Discussions that mention morphine

Pain Management board

Hey Jenn, Like MH said, if they started you at 25 or 50 UGH, you may simply not be getting a large enough dose. If you were takng 8 10 mg Norco a day, a 25 ugh patch would actually be weaker in comparision. With any new drug it's all trial and error. There is no way a doc can look at you and say 90 mgs of morphine or 80 mgs of oxy or a 25 ugh patch will manage your pain. The process of adjusting your dose and dosing schedule is all part of titration. If you only give each med one shot at working, you will burn through every long acting med on the market in a matter of months. Where it nortmally takes months to get the dose right on any single med.

For example, when I switched from meth to morphine, they started me at 200 mgs, it wasn't even close, I called the doc back the next week and explained the situation I was in and they increased to 300 mgs a day. Sstill no luck so the next week they increased to 400 mgs a day. That seems like a large dose, but still wasn't cutting the pain, so after a month of being miserable I said switch me back or increase the morphine, You reach a point where the number of mgs is just a number, you become just as dependnet on 400 mgs of morphine as you do on 600. Side effects were not a prblem so there was no reason t give up yet. It's just a guessing game and a matter of trial and error, they increased again to 600 mgs and I was getting the best relief I had in years. Had I given up at 200 or 300 or even 400 I wouldn't have had the decent year I did and would have had to switch back to a med that simply made me feel bad.

No doc can promise X amount of relief regardless of how experienced he is or what name brand hospital they practice at. If you haven't increased or adjusted your dose schedule, your really not giving it a fair shot. You may need to chang patches more often than 72 hours and you may need 4 times the dose you started on.

When they put my pump in they started at 2mgs of morphine a day, It took 6 months and 16 adjustments to get back to where I was with oral meds. There just iisn't a quick fix and everyone responds differently to different meds. It doesn't make sense to ask for another med that you haven't tried and you don't know if it works because your not getting relief from the starting dose of the first med.

Why not just explain your still not getting relief and let the doc do his normal adjusting. They don't start you high and back you down, they start you low, even when converting from one med to the next. They hope you respond better to the new med and they start low to be safe. They rely on patient reporting, physical exam and experience to make needed adjustements, but aside from Duragesic you only have morphine products, OxyContin and methadone.

It would be easy to say opiates don't work for your ain if you give up on the med if you don't get the relief you expect from the starting dose and before giving the doc a chance to adjust your dose and dosing schedule. Give it time, the doc expects to hear from you more often when they start you on a new med, it's normal and part of the process. With a drug like Fentanyl, you wouldn't normally be exposed to outside the OR, they always start low unless you have previously been on high doses of LA opiates and even then, they start on the low side.

Many of the LA pain meds full prescribing info suggest you do the math, make the conversion from one drug to another and then start at half of what you calculated. It simply means it takes some time to find the right dose. 0 pain isn't the goal of pain management. Even with pumps and SCS's they consider 50% relief a succesfull trial and reason to go ahead with the implant.

Med adjustments are just part of the process of finding relief and nobody can guess what dose of what med will provide the best relief or what med will. I'm sure he mentioned fentanyl is a potent med, but that's why they start you with 25 micrograms per hour. Mg to mg Fent is much stronger than any other med, but if you reduce the dose down to a few micrograms instead of mgs, you really aren't getting a significantly larger dose of meds than you were with hydro or any other med. A microgram is 1 milionth of a gram versus mgs which are 1/1000th of a gram.

Give it time, explain your condition and I wouldn't specifically ask for a new med that you really don't know if the starting dose of that med wold be any more effective then the starting dose of duragesic. You would still likely have to adjust the dose of any other med they switch you to, so why not give duragesic a fair chance to work. I know folks that use up to 7 100ugh patches at a time and change them every 48 hours. They certainly didn't start there and it probably took years of trial and error to get to the point of trying a med at that dose, but that's what worked.

The only thing limiting the dose of opiates they can use is the side effects. If your not having breathing difficulty and can still pee, there realy is no reason to change anything but the dose and the timing between changing patches. JMO

BTW, Using left over meds with a new med your PM doc is prescribing is a pretty sure way to get booted from a practice. If he didn't give you break through meds than you really need to comply with his instructions. Did you know if it was safe to take hydro with fentanyl before you took it. Who do you think your family would bring a law suite against if you self medicate and overdose?

Let the doc do it all or you won't have a doc for long. If you thought the pain was so bad with a patch on that you needed to take norco on top of it, Imagine loosing every docs trust and having nothing to take.

IN pain management a 30 day supply is a 30 day supply, there is no such thing as an early refill, If pain was a legitimate excuse for CP patients to self medicate we would all do it. Personally I wouldn't risk my future and ability to walk because I was having a bad day. I've had 13 bad years so I can get through a day or a month without taking more than prescribed.

PM docs are under more scrutiny than any other doc out there, the biggest red flag they see is when patients refill scripts early and a 30 day supply becomes a 25 day supply and the doc takes no action to stop it.

The DEA has to wonder who is in control of the amount of meds you take if the doc does refill early and takes no measures to prevent abuse and diversion. Most of us in PM have contracts that spell this out, we have to take random UA's to look for the meds that were prescribed and to look for meds we weren't. I have to take all my meds to the doc each month and they check the fill dates to be sure I didn't refill anything early and they count the remaining pills.

If it sounds overboard, it's really not, considering were asking the doc to belive we are in so much pain we can't function without these meds and ask the doc to risk his licence and prescribe the most potent meds that just 10 years ago were reserved for cancer patients only. If I got cought with hydro in my system, even with a pump implanted, my doc can simply turn my pump off and referr me to rehab for drug abuse.

I know the consequences and won't risk it over a left over pill from the dentist or an early refill thinking the doc hasn't heard the excuse that my meds fell in the sink a hundred times already.The DEA wants to see the steps your doc is taking to demand absolute compliance and prevent diversion. The doc has no obligation to continue to prescribe the most potent opiates to someone that self medicates. At best you may get a referral to a rehab or some BP meds to keep from blowing a gasket.
Take care and give each med a fair trial, or there won't be anything left to try.
Good luck, Dave