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#85924 - 01/25/08 01:23 AM A to Z of Narcotic Painkillers in order of potency
Stuart... Offline
Registered Visitor

Registered: 03/24/07
Posts: 33
Loc: London
Hi Guys,

I am visiting my doctor again because my current Dihydrocodeine painkillers are not cutting it any more. Therefore I would like to get a list of painkillers in order of anegesic potency so that I can go through these with him and work out which is going to be right for me. Also from a point of interest.

It would also be very useful to have the potency in comparason to codeine in brackets afterwards. For example, I know that Dihydrocodeine is supposed to be twice as potent as codeine and thefore I shall put (x2) aftterwards.

So far in my list I have:

Codeine (x1)
Dyhydrocodeine (x2)


I would be extremely grateful if you guys could add to this list so that hopefully we can exventually get and exhustive list of painkillers with there relative potency.

Thanks everyone!

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#85925 - 01/25/08 02:46 AM Re: A to Z of Narcotic Painkillers in order of potency
Tabalee Offline
Registered Visitor

Registered: 04/05/06
Posts: 158
Loc: Michigan
Here's a few from the USA, don't know what is available from the UK..
Duragisic patch (Fentanol)sp
Methadone
Percoset
Norco
Vicodan
Darvon
Geez, this is just a very short list of opiate med's, you might want to google it..Different dosages for different people and if they can tolerate the side effects. I personally cannot take any "strong oral" opiates...vomiting, sweats, worse than the pain they are supposed to mask....so I'm stuck with Norco (Hydocordone) I also cannot take any NSAIDS (Celebrex, antimflammatory's) due to GI problems(Colitis)..Good Luck in finding some relief..For myself I'm just thankful I can get a bit of pain relief from the Norco, but having to go off Celebrex has been a "real pain"...
_________________________

Learn something new each day,
Practice tolerance and fair-play,
Tell those you love every chance you get,
Stick together when the going get tough,
Smile like you mean it,It could make
someones day!

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#85926 - 01/25/08 05:08 AM Re: A to Z of Narcotic Painkillers in order of potency
Stuart... Offline
Registered Visitor

Registered: 03/24/07
Posts: 33
Loc: London
Hi, thanks for the reply!

Just to clarify - are they in order of potence - your list?

I am also getting to the stage where I cannot take any more NSAIDs and my enbrel has stopped working. Joy.

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#85927 - 01/25/08 09:50 PM Re: A to Z of Narcotic Painkillers in order of potency
kayAS Offline
Registered Visitor

Registered: 08/29/07
Posts: 29
Loc: WA
Take a look at the Arthritis Foundation's Drug Chart at this link:

http://www.arthritis.org/drug-chart.php

and select "Analgesics" on the upper left, they show a list that appears to be in increasing order of potency. I like it, because they show what the common dose ranges are, what to watch out for, and a lot of other good information.

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#85928 - 01/25/08 10:02 PM Re: A to Z of Narcotic Painkillers in order of potency
cassilynn Offline
Registered Visitor

Registered: 09/30/07
Posts: 835
Loc: Indiana
Opana ER 20 mg, I VERY HIGHLY RECCOMEND VERY FEW IDE EFFECTS RELAESED EQUALLY OVER 12 HOURS. TAKE I EVERY 12 HOURS. This is "oxymorphone" it is a controoled schedule 2 highly potent morphine derivative.

How strong is it?
twice as strong as dilauded
oymorphone twice as strong as morphine

oxynorphone is four to six times stronger than oxycontin

Poana comes instant release pills also. They were not strong enough for me alone. But the OpanaER extended release is a godsend to me. Strong and long-acting. Helps morning stiffness and pain, cause you are constantly medicated.

Good luck!! hope ya feel better! Cassilynn
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Cassilynn

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#85929 - 01/26/08 09:28 AM Re: A to Z of Narcotic Painkillers in order of potency
Mark D Offline
Registered Visitor

Registered: 10/02/03
Posts: 1799
Loc: Austin, TX
Stuart, the relative potencies are really not that important, I think, because even though the different opioid drugs do carry different potencies, the dosages prepared by the pharmaceutical companies are made to be comparable and come in several different strengths anyway. And a prescription might be to take several pills. So in other words, even though a synthetic narcotic like Fentanyl is said to be 80 times as potent as morphine (wow!), a Fentanyl tablet or patch is not going to be 80 times as strong as a typical morphine tablet -- because if it was, it would kill you.

That said, Fentanyl is on the atomic bomb end of your options and codeine is just a step above paracetamol. Hydrocodone is after that. Morphine, oxycodone, and oxymorphone are somewhere in between. I am not sure what British options you have since they are probably different from US options I know (I live in Japan which has only morphine for general analgesia, oxycodone for cancer, and Fentanyl for post-surgery/cancer). You are likely going to get something on the weaker end and doctors may vary in their willingness to prescribe even weak painkillers for AS. If you need morphine, I hope you get it.

