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In my career I have always been amazed when I talk to patients about their medications and they tell me they are taking “a green one and a yellow one and 2 blue ones at night.” Some will also be taking medications that they know the name of but have no idea what they are taking them for or how they work. Most patients coming to pain management know that if they are given a medication that it is likely to help with pain however not all pain pills are the same, in fact the way that they work can be quite different.
A number of opioid medications come in two different forms, immediate release often referred to as IR, and extended release often referred to as ER. Though they are the same medications in name (Example Morphine IR Morphine ER), they perform very different functions and both can be of benefit to people with chronic pain.
Immediate release medications work quickly just as their name suggests. They go into the system quickly and start relieving pain. The advantage to them is they start working quickly but often the disadvantage is the relief does not last longer than a few hours. Also some patients describe almost a roller-coaster type of relief with immediate release medications. The pain is high, they take the medication, it begins working, it starts working well for a few hours and then starts tapering off. It is then that they would need to take another tablet. Some patients are not bothered by taking multiple tablets throughout the day and immediate release medications work well for them. Examples of immediate release medications would be Percocet and Norco.
Extended release medications on the other hand are generally only taken once or twice a day. They are specially made capsules designed to provide a pre-designated amount of medication throughout the day. This eliminates the roller-coaster type of relief and provides an improved steady foundation of relief. Many patients prefer this as they do not have to take as many pills. Examples of common extended release medications would be Xtampza, Morphine ER, and Hysingla.
Not all patients require opioid medications for their pain but it is nice to know that there are a number of options available. If you have any questions about IR or ER medications, or any medication related questions please don’t hesitate to call us or speak with your provider.
