Morphine?
 

Today I went to see my new doctor, establishing him officially as my "pain management" doctor and 'authorized treating physician' for work comp.
In the beginning, I was very impressed with his listening skills, and bedside manner, as he seemed to understand my concerns, and was quite compassionate about my pain levels.
The fact that I used and brought in a pain journal I printed out from the American Pain Foundation (Thanks a board member here- though I forget exactly who- thanks, though!!) helped a great deal.

He explained how my hydrocodone was a short acting med and that it was inappropriate for my long term chronic pain condition, and pointed out, without me saying it, how my life is/ has been dominated by my pain levels and the medication for it- needing to take a pill every few hours and then wait for it to kick in to allow 1-2 hours max each day of decent pain control...

So, he had me sign a pain contract, which I have NO problem with at all, and prescribes me Morphine 15mg extended release tabs twice a day, 12 hrs apart, and Ultram 50mg twice a day for the breakthrough...He compared my 7.5/500 hydrocodones 5x daily to this morphine dose, and said he expected it to be better than my current pain control without the peaks and valleys.
And I was ecstatic! I thought finally I'd get some relief!

BUT THEN>>>>> total letdown....:(
My last hyrdrocodone was taken at about 2:30pm, about an hour before my appt.- I was hoping to not hurt too terribly bad if he needed to poke and prod and stretch me around in exam...The pharmacist said to go ahead and start the morphine tonight, and usually my daily hours are sleeping from 6am to Noon-ish, and I am awake from Noon to 4am ish- the two hours from 4am-6am are generally spent fighting in my chair or my bed on the floor to get comfortable and pain reduced enough to sleep...
Anyway, so I was at about a 9/10 pain wise by 9pm, so I went ahead and took the morphine, figuring I'd get up again at 9am to take the next dose...but NOTHING. My pain did not go down AT ALL. Not a half a step. NOTHING.:Bawling:
I took an Ultram and two tylenol to give it a boost around 10:30pm and the pain went down to an 8/10...but thats where I stayed. Now it's almost 2am, and its going back up to 9/10. I signed this stupid pain contract promising that I would not take anything other than this that he gave me, and I don't want to screw this up because I think he will genuinely help me deal with this...but there is no one I can call, and nothing I can do through the night but suffer. (And vent to everyone here. :( )

My next dose of morphine should be at 9am, and the doctors office opens at 8, but idk if I'll be awake then...hopefully not!
Does anyone know about morphine dosing? From what I have read online, this 15mg is the lowest dose- is it pretty common? Is there some sort of conversion ratio between the hydrocodone and the morphine? Do I need to give it time to build up in my system? And is it ever going to work better than it is now????
It feels like I haven't taken anything- it is not even touching the pain at all, let alone relieving it. HELP???

Funny you should bring this question up. I'm going through something similar. I have different symptoms and a different diagnosis, but (now I'm not a doctor nor do I play one on t.v.) I really think a great deal hinges on just exactly what your issues are. Morphine for me has been less than effective as well and I'm eager to get back to my doctor on the 7th to see what we can do. I do know that morphine is for pain, and if you have any kind of nerve issue then it really won't help much. There may be other problems that morphine, as a pain killer, simply won't help. If I'm able to find out anything further I'll let you know. In the interim, don't hesitate to contact your doctor if something isn't working...because there's probably a good reason why it isn't! Fingers crossed for you and best of luck to all of us.:hug:

Morphine takes a little longer to get going, because of its liver metabolism etc.

Give it 2 to 3 days before reporting to doctor. But you might need an increase or adjustment.

Hi 72daywmn,

What she said. Morphine is one of those that has to build up in your system; hang in there!

There are conversion guidelines (websites), BUT I hate to utilize them for the simple fact that they aren't really relevant, as illustrated by those who report that one opioid doesn't work at all, but another (of "equivalent" dosage) works great. Guidelines are just that; every drug needs to be titrated independently to find the correct dosage for the patient.

Here are a couple posted here a few years ago:
http://www.globalrph.com/narcotic.cgi
http://www.mywhatever.com/cifwriter/...y/70/4932.html

Doc

Thanks for the help everyone!

UPDATE- It's working, it's working!!! Imagine my surprise and relief this morning when I woke up fairly early- which in itself is a miracle for me - to take my second dose of Morphine, and exactly one hour later I was nearly pain free!!!
3 hours after the second dose, the pain is not totally gone, because I can feel the "zaps" but they are seriously muted, and the hard, excruciating ache is more an uncomfortable ache than the kind that would normally bring me to tears. I am seriously amazed! I just hope it lasts the 12 hours it's supposed to!
So far, the only side effect is a slightly elevated heart rate and blood pressure, for which my regular Lisinopril should do the trick.

Help!!!
 

Ok, well the pain control lasted until about 3:00pm- so roughly 6 hours after the second dose, and the pain's been climbing since. I took 4 tylenol and a tramadol as I was supposed to for breakthrough pain, but its nowhere near helping. My next dose is at 9pm, and tomorrow is my son's 14th birthday, so I've got a cake to make and laundry to be done and UGH!

