Need med advice ASAP - Pain Management Message Board

NeedANewJaw · 08-17-2004, 01:06 PM

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I have an appt with my doc first thing in the AM and am pretty desperate for some advice on my meds. I thought I would find you here quicker than anywhere else!

Here is my situation: I've been on mscontin for 7 months now with roxi for BT (90 mg a day). I take 400 mgs of morphine a day and dont use all the BT I am allowed because of the excellant pain relief I get from the morphine.
My problem is that I have had severe sedation with it also. I had hoped it would go away in time but it hasnt. I am constantly fatigued and my body literally shuts down about every 7 days...and I sleep for about 46 straight hrs then I am OK again. But it keeps happening this way, almost exactly every 7 days...and my family has basically given me an ultimatum...they cannot continue to take care of my kids while I sleep this day away. So I feel as though I must make some med changes so this doesnt keep happening. It started around the same time I started the mscontin.
There are other things that may contribute to the fatigue and sleeping but I am almost positive the main culprit is the morphine. I have tried stimulants, specifically dexadrine...and while it does help on the days I am up and about, it does nothing about that one day my body shuts down. I can take the stims and still sleep all day and both nights.
I have mentioned this to my doc but havent let him know how serious it is. I am pretty seriously looking for a job and if I get one, I simply cannot keep doing this.
My thoughts are if I switch my meds around perhaps I can prevent some of the constant fatigue. Is there any reason to believe that a different stim. would help?? And what are your thoughts about changing narcotics? I have tried them all for the most part (except the longer acting morphines) and none of the others helped NEAR as much as this does. I am scared about going back to how I was before I started the mscontin. We have discussed lowering my dose but Im not sure I think its possible to get low enough for the fatigue to go away and still have proper pain control.
One idea I had is to cut my msc in half (well go from 400 down to 240) and double my BT meds. I know this goes against what most docs think is best but the roxi doesnt cause fatigue at all and in fact gives me a gentle boost (NOT a high, just a small energy boost). My thought is that by lowering the morphine and raising the oxycodone, I could prevent some of the fatigue. I have also thought about possibly taking two different LA meds to help also.

Please let me know if you have ANY advice for me. My appt is at 8 AM tomorrow so I will check back here when I can. I REALLY need some advice and am SO sorry I waited this long

Kissa · 08-17-2004, 01:17 PM

I would just be honest with the doctor and let them know the severity of the side effects. My husband had a similiar situation with a medication he was taking the he had to take to remain healthy. At any rate his doctor put him on a medication that is meant for narcolepsy, it was not dexidrine or anything similiar, it was completely different and it did help him a lot. I'll have to see what it is called. He did change meds after a while because this med caused him to be too stimulated that he couldn't sleep.

I've heard good things about Oxy, have you tried it? If you need to change that might be something you'd consider but unlike shore, I don't know what the equivelant of that would be. You are on a very high dosage of the MS Contin, how long have you been on it? I too am pretty sure that would be your culprit as it is known for it's sedating effect.

Not sure what to tell you other than be honest with your doctor and get their advice on what to do next. Obviously you can't continue like this or ask that others be responsible for your children as you deal with your side effects of the morphine. Somehow you need to strike a balance between what you can deal with in terms of pain and trying to stay awake at the same time.

Good luck

NeedANewJaw · 08-17-2004, 01:26 PM

Kissa thanks for the response and you are exactly right...i can no longer continue like this and have to at least try to get this straightened out.
I have been on daily narcotics for 5+ yrs. I have tried oxy, also the patch and meth. Oxy was good as far as the fatigue goes (didnt make me tired at all) but the pain control went from fair to bad over the 8 months I was on it. I was needing increases every 2-3 months and I didnt want it to continue that way.
I've been on the mscontin for approx. 7 months and havent needed an increase yet. In fact during the conversion from oxy to morphine, I was able to get by on a lower dosage of morphine than I was oxy. He started me out lower in hopes it would work and it has!! That is why I am so frustrated with this issue and hope we can find an answer that doesnt bring that horrid pain back.
Thank God I have a doc that wants me to be comfortable, whatever it takes. He likes the fact that I bring in suggestions and almost always has let me try what I want to try, even if he would have suggested something different. What a doc huh?

madhatter · 08-17-2004, 04:19 PM

The same thing happened to me when i was on ms cotin,boy it made me tired,but when i switched to oxycotin,i couldn't sleep[l.o.l]I did adjust to the oxycotin,but never the ms cotin.

Kissa · 08-17-2004, 05:11 PM

It's one of those things if it ain't broke, don't fix it. It sounds like you have run the gamut of meds and this is the one thing that works for you which makes it difficult.

As mentioned, talk to the doctor, there are ways of keeping you awake that do not involve adhd meds or diet meds. Might want to try something that is used for those who are norcoleptic, there's quite a few (well over 12 standard ones). I am not sure if your doctor will be open to it or not but I do know for sure it's been done. Some are even antidepressants.

The one antidepressant that I know makes people feel energetic is Lexpro, I've been on it quite a while for mild depression and anxiety, it works really well for me and has given me a lot of energy, even on days when I hurt that energy is still there.