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    Old 05-13-2004, 04:32 PM   #1
    smackliet
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    Whats more effective

    Can any of you tell me which seems more effective Morphine or Dilatad (sp)
    My Dr. gave me morphine but it doesnt help alot. I was thinking of asking for a med change but i am afraid something else may work even less. I cant take any codines even synthetics.

    Thanks for any advice
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    Old 05-14-2004, 05:59 AM   #2
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    Re: Whats more effective

    Hey Sheila, Both meds are much more effective when given IV. Dilauadid has a very short half life and duration when given orally. It is considerably stronger than morphine mg to mg, But that's why dialuuadid comes in smaller MG strength. 2 mgs of Dilaudid is roughly the same as 15 mg of MSIR and 4 mgs is about the same as 30 mgs of MSIR.

    If I had a choice of IV pain meds post surgically I would certainly choose hydromorphone but when it comes to oral meds I have't seen a huge difference in oral morph vs oral hydromorph, However asking for Dilauadid specifically can certainly send up a red flag because of the ease in which oral dilauadid is turned into injectable material and the potential and history of abuse.

    It would be better to do your best at explaining the increase in pain, how it efects you and let the doc make the decision as to what med should be the next choice. When patients ask for specific meds it can certainly through up a red flag and make the doc wonder why you want that particular med if you have never used it orally. Dilauadid is really not as impressive when taken oraly, but works great PCA, Oral morphine, is also the least effective way to take morphine too, only half actually crosses the blood brain barrier.

    Are you talking about a BT med , what strength morphine have you tried? the 15 and 30 mgs pills aren't limited to one at a time as long as you have the tolerance to handle that large of a dose of morphine. If you don't, you need to work slowly up in strength to find greater relief. You also have some other choices but it depends on what your base med and dose are as to what would be the better BT med
    Goodluck, Dave

    Last edited by Shoreline; 05-14-2004 at 06:02 AM.

     
    Old 05-14-2004, 01:34 PM   #3
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    Re: Whats more effective

    Thanks thats good to know.
    I dont have to worry about my Dr. thinking me asking is worth a red flag. I HATE pain meds and she knows it. I rarely take it and i have been in pain for years. I am very sensative to pain drugs. I dont like the way they make me feel. My Doc knows this. I dont have any BT meds cuz the whole class of codines and codones all make me itch like crazy. I really dont know what to take. And the morphine only 15 mg knocks me on my Booty, but doesnt relieve all the pain just reduces the intense burning. If Dalated is that much stronger i probably couldnt handle taking it any ways.
    Any other suggestions? I can take Percacet with out itching and it seems to help with the pain pretty good. But I dont know if she would Rx it for me. She is kind of funny about what she will or will not Rx.
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    Old 05-14-2004, 04:53 PM   #4
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    Re: Whats more effective

    Percocet is OxyCodone.... so maybe you can take the "codones"

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    Old 05-14-2004, 05:29 PM   #5
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    Re: Whats more effective

    If percacet helps you some you can get it perscribed in oxycodone (that is percacet without the tylanol) and then you can take it in larger doses and maybe it will work better then on your pain. I have tried shots of morphine in the ER and morphine will not touch my HA pain but dilaudid kills it everytime. So I think Dilaudid is stronger. My nose itches with it but that is about it.

     
    Old 05-14-2004, 06:01 PM   #6
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    Re: Whats more effective

    There are several oxycodone products that don't conatin any tylenol, along weith the 3 strengths percocet now comes in. They make Roxicodone 15 and 30, Both are stronger than 15mgs of MSIR but oxy tends to be less sedating. But if you took morphine more freqwqqqqqqqquently you woul become used to the drowsiness. Most prescrib9ing info tells you about sedation but it's rarely a reason to discontinue morphine because it does get better after a week of continued use. It sound as if you have done well PRN which is great. I would much prefer not to be dependent and that's just a consequence of LA meds. Unfortunately some folks need continous relief and the price of physical dependence is worth it. Depenndence doesn't mean addiction, it just means you will experience abstinence syndrome if discontinued abruptly. The dirty name the press lke to use while talking about opiates is withdrawal. If it's a problem discontinueing Paxil, It's called abstinence syndrome. Interesting the slant put on people physically dependent on narcotics. Many drugs have severe reactions when discontiunued abruptly.

    Oh well , we could go way out there talking about the politics of pain. I hope you find something more effective, you doc can't predict your response to a specific med so the best way to guide him is to acurately describe the symptoms morphine cause and the pain you experience. Pain diary's are good for showing docs paterns in your pain or areas that need improvement. If you have a month you have plenty of time to complete a very acurate and complate diary that describes level and time of pain, the effect the medication has. What you were not able to do prior to meds and what the meds allow you to do.

    There needs to be more benefit than just feeling beter most of the time , unless palliative care is all you have, even then they like to see increased function and social paticipation ec..

    THat's why properly explaining the problem will lead your doc to the right choice. If drowsiness but not enough pain relief, short duration of action, these things lead your doc to hopefully the proper choice. Oxy has a longer half life and actually last longer than morphine and diluadid and it's more stimulating. Itching is a property any opiate can have. Most cause a hystamine release, It's just a matter of how you handle it and is he willing to trate the itching as a side effect with an inti-hystamine.

