Is "breakthru pain" a real phenomenon ?

Alright, both of my uncles have very damaged vertebrae and get some heavy duty painkillers. One even has a morphine pump installed in his stomach and still gets 80mg oxycontin and 15mg oxycodone every month. He says that the 15mg oxycodone is for his “breakthru pain.”

I’ve always looked at that expression with a raised eyebrow, because pain is pain. If you are having pain, you’re having pain. What is the pain breaking thru, the 80mg oxycontin?

Why not just take the 165mg oxycontin or whatever it is in one large dose? If they even make that strength any more these days.

Is “breakthru pain” a noted medical condition or is it a way for some people to just get extra pain meds? I mean, I have pain and when I start to feel it, I say, “hmm, guess my pill wore off, time for another.” Not, "man, there is a little bit of pain sneaking thru, I guess I’ll cover it up with a little extra painkiller.’

It’s like painting a wall and saying, “oops, missed a spot” or “I can still see some of the old color peaking through, good thing we bought that breakthru paint.”

I thought sensory gating systems in our nervous system prevented this from happening. However, I also know that when dealing with the spine things are a bit different.

Here’s the Wikipedia article on “breakthrough pain”.

Speaking as someone who has been on low-level painkillers (Vicodin) for my shoulder after a car crash a few weeks ago, I can attest that sometimes the chronic pain that is dulled by the painkillers isn’t always alone - occasionally a very acute stab of pain joins the party and hangs around annoying the houseguests for a while.

Phlosphr, I don’t know from sensory gating systems, but I know that when it happens it hurts like a mother, and it feels like a completely separate physiological event. Though luckily it’s getting much less intense lately as my shoulder heals.

digglebop, IANAD (or a pharmacist), but I would imagine that your uncle’s pain management strategy is such that the larger Oxy doses and the morphine pump are likely designed to spread a timed-release dose throughout the day, to provide a sustained level of pain relief, while the 15mg dose is probably taken “as-needed” when an extra jolt of pain hits. Per the Wikipedia link, the 15mg is probably some variation of Roxicodone, designed to be metabolized more quickly for immediate relief.

Personally, after taking 1 Vicodin every one or two days to manage my pain and feeling all dopes up and icky for several hours after taking it, the thought of being on morphine and large doses of OxyContin makes me feel feel like puking. And also makes me feel very sorry for your uncle - I hope his prospects are good.

That’s a very interesting phenomena. I didn’t know of it as a term, but I was aware of the phenomena.

Diggle was your uncle a soldier? I know a guy who really screwed up his back in Iraq and he’s got permanent nerve damage going down both legs. He has a contraption like you describe that continuaourly bathes his spinal cord in “[insert medicine here]” throughout the day. Sounds similar

Is Vicodin actually considered a “low-level painkiller”?

If yes, what is Tylenol?

Well, everyone’s mileage may vary when it comes to analgesics (painkillers) but Vicodin seems to be considered suitable for certain mild or moderate pains. Tylenol (one of the ingredients in Vicodin) is for minor aches and pains.

(For me, Vicodin made my broken wrist throb a bit less, and I didn’t care quite so much that I broke it. Then it made me throw up 20 minutes after taking it, and after a couple more tries I stuck to mega-doses of OTC naproxen.)

Sorry, I should have called it a low-level narcotic painkiller.

Funny story - as I was in the ER, on a board, with a neck brace on (I wasn’t that badly injured, but the paramedic saw my completely mangled car, and resolved to take no chances), the nurses were discussing my pain medication options.

They asked me if I want a scrip for Vicodin, and I asked “do you have anything less powerful?”. The nurses looked at each other, laughed their asses off, and then one said to me, “honey, about the only thing lighter than Vicodin is Tylenol. We can give you some chewable kids Tylenol if you want. Trust me, unless you’re in recovery, you’ll wanna take the Vicodin”. Which I did. And while it’s proven to be better at managing my pain than ipubrofin, it makes me so fuzzy and dopey that I can barely function. Although the kids think Daddy’s hilarious when he talks all slow and funny.

When I asked for something less powerful than Vicodin I got Darvocet, which turned out to make me much less loopy/itchy/nauseous as I recovered from my surgery.

They try to minimize the amount of pain killer you use . They give you the minimal dose of a longer lasting narcotic, and leave the short term narcotic for when the longer lasting one doesn’t cut it. Oxycontin is a 4 hour dose fast to respond pain killer. Needing to take the short term one often, means it’s time to up the long term narcotic’s dosage. Taking the minimal needed will make it take longer for you to need a higher dose to do the same thing it did in the past.

Oxycontin is the long acting, extended release, 12 hours dosing form of the shorter acting oxycodone

You’re right.

I was thinking about this, and while the answer is probably. “They give you the minimum dosage you need for the standard level of pain.”, I couldn’t help thinking of phantom limb syndrome. There are levels of the interpretation of pain. Some of them are the direct feed from the sensory neurons, but others can be within the cognitive portion. The sense that you should be in pain tells you that you’re in pain.

http://www.ted.com/index.php/talks/vilayanur_ramachandran_on_your_mind.html

: Sorry, I should have called it a low-level narcotic painkiller.
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Thanks for mentioning that it is a narcotic. It sounds like you are handling your medications very well. No one should think casually about Vicodin. It can be very addictive. I have to have it when I get a very bad headache. They are rare, but very painful.

Do people use tens-boxes anymore for pain? That helped after one of my surgeries.