If your pain is constant, round-the-clock, ask about extended release options. The bottom line is that opioids share a lot of properties and generally work the same way in the brain. They all can also cause constipation, tolerance, and even addiction if taken in high doses over a long time. But a drug like hydrocodone (combined with paracetamol in Vicodin) is thought to be a good low-level option, followed by morphine in various doses. One thing to also consider is cost. Some synthetics are expensive. My morphine costs almost nothing here.
_________________________
DXed with AS 30 years ago

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#85930 - 01/27/08 04:13 AM Re: A to Z of Narcotic Painkillers in order of potency
Charlie Offline
Registered Visitor

Registered: 07/28/04
Posts: 2766
Loc: UK
hi Stu

Yes, it is hard getting advice on what your next option is in the UK. That being because nobody medical ever seems to want to tell you. Why they are so secretive, I don't know. If you have a lot of trouble getting the pain relief you need, I suggest you ask for a referral to a Pain Clinic. in general they are much better at prescribing than rheumatologists / GPs are.

In terms of the "hard stuff", I've had Fentanyl patches (only the teeny 12.5 mg ones) and Oxycontin. Fentanyl gave me a nice background level of pain relief, but I had to take Tramadol 50 mgs in addition. The Oxys I reserved for rainy days (literally!) so I did not build up a tolerance to them. They work quite well. On an average day I would have neither of these, and be taking 4-8 Tramadol 50 mgs. The latter, I recommend over and above Codeine, which must surely be the most constipating of all the narcs!

If you feel your meds aren't as effective as they were, sometimes it helps to take a short break from them. Although it sounds like a stupid thing to do when you're in pain, a few days absence and when you take them again they work so much better -- your tolerance goes down.

HTH to an extent!
_________________________



37, Female, Psoriatic Spondylitis
www.charliefoulkes.com

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#85931 - 01/27/08 04:16 AM Re: A to Z of Narcotic Painkillers in order of potency
Charlie Offline
Registered Visitor

Registered: 07/28/04
Posts: 2766
Loc: UK
Oh, meant to add... your new best buddy is the British National Formulary. Nobody will ever be able to BS you again about what is/isn't available in the UK. Every single medicine in the UK is listed in this book / web site > they are standard issue to doctors. However, these days the public can also register onto the web site. Happy surfing!

British National Formulary Online
_________________________



37, Female, Psoriatic Spondylitis
www.charliefoulkes.com

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#170854 - 04/04/10 06:12 PM Re: A to Z of Narcotic Painkillers in order of potency [Re: Stuart...]
bytegirl Offline
First time visitor

Registered: 04/04/10
Posts: 1
I have had most of the narcotic painkillers, starting with Vicodin and working up the list. I eventually asked to be sent to a pain clinic, where we tried steroid injections in the facets and SI joint, which didn't work. We wound up doing a spinal cord stimulator implant, but that wasn't enough to get me off painkillers, and the more I use it the less effective it is. I've also done loads of physical therapy and pool therapy, which didn't help at all. Anyway, I've found that I built up tolerance really fast when I was on pills, thus we had to keep bumping to a stronger dosage and eventually, a stronger painkiller.

Fentanyl has been the most effective for me in the long-term, as it sends a constant, even dose, so no highs/lows as the pills are digested and then work out of your system. Oxycontin was probably the best of the pills, although I've only had morphine & dilaudid after surgeries, not for chronic pain. Otherwise, I've pretty much had all the other drugs. A pain clinic will be better at working to manage your pain effectively, and should look at multiple strategies to achieve that goal. Also, I've used Remicade off and on for years, and there are several other biologicals on the market for AS and Rheumatoid. I would recommend having your rheumy try one of the other bios.

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#170856 - 04/04/10 06:38 PM Re: A to Z of Narcotic Painkillers in order of potency [Re: kayAS]
Kentucky_Girl Offline
Registered Visitor

Registered: 03/25/10
Posts: 297
Loc: Central Kentucky
Originally Posted By: kayAS
Take a look at the Arthritis Foundation's Drug Chart at this link:

http://www.arthritis.org/drug-chart.php

and select "Analgesics" on the upper left, they show a list that appears to be in increasing order of potency. I like it, because they show what the common dose ranges are, what to watch out for, and a lot of other good information.


i don't think the arthritis foundation list is in order of potency. it has acetaminophen on the top but listed on the very bottom is ultram and ultracet and those are the first pain killers and the mildest prescribed.
_________________________
Ang aka Kentucky Girl
Psoriatic Arthritis w Spondylitis
HLA-B27 positive

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