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Old 07-12-2008, 07:58 AM   #1
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Morphine vs. Methadone

My PM doctor is interested in switching me from 40mg Oxycontin every 12 hours to either Morphine, or Methadone. I have been reading up on both medications, but am interested in hearing what others may have learned from experience with either, or both, of the medications. I have chronic abdominal pain brought about by a greatly delayed diagnosis of Hypo-Pituitary Adrenal Insufficiency.

Along with the 40mg Oxy twice a day I also take 1-2 8mg Dilaudid pills for BT pain....I am not concerned with the particular dosage of the switch as I am confident that my PM doc is more than competent....I am merely interested in making the best possible decision regarding which medication will be most beneficial. Thank you in advance for any responses!

SteelTown

 
Old 07-13-2008, 03:37 AM   #2
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Re: Morphine vs. Methadone

I must say that your Dr is dosing you really low on the oxycontin. This med does not last nearly 8 hours, and your only taking (1) 40 mg tablet every 12 hours? that is not enough and MOST PM DOCS know that this med does not last 12 hours. no way! I am dosed with the same strength 3 times a day and i still have pain and I also take 5mgs of oxy IR for my B/T MED. I don't use it daily but some days I need it and seem to use at least 90 tabs a month and I get 100 tabs a month. I usually have some left over that I save for me ER stash b/c they are week and the brand I get sucks. I used to get Amide but can't get them anymore, so I am an another brand that is not nearly as good, so 2 tabs barely touch my pain.

before you make such a drastic switch how about asking your Dr to dose you every 8 hours or at least allow you to take (2) tabs a day of the oxy. It just doesn't last 12 hours so that is why its not covering your pain. speak to your DR about this before you make the switch.

good luck, SS

 
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Old 07-13-2008, 03:40 AM   #3
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Re: Morphine vs. Methadone

OKAY I miss read your post, you are dosed twice a day but it does not last 12 hours. ask him to increase you to (3) tabs a day, so you can take them every 8 hours, I bet this will do the trick for you.

 
Old 07-13-2008, 01:35 PM   #4
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Re: Morphine vs. Methadone

Hello All,

I appreciate you taking the time to read, and respond to my post. The reason I am making the switch to either Morphine, or Methadone is due to my previous experience with Oxycontin. I ended up developing a high tolerance rather rapidly and it ended up getting to a level that I simply was not comfortable with. I had to taper off all pain medication in order to have some testing done regarding my Cortisol levels, so I find myself "starting over" so to speak.

I am in complete agreement with the 8 hour dosing of Oxycontin, but this particular preliminary plan was established by my PCP just to provide some coverage until I met with a PM doc. My PCP has been an absolute Godsend and I feel amazingly fortunate to have found such a fantastic doctor. He referred me to the PM doc because he felt that he may have a greater handle on some options, or medications, that we have not previously considered.

After exhaustive research, and careful consideration, I have decided to go with Morphine. There is still hope that I will not be forced to rely on pain meds the rest of my life, and based on that hope I am not ready to commit to a medication such as Methadone that presents an even "greater than normal" difficulty of coming off of. Perhaps down the line it will be something that I must consider, but at this juncture I believe that Morphine is the best option.

Up to this point, my PCP has managed my pain but I am now going to be under the care of the PM doc and he has informed me that I must go through some rather rigorous Psychological evaluations and screening process....have any of you gone through this before? From what I understand it's the modus operandi for Pain Clinics, but I just thought you might be able to clue me in as to what I can expect.

Once again, I greatly appreciate your insight and for taking the time to offer your suggestions!

SteelTown

 
Old 07-13-2008, 07:24 PM   #5
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Re: Morphine vs. Methadone

Quote:
Originally Posted by SteelTownPain07 View Post
Up to this point, my PCP has managed my pain but I am now going to be under the care of the PM doc and he has informed me that I must go through some rather rigorous Psychological evaluations and screening process....have any of you gone through this before? From what I understand it's the modus operandi for Pain Clinics, but I just thought you might be able to clue me in as to what I can expect.
Glad I can help. BTW, I'm also a HUGE Steeler fan...Grew up in the Bradshaw, Franko Harris, Lynn Swann, Jack Lambert Era. Go Steelers!

I have been in PM for about 10 years now and have learned a lot. Many other regular contributors on this board have a wide array of experiences who will undoubtedly weigh in @ some point. No, I have not been subject to the evaluations you refer to. I'm guessing that it's part of the ever growing rigors of PM. Family Docs don't usually have many, if any, rules or regulations, whereas PM Docs are rule laden.

