Shoreline

Hey Jason, I honestly believe docs expect to here from you more often at the time during initial titration, We are all afraid to rock the boat but it's not that hard to find out what your doc expects as far as how much time you should give it. A month is a long time if your over medicated or under medicated. When changing meds ask how long it take to really know if it's right and if he says you'll know within a week or it takes a good month, he's pretty much telling you how often he expects to hear from you.

As far as drowsiness, everything I have experienced and have read about morphine is that it's much more sedating than the synthetics and patients should really try to give it a chance to pass. That groggyness and tired feeling will deminsish and if you don't give it a fair trial, you will run out of meds to try very quick. I would say handg in there. Groggy is one thing, feeling like you can't catch your breath or aren't getting enough air means too much respirtory supression. If youir simpy drowsy, you should really give it more time.

You also have to understand that the synthetics hydro, oxy, dilaudid are in a a different class that causes a significant hystamine release and can actually be energizing, even more so when taken in short acting form. Going from short acting oxy to morphine is a significant change in side effects but it if it takes 3 weeks to pass and you don't give it 3 weeks, you may never know if morphine could have been the right choice in the long run. If you think morphine is sedating, you would hate methadone. You don't want to rule out meds before you try,so don't expect one to feel the same as another particlualry when you first start.

I've never found the right dose in less than 4 tries and some of the increases were quite significant. The prescribing instructions for many meds say to make the conversion and then start at half of the equianelgesic dose. If your going from a dose that isn't working, to half the equal amount of the new med you have to work just to get back to the same level of discomfort you had with the old med. Switching meds may mean taking 3 steps back before making any progress but the long term goal is to find the most efective method. Not relief as fast as posible or that has the least side efects when you first start.

Expecting severe chronic pain to be brought under control in a matter of weeks or months just isn't realistic. Unless your doc says we will work with you weekly untill we find the right med and dose. It's just not a reaonable expectation. Weekly is a bit much, but 2-3 weeks Vs a month is reasonable.
If it's only been a week, I think you need to give it more time, what is the harm in being drowsy right now if it turns out to work great in 3 weeks once you used to a very different opiate than you have taken in the past.

Good luck and don't be afraid to talk to your doc, but give it a fair trial. Especially morphine when all you have to do is read the fullprescribing info on any morphine product to find out how sedating most people find it initally.
Take care, Dave