Hi Executor,

I've read a lot of your posts, and you seem to be the "resident medicine expert" - whether you want the title or not :)

Anyway, I posted a couple of days ago a thread called "MS Contin (Endo generic) Questions" or something like that. Anyway, the short story is I have just been taking Roxicodone for a long time, 45mg at a time, 2-3 times per day (total: 90-135mg/day). Anyway, my pain has increased since I had the Transdiscal Biacuplasty done on 2/13 (on 2 discs), and so we decided it was time to go back on a long-acting med (I had been on Avinza for less than a month a year and a half ago, and quit it b/c insurance wouldn't pay for it, then was on Duragesic at 75 mcg for appx. 6 months - got off that August of last year and have only been doing the Roxi since, which had been my BT med while on LA meds). Hmm, this is seeming like the long version - sorry! Anyway, so he recommended MS Contin, b/c insurance won't pay for Kadian or Avinza until you "fail" a trial of MS Contin. So he's like either you'll "fail" and we'll try one of the others, or you don't "fail" and you do fine on this med.

So he started me on 30mg 2x/day, but gave me lots of leeway (he trusts me completely - we have a great relationship) to increase as needed: doubling the dose to 60mg, 2x/day, going to 30mg, 3x/day, etc. So I'm playing around with it now. I took 60mg this AM for the first time, and am quite pleased with the results. For the previous 5 days I had been doing 30mg, 3x/day and wasn't impressed - still needed lots of BT. So the 60mg seems to be good, but I'm wondering what to do from here. I could do 30mg in the afternoon, then 30mg at night. Or I could do 60mg in the afternoon (so it's most effective when I'm actually awake and doing things in the late afternoon/evening - makes most sense to me) and 30mg at night. Or, of course, I could do 60/60/60, but I'm trying to take the least amount of medicine possible, so I don't want to go straight to that.

So my question (finally) is: if I do different dosages throughout the day (i.e., 60/30/30 or 60/60/30) will this mess up the BPL's and not work as well, or will it be OK? So that's the question, if you have any thoughts on it.

Lastly, I have done a lot of research trying to find out how MS Contin (or the generics, which I would assume have the same "release mechanism," but that could be a stupid assumption) releases the medicine and have come up with NOTHING! All I can find is that it releases slower than IR morphine (no, really?!?!) and that the peak is at about hour 4-5 or 5-6, can't remember. So I guess that's question #2, if you know anything about how this med is released.

Thanks so much! Hope you're having a good day - or at least the best you can hope for :)

-Liz

Hi Executor,

I've read a lot of your posts, and you seem to be the "resident medicine expert" - whether you want the title or not :)

Thanks for the kind words Liz. I try to help others as much as I can. This is a great site where many here have a wide variety of experiences and thus, can offer lots of support and guidance.


So my question (finally) is: if I do different dosages throughout the day (i.e., 60/30/30 or 60/60/30) will this mess up the BPL's and not work as well, or will it be OK? So that's the question, if you have any thoughts on it.

Everyone is different, so you have to take my comments with a grain of salt. PM is a very difficult field because it's so individualized....What works for one may not work for another.

Given your general question, normal protocol is for the LA dose to be consistent. This keeps the BPL steady and avoids the "ups and downs." If one of your doses is quite a bit lower than another, invariably, you may have more pain at that time, or you'll suffer from minor WDs at some point.

It is common, however, for a night time dose to be different....To ensure a restful night's rest. For example, when I first started in PM years ago, I was on OC 10mg 2 x day and at some point, I started to have trouble at night....Waking up in pain (can't really use BT pains while you sleep). So, the Doc went to 10mg 3x, but still every 12 hours, but (2) pills at bed time to help get me through the night....It worked well. Thus, sometimes, it takes some trial and error by the Doc to get one completely dialed in. Sounds as if you have a really good Doc who is open to trying things, which is good.

Ms Contin is the shortest acting of all the oral morphines. It's a 10-12 hr med at the most. Kadian is 1-2 x per day, and Avinza is 1 x. However, some do take Kadian 3 x (I do) and some take Avinza 2 x (I did). I was on Avinza, but switched to Kadian because I moved to 3x and Avinza doesn't make the strength dose my Doc wanted to use. I have found both Kadian and Avinza to work very, very well.

If you go 60/60/30, your BPL may be built up enough by the night time dose to get your through. If not, then you'll have to be consistent throughout.


Lastly, I have done a lot of research trying to find out how MS Contin (or the generics, which I would assume have the same "release mechanism," but that could be a stupid assumption) releases the medicine and have come up with NOTHING! All I can find is that it releases slower than IR morphine (no, really?!?!) and that the peak is at about hour 4-5 or 5-6, can't remember. So I guess that's question #2, if you know anything about how this med is released.