The psychological evaluations and screening process is probably to ensure that prospective patients aren't "addictive" in nature. No disrespect to any of the PM Docs because they all have a very difficult job, but IMO, I think a lot of these rules and regulations are CYA in nature. Think of it this way....Almost all a PM Doc does is prescribe massive amts (overall) of narcotics. Invariably, there is a bag apple (or two) on the patient list, and as a result, the practice can be the target of the DEA or State Police. Thus, these measures help build a file on each patient to ensure the Doc's liability is limited in nature. Also, there is an ever increasing tendency for patients to sue Docs and the more a Doc can justify and build in the file, the better. For example, I've seen actual advertisements of lawyers "recruiting" OC users to join class action lawsuits. What a shame!

If you haven't been part of a PM practice before, you'll also notice that regular drug screening, prescription monitoring (state data base), and even pill counts can be common place. In my PM clinic, patients are typically drug screened 1-2 per year and we sign a contract stating we will only use one pharmacy for all our pain scripts. We also sign a "release" allowing the Doc to periodically search the state database to ensure compliance (no meds from other Docs). All controlled substances must be entered into the state database after each prescription. Lastly, my Doc uses pill counts for patients who are on "probation" or who they've had problems with in the past. I've never been subject to one...Most PM patients aren't, but they do happen.

Hope all this helps. Any additional information you need, please let me know.

Regards,

Ex

 
Old 07-13-2008, 08:35 PM   #6
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Re: Morphine vs. Methadone

Quote:
Originally Posted by SteelTownPain07 View Post
I have chronic abdominal pain brought about by a greatly delayed diagnosis of Hypo-Pituitary Adrenal Insufficiency.

SteelTown
If I may ask....how were you diagnosed? What were your symptoms? Was it your cortisol level that brought about the diagnosis? Or your thyroid? What is your abdominal pain like?

I ask because my daughter has had severe abdominal pain and nausea for years and it is just getting worse and worse and the doctors can't figure out what is causing it. They all say it is anxiety(which she does have) but they fail to listen to the fact that the anxiety came from the many, many doc visits to try to find out where the pain was coming from!!

Thank you for any info you can give me and good luck with your med switch. I, too, am having tolerance issues with oxy. I tried mscontin and it didn't work for me. I've heard methadone is excellent if you can handle the side effects.
Welcome, to our supportive(if miserable) family!!!~Mush
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Old 07-14-2008, 04:31 AM   #7
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Re: Morphine vs. Methadone

Ex,

BIG TIME Steelers fan here as well! My father and I had season tickets at Heinz field for the first three seasons, but grew tired of the escalating costs and prefer to watch the games together on the Big Screen....now back to the discussion at hand....

I can understand the reasons behind the Psychological evaluations, but I have been under Pain Management with my PCP for the last 14 months and have never been a "problem patient". I do not misuse, or abuse, the medication so I am not worried about possible screenings, pill counts, etc. I have been dealing with this issue since December 2005 and the first 18 months were absolutely horrific. Hypo-pituitary Adrenal Insufficiency is a rare condition that is extremely difficult to diagnose and the way the symptoms present lead most Doctors to go through the usual testing process of CT scans, Ultrasounds, etc. The first two PCP's that I tried did the superficial, preliminary tests....concluded that there was nothing wrong with me....and labeled me a "narcotic seeker". I am sure that there are many on these boards that have gone through the same type of extremely frustrating, and exhausting, process.

The PCP I am with now was rather skeptical of me at first and admitted that my pattern of behavior seemed a classic case of "doctor shopping", but confided that his intution led him to believe that this was not the case. I offered to sign an opioid contract, submit to drug testing, pill counts, etc.....I signed the contract and have never been an issue. Over the course of the last 16 months we have established a very close, and open, doctor/patient relationship and he has taken exceptionally good care of me. Upon the referral to the Pain Clinic he even dictated a rather detailed letter explaining that was extremely compliant, have never abused any medication, and have done everything he has asked me to do.

It is an absolute travesty that good people suffering from legitimate CP issues are forced to endure the ridicule and derision that so often accompanies this process. I will refrain from ranting about the current Administrations immensely negative impact on the subject of CP patients and the doctors that care for them, but the system has become a difficult one to endure.....and I empathize with everyone that must not only deal with their condition, but also the negative stigma that comes along with opioid treatment programs.

