Doctor insights on:
What Is Baseline Pain And Breakthrough Pain
Acute pain: Breakthrough refers to episodes of acute worsening of pain symptoms in a person being treated for chronic pain. If it occurs infrequently then immediate releasr pain meds are used to relieve discomfort. If it is occuring frequently, then an attempt to adjust the dosage of long acting analgesic can be attempted. The goal is to limit breakthrough pain and keep the patient as comfortable as possible. ...Read more
No: Breakthorugh (btp) pain is pain that is above the baseline pain. Not all episodes of btp require attention. 50% have no cause - it just happens. Btp usually peaks in 3-5 min and lasts about 40-60min. ...Read more
Maybe: Actiq is not the best breakthrough pain medication in my opinion. It is expensive and from my experience doesn't work better than less expensive oral options. Also, fentanyl has a relatively short half life and I find that most of my patients who are prescribed breakthrough pain medication almost never have any left at the end of the month, so they are really using it as maintenence medication. ...Read more
What would be a good med for me for breakthrough pain? Oramorph 10mg/5ml doesn't seem to help much.
No easy answer: As to be able to best guide you, one would ideally need to know more specifics about the exact causes of your pain, quality of your pain and what medications you have tried in the past. Sounds like you need the input of a pain specialist. Best of luck. ...Read more
Very short effect: For this reason this med shouldn't be used for non-cancer pain. The effect lasts for at most 1 to 1 hours. Tolerance develops rapidly because of the rapid, intense effect. This results in the need for higher and higher doses over a very short time. This med is most appropriate for patients not expected to survive for more than several months as the med becomes less effective rapidly. ...Read more
Maybe: The active ingredient in Actiq is fentanyl, the same medication in the Duragesic patch. As such, I tend to prescribe fentanyl products for breakthrough pain in my patients with chronic pain on around the clock opioid treatment. Actiq works well, but takes a while to kick in, and needs to be rubbed on the cheek for a while. There are other products that work faster and not swallowed as much. ...Read more
I have been wearing norspan 10 + 20 for 2 years and 5 months. Breakthrough pain is frequent now. Doc is reluctant to increase weekly dose. I am 72.?
Opioid issues: Some docs just don't feel comfortable increasing pain meds, but it sounds like you might be due for an increase. However, other things need to be considered, including other health issues, concerns about falls, and the nature of your pain. I would recommend seeing a pain specialist or physiatrist to discuss other modalities, functional issues and increase or change in pain meds. Best of luck! ...Read more
Impossible to answer: Chronic narcotic use has enormous risks, especially in a 35 year old. Without detailed knowledge of your history, this question is impossible to answer. From the list of your other medical issues I would urge finding other treatments to address the pain and anxiety/depression besides narcotics. ...Read more
As directed: As directed by your prescribing physician. Usually if you have been on a stable dose of oxycontn for several days, you have achieved a relatively stable blood level of the drug. This is why it is scheduled to be taken at regular intervals (eg. Every 12hr). In this case, bt medication can be taken irrespective of last long acting med dose. You really need to discuss bt pain with your physician. ...Read more
My doc just increased my meds (dilaudid) from 1mg to 2mg for breakthrough pain. Should I notice much difference?
Better pain relief: If you are having increased breakthrough pain and your physician adjusted breakthrough pain medication dose. You should experience better pain relief assuming your pain is opioid responsive. Since you are not opioid naive, you should not have much side effects, but also with increased dose you have to be vigilant about possible increased sedation. ...Read more
Is it safe to take 240mg of codeine daily and 5ml of morphine for breakthrough pain upto x4 a day? What ratio is codeine to morphine on average thanks
Probably too much:
Oramorph is much stronger, and shorter lasting, than tramadol, so it may work too well, for too short of a time.
It can be surprising, but sometimes these medicines do not work the same as you would expect. Their effects vary from person to person.
If tramadol usually worked, normally naproxen, amitriptyline or gabapentin would help for remaining pain. ...Read more
Doctor won't increase oxycontin amount, need something for breakthrough pain - what do you think?
Is there any reason a chronic pain patient should not be prescribed immediate release medication for breakthrough pain?
NoReason/MD'sChoice: There is no reason why chronic pain patients should not be prescribed immediate release pain meds and these are often prescribed. But what medicine and for whom it is prescribed is the decision made by the treating physician who knows what kind of pain Medication is indicated in particular case ...Read more
Is it true that having an oxycodone prescription for breakthrough pain just makes people take more pain medication?
Oxycodone: Yes and no. Oxycodone is a frequently prescribed immediate release narcotic given to people who are on chronic opioid therapy with a sustained release narcotic taken orally or by patch. The key is frequent follow-up with your pain physician to get to a regimen of sustained release narcotic where you require the minimum amount of oxycodone/breakthrough meds for emergency only. ...Read more
What pain medicine works best with fentanyl patch for breakthrough pain? I'm currently on fentanyl patch and percocet.
