Discussions that mention morphine

Pain Management board

Hi Ms

Welcome to the boards :wave:

When you deal with chronic pain such as yours, there are options to help reduce that pain differently then acute pain. Acute pain can usually be treated with a short acting med for a short time and the person is better. However, chronic pain really needs to be treated differently.

When dealing with meds, probably one of the best ways to deal with chronic pain is by long acting meds with short acting for breakthrough. This helps to keep you pain down to a manageable level during the day, and be able to take a smaller amount of BT meds.

There are many options for long acting meds. You have MSContin, Avinza, Kadian (which are all Morphine). There is OxyContