Levorphanol is my opioid of choice. It is a pain killer in a class of it's own so there is minimal cross tolerance with morphine, hydrocodone, oxycodone, hydromorphone or oxymorphone. It is the only pain killer that is a phenanthrene derivative (it's parent compound is not opium but coal tar).
I hardly respond to Dilaudid (hydromorphone) or Opana (oxymorphone) and have a tolerance to morphine and hydrocodone/oxycodone. I used levorphanol for about a year in 1993 and 2003 during opportunistic infections associated with HIV/AIDS. Although my tolerance to most other narcotics had probably doubled over this period, the effective dose of levorphanol had not dramatically increased.
I found it effective for AIDS neuropathy, herpatic pain and post-herpatic neuralgia in addition to lower back pain.
However, because it is so unique it is difficult to find a doctor comfortable, experienced and qualified to prescribe it. Historically it has been plagued with supply problems producing lack of availability. Fortunately, I found it relatively easy to taper off of or can be substituted with other narcotics.
Dose needs to be slowly escalated in a similar fashion to methadone and has some of it's advantages like NMDA antagonism. It is a serotonin and norepinephrine inhibitor like Tramadol and subjectively feels like a strong version of Tramadol to me.
I would theorize that it might interact with some selective serotonin reuptake inhibitors causing serotonin syndrome in susceptible patients. Lake of recent clinical experience suggests that it should be used with caution and as an opioid of last resort until there is more recent clinical experience using it.
Never-the-less, if you suffer from moderate-to-severe chronic pain that does not respond to other opiate analgesics or you find their side effects intolerable, this may become your pain killer of choice!
Levorphanol is my opioid of choice. It is a pain killer in a class of it's own so there is minimal cross tolerance with morphine, hydrocodone, oxycodone, hydromorphone or oxymorphone. It is the only...... (more)