No best: There is no such thing as a "best" medicine that can be generalized. Everyone needs individual assessment. Discuss with your doctor. It is concerning to me that you are on these medications at age 27. ...Read more
I have constant pain and I want something to keep me pain free most of the day, and just use the percocet as a breakthrough pain reliever?
I have rheumatoid arthritis and I'm on methotrexate, is it ok to still have breakthrough pain flare ups?
No: That is a sign that your rheumatoid is still active. See your rheumatologist to see what other medications you are a candidate for. ...Read more
I'm prescribed hydrocodone 10mg but I've been having sum pretty serious breakthrough pain I was curious bout what I could ask my doctor about tramadol?
Neuro prescribed baclofen for breakthrough pain from Trigeminal Neuralgia; is this common? How long will it take to work? What should I expect?
Is a muscle relaxer and may have some "off label" benefit in cases of Trigeminal Neuralgia. This condition is a frustrating one and I am sorry you are afflicted! That being said you are ON THE RIGHT TRACK seeing a NEUROLOGIST and following their suggestions for treatment!
Hoping this reassurance is helpful!
Dr Z ...Read more
What is a strong, clean narcotic for breakthrough pain? I currently have a Butran Patch (5mg) & it's not working. Possibly need a bile duct stent.
Pain killers: What was the butrans written for, who prescribed it, if for cholongitis that is a wrong medicine all together, gi guys are capable to handle it ...Read more
I am now taking norco (hydrocodone and acetaminophen) 10 325 my back pain but I think I need something else for breakthrough pain just say something recommended?
Have progressively worsening upper stomach pain since May of this year. Now take 40mg omeprazole w breakthrough pain. Normal blood h. Pylori. Help!
Gastroenterologist: Have you been evaluated by a gastroenterologist for this persistent upper abdominal discomfort? It appears that studies should include a gastroscopy and, if unrevealing, an abdominal CT scan as well as blood work to include liver and pancreatic tests. Possibilities include chronic gastritis (requiring more than one dose of prilosec daily), duodenal ulcer, stomach or pancreatic cancer, pancreatiti ...Read more
Excuse me?: I'm not sure why you feel there are no breakthroughs, but new scientific & medical discoveries are made every day. Behavioral epigenetics, which opens the door to many previously unrecognized associations and things we can do to help ourselves, is for me quite profound. Here's a taste: http://discovermagazine. Com/2013/may/13-grandmas-experiences-leave-epigenetic-mark-on-your-genes. ...Read more
Vaginal bleeding: Btb is vaginal bleeding. It usually refers to mid cycle bleeding in users of contraceptives. So if the cycle is 28 days you have spotting at a time that does not match your cycle. It sometimes is attributed to not enough estrogen. It usually ceases after one or two cycles. If it continue go to your doctor for evaluation and treatment. ...Read more
No 21OH-ase defect: 17 hydroxyprogesterone screens for a congenital condition, congenital adrenal hypertrophy (cah) which can lead to abnormalities of normal cortisol production and excessive adrenal male hormone production. These can present at birth, in childhood, adolescence, or adulthood depending on the nature and severity of the defect. The sensitivity of the baseline test can be increased with acth stimulation. ...Read more
Does injury in the vegus nerve cause baseline hr to be 120 bpm? What else suddenly change the baseline hr?
Autonomic imbalance: The reduced vegus nervous output will cause the balance to shift to increases sympathetic output, thus faster heart rate. There are other consequences from the injury itself depending on the extend. ...Read more
Breakthrough 2 wks in July. 6 days in Aug (missed a few pills on the week). Over 3 wks in Sep. What's happening now?
Due to missing pills: When you miss birth control pills, the hormonal levels are not consistent with frequent ups and downs, which leads to irregular bleeding and unpredictable patterns. May want to use your pills regularly. If the problem still persists please see a gynecologist. Based on your sexual activity, if necessary, please do a pregnancy test. ...Read more
I've lost 20 lbs in 11 months. I started a new pill with a high estrogen content 6 months ago. I get breakthrough week 2 like clockwork. Why?
Baseline cortisol3.9 after acth stim injection 30min draw was 20.7 and 60 min draw was 17.3. is this normal to more than triple after acth stimulatio?
Increase is normal: This is the appropriate response to stimulation. Roughly at least a 15point increase is expected. ...Read more
Depends...: ...on the cause. If you're not on any hormones (like birth control pills), then this is not normal, and you should be examined right away. If you're taking birth control pills, you probably need a higher dose. ...Read more
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