What pain medication is the strongest for chronic back pain?

Answer 1

It depends on the exact problem, severity of pain, location, and if it's really chronic (24/7/365).

Having just started my 11th year in formal Pain Management, and after 3 major spinal operations, I've been using Duragesic patches for primary pain and Percocet 10/325's for breakthrough. My Duragesic dose is 1 100mcg patch, every 48 hours (most people get 72 hours), Percocet is PRN, but I average about 120/150 per month depending on the time of year. I use more in the winter because cold weather and lower barometric pressure hurts me more. I also use 100mg Demerol tabs and 30mg MS Contin tabs when the need requires it, in addition to my normal meds. But that's not very often, and when it is, I'm usually looking at another surgery.

For primary chronic pain, either Duragesic or OxyContin are the main drugs of choice. I used OxyContin for about a year, but it only lasts 12 hours and has a steep drop-off point (the point where it starts to wear off). Duragesic (Fentanyl Transdermal patches) by virtue of lasting so long, takes much longer to wear off. The biggest plus is that you get effective pain control for 2-3 days, not just a few hours. Breakthrough meds are usually prescribed as well, for those times when your activity causes pain to increase to the point where your primary med isn't controlling the increased pain level.

In order to use Duragesic, you must be opiate tolerant - in other words, you must either be using an opiate now or have used opiates in the past without problem. Depending on any opiates you may be using now, there is a direct conversion chart that's used to determine the initial starting dose (12.5, 25, 50, 75 or 100mcg). Patch dosed can be mixed/matched to achieve whatever dose is required. I've had to increase my patch dosage in the past to 200mcg (2 100's), and I've known of cancer patients (terminal) who have used up to 600mcg's (6 100mcg patches). Keep in mind that the conversion chart is on the conservative side and is usually lower than an actual direct conversion to be safe. It also means if your doctor believes it to be a 1-1 conversion, you're going to have withdrawals out of the gate. So adjust the dose a little higher if you're already using opiates on a regular basis.

Keep in mind that Duragesic and the other drugs I've mentioned here are for severe chronic Back pain, not just a sciatic episode or something similar that doesn't last but a few days or weeks. These drugs are used for people like me who have major spinal/back problems and severe pain all the time, and will have that pain for the rest of their lives. It is not for muscle, joint, Arthritis and similar types of pain.

TSD -RAVEN- Category Supervisor

Answer 2

I am not a physician, but doctors have told me that some medications which treat depression or psychosis can be used off-label to treat chronic pain. 50 mg Seroquel several times daily as prescribed by a physician has worked. Physicians have also reccomended effexor, amytriptelene, cymbalta, and others that I can't remember. Narcotics are highly addictive and therefore are problematic for long-term conditions. Relaxation therapy from physical therapists can also help reduce pain caused by stress.

Answer 3

There are many drugs that can relieve pain.

The severity of pain is a very personal thing, and severe pain for one person may be moderate for another. As such, pain is usually treated from "the ground up." Initially Tylenol, Aspirin or one of the other NSAIDs are tried. If, after a significant trial, the pain remains unrelieved then stronger medications are tried. At this point Tramadol (Ultram), Tylenol and Codeine or Vicodin (Tylenol and hydrocodone) may be prescribed. If the pain is nerve related they may also try antidepressants or anti-seizure meds as these have shown much promise for treating this kind of pain. If pain remains severe stronger meds are tried, as in stronger narcotics like oxycodone with Tylenol (Percocet). Finally, if needed, the strongest meds are tried, like morphine, oxycodone by itself, oxymorphone, methadone or fentanyl. This last group has no ceiling, meaning there is no upper limitation - doses can be increased as long as they are tolerated. This kind of treatment is usually only for cancer patients.

It is a very serious decision to begin treatment with narcotics long-term. If taken long term, longer than a week or two, one becomes physically dependent and will suffer withdrawals if the med is stopped abruptly. If the drug must be stopped then it must be cut back a little at a time to avoid withdrawal. This experience is never pleasant and no one who has experienced it before wants to repeat the process. For this reason alone one should seriously consider alternatives before submitting to long-term narcotic treatment for pain.

Answer 4

If you're already an opiate-tolerant patient (meaning you're already using Percocet, Vicodin, Dilaudid, MS-Contin, OxyContin, or something else), and your pain is chronic, there is no better medication than Duragesic (Fentanyl Transdermal Patches).

OxyContin and Duragesic are currently the only 2 long dose pain drugs on the market (along with their generics). OxyContin lasts up to 12 hours (in reality, 7 or 8 if you're lucky), while Duragesic lasts from 48-72 hours. Having used both (see my Supervisor bio for a rundown of my own spinal problems), I can say that Fentanyl patches are by far the best medication for severe chronic pain.

Switching to Fentanyl patches should not be considered lightly, though if you're using a lot of acute meds, it's a no-brainer. But for anyone who does use it, it's a quality-of-life decision that comes with a lot of restrictions due to the many regulations on Schedule 2 opiates. You're required to obtain new prescriptions every month (they can't be refilled or called in) from your doctor, you have to agree to only use one pharmacy (unless it's an emergency), and you can only get a month's supply. However, if your pain is bad enough, it's worth the hassle.

There are other things to consider as well; Fentanyl is the strongest opiate on the planet, and using it means that the side effects are increased as well. If you've been using pain meds for some time it shouldn't be an issue, but it's important to educate friends and family to the reality that it can cause wide changes in mood and personality. That being said, severe pain does that anyway if you've got nothing to control it. But people that have never experienced this kind of pain can truly grasp the physical and mental toll it takes on a person, no matter how strong they are.

Aside from mood swings, the other primary risk is becoming overheated. The patches deliver the dose transdermally (through the skin membrane), and is regulated by body heat. This means if you expose it to an external heat source (sun, heating pad, etc.), get a fever, or your core body temperature increases due to activity, it can increase the dosage delivery rate to the point where you'll become dizzy, disoriented, or if you're not as tolerant, respiratory depression and death can occur. Most of us who use it regularly don't have that problem though, but it's important to be aware that it can occur and know what to do if it does.

If you have any specific questions about it, feel free to contact me through my WA email on my Supervisor Bio page.