I'm in a small rural town and no way contact the doc until Monday- don't want to violate m pain contract but don't want to ruin my boy's b-day being in agony all day and unable to do anything with or for him either...

Does anyone know how particular doctors can be about pain contracts? Especially when they've just begun? If I take my hydrocodone as needed for BT pain over the weekend and am totally honest with the dr on Monday about it, is this going to screw everything up??? I've tried everything I can think of to avoid it, but can't stand this pain, and the only other option is to look up the dr's home address and number, which seems really desperate and ridiculous in a way, but what else is a girl to do?
HELP!

Speaking as one raised by a single parent disabled w/ chronic pain, your son will understand.

I wish I could answer that for you. You did get some relief from the last one you took, and since they're 12 hrs apart, you won't really be going through the whole weekend like this. 12 hrs. - one pill - at a time; try to give them a chance to build up like they're supposed to, and by all means contact your Doc Monday morning if things don't get better.

Doc

Thanks Doc, for your encouragement! You were right, my son does/did understand- today's his birthday, and I was beating myself up over not being able to take him anywhere because I hurt too bad to leave my chair, but he says he's rather just hang out in his room and play his pc and xbox games with his 'adopted' brother and order pizza. (He's 14, so that's like a dream! lol) so tragedy averted there! Phew~


Unfortunately, we're on day two- took the third dose last night, and fourth this morning, and I'm miserable. Of course, I don't know quite how to explain it to the doc Monday morning, but I'm thinking that in general, the baseline med is close to ok- could be a little stronger if that's what it would take to last longer as an extended release, but most importantly, my breakthrough pain is unbelievable. I thought I had so many high and lows with the hydrocodone because of the way it would wear off and I'd have to wait for another pill to kick in, but with this, it's like there's never any 'kicking in' and the breakthrough is more noticeable. :'(

The doc had said on Thursday that he appreciated my pain journal, so I'm just tryin to keep track in it still where my pain levels are, and I'll go see him on Monday. So far, I did end up taking one more Tramadol than I was *supposed to* last night just to get some rest, I figured that's what he told me to use for BT pain, so one extra might be more ok than taking something else not on the plan, and I took four tylenol and four advil before getting to bed finally at 6am- but I've resolved myself that I am NOT going to take any of the hydrocodone, no matter what, unless he tells me to use that for the BT. It occurred to me last night that some of the pain I'm having now could be a physical withdrawal from the hydrocodone I've been on for 30 months- know anything about that?

Well, fingers crossed that the morphine will 'build up' enough as you say to do some good!

Thanks all for the support

Google: how talk doctor pain

It's all there. Talk about your pain and its effect on your day-to-day life - levels, location(s), type/description of pain, etc. Show him your journal if he wants to see it - he may or may not. Don't push it. Let him make the decision about how to adjust your meds. Titrating can take a little time; it will be worth it. The two things to keep in mind are:

1. The goal is not to be pain-free; the goal is to reduce the sense of suffering and improve the quality of life.
2. To find/use the least amount of medication necessary to achieve the desired result.

It's very possible and not unlikely. It's known as rebound or rebound effect. It should dissipate as your body adjusts to the new meds.
http://en.wikipedia.org/wiki/Rebound_effect
http://www.merriam-webster.com/medlineplus/rebound

Doc

Basically the long acting products with opiates do not last what they say they will. I wouldn't expect a 12 hr. release. Neither does your doctor. Hence he gave you breakthru meds.

The next size up is 30mg/tablet for this product.

Give it two more days, to reach steady-state. If you don't see any improvement by then start your pain journal again.

Well, so my morphine still isn't working much, if at all. I spent all day yesterday unable to leave my chair, even to use the restroom- my son had to help carry me to the toilet. (Quite embarrassing, I feel as if I've hit a new low!)

I'm taking the 15mg morphine sulfate twice a day, usually like 10 am and 10pm (ish), 50mg Ultram twice a day, usually around 11am and pm, and then 1000mg tylenol and 800mg ibuprofen every 4 hours, alternating by 2hrs between the tylenol and ibuprofen.
I usually sit on heating pads, which has been a help, but I've also tried this weekend to put the heat on my lower back, and then sit on an ice pack for awhile (until it melts) which has been some relief temporarily.

I called the doctor's office today, and they say to give the morphine until Thursday- a full week- and to take up to 1000mg tylenol 4x a day. When I explain that I already am, and the ibuprofen, they say 'We'll ask the doctor again and call you back". I would gladly go in to the office, return all of the meds he gave me and take a blood test or whatever to show that I have been taking everything as instructed so far and so they can see that I don't want to keep the morphine for some other purpose- but it is NOT WORKING!
And then it occurs to me, part of the reason he put me on morphine is because on hydrocodone, I was taking too much tylenol each day, but now they are advising me to take tylenol??? I'm sure this had to be a suggestion of the nurse speaking, rather than being relayed from the doctor himself...