I don't know the exact release mechanism for MsContin. Solid pills usually all use the same methodology....It's probably similar to OC or any other type of time release...Half is released right away, and the other half is released in 5-6 hours.

With Kadian and Avinza, they come in capsules and there are "beads" in each. The directions actually indicate that one can open the capsules and spread the beads, or pellets, on one's food, or put in apple sauce, peanut butter...That type of thing. 20% of the beads are IR, 20% are released in 4-6 hrs, 20% are released in 8-10hrs, 20% in 12-14hr, and 20% are released in 16-18 hours. This is all dependent on one's metabolism of course, and is just an average. Those who have higher metabolisms, will burn through the med faster and vice versa.

It's also important to note that oral morphine has very poor bioavailability. This means one has to take much more of it vs other pain meds to get the same effect. Think of bioavailability as "efficiency", or like miles per gallon (MPG) in a car...If oral morphine was an automobile, it would have poor MPG. Conversely, Oxycodone has very good MPG. As a general rule, Oxycodone has at least twice the oral efficiency compared to oral morphine.

Hope this helps, and please let me know if I can help further.

Regards,

Ex

Hey Liz,

It sounds like Ex has given you some great advice. I haven't taken morphine, I use oxy. My dosing schedule started the same as Ex explained though, with twice day dosing, followed by a higher dose at night, followed by 3 x daily dosing.

I can certainly understand you wanting to take more at the times you are awake - that's how I used to take my meds also. However, I did find that I woke up with pain and had a great deal of trouble getting out of bed. It was Ex who also helped me find a more even dosing schedule (without so many ups and downs and mini wds). I now take the same amount of oxy 3 x a day and use my bt meds as needed to help me get through the day - especially late afternoon when I struggle. To put is simply, if my dosing was the same as yours (as in same med, same schedule) I would be taking 45mgs 3 x a day but using slightly higher bt meds.

A higher level of BT meds can be difficult to obtain depending on your drs opinion (and your own, of course - many members take no bts whereas others use them multiple times a day. I just found, with help from Ex and others, that I was all over the place and trying to manage on one bt dose a day (I had good BPL but that doesn't treat bt pain). Now I might use more if I need to but my LA meds are stable and I don't feel that I need an increase any longer. In the long term, I think that this method will help me keep my LA meds at a lower level.

I hope that this helps and isn't too confusing. It is difficult trying different meds and dealing with bt pain and LAs etc. I hope that this works well for you.

Hi! Thank you both for you replies - you've provided some very helpful information. See, my pain tends to be BEST in the mornings (unlike a lot of others) and gets worse throughout the day. PLUS, the morphine has made me sooooooooooooooo sleepy thus far in, that I'm having ZERO difficulties sleeping. So I've been doing the 60/60/30 for 3 days, today is day 4, so we'll see how it goes. So far, so good. I still feel increased pain towards the early afternoon, but I think that's just my pain getting worse - that's just its pattern.

So, I hope this works. If not, I'm sure he'll have no problem going 60/60/60. I see him in 1.5 weeks, so I'm going to stay at this dose until then, then we'll chat about it and see what he (my PM doc) thinks.

Anyway, wanted to thank you for writing, and hope you both (and everyone else!) are doing as well as can be expected.

-Liz

PLUS, the morphine has made me sooooooooooooooo sleepy thus far in, that I'm having ZERO difficulties sleeping.

Yes, it has the same effect on me....I take my last dose of the day about 15-20 minutes before I want to go to sleep and I'm out like a light.

Glad to hear all is going well. Please make sure you stay in contact with your Doc.

Regards,

Ex

Yes, it has the same effect on me....I take my last dose of the day about 15-20 minutes before I want to go to sleep and I'm out like a light.

Glad to hear all is going well. Please make sure you stay in contact with your Doc.

Regards,

Ex

Does the sleepiness go away with time? Does it make you sleepy during the day time too? It does me. I've been taking naps at work during lunch! Can't keep doing that forever! I'm just curious if it eventually subsides or not.... or at least your experience with it. Thanks again!

Hi, when I first started taking Morphine, it REALLY made me so sleepy. And I was very opiate tolerant having been on oxycontin for many years. I could barely handle a 15 mg pill. I remember when I stated morphine I was not able to take the dose I was supposed to take because it made me that sleepy, spacey and it gave me incredible headaches. I almost gave up on it, but than one day all the side effects went away and now I dose 3 times a day using 100 mg ER Tablets. and 30 mgs of IR as needed. So yes it gets better. It took me 2 weeks to get adjusted to this medication and now that its working I am so happy with the pain relief I am getting. Morphine is weaker than oxycontin so the dose your on is not that high, you may need more to control your pain. People talk about how this med isn't great and how it doesn't last long but I find that to be untrue. at least for me it last a long time and I don't wake up in withdrawal like I did on the oxy. If after a few weeks your still really sleepy than the side effects may not be worth the pain control you get out of it. Everyone is different but give it a chance, its not expensive and has been around a long time, which I like. good luck with it.
BTW Morphine really helps me sleep. I am able to cut my dose of sleeping meds in half, so it really allows me to sleep for a long time and not wake up with pain.

