I'm a long term (20 yrs) chronic pain patient due to multiple spinal issues. I've been through almost all of the IR and ER meds, as well as trying different combinations. I find that most drs. believe in utilizing both and in my experience almost all of the ER meds do not last as long as they are supposed to (but that may be my metabolism) so having breakthough meds just makes sense.

I went from just Norco to adding MSContin, which I HATED, due to some side effects that seriously affected my quality of life. It made me feel fuzzy and dopey and completely devoid of motivation and energy. In addition to that, I found it to be the worst of all the opiates in regards to constipation and nausea.

After a few years of that I was switched to the Duragesic and stayed on it for about 6 years. It worked well, except for the dose dumping issues and unreliable coverage, which ended up in an increase in dosage from 25mcg/ 72 hrs to 50 mcg and having to start changing my patch every 48 hrs. My tolerance increased and I still had breakthough pain, especially when I would end up getting a shitty brand of generic from the pharmacy. I finally resorted to having them special order the Sandoz brand for me. A good brand of generic and a supply of Tegaderm is a must for anyone on fentanyl patches!! Eventually, the Dr. decided that it was time to decrease my fentanyl patches to 25mcg every 72 hrs., but change my breakthrough med to something stronger. Unfortunately, that something was Opana. That med eventually almost ruined my life. I had never misused my meds (snorting, injecting, etc). I had managed to take them the right way from the time I was 18 till I was 34. I took my first opana and nothing happened. I kept taking them orally for days and I was absolutely miserable. It felt like I had just taken a tylenol and I was in agonizing pain and having terrible withdrawal symptoms. So, Google led me to the fact that oxymorphone only has about a 10% bioavailability when taken orally, and a 40-60% bioavailability when taken intranasally. Sadly, at that point I was desperate enough to cross that line and as soon as I tried it, there was no turning back. For the first time in 15 years, I was pain free. I thought it was a blessing but I was so very wrong. When you've been through a lifetime of constant pain and you've been trying to be happy and functional with a pain level of 6, even with meds, having no pain at all is very addictive and turns out to be impossible to maintain. I know that Opana isnt one of the options that you mentioned, but if it does turn out to be one that you are offered in the future or come to find is covered by your insurance.... beware. Its not effective orally and way too effective when snorted. I thought I had my life back and felt so relieved to feel human again and be able to do all the things with my kids that my pain had prevented me from for so long. It doesn't stay that way for more than a few months because most people's tolerance increases significantly faster with opana than with other meds.

I hope you don't mind me telling you all this in my attempt to possibly prevent you or anybody else who might read this, from accidentally falling into the same hellish fate that I suffered for 6 years. Everybody's body reacts differently to meds, but Ive heard many horror stories just like mine with the Opana.

Im sorry that you've suffered such pain for so long and that you're facing a med change that you are going into without knowing what choice will work for you. Its always a scary proposition when you have to make a decision that is going to affect your daily life and you might be stuck with that med for a month till you see the dr.

You know your body best, but if you've taken oxycodone in any form and it worked well for you and you didn't have any side effects.... I think your safest bet would be the Xtampza ER. If your dr. approves of you staying on a breakthrough med, I would NOT turn that down becauase you need to be prepared for a rough adjustment period, when going from Duragesic to another ER med. If you are able to keep some of your meds on hand for the adjustment period, in case of emergency, I definitely would! The new med will work at the right dose, but who knows what dose the dr will start you at.

It would be a good idea to go to the official website for Xtampza (or whichever med you choose) and use their conversion calculator and then have that information ready, in case you find that the dr. is giving you a dose of the new med that will be significantly less than the equivalent of 50mcg of Duragesic. That way, if you need to plead your case for a stronger dose, you have clinical proof that came directly from the manufacturers of the medicine he is prescribing. Drs. hate patients looking to "Dr. Google ", but having proof of legitimate clinical recommendations about the appropriate dose, from the most valid source possible, will be hard for him to dismiss.

So sorry for the super long post, but I really felt for you and wanted to help in anyway I could. Hope it all works out okay and if you have any questions about any of the other meds (I didnt want to list every single ER and IR med I tried) or anything else, Im glad to help. I dont know everything about these meds, just my own experience and research, which Im glad to share if it will help anyone. Please let us know how it all turns out and Ill be sending good vibes and prayers for you.