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Old 06-28-2006, 05:59 AM   #1
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Question Introduction & Question

Good Morning All-
I'm new to the boards. I hope everyone is having a good day.

I just saw my new pain management doctor and he is very nice. The meeting was a bit rushed because he was going out of town and needed to get out of the office. I didn't like feeling rushed, but hopefully the next appointment will be more indepth.

Anyway- he has prescribed Avinza which from what I gather is a time release form of moprhine. I've had 7 knee surgeries (all right knee) and after two of them I was kept in the hospital over night on a pain pump with morphine. Now, the morphine made me very ill. It made me vomit, so I am wondering if the oral medication will have the same effect. I am willing to give it a try, but was hoping that someone here might be able to give me some advice and/or useful information. Anyone here have any experience with it?

I'm so scared to take it because I know morphine is a powerful narcotic, but I guess it's better than trying the methedone he briefly discussed. I think I'd almost rather try oxycontin than the morphine because it scares me less.

Any information would be greatly appreciated. Have a great day, and take care!

Lezlee

 
Old 06-28-2006, 07:03 AM   #2
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Re: Introduction & Question

Hey Ozzybug,
Feelings of nausea from opiates frequently go away after a few days as you become accustomed to them. You also may find that taking it orally causes less nausea than IV. If it is still troublesome, your doctor can prescribe an anti-nausea medicine Phenergan (spelling?)
Hope it works out for you.

 
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Old 06-28-2006, 07:23 AM   #3
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Re: Introduction & Question

Badoldback-
Thank you so much for the information. I was hoping that maybe the oral medication wouldn't hit as hard as the IV kind does. My pharmacy has to order the Avinza as they don't keep it in stock, so when it comes in, I will give it a try. I trust my pain management doctor and since I hurt so bad, I think I'd hang by my earlobes if they told me it would help.

As far as the Phenergan, I really wish I could take it, but I'm allergic. There is some other medication for nausea that they usually give me. You know, I've found that Phenergan is not the best of medications to be allergic to- especially when you end up in the ER with a stomach virus. The local hospital didn't have the other medication and I was kind of out of luck that night and had to stay in the ER for 4 hours with IV's and no releif from the vomitting. Urgh..

Again, thank you so much, I do feel better about trying the Avinza.

Lezlee

 
Old 06-28-2006, 07:43 AM   #4
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Re: Introduction & Question

Switching to a long acting med made a huge difference for me.
the fluctuating pain levels throughout the day makes it harder to manage the pain.
It is much easier to keep pain levels down then to bring them down if you understand what i mean.

I would give it 2 weeks if you could.Any less then that is not giving it a fair trial.Most side effects such as naseu and itching will subside.the only thing that doesnt is constipation which is easily managed with stool softeners.

I think once your body adjusts you will see a huge difference in pain levels.
I also take a long acting morphine but not avinza.I like it because there is no feeling of being on narcotics as i had with oxycodone.I never feel it kick in or wear off.

hope it works well,scott

 
Old 06-28-2006, 08:44 AM   #5
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Re: Introduction & Question

Hey Ozzy, Weclome to the boards

Glad to hear that you got on some LA meds. You mentioned Avinza which is a LA morphine with a little bit of an immediate release. Something to remember is, Morphine is not the top dog of meds. I know that we all think that when we first start PM, but you will soon see that it is actually on the lower end of things.

So just because you are on Morphine does not mean that you have maxed out. Far from it. Morphine is an old drug and it is the gold standard that other drugs are compared. It is generally one of the first run drugs in a hospital for surgeries, etc. But looking at Morphine on an equianalgesic chart you will see that it actually is approximately a 1:1 ratio with Hydrocodone. And Oxycondone is approximately 1.5:1 ratio with Morphine, meaning that oxy is approx 50% stronger than Morphine. I could keep going, but just wanted to give you some examples because there is a stigma about Morphine being the strongest when its far from it.

As far as nausea, this is a common side effect with Morphine. You mentioned you are allergic to Phengren. There are other meds like Vistaril or Reglan and even some OTC meds. You may not experience the same nausea that you did with IV Morphine. IV of anything is usually stronger and affects you immediately vs long acting like Avinza. The good news is, nausea will usually go away with some time on the med. Constipation on the other hand usually will not and needs to be managed with diet, supplements, etc.

I hope the Avinza works out for you. Keep us posted.