    Oxycodone products like OxyIR or Roxicodone, liquid versions for faster relief or the Percs may do great for BT pain or as PRN medication. The conversion from Oxy to morphine is 1:1.5 meanng 15mgs of Oxycodone s 50% stronger than morphine plus it'snot as sedating. He has lots of choices,

    Why don't you see what he comes up with. It does take time to find what meds work the best. Treating pain PRN will also mean more frequent visits are needed, closer charting due to lack of a maint. type plan. If he's willing to do the work and your willing to be seen more often and it works, then more power to his abilities.
    Good luck, Dave

     
    Old 05-15-2004, 03:30 PM   #7
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    Re: Whats more effective

    I use the generic liquid Roxicodone for BT pain. I just commented because she said she couldn't take any of the "codones" but then said she could take Percocet. I was just pointing out that Pecocet contains oxycodone. I know oxycodone causes itching, but for the life of me cant figure out how Percocet doesn't cause her to itch if in fact she has trouble taking "codones". I take the Roxicodone because it doesn't have the acetaminophen in it, thus enabling me to take higher doses of the oxycodone.

    Ok, I've rambled enough.

    One last thing, I did have the itching when I first started taking oxycodone, but it was a side effect that subsided after a while. I really don't recall how long it took. In all honesty, the itching wasn't bad enough to contraindicate the pain relief I received. So, I took an antihistamine until it subsided. Good Luck

    God Bless,
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    Old 05-16-2004, 04:45 PM   #8
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    Re: Whats more effective

    I did notice when I was on dilaudid for my bt med that my tolerance level got pretty high. I asked my doctor to take me off of it and put me on something different to lower my tolerance level again. I'm not sure if the tolerance issue affects everyone or if it was just me. Shore, can you answer that? I sure hope you can find something to help and not have to itch while on it.
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    Old 05-18-2004, 02:05 PM   #9
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    Re: Whats more effective

    It's isnt that the Oxy doesn't itch it just doesn't itch as much as Codine.
    I am incouraged that the sadating effects gets less with use. I guess I am a little phobic of being sadated but i am going to get brave and start using it more. I let myself suffer all the time. I make up excused why I shouldn't take the med. I really just need to convince myself the I don't have to endure the pain.
    All of your reply's are very helpful and more incouraging than you could know.
    Thank you
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    Old 05-18-2004, 10:33 PM   #10
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    Re: Whats more effective

    Not trying to step on any toes but a couple things should be addressed here.

    Firstly, identifying a medication to your nurse practitioner or physician should never raise any "red flags". Alot of times, people come in asking me for Methadone, because they know I write alot of it for pain. Some will ask for Oxycontin, again because they know I write it. Oftentimes patients will have a friend or relative who suffers from chronic pain and feeling that what's helping them might help them, they may ask for that medication. What's more worrisome is when a patient identifies a certain drug and a psychological condition for which it treats. What I mean by this is a patient who requests Soma (Carisprodol) or Lortab (Hydrocodone & APAP) because it helps their "nerves" or "its what helps me when I get stressed out". Just because you know a medication, doesn't mean anything. Nor should it.

    Now... as far as Morphine -vs- Dilaudid. When given at equal doses, Dilaudid is going to kick your rear. Inital studies of Dilaudid say it's 8-10x stronger than Morphine, but newer studies are saying it may be as much as 10-15x stronger. One good point raised was in the difference from IV medication verses PO (Oral). Anytime you give a pain medication through and IV, it's going to be stronger. Not only will it be stronger, it will will work much faster. That is why we have equianalgesic charts. These charts are designed so we can convert the power of IV medicine, to oral medicine. What I mean is this. If I give you 10mg of IV Morphine, I'm going to need to give 30mg of MSIR for that to work equally as well. For Dilaudid IV 1.5mg, you'll need 7.5mg to get an equal effect. When doses are calculated correctly, there should be little (if any) difference in the IV -vs- PO route, unless you just happen to be one of those people who don't tolerate the drug well orally.

    Now, you mention that you do well with the codiene type drugs. Oxycontin would be a great option for you. It contains not Tylenol (APAP) so you eliminate the hepatotoxicity. Another good option to consider is Methadone.

    If, in the end you decide to go with oral Morphine, please let me encourage you to have your practitioner write for BRAND NAME Kadian. MS Contin has a very weak delivery system, and many people TID or QID dosing with it, to get the same effect (usually less) then they get with 1-2x daily Kadian. The cost difference isn't all that much, but I promise you... the pain diffence is. I've seen it in too many patients.

    Best wishes!
    David Adams, ARNP

     
    Old 05-20-2004, 03:09 PM   #11
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    Re: Whats more effective

    A couple of days ago I had a flare of back pain so i decided to be brave and use the morphine. Will first of all it did nothing for the pain. I got hirrible stomache cramps and my back went into major spams. I was in so much pain I had to go in to the Dr. I was told I was intollerent to morphine. The Doc on call gave me Dilauded. It worked stopped the back spasms (which i am convinced were actually caused by the morphine) I seemed to tollerate it ok. Although nothing helped the stomacke cramps. It made my ears a little sound sensitive but I didnt itch.

    Dave,
    Thanks for you responce, it was very helpful. I am pretty lost on the subject of pain meds. I have avoided them for years and just endured. But I am getting to the point where i would just like to feel normal even if just for a little while. Although I guess you don't really feel normal on a narcotic pain reliever but somethings got to give, right?
    What is methadone?
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