spinergy SPOX, Jay J2 Seatback, Jay J3 cushion | 2002 Mercedes E55 AMG, Brilliant Silver, Autoadapt Menox control, hard-wired Valentine 1


          • #6
            i take fentora, it is the only thing that works when the pain rockets, and i need to put out the pain fast, It is a quick acting fentyl med, that is very powerful,you need to be opiod tolirent to be on it, it is buccal,not sublingual, it is suppoe to go in your mouth between your cheek and a rear molar. it will dissolce there and hopefuly the medicine will enter the bloodstream via the cheek membranes. if
            it works properly, you will start having pain relief in 15 minutes, that is the whole point of the buccal delivery,fast pain relief. itf i suck on them then the medicine will go through my stomach and take 45min like the ret, and all that money for nothing. however the manufacturer gives the buccal tablets a lemon,pleasant taste,like a sweet tart. This si incredible stupid since it causes the patient to suck on them A neutral taste would be fine, it is expensive . I am also using methadone 30 mg x 3 times a day. The methadone works very well but the side effects suck.Same with fentora i relatively short acting, whereas methadone is long acting.
            tramadol and neurontin are my other meds. I couldn't live without the fentora, i went on it because i was worried i was going to wake up dead. The opana i had for bt pain would take too long to work, and i had to take another, as i was in a ball on the floor, with shocks every 7 to 15 seconds, i'd wake up after almost an eternal sleep, with feces all around me. I took that for a bad sign, of worse too come. Ask the manufacturer to help, there are also about 3 other meds in the came catergory of fentora, price may be the same ,but the manufacturer may help you out. take care
            cauda equina


            • #7
              Thanks for the reply, Metro,
              Mind if I ask how much Fentora you were taking, micrograms and how many times a day? Do you have insurance coverage for it? Also, what side effects were you getting from the methadone? I was okay the first week I was on the methadone but then started feeling occasional nausea and seizures (I have a very mild seizure disorder, under control with divalproex). Then last week, two days after my pump refill, I spent half the day leaning over the sink having dry heaves and just feeling like crap. I couldn't fall asleep because as I did I'd have petit mal seizures that would wake me up. My pain doc said it probably wasn't meds in the pump and I did feel fine the next day. I've stopped taking the methadone for now anyway. FYI, I always took Fentora buccally, just had a brain fart when I wrote sublingually in my first post. I agree with you re Fentora being fast acting, so much faster than oxycodone, and just about any other oral pain meds! I've also tried Neurontin but unfortunately, it did nothing for my pain. Thanks again.
              Dan G. in CT