Discussions that mention morphine

Pain Management board

hello everyone!! i'm a first timer and need some valuable info on convering my chronic pain meds. i've been a chronic pain patient for over 15 years. i've recently been using 60 mgs of methadone daily but have benn falling short between doses. i recived my refill this morning and i mentioned it to my pain doc, she responded with a possibility of switching over to a long acting morphine product, either ms contin or kadian(?). i've never used either but have run the gammot with everything else out there. my fear is resolved from a previous conversion from discontinuing the fent-patch 75mg. with 40 mgs of methadone to solely 60 mgs of methadone. let me tell you she practically left me in withdrawls for a month.. noway was that an equal trade-off. now i'm afraid of her next calculation. what would the conversion of 60 mgs of methadone to ms contin or kadian (her two choices) be?? i wanted to suggest adding another 20 mgs of methadone instead of switching at all but she was concerned about tollerance. i dissagree, she insists that 80 mgs of methadone is too high for some reason but is willing to foll with these others?? some advice please???
i took 20mgs of ms cotin every like 6-8 hours i think.... ya that sounds right. and the first week or two it would knock me off my feet. i'd pass out in like 10 minutes, if i forced myself to stay awake i'd be laughing at everything, acting all dingy and ditzy, would be stumbling.... don't get me wrong i loved it and i did not hurt what so ever! then after i learned to manage my pain better i moved down to dilaudid 5 mgs every 4 hours, still morphine based, and that worked well. i increased that over 2 months or so to 15 mgs. then i saw a new pm who didn't want me on that kind of pain killer cause i'm only 21, so he put me on methadone, which you have to increase slowly, i started on 5 mgs twice a day, then 3 times a day, then 10 mgs 3 times a day. well that wasn't working, and i gave the 10 mgs about 2 weeks, so then i got bumped to 20 mgs 3 times a day. still nothing. so i felt great on 20 mgs of ms cotin like 2-3 times a day and horrible on 20 mgs of methadone 3 times a day. methadone doesn't "peak" like morphine based meds do, they reach a level and then are steady. morphine will peak. a lot higher then methadone, and then will come down. now i'm on the patch system... 50 units of the fentanyl patches as i am awaiting for a spinal cord stim to be implanted in me, so hopefully i can get off all these meds. but when i got off the ms cotin i did go threw withdrawls for about a week, and my doc had to give me a different med to help with that. but i really do prefer the ms cotin then methadone, like a ton more. good luck!
Hey Blue, I just checked the FDA orange book to see if there was a new 20mg MSContin or genric and the only lA morphnine product available in 20mg is Kadian, which is a 24 hour version of MScontin, small capsules with pellets.
Are you looking at a Kadian bottle or MSC?

As far as converting opiates, 20mgs of oxyC to 60 mgs of MS04 would be a healthy increase, The problem with charts is I just checked 3 different equianelgesic charts and they were all different, one was a 1:1 ratio, one was 1:1.5 and the last was 1:2. Most docs I have seen convert use either 1:1 or 1:1.5 meaning oxy is 50% stronger however Morphine is inherently more sedating than oxy because oxy is a pro drug and somehwat stimulating.. 20 mgs of oxyC would be replaced by 30 mgs of MSC..etc

Methadone is much harder to convert though. It produces the widest range of response of any med. 60 mgs is not alot of meth but if the doc isn't comfortable be clear with the doc about how long you have to wait for adjustments if your having problems.

Because diffrent opiates bind to different receptors and sub receptors, changing from Fenatnyl to any drug can be a problem. Fentanyl binds to specific receptors that no other opiate do, this can induce differential withdrawal, withdrawal from changing opiates and the different qualties they have. Particularly changing from one class of opiate to another.

The same goes for switching away from methadone, No other opiate blocks the NMDA receptor and binds to a couple of other receptors, particularly the delta which have liitle euphoric qualities.

My own experience although I was taking 150 mgs of meth was when switching to morphine a 5:1 ratio produced equal if not suppeior relief. This means a dosage in the 300 mg range which sounds kind of high for your doc if he/she thinks going beyond 60 mgs of meth is high. 3:1 is proabbly enough to stop most withdrawal which would be closer to 180 mgs of morphine daily, but no chart is perfect nor works for every patient.

