It is clear to me, Debi, That your ER morphine dose is too small. Any time you have to use breakthrough meds as a part of your regular regimen (especially at the same time other meds are in force), it's because the base medication isn't enough to properly control your pain.

You need to tell your doctor, but you really don't have to tell him you've been doing it all the time. Just tell him you've done it enough times to confirm the positive result and then waited to discuss it with him. Hopefully, he will see the clear signs that you need an increase in the morphine.

Break through meds are actually only to be needed for times when you over exert in some way or other times when your morphine wears off before the next scheduled dose.

The 'head' thing is also clear signs of too much pain. On the patch, you were receiving around the clock relief (or at least reduction of pain)...enough to keep the head stuff from happening. Severe pain can cause many other symptoms besides pain. I get nauseous when in severe pain.

I think once your pain meds are properly dosed, you will be able to do what you want without fear of paying for it later. Some discomfort later after over-exertion is one thing, but what you are describing is just too much pain and not enough meds to cover it.