Re: Morphine Sulfate ER vs CR
Hi Blue, Morphine is morphine, there really isn't a difference in the amount of drug that passes the blood brain barrier or the pahrakentics of the drug. The iiffernce is the way the morphine is released. ER morphine basically sustains half it's mg strength for about 8 hours. 60 mgs of ER morphine is equivelent to taking 30 mgs of short acting morphine every 4 hours.The only difference is that the long acting has a slower onset to you don't feel it kick in and you don't feel it slam wear off at exactly 3.45 hours.The idea is to maintain a constant level of pain meds in your system sbecause it's easier to keep pain in check than to bring a sky high level back down to normal.
As far as BT med, 7.5mgs of hydro really isn't disproportionate to to the amount of morphine your taking. Hydro and morphine are pretty close in strength. Most conversions have hydro being about 80% as strong as morphine. So if the 60 mg Morphine ER tablets sustain 30 mgs of morphine in your stystem, taking 7.5 of hydro would be like a 20% increase in your opiate serum level. A 20-30% increase in opiates is considered the standard dose for BT pain that most docs and manufacturer suggest. The idea is to free you from **** watching and living in 4 hour increments by using longer avting meds. You don't have to take a pil, wait 45 minutes and then cram your activity in the next 2 hours before it starts wearing off.
The biggest mistake people make with BT meds is using them as part of their daily routine whether they actually have a flair or BT pain. If your allowed 2 or 3 lortab a day and you take them every day for 4 months, if you do have a flair, those same meds you took every other day, won't provide any additional relief your not already very use too. Some docs don't use BT meds at all because they believe if they gave us 2 BT doses a day we would take them every dasay and if they gave us 4 doses a day we would take 4 every day, whether we were having a flair up or not. It leaves you in the position of really having nothing addtional to take should you actually have a bad day. TRy to keep this in mind, The doc isn't usually going to be too understanding when you call and say you pain is out of control and the BT meds aren't working because you have been taking them every day, whether you needed them or not. They aren't meant to be part of the routine, they are meant for actual BT pain, Pain from overdoing it, pain when the weather changes, pain that isn't managed or Breaks through the level of relief the long acting med provides.
Managed doesn't mean complete relief, usually docs shoot for about 50% relief with LA meds. The rest you do have to learn to cope with or you will always need/want an increase to stay pain free and eventually you will hit a ceiling from the side efects. Either too sedating, too constipating, too much urinary retention "cant pee",nausea and vomitting or someone is taking so much the meds cause sexual dysfunction. If the meds hinder the patients abilty to function more than they help it's hard to justify the risks and benefit when the patient is so medicated the meds themself become the impairng factor rather than whatever the reason they take them for.
Good luck and welcome, Dave