Take Care

 
Old 06-28-2006, 09:10 AM   #6
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Re: Introduction & Question

Thank You Both Scott & Aranger-
I really appreciate all of the wonderful information. It gives me something to think about. You are right- I am one of the ones who thought Morphine is one of the stronger pain meds. It makes me feel better that it's really not. I'd hate to think we were starting with the really powerful stuff. I'd rather start small and if that works then wonderful. If for some reason, it doesn't then we do have other options.

I will give it a try and also will give plenty of time for my body to adjust before making any judgements. Like I said before, being in pain for 3 years kind of makes you be willing to try almost anything.

I will let you all know how it goes once the pharmacy lets me know it's been delivered.

You have all been very kind in making me feel welcome to the boards and I appreciate it so much. If I can ever share useful information, I'll be more than happy to.

Thanks Again!
Lezlee

 
Old 06-28-2006, 09:16 AM   #7
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Re: Introduction & Question

Ozzy, Arranger did a great job welcoming you to the board. One other thing to remember is...NEVER cut the pill or crush it or chew it. Long Acting meds have time mechanisms that will be defeated by such actions and as a result, too much morphone could get released at one time.

This isn't meant to scare you. As long as you follow directions, you should be fine. Many of us on this board take morphine, oxycodone, fentanyl, methadone and dilaudid among others, and in higher dosages too.

If you ever have any questions, this is the place where you will get some answers. Welcome aboard and Good Luck.

Alan

 
Old 06-28-2006, 11:02 AM   #8
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Re: Introduction & Question

Hey! I am, too, on Avinza. I'm on 30mg once a day- the first 2 weeks were really rough as far as the nausea goes. I can't really lie about it. I was honestly contemplating just stopping it it was so bad... luckily my Dr. talked me into sticking with it because he said it would pass... and sure enough it did. I rarely, if ever, get nauseous from the medicine anymore. I was so nauseous in the beginning I couldn't even get out of bed or move my head or I'd throw up... so it definitely has the potential to pass if you do indeed get nauseous.

And like they said, there are other meds besides Phenergan.

I make sure to eat with it- I like taking it with Gatorade. I do take it at night with dinner which was better for me than taking it in the morning as far as the nausea goes.

 
Old 06-28-2006, 01:10 PM   #9
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Re: Introduction & Question

Thank You Alan & EverSoSweet
Yes, my script. is for 30 mg once a day. As long as that nausea will be relatively short lived I can deal with it. I will be sure to take it with food. Other times that I've taken medications that made me nauseaous, I would take it with peanut butter toast and that has always done the trick for some reason, so I will be taking it with food.

My doctor said he wants me to take it in the morning, but if that is a problem I will take your advice EverSo and try taking it at night.

I will also make sure not to crush or chew the pills because that was a big part of my concern at first- the time release part. Now, what concerns me is once that pill is in my body, I'm affraid something will go wrong and too much will release. That sounds really paranoid I know, but again, for the past 3 years the doctos always gave me the short/fast acting stuff like Vicodin. I did some research on Avinza and the first thing that jumped out at me was about never crushing or chewing them. That is a good thing to know since so many people (me included) are used to being able to break a pill in half if we don't feel we need the whole thing.

I really am so glad I found this board because my pain management doctor has told me that this will be a long proccess of treatment and I am full of questions. Along with my knee & back issues, I've just been diagnosed with Hypermobility Syndrome as well as Hyperlaxity, so I have lots of research to do in the next few days.

Again- thank you all for your kindness and for sharing. Let me know if I can return the favor.

I do hope everyone is having a good day! Be safe, and please take care.
Lezlee

 
Old 06-28-2006, 02:28 PM   #10
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Re: Introduction & Question

Hi Lezlee - Just wanted to welcome you as well - you've found a great group of caring and understanding chronic pain patients on this board! You may be a "newbie" but your past physical, emotional and daily experiences with chronic pain are of value to everyone - senior veteran or the new kid on the block! No question is to small to ask. I've been on many medications and there is no "right" drug for everyone. Like your doc told you - finding adequate pain relief is definately a process. I'm currently taking Methadone for my pain control and it's been great for me - and now that I'm feeling better I'm slowly tapering down my dose. Keep posting - glad you found the board! KathyMac

 
Old 06-29-2006, 11:00 AM   #11
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Re: Introduction & Question

KathyMac-
Thank you so much for the welcome and information. I do feel that I've found a wonderful support group here and it is comforting to know I'm not alone. Not that I enjoy knowing there are others out there (and in here) that are living with long term, chronic and debilitating pain.