It continues to astound me that the vast majority of doctors seem to have no hesitation to prescribe adjunctive medications that can have potentially devastating, psycholigical ramifications such as anti-convulsants, tricyclic antidepressants, and ssri's.....yet are so apprehensive with the administration of opioids. It is a true shame that such a small percentage of patients that abuse medications have made it so difficult on legitimate CP patients that have no history of abuse, or addiction.

A lot is often made regarding the anger, hostility, and depression that accompanies CP....but I have found that the greatest source of anger and depression comes from the constant fight that comes along with attempting to be viewed as a legitimate CP patient that is looking for quality care. I apologize for the rant.....but I know that there are many others that have gone through the same sort of situation.

SteelTown

 
Old 07-14-2008, 04:43 AM   #8
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Re: Morphine vs. Methadone

Mush,

My symptoms presented themselves after a severe bout of pneumonia and included: extreme fatigue, loss of appetite, nausea, vomitting, low blood pressure, and extreme abdominal pain. The diagnosis process was an absolutely horrific experience. It took over 18 months, three PCP's, two extended hospital stays, and COUNTLESS trips to the ER to achieve the diagnosis. As I mentioned in my previous post, the first two PCPs did preliminary tests that included Ultrasounds, CT scans, Upper Endoscopy, kidney tests, Hedi Scan, numerous blood panel workups.....all of which were normal.

I kept getting worse....and eventually collapsed at home one night and went to the ER. My labs showed an elevated Pancreatic Enzyme so they felt sure that they had a diagnosis of Pancreatitis....I was admitted and they began doing a complete workup on my Pancreas. After three days and countless tests.....my Pancreas was deemed to be fine. At this point, I had a team of GI doctors on the case and one of them suggested doing a Cortisol blood test.....and lo and behold....that is what led to the diagnosis.

There are a couple of different types of Adrenal Insufficiency with different causes.....but if you would like to discuss this in greater detail I would be happy to share the information I have with you. I am not sure what the rules are about exchanging e-mail addresses and what not.....but you can always start another post and I will be happy to continue the discussion there.

I can certainly empathize with what your daughter is going through......the frustration, anxiety, and anger that comes with fighting doctors and worrying about your health is quite often overwhelming. I would suggest contacting your doctor and asking them to do a simple blood test, or saliva test to test her cortisol levels. If you are interested in reading more about Adrenal Fatigue as well as Adrenal Insufficiency a fantastic book is "Adrenal Fatigue: The 21st Century Stress Syndrome" by James L. Wilson

If you have any other questions, or would like to exchange e-mails....please let me know. In the meantime, be sure to contact your doctor and suggest that they possibly pursue this line of testing.

SteelTown

 
Old 07-14-2008, 06:33 AM   #9
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Re: Morphine vs. Methadone

Quote:
Originally Posted by SteelTownPain07 View Post
Over the course of the last 16 months we have established a very close, and open, doctor/patient relationship and he has taken exceptionally good care of me. Upon the referral to the Pain Clinic he even dictated a rather detailed letter explaining that was extremely compliant, have never abused any medication, and have done everything he has asked me to do.
Sounds like you received excellent care via your GP. Is it a "must" that you switch to a PM Doc? Many GPs are more than willing to remain in charge of a patient's care. If you don't like the direction of your new PM Doc, I'd explore this possibility. Sure some PM Docs are on the cutting edge of things, but surprisingly, most aren't.

Quote:
It is an absolute travesty that good people suffering from legitimate CP issues are forced to endure the ridicule and derision that so often accompanies this process. I will refrain from ranting about the current Administrations immensely negative impact on the subject of CP patients and the doctors that care for them, but the system has become a difficult one to endure.....and I empathize with everyone that must not only deal with their condition, but also the negative stigma that comes along with opioid treatment programs.
Well said!

Quote:
It continues to astound me that the vast majority of doctors seem to have no hesitation to prescribe adjunctive medications that can have potentially devastating, psycholigical ramifications such as anti-convulsants, tricyclic antidepressants, and ssri's.....yet are so apprehensive with the administration of opioids. It is a true shame that such a small percentage of patients that abuse medications have made it so difficult on legitimate CP patients that have no history of abuse, or addiction.
Again, well said. I'm probably preaching to the choir, but it's because "narcotics" get the headlines in the papers and on the news....These other situations you list don't. But, you make some excellent points.

Quote:
A lot is often made regarding the anger, hostility, and depression that accompanies CP....but I have found that the greatest source of anger and depression comes from the constant fight that comes along with attempting to be viewed as a legitimate CP patient that is looking for quality care. I apologize for the rant.....but I know that there are many others that have gone through the same sort of situation.
I concur.....And, this is why I channel my energy towards positive things....Most notably this site in a way to help others. I've got a lot to learn, but I've also got a lot to give and I enjoy helping others, or at least pointing them in the right direction.