SS

If the sleepiness is really interfering with your life after a few weeks, then you should tell your doctor. Your doctor may want to give you a stimulant type of medication to offset the side effects. Many people in pain management take stimulant type of medications prescribed by their doctor.

brian

Does the sleepiness go away with time? Does it make you sleepy during the day time too? It does me. I've been taking naps at work during lunch! Can't keep doing that forever! I'm just curious if it eventually subsides or not.... or at least your experience with it. Thanks again!

I've been on it a while now, and the sleepiness of my night time dose has not changed....It causes me to fall asleep fairly quickly.

However, with the daytime doses, I did adjust....Although I do feel a bit of the effects....But I like the oral morphine because you don't get some of the other effects that one might get with OC and etc. Personally, I think oral morphine is more sedating that most of the other pain meds....Just one of those things.

Take care,

Ex

EX I had no idea you also took morphine. I am glad to hear its helping you too. Its much cheaper than oxycontin isn't it. that is always a good thing. and yes, it does help you sleep too. that is a bonus.

take care,

SS

EX I had no idea you also took morphine. I am glad to hear its helping you too. Its much cheaper than oxycontin isn't it. that is always a good thing. and yes, it does help you sleep too. that is a bonus.

Yes...I was once on the patch, but switched to Avinza, then Kadian when the whole patch recall thing went down. It's worked out well for me.

Regards,

Ex

I've been on it a while now, and the sleepiness of my night time dose has not changed....It causes me to fall asleep fairly quickly.

However, with the daytime doses, I did adjust....Although I do feel a bit of the effects....But I like the oral morphine because you don't get some of the other effects that one might get with OC and etc. Personally, I think oral morphine is more sedating that most of the other pain meds....Just one of those things.

Take care,

Ex

Ex,

Just curious what "other effects" you are talking about that one might get from OC and etc. I've never taken OxyCONTIN, but have taken OxyCODONE IR for years. So just curious, b/c OxyContin was the other option the PM doc gave me, but we decided to try the ER Morphine first. Thanks!

Ex,

Just curious what "other effects" you are talking about that one might get from OC and etc. I've never taken OxyCONTIN, but have taken OxyCODONE IR for years. So just curious, b/c OxyContin was the other option the PM doc gave me, but we decided to try the ER Morphine first. Thanks!

Addiction is a big problem with PM because the the meds that "quiet" the receptors in one's brain, are also in large part, the same receptors that cause euphoria, excitement and etc. Thus, some may get these type of things as a side effect of the med working properly. Also, certain meds target these receptors better than others. For example, OC...It's primary ingredient, Oxycodone, is a great pain reliever because it works on so many different receptors and the main receptors that control pain. However, these same receptors are responsible for euphoria & etc. so it comes along with the package so to speak.

Opana is relatively new med on the market.....It's claim to fame is that it supposedly targets those receptors that don't cause euphoria. However, because it appeals to other receptors, it basically ignores the primary receptors, or the ones that mainly control pain. That's fine if the pain one is having is on those receptors the med hits....But, if not, then it won't work very well, or even possibly at all. Therefore, it's no surprise to hear many report that Opana does not work very well. Do a basic search in the search box and you'll see what I mean re: poster feedback. Some report that they take it and can't tell a thing...Kinda scary.

Current research shows that an overwhelming % of PM patients don't experience the effects of addiction due to their actual pain....The pain firing mechanisms. However, if you're not in pain and take the meds, then the receptors are overloaded due to the lack of pain, and thus, this is what causes the side effects that are the precursor to addiction. Additionally, physical dependance sets in at some point, and then the addict is locked in both physically AND mentally (the addiction part).

Lastly, some meds are more sedating than others...It's part of the chemical make up...Just like antihistimines....Some are more sedating....Particularly the older ones. Some of the older antihistimines were actually used to induce sleep and even as anti-anxiety, to a certain degree. Same with pain meds. More of the "newer" pain meds were engineered to avoid certain effects. For example, Docs don't use "codeine" very much anymore because of it's side effects....Hydrocodone has replaced it as the first line DOC by most docs.

Hope this helps.

Regards,

Ex

Liz, sending warm thoughts back to you - it was you who raised the BPL but when I was reading it this morning, I didn't feel well but thanks for posting these types of questions as I am lurking and gleening and trying to learn how to take my meds and your post was qutie timely indeed.

Well done to you for getting off the patch - sounds like you have a good hold on your situation thought it does sound awfully painful indeed (I feel almost embarrased posting about CMP). I just really want to send along well wishes and it's great to read these very interesting questions - I hope you continue to find success with this medicine.
Tara