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Old 05-22-2006, 04:06 PM   #1
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Question Morphin Enjection In Back

Any Info On Geting A Morphin Enjection In Back For Back Pain Due To Have One On Wed. Thanks Mike

 
Old 05-22-2006, 04:23 PM   #2
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Re: Morphin Enjection In Back

Hey Mike,

Can you clarify your post a little. I'm not understanding exactly what you're asking?? I haven't heard of scheduling a Morphine injection except for testing out a pump or something along those lines. Morphine injections are given either IM or IV unless you're in surgery, then they may inject it in the spine area (epidural).

Are you talking about a steriod injection by chance? If you are having back pain, then a morphine injection is usually given at an ER. They usually are not scheduling one for another day.

Anyway, maybe you could clarify a little for us.

Thanks.

 
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Old 05-22-2006, 07:38 PM   #3
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Re: Morphin Enjection In Back

This Is Scheduled Through My Pain Managment Doctor I Have Already Had Epidurals A Few Times With No Luck I Have Had 2 Back Surgeries The Last One A Fusion In 2005 I Was Diagnosed With Failed Back Syndrome Im Curently Taking Oxycotin For The Pain And Neurotin For The Nerve Damage All He Told Me Is It Was A Morphin Enjection And That I Would Need To Have Someone Drive Me Home Afterwards Thanks Mike

 
Old 05-23-2006, 05:35 AM   #4
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Re: Morphin Enjection In Back

It sounds as though they are testing to see if a pump would be viable for you as opposed to oral medications. That's the only time I can think of why they'd do an injection as such.
Did the doctor ever mention a pump for you?

 
Old 05-23-2006, 05:57 AM   #5
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Re: Morphin Enjection In Back

Hey MPD, Like Aranger mentioned it's normally done for pump trials or a new product called Depodur is available for post op pain. This product will give you more than the normal 4-6 hours of relief from epidural morphine injections. It may be interesting how he bills it as far as treatment code because he's either using it hopefully to stop a huge falir and the pain cycle or your leading towards a pump if you get excellent relief.
You can google Depodur and read more about it but this is a longer acting version of the preservative free injections they do for a pump trial. Pump trials can either be done into the intrathecal space where morphine would be most potent or into the epidural space which doesn't require puncturing the dura or a catheter but isn't quite as potent. The newer formulation will give longer lasting relief but it's not a recognized use as a treatment method for the management of chronic pain, meanng It's an option to reduce a flair but not a weekly option that would most likely cause scarring over time.

The big advanatage of epidural or intrathecal morphine is placing an opiate where you have exponentially more opiate receptors than anywhere else in your body and the newer long acting version can give you relief for several days. Do be carefull with your normal dose of meds while the morphine is working. You will have a much clearer head than an equal amount of oral or IV morphine because epidural and intrathecal meds don't run through your entire body. Epi drugs will migrate through the dura into the intrathecal space where pump meds are delivered.So an epi injection is just as telling as an IT injection as far as a pump trial without the risk of nicking the dura.

MY concern would be lack of comunication and not being aware if he's leaning towards a pump trial without first discussig the option. If you have a positive result from the injection it would make sense to go ahead with a pump, but the trust me and don't ask questions level of communication is far beyond the blind trust I would give any doc. The advantage for the doc is not having to write more scripts, avoiding the DEA spot light and not worring about rapid growing tolerance with OxyC in particular.

I knew the product so it was easy to google and find more info about it's use. In your case it would be an off label use, or a variation of a pump trial. The doc may ask you to discontinue you oxy for 48 hours after the injection which shouldn't be a problem if your given an equianlegesic dose of epi morphine.

DepoDur® is the 1 dose decision for epidural management
of pain following major surgery. DepoDur's DepoFoam®
technology is designed to reduce peak morphine plasma
concentration and extend release for up to 48 hours.
1
Previously, extended-duration delivery of an analgesic
could only be provided with continuous infusion of
morphine through an indwelling epidural catheter.
2
DepoDur® is indicated for epidural administration, at the lumbar level, for the treatment of pain following major surgery
DepoDur® is administered prior to surgery or after clamping the umbilical cord during elective cesarean section
DepoDur® is not intended for intrathecal, intravenous, or intramuscular administration
Administration of DepoDur® into the thoracic epidural space or higher has not been evaluated and therefore is not recommended

DepoDur® is a Schedule II controlled substance and is subject to abuse and diversion.

DepoFoam® is a registered trademark of SkyePharma.


Good luck and let us know how it goes. Dave

 
Old 05-23-2006, 09:21 AM   #6
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Re: Morphin Enjection In Back

Thanks So Much For The Great Advice Mike

 
Old 05-26-2006, 01:37 PM   #7
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Re: Morphin Enjection In Back

well i had the morphin injection on wed. doctor called a intrafecial morphin injection (spelling not sure) well no relief so its back to the oxycotin 3 times aday hope all is well with all thanks mike

 
Old 05-27-2006, 06:18 AM   #8
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Re: Morphin Enjection In Back

Hey Dave, The only reason I ca think of to give an intrathecal morphine injection is while doing the single bolus method for a pump trial. There are a number of ways to do the trial, single bolus, portable infusion pump with a temp cath placed in the IT space or in patient with a pump delivering meds to the intrathecal space. Believe i r not, tmedtronics "the manufacturer of the most used pump recomends doing a plecebo injection to rule out candidates that get pain relief because they think they should get pain relief. I've met people that failed the pump trial because they reported relief from saline.

If they used an actual opiate, one injection could easily fail if the dose isn't high enouugh or you simply don't respond as well to morphine as you would to dilaudid or one of the Fents. If they used .8 mgs you may have gotten relief at 2mgs or relief from the right amount of dilauidid or the right amount of Fentanyl or suffentanyl. The single bolus method doesn't allow a doc to make adjustments which is no different than the initial setting they use for the implant. They started my pump at 2mgs a day and I was miserable, but after 16 adjustments over 6 months I was getting significant relief at 12mgs a day. IF they happend to use substantially less than you require, you wouldn't notice a huge difference. It would be like getting one mg of morphine IM, not enough to make a difference.

Was his conversion from oral oxy to oral morphine to IT morphine acurate? That's hard to say because most literature has IT morphine between 50 and 100 times more potent than oral morphine. That's a pretty wide varaible and hard to say if the right conversion was used for you or the right dose was used to obtain relief if an opiate was actually used. With so many questions still unanswered, you may show up at your next apt and find you passed the initial phase of a pump trial by not reporting relief from a plecebo. Another part of the trial process recomended by medtroncs is a psych eval. The longer trials using portable pumps or in patient, allow the doc to make daily adjustments to your dose to allow the doc to find an actual working dose. The single bolus method is a one shot kind of deal unless you know he's willing to work on the dose and med with future injections, so I wouldn't be convinced a pump is out of the question by one blind injection.

My initial in patient trial was a complete failure due to a spinal fluid leak from placement of the cath. I ended up getting a blood patch on day 5 and waited 6 monhs before I would allow them to try a single bolus injection. But at least they had the info from my in patient trial and could start based on where they left off which by the 4th day, they had increased the dose 4 times that of the starting dose they calculated. They adjusted the dose a little more and the bolus injection was a success.

What you have been through so far really isn't enough info to predict whether a pump would work or not. If that's the only chance your doc is giving it, you may want to keep the option open in the back of your mind should you ever want to try again with a different doc that uses a different method if he's completely ruling out the possiblity based on one injection.
Good luck, Dave

 
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