Glad to have you aboard.

Ex

Last edited by Executor; 07-14-2008 at 06:34 AM.

 
Old 07-14-2008, 06:45 AM   #10
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Re: Morphine vs. Methadone

Ex,

My GP didn't make the decision to include a PM doc because he no longer wanted to handle my treatment, he was merely interested in bringing in an "expert" that may be able to offer a treatment or perspective that he hasn't considered. Based on my initial consult with the PM doctor, I think that he is the type of doctor that understands the trials and tribulations that CP patients go through and fosters an atmosphere of openess and honesty. With that being said, I will not hesitate to go strictly with my GP if I do not like the direction the PM doc is heading. I am approaching this with the utmost hope and optimism and will continue to do so until given a reason to change my perspective. I can only hope that he is as fantastic as my GP has been.....I truly feel blessed to have found a doc like him!

ST

 
Old 07-14-2008, 09:40 AM   #11
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Re: Morphine vs. Methadone

SteelTown,

I have used OC, methadone and morphine. I am currently using MS Contin (morphine). It works fine, but not as well at methadone, which I consider to have been the best PM med I've ever used.

I believe you made a wise decision to go with the morphine for now, for exactly the right reason. It is, indeed, harder to go off of Methadone than most any other opioid. Good for you.

Regarding the abdominal pain - this really interests me. I have had severe abdominal pain for a number of years, but it is not the main reason I am in PM (knees). The few times I have discontinued opioid therapy my abdominal pain becomes unbearable. IT is centrally located, about a inch or two below the base of my sternum. It does not feel to be absolutely GI related, but rather a strong pain in my middle gut. When I wake in the AM it's kind of OK. As the day progresses it gets worse, until the evening I can only lay on my side with my knees up. The reason bring all this up is because I have been diagnosed with a Pituitary Adenoma, a tumor on my Pituitary gland. So far, I am taking testosterone replacement therapy, am taking excessive amounts of calcium and Vitamin D for poor bone density , and am about to start human growth hormone for that deficiency. Testing is ongoing. I am asking if you know of any relationship between your gut pain and the pituitary as it may pertain to a Pituitary Adenoma? I was recently tested for cortisol levels and do not yet know the outcome - my next appt is this Friday.

steve

 
Old 07-14-2008, 10:19 AM   #12
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Re: Morphine vs. Methadone

Hi SteelTown,

I've been on every single LA med available and finally, I'm on Methadone. It has been a GODSEND!!!! This is by far, the BEST pain med I've ever been on, and I've been on all of them. Methadone isn't for everybody. Some people cannot tolerate the side effects, like the occasional "nodding off" and the sweats.

For me, I've only experienced the occasional drowsiness, never the sweats. Plus, it's very potent and has a long half-life. So, your doc needs to be experienced with prescribing Methadone. Most PM docs are, but there are some GP's that prescribe it. That kinda scares me. If they don't know what they are doing, they could easily kill someone.

P.S. I will never have to go off the Methadone, so that doesn't concern me. My only kidney is dysfunctional. So, I'll be on Methadone until the end. I have heard, though, it is very difficult to come off of, but it is possible. You just have to do a slow taper and hopefully your doc knows how to detox people off of Methadone, if warranted.

Last edited by friendly_one; 07-15-2008 at 04:00 PM. Reason: add info

 
Old 07-14-2008, 11:57 AM   #13
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Re: Morphine vs. Methadone

I'm going to start another thread about adrenal insufficiency/pituitary issues and chronic pain.

Steve, come along with me!~Mush
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Old 07-14-2008, 01:09 PM   #14
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Re: Morphine vs. Methadone

Steve,

I will continue our discussion pertianing to Pituitary/Adrenal Insufficiency on the new thread....see you over there.

ST

 
Old 07-14-2008, 01:44 PM   #15
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Re: Morphine vs. Methadone

Friendly,

I am sorry to hear about the severity of your condition, but am quite glad that you have found something that works so well for you. One of the primary factors that led me to choose Morphine was the fear of overdosing during the titration period. I have had enough experiences with doctors over the course of the last 3 years to know that they make more than their fair share of mistakes.....and a mistake with the Methadone can be lethal. I also mentioned the "coming off" factor.....and those two areas of concern were enough to make me come to the conclusion that Morphine was the right direction in which to proceed.

I thank you for taking the time to respond....and I hope things go well for you!

ST

 
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