I am feeling much better about starting the Avinza and will give it a fair shot. You never know if something is going to work unless you try it. I am going to make sure that my husband is going to be home when I take it for the first time, and may even have my kids at my parents house just in case it makes me too loopy. I don't like for them to see me taking lots of medications because I don't want them thinking medications are the cure-all for every little ache & pain. Does that sound rediculous? Hope not.

I wish you the very best with tapering your medications and am glad you are feeling good enough to be able to taper. I hope with all my heart it is successful and that you will continue to feel much better.

I am just so very thankful to have met everyone here...words just cannot describe it.

Sincerely,
Lezlee

Last edited by ozzybug; 06-29-2006 at 11:02 AM.

 
Old 06-29-2006, 10:37 PM   #12
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Re: Introduction & Question

Hi Lezlee. Just wanted to say howdie, The other folks have exlplained it well, but you may not have the eproblems you did with post surgery anelgesia. One, it's IV and hits you instantly and #2 you just had anesthesia,. There are so many anesthetics they can use from minimal sedation and nerve blocks to full anesthesia with you on a vent. Anesthesia is notorious for causing vomiting afterwards and it's likly you had more than one type with that many surgeries.

30 mgs spread over 24 hours really isn't a huge dose, nothing compared to what you would recieve IV , I would try to eat something prior to taking the med just so you not putting something on an empty stomach, but the way Avinza works, is the beads have different amounts of polymer coating so they disolve and release at different points through the day. Unless you drink a glass of acid or alcohol your really not going to bypass the release mechanism.

30 mgs spread ove 24 hours realy is no stronger than 30-40 mgs of hydrocodone spread over 24 hours. Docs usually start low and work towards a reasonable goal. I wouldn't expect total pain relief from any dose but there is no reason other than side effects to stop the titration process where they adjust the dose in the beginning because they are playing it safe rather than taking any risk

. IT's better to be honest about the relief your getting and get our dose right from he get go. If you except less than adaquate out of fear of loosing what you have. Doubling and trippling isn't uncommon from a starting dose and if opiates are you only choice, mgs are just a number. No doc can guess what you will require so they expect to have to make adjustement.

I wouldn't be afraid of the morphine, you aren't allergic, you can't cause it to all release and the dose is safe if you have taken more than 30 mgs of hydro per day. 30 mgs of avinza is probably pretty darn close to taking a 5 mg Vicodin every 4 hours.

Hopefully the doc will have more time and be able to talk about goals and possibly using other tools to manage pain. The more things you can turn to aside from a bottle of pills, the better you will be in the long run. So don't toss your ice packs and braces yet.

Take care, Dave

 
Old 06-30-2006, 03:46 AM   #13
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Re: Introduction & Question

Dave-
Thank you so much for the information- especially about how the time release works. (The coating on the pellets) I don't see myself deciding to drink acid...hahha. Seriously, though I'm not a drinker, so no alcohol either. The last time I had any alcohol was in Feb. for a special occassion and I had about 4 sips of champagne. (Wasn't on pain meds at the time though)

Anyway- I still have my TENS unit, and like you said, hope to be able to use other methods of helping to ease the pain and not just rely on medication. I am hoping to be able to get my hands on an "Alpha Stim" because they work wonders. I'll be speaking with my pm doctor about it on the 17th.

As always, I truly hope everyone is having a good day. Be strong, and please let me know if anyone needs support. I am happy to return the favor.

Sincerely,
Lezlee

 
Old 07-02-2006, 08:40 AM   #14
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Re: Introduction & Question

Hi Ozzy. And welcome to the boards! I have found so much help here over the years, and a lot of good friends as well. I wouldnt put the cart before the horse here, you may not have naesuea at all in the oral form, but if you do, it will pass in a few days as the ealier poster said. You could try to have some peppermint tea and papaya extract on hand, these can be bought at any healthfood store, and my friend who was going through chemo had better results with those then with all the pharmacuticals they threw at her. Best of luck and please let us know how youre doing, we care! Your Friend, Fabby

 
Old 07-02-2006, 04:25 PM   #15
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Re: Introduction & Question

Fabby-
Thank you for the suggestions. My daughter drinks lots of tea, and I'm sure she has some in her collection. If not, I will run to the health food store and pick some up. I will also pick up some of the papaya extract as well. If I don't need them wonderful,but if I do, then I'll have them.

Have a great evening!

Lezlee

 
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