I guess I didn't realize how much worse my pain could be. :(

How long does this garbage really take to begin working????

UPDATE--

The dr's office called me back, and I've officially been up-ed to 2 15mg tabs twice a day, but she told me to take a second pill now (4pm) and then take 2 at midnight (my reg. dosing time). My stomach is pretty upset already from all of the tylenol and ibuprofen, but hopefully (FINGERS CROSSED) this will ease the pain...

Thank you to all for the advice and support!

Hi 72daywmn,

Using these two together usually isn't recommended unless specifically instructed by your doctor. More likely than not, it's the ibuprofen that is causing the stomach upset. In any case, no more than 4000 mg of tylenol should be taken within a 24 hr period, and no more than 1000 mg within any 6 hr period (including any that is part of a combination drug like vicoden or percocet). If taken long-term (longer than 2 weeks) the daily maximum is 2600 mg within a 24 hr period. Be sure to check the strength of tylenol you're taking; regular is 325 mg, but extra-strength is 500 mg.

In any case, if taking that much tylenol on a regular basis, it is recommended that you start taking NAC (N-acetyl cysteine) on a regular basis, 750 mg twice a day for as long as you are taking those doses of tylenol, to prevent liver damage
http://yarchive.net/med/tylenol.html

If you develop any severe stomach cramping or rectal bleeding (sorry) discontinue the ibuprofen IMMEDIATELY (voice of experience) and call your doctor.

Doc

Yes, I was thinking that too, that is a lot of both Tylenol & IB to be taking...
unless your Dr suggested /ok'd it.

Yes, when I phoned the dr office this morning, the nurse called back and said that the doc had said to allow a full week (Until this Thurs) for the morphine to really work well, and to take up to 1000mg Tylenol up to 4x a day, and up to 800mg Ibuprofen up to 3x a day, but to alternate between the two every two hours instead of taking them both at the same time. When I explained that I was already doing that since I wasn't allowed to take anything else but the pain was unbearable, she said she's talk to the dr and get back with me.

Then awhile later she rang back to say the dr has changed my script, and I should now take two 15mg morphine every 12 hrs (so basically 30mg twice a day). I had taken my one dose of 15 mg at noon, and this was at 4pm when she called, so she said take another 15 mg then, and then at midnight when my regular 2nd dose would be scheduled, to go ahead and take two pills.

Within 2 hours after the 2nd morphine pill I felt great- little pain at all, but quite shaky and nauseated. After eating, my stomach is better, and it's now almost midnight, about time for my other dose, and I'm just starting to hurt again- about 6/10, which is still pretty mild for my regular pain.

I'm hoping that my stomach can tolerate the two pills together, because overall this dose seems to work for the pain, and I haven't felt a need for a breakthrough dose. So far, it's been the best I've felt in almost 3 years!

Nausea/upset stomach is a common side effect of morphine (and other opiates) but people have been known to tolerate some better than others. Taking with food should help. If not, and the side effects aren't workaroundable, don't despair - there are other long-acting opioids you doc could switch you to (but let that, and which one, be his decision).

Doc

Nausea from opiates does not come from the stomach. It comes from the nausea receptors in brain being over stimulated when pain receptors are full of drug and excess is floating around and move to the apomorphine sites.

Typically nausea will resolve once the pain receptors get used to the new dosage.

I did not know that - just passing along the conventional boilerplate wisdom:
From: http://www.drugs.com/cdi/morphine-su...e-tablets.html
Doc

Morphine doesn't irritate the stomach. Those things are written for the layman.

Morphine has an isomer called apomorphine. The receptors for that cause nausea/vomiting.

This article describes the area of the brain that the nausea receptors are located in.

http://docs.google.com/viewer?a=v&q=...do8bowR4rNZ1TQ

Re: low dose
 

Hi and I do know just a little about morphine. What you are on is a very very low dose. Hydrocodone would work better as you have discovered. Extreme neck issues, failed surgery and another C3-7. I was on 60's three times aday with hydrocodone for breakthrough. I had to sign the contract too. Now that you have, call him and tell him it is not working at all. He is under contract with you too, to help you. It is not your fault this low dose is not working, you can't be afraid of your dr. or not talk to him. The only way they can help is by telling them the truth, loudly if you have to. I didn't care a bit if my doctor saw me cry or mad. There are other doctors also. Sometimes it is a fight to get the relief you need. I am not intimidated by any doctor, they are just humans too. I wish you all the best, and I hope he will up your medication until you get that relief. MS contin, or morphine does work in the proper dose, and I had no symptoms at all from it. Now getting off it, is another story....it is definately one that is hard to withdraw from/ I now take 30's twice a day 8 months post surgery. I can increase, or decrease, my pain specialist gives both 30's and 15's so I can adjust accordingly. He had given me epidurals, and made sure I got the help I needed. Don't settle for less. Ginnie :hug:

I respect pain contracts but I would not spend the weekend in pain when I had my pain meds in the house and a childs birthday to plan. Maybe you can take the hydrocodone and tell him the truth when you see him. Good Luck to you.... Linda