Shoreline

Hi Gail, Unfortunately I don't think docs understand how the 24 hour meds work. A 60 mg Avinza spread over 24 hours would be roughly the same as taking 10 mgs of regular morphine every 4 hours.

60mgs of MSContin 3 times a day would sustain the same serum level as if you took 30 mgs of morphine every 4 hours which would be equivelent to your present dose of oxy. All you can do is call the doc if you are still hurting and using excessive BT meds to make up the difference.

I think Avinza and Kadian could be very efective meds when dosed properly. 60 mgs of avinza doesn't sustain 60 mgs in your system, It's spread out over 24 hours unlike OxyContin or MSContin that sustains half the mg strength for 8-12 hours.

Unfortunately docs often start low when tritrating any new med. However I have seen people get better releif from a different drug at a significantly lower dose, so I don't want to predict it's going to be too weak.

Morphine has a different mechanism of action, causes more euphoria which is part of the anelgesic process. That false sense of feeling well when your not is part of why morphine works. If your doc is willing to titrate the dose properly you may find excellent relief but it's hard to predict. Equianelgesic charts are just guides, Most conversion from Oxy to morphine are 1:1 or 1:1.5 meaning you need 50% more morphine than oxy.

When the patients pain spikes, or they experience some withdrawal it's natural to want to go back to the old med before Avinza or Kadian is really given a chance to work at the right dose. Most people also find morphine very sedating at the initiation of therapy, but you have to ride that out and it does go away. You just have to suck it up during the titration process. I'm sure my pump setting will be 3 times what the original dose was, I can't speed it up, but I do have weekly apts untill I'm comfy. If you know your doc will respond when you say you hurt and make adjustments it's probably worth sticking it out to give it a fair trial.

Personally I don't think the doc would be giving Avinza a fair chance untill you at least reach a 1:1 ratio from oxy to morphine and then fine tune it. Titration is never fun, they always start low with meds you haven't been exposed to and this is just the life of a CPer. If you give it 3-4 days and let the doc know how your feeling that's plenty of time to know if 60mgs is enough.
Good luck,and let us know how you do. Take care, dave