Narcotic Therapy for Patients with Chronic Non-Cancer Pain
Gary W. Jay in Chronic Pain, 2007
There are three types of breakthrough pain: incident or episodic—patients know what can cause the pain and take a preemptive, fast acting pain medication. Next is idiopathic or spontaneous breakthrough pain, which comes on suddenly and not infrequently for no obvious reason. Lastly is end-of-dose failure, which is not as unusual as one would expect. Some patients will need to take MS Contin or even OxyContin two or three times a day. Some patients using transdermal fentanyl patches, which are labeled to last 72 hours, in some patients do not—they may only last 48 hours. The physician can see the end of dose failure by the marked increase in breakthrough pain that occurs when the time release medication has been metabolized and the blood level is dropping.
When I Control the Pain, I Control My Life: Opioids and Opioid-Containing Analgesic Medication in the Management of Chronic Intractable Pain
Michael S. Margoles, Richard Weiner in Chronic PAIN, 2019
Dosage increases should be stopped if tiredness sets in, thinking becomes clouded, or nausea and vomiting develop. As you gradually increase your dose of MS Contin® (or similar drugs), begin to taper down on your consumption of Anexia®, Percocet®, Vicodin®, etc. Do not stop the MS Contin®, etc. medication abruptly. First, call your physician for directions. In the worst-case scenario, if you need to taper the medication but have no professional to help reverse the order of the MS Contin®, start at day 13 and begin to taper yourself down, right down to day 1 dosing, and then stop use of the medication.
Opioids and Related Agents
Frank A. Barile in Barile’s Clinical Toxicology, 2019
Oxycodone, in combination with aspirin or acetaminophen (Percodan® and Percocet®, respectively, 2.5 mg per tablet), has enjoyed popularity as an effective analgesic for the relief of moderate to severe pain of chronic inflammation and surgery. It is particularly useful in the alleviation of chronic pain of many cancers. In 1985, MS Contin® was introduced as a delayed-release morphine tablet, with the advantage of decreasing the frequency of dosing in patients with chronic pain. This formulation was especially convenient for elderly individuals. By 1994, morphine consumption in the United States had risen by 75%. Based on this success, Oxycontin® was introduced in 1995 as a delayed-release oral dosage form of the more powerful oxycodone. Revenues from Oxycontin® rose from $55 million in 1996 to $1.14 billion in 2000, at which time it became the number one opioid analgesic, with 6.5 million prescriptions in 2000. By 1995, the first cases of Oxycontin® abuse (“oxys”) appeared in rural Missouri and spread throughout the rust belt states of Pennsylvania, Ohio, West Virginia, Virginia, and Appalachian Kentucky. Increasing unemployment rates in these states and the large numbers of chronically ill and disabled elderly people who were unable to relocate, coupled with the remoteness of the regions, created an environment conducive to illicit drug distribution (the drug became known as hillbilly heroin). Economically poor, the elderly would readily sell their Oxycontin® medication to young teens offering money, producing a captive market of nontraditional drug abusers. Unlike heroin, “oxys” are regarded as legal compounds, more easily available, and with less ambiguity associated with “copping dope” on the street. The allure of the substance was not in the potency of the tablet form but in the large quantities of active ingredient immediately accessible when a 10 to 40 mg delayed release tablet is crushed and either “snorted” or injected.
Treatment of painful polyneuropathies of diabetic and other origins with 10 kHz SCS: a case series
Published in Postgraduate Medicine, 2020
A 70-year-old female diagnosed with chronic inflammatory demyelinating polyneuritis (CIDP) presented with severe pain in bilateral lower extremities. She was also left with pain in her buttocks and right thigh after her laminectomy. She was using 60 mg TID of MS Contin (morphine sulfate) and 10/325 QID Norco (hydrocodone + acetaminophen) for the management of pain. She was offered 10 kHz SCS treatment for the management of lower extremity pain. At baseline assessment, her pain intensity score was 7, which reduced to 3 at EoT, a 57.1% pain relief (Figure 2A). After receiving a permanent implant of the PG for her lower extremity pain in December 2015, she reported significant improvement at the time of her first follow-up visit. At this visit (11.9 months post-implant), she rated her pain intensity as 2.5 (64.3% pain relief) and described improvement in her daily activities that included being able to cook on her own and able to stay on her feet for longer periods of time. In her second follow-up visit (12.9 months post-implant), she reported a slight increase in her leg strength and function in addition to pain relief. In her last follow-up visit (26 months post-implant), she rated her pain score as 3 (57.1% pain relief) and reported that she had to increase her pain medication for her neck and upper extremity pain (Table 2). Her latest outcomes were not available as she moved out of the area.
Syringeability of morphine ARER, a novel, abuse-deterrent, extended-release morphine formulation
Published in The American Journal of Drug and Alcohol Abuse, 2019
Eric R. Kinzler, Carmela Pantaleon, Matthew S. Iverson, Stefan Aigner
Morphine ARER 100-mg tablets were left intact, cut with a knife, or crushed for 60 s using a household tool shown to produce the greatest reduction in particle size in previous in vitro studies (14). The comparator, ER morphine (MS Contin®, Purdue Pharma LP, Stamford, CT) 100-mg tablets, was crushed with a glass pestle on wax paper. Intact, cut, or crushed tablets of morphine ARER were placed in glass vials containing 1, 5, or 10 mL of water. Crushed ER morphine tablets were assessed in 10 mL of water; other volumes were not assessed because of the known dose-dumping of ER morphine. The vials were incubated for 1, 5, 10, or 30 min at room temperature (morphine ARER and ER morphine) or elevated temperatures (90°C; morphine ARER only) with agitation in a laboratory shaker at 100 revolutions per minute (rpm).
Morphine sulfate abuse-deterrent formulations for the treatment of chronic pain
Published in Expert Review of Clinical Pharmacology, 2018
Andrea Fanelli, Maria Cristina Sorella, Daniela Ghisi
Johnson et al. reviewed three studies that determined the quantity of naltrexone released upon tablet crushing, the ability of released naltrexone to reduce morphine effects, and whether intact morphine and naltrexone morphine withdrawal [28]. In these studies, sequestered naltrexone in the agonist/antagonist formulation met the bioavailability criteria when compared to naltrexone injection alone while drug-liking and addiction scores were significantly reduced in the combined formulation versus morphine alone. After administration, 77% of patients did not have a detectable naltrexone concentration in their blood. Patients with the highest detectable concentration failed to demonstrate opioid withdrawal based on the clinician opioid withdrawal scale. When not taken intact, morphine + naltrexone demonstrated moderate opioid withdrawal symptoms. In a study on healthy volunteers, bioequivalence between morphine and naltrexone and extended-release morphine was reported [29].
Related Knowledge Centers
- Morphine
- Pharmacodynamics
- Modified-Release Dosage
- Equianalgesic
- Pro Re Nata
- Cochrane Library
- Opioid Agonist Therapy
- Opioid Use Disorder