If you have nerve pain, meth is the opiate of chocice, switching to morphine you lose all NMDA and GABA actiuvity which controls your tolerance to pain, decreases tolrance to opiates and does several other technical things that help with Neurgenic or neuropathic pain. Adding Nemanda, Dextromathorphan , an isonomer of levorphanol, or adding baclofin or clonodine can greatly increase the effects of opiates.While clonidine can also ease withdrawal symptoms.

Good luck and if your feling bad call your doc, there is no reason for any transition to be worse than it has too.
Take care. Dave
Hey Fine art, Obviously you see the wide variations in response to different meds, Blue went from 60 mgs of meth to 60 mgs of mscontin and got better relief, would have been chivering like a wet chawawa. She didn't mention how long and if it was long enough to become acomadated to meth. For me I made the switch from 120mgs of meth for a year to 600mgs of Kadian for a year and back to 120 mgs of meth for 2 more years. I increased the last 6 months of meth to 150 mgs a day and that's what they are trying to convert to intratchecal morphine which I'm on about adjustment # 14.

The thing is you can't print out a equianelgesic chart that ays X amount of morphine = X amount of meth and force your doc to follow the guide you found. He may use one of the other many guides that have completely different conversion rates.

The most reccent artricles do suggest that the conversions I have found and used for other meds grossly underestimate the potency of meth. They also explain that those charts are for single dose conversions. I can see where on a single dose the conversion rate would be be smaller because you have no build-up from the previous 5 days doses. With a 24 hour half life, that means every 24 yuor serum level drops by 1/2.

Monday you take 60mgs
Tuesday your still have 30mgs from monday in your sytem plus the 60 on tuesday.=90mgs
Weds, you have 15mg left from monday 30 mgs from tuesday,plus the 60 mgs on weds=105 mgs
Thursaday you have 7.5mgs from monday, 15mgs from tuesdays dose, 30 mgs from wed, dose and 60 from thursday=112.5mgs.
On friday uou take 60 mgs, have 30 left from thursday, 15 left from wed, 7.5 from tuesday and 3.25 mgs from monday, and you have the same serum level as if you were to take 115.75mgs in a single dose.
This is why meth is underestmiated. You can't really compare a drug that has a 3-4 hour half life to a drug that satys with you 5 days.

By the end of the 5th day you have the serum level of twice what a single daily dose would create.

The longer you take it, the more buid up you have and the more acomadated to meth you become.If you only tok meth for a a month, converting would smoother than if you had taken it a year and become completely acommadated to all the aspects of meth.

Docs tend to start on the low side and I would hate for you to come home upset because I think he should start at at least 3:1

5:1 ration works for me from mrphine to meth and back, meaning meth is 5 times stronger too me. 3 doses a day would leave huge gaps in my relief too.
Have you tried taking 15X4 more frequent doseing will give yo smoother coverage and by the end of the day you do have the entire days dose in you and may find sleepning through the night easier.

I hated changing meds too. I never got relief from OxyContin , meth worked well but I sweat so much and it effected labido tremendously, duragesic didn't touch my pain even up 150ugh per day and I gae it a good 3 weeeks to see how it worked. But was use to the relief from meth and just had them switch me back.

If the doc prescribes 60 mgs a 3 times a day and you devide it into 4 doses, who cares? Why even mention it, your daily mg count is the same.

Knowing in advance what ratio worked for one person or another gives you an idea but when yous ee 1:1 and 1:5 depending on the person in this one thread.

The important thing is to be clear with your doc about how long you should give each dose, Just say your concerned about withdrawal and you don't want to half to wait a month sick to see him again.Ask o se him in 10 days to 2 weeks, That's plenty of time to know if morphine is working at that dose, and enough time for most of the meth to leave your system. Meth is stored in fat so it can take a little longer if you have a higher body fat ratio.

PM docs should know they can't look at someone and guess what dose of any med wil work . It's trial and error and docs will be safe rather than sorry, After 14 trys this pump[ adjustment gets oldd, BUt I would rather keep at it tuntill it's right thanb settle now and then ask for an increase in 4-6 months. You can always go up, but if it's too high from the get go, he would be extremly liable. Tell him your concerns and hopefully he will let you know it's OK to call anfor an adjustment.
Good luck. Dave