breakthrough pain

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User offline. Last seen 7 years 25 weeks ago. Offline
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i'm currently on 100mcg/48hr fentanyl and have been for almost 6 mos. Started on 25mcg and titrated to current dose. I fell from the second story to the cement and damaged 3 vertabrae that require surgery and bone grafting. I have not utilized a btp med yet and have not had one prescribed. I am horribly impatient and I have never been off work in my life so I waited for my wife to go to a baby shower and tried to do the yard 6 weeks ago and caused more spinal trauma confirmed by an updated MRI. Since then I have had 4 episodes lasting from 1 day to 3 days of pain that is off the chart. my wife asked me to go to ER but i will not when I am already on meds and have a doctor to go to locally that oversees my care. I have not asked for any breakthrough med and do not know what would even be given to someone on fentanyl. My surgery was postponed because the insurance is having some issues with pre and post studies because i jave MS . In my favor my MS afforded me clear and current MRI pics to show the condition of my spine prior to injury since i had a preemployment physical and MS study requested by my primary for my benefit as well as his so he could release me to work with an A OK.  I worked for 3 years without incident until the fall and thats where i am today. My question is this: What would be a functional breakthrough med for someone on fentanyl patch

goat's picture
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works for me..when starting the patch my dr just added it to my regular oxycodone dose

HCandKROD's picture
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There are so many possibilities

it would be hard to even advise on this topic. Everyone is different as are the doctors we all visit. What works for me is Levorphanol (an opioid with a very long half-life ) and Oxycodone for b/t pain. But that is me don't take my word as gospel. Talk to your doctor openly about your pain and see what he/she says. Could be a lot of trial and error. Oh, take it easy on yourself!! Patience is a virtue Tongue out. Slow and steady wins the race. Good luck and have a great day everyone!!

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HC is right on when it comes

HC is right on when it comes to this... what works for one, doesn't for many others... but it is a good question to see what others take... myself: my BT med is Opana 10mg and works as it should...but, my long acting med is also Opana...      best of luck...

User offline. Last seen 7 years 2 weeks ago. Offline
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Yes, almost anything could be

Yes, almost anything could be prescribed by your doctor. I think to get a better answer from people your question should not be what would be a good b/t med to go along with your patches but instead is there any b/t med that would NOT work well or would cause interactions with your fentanyl patches.

I used to be prescribed 50mcg/72 hr fentanyl patches as well as 11 10/325 Norco/day. This worked pretty well for the most part. I do find it odd that you are given these patches for a 48hr period. I've only ever heard of people getting them for 72hrs, although most who use them regulary know they do not always last that long.

User offline. Last seen 3 years 22 weeks ago. Offline
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Not everyone takes a BT

Not everyone takes a BT medication/s.Hopefully your pain will improve and will not require a BT to manage it.With surgery on the horizon you or your surgeon might find it best (looking ahead) to manage your pain now as conservatively as possible so that it will be easier to keep your pain at bay during and after (or while recovering) from spine surgery.

In the meantime,while awaiting surgery I'm sure your Dr/s have talked to you about pacing yourself so that you don't cause possible further damage.I know it's hard to be patient,but it will be good practice for what is coming during your recovery time when you wil have no choice but to patient if you want this operation to be successful.

After surgery you will more than likely require more medication & BT meds,but building a tolerance to them before spine surgery is generally frowned on by most spine surgeons.

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My long acting Med is Opana

My long acting Med is Opana ER(asmmw is my Opana buddy Smile) and I take dilaudid 4mgs 1-2 tabs every four hours as needed and it really keeps the pain at pay, my script allows me to take 8 a day but I usually stick in the 6-7 times a day depending on the day I am having. Like HC said everyone IS different when it comes to taking an extended release opiate and having breakthrough pain meds on board. Talk to your doctor. Most people on this board seem to favor hydrcodone/apap(Vicodin, Lortab, Norco, Lorcet, etc.) or Oxydone with or without APAP(Percocet, Tylox, Endocet, Roxicet, Roxicodone, OXYIR). Everyone is different and responds to meds differently. I can't stress enough to talk to your doctor. Just tell him you are getting pain attacks every now and again and the fentanyl patches alone aren't cutting it. I am sure you aren't the first person this happened to in your doctors practice..hopefully he will fix you right up

User offline. Last seen 3 years 12 weeks ago. Offline
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Would appreciate any advice on converting from Methadone/Lyrica to Levorphanol.  My pain doc knows nothing about this old drug which is the only opioid indicated by FDA for neuropathic pain.  Your know-how is valued.

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Cost   Levorphanol is

Cost   Levorphanol is relatively expensive. A 2 mg tablet is roughly 10 times more expensive than an equivalent dose tablet of methadone and 2 times more expensive than an equivalent dose of a sustained-release morphine tablet. 

Conclusion Levorphanol is a unique opioid analgesic, has pharmacologic properties which may make it particularly suited for patients with neuropathic pain, and recent data suggesting it is a safe and effective opioid in patients having inadequate response to other opioids. 

Dosing Parenteral levorphanol is twice as potent as the oral formulation. Published oral morphine:oral levorphanol equianalgesic ratios range from 30:4 to 12:1 (4, 6). The most recent case series looking at switching from other opioids to levorphanol used a staggered morphine:levorphanol ratio (6), similar in concept to switching to methadone (see Table). Available data indicate these ratios are reasonably safe and effective. The medication is dosed every 6 – 12 hours depending on an individual patient’s duration of analgesia. Opioid naïve patients can start with 6 mg orally a day, divided. Levorphanol is available in 2 mg tablets and 2 mg/ml or 2 mg/10ml parenteral formulations. 

Table. Conversions to Levorphanol (6).


Baseline 24 hour Oral Morphine EquivalentMorphine:Levorphanol Ratio

<100 mg

12:1 (e.g. 60 mg PO morphine/24h = 5 mg PO levorphanol/24h)

100-299 mg


300-599 mg


600-799 mg


>800 mg

No data