Pain Management Community

I have not heard of rotating medications within that short of a time span (1 month). Would you be willing to provide a link to the research study that states that? I heard of every 6 month to 1-2 year range for opioid rotations.

I think whether one rotates opioids or not, dependance is inevitable in most cases such that when the opioid is stopped cold turkey, withdrawal symptoms present themselves. However, given the right physician supervised taper along with additional medications to help with the withdrawal symptoms, coming off the opioid(s) is not as difficult.

I think that taking a long-acting opioid like Morphine ER, Oxycontin, Kadian, Fentanyl, Opana ER, Butrans helps slow the build up of tolerance due to how the long-acting opioid medications work versus how short-acting opioid medications work. I'm interested in hearing you all's opinions on this. I just noticed when I was taking short-acting medications alone, my pain was poorly controlled and dose increases didn't increase the duration in which the medication provided analgesia and the dose increase only helped for a month and it was back to the struggle. Now with both long-acting and short-acting opioids, my pain is controlled much better and for much longer on the same dose. In other words, the pain relief is now more consistent.

there isnt research... just antedoctes from people on various message boards, forums, and blogs. i think it would be great to have a long acting med, but since im just starting out on narcotics ( tramadol for 5 years, now 5/325 norco) i doubt it would be appropriate to jump right to one of the stronger, long acting drugs? it would be great if i was wrong!

Well guess what? You are wrong! I was on tramadol for 3 years, then a vicodin (very similar to norco)/tramadol mix for 6-9 months, percocet for a month (didn't work so well by itself), and then I was started on my first long acting med, Morphine ER...started out on 15 mg every 12 hours w/ percocet for breakthrough pain. Had it increased to 30 mg every 12 hours and I was on Morphine ER for a total of a year and then I was bumped up to Opana ER w/ percocet for breakthrough pain. Opana ER is very strong but I was taking so much percocet while on Morphine ER to control the pain that my new doctor wrapped all the breakthrough meds plus the morphine ER into 2 Opana ER doses taken every 12 hours. I still need percocet for breakthrough pain but I can get by with 3 pills instead of 7-8 pills which is a big improvement. So the answer to your question is no.

Morphine ER is a great long acting medication to start off with because it isn't very strong and then your doctor could titrate it up to a therapeutic dose for you. Oxycontin wouldn't be a bad long acting med to start with either as the starter doses are low enough to bridge you onto...and now that I think of it, Opana ER (even though it is a very potent medication) has doses that you are opioid tolerant enough for...like the 5 mg Opana ER tablet. I take 60 mg of Opana ER per day which would be way too much. But besides Fentanyl, all the long acting meds out there have starter doses for those that are opioid naiive or not very opioid tolerant yet.

lol, awesome thanks for the info. definately something to discuss at my next appt

I have read medical studies that showed less tolerance with long acting opiates than with short acting opiates.

I think the rotation of opiates depends on the doctor and patient's preferences. I do not think a monthly rotation is necessary though.

I have read of doctors doing this when a patient's daily opioid dose seems too high and they want to rotate to a new opioid to find a lower dose. I do not know of any evidence based studies to support this, but perhaps someone else does??? Lots of doctors seem to do it, according to this site anyway.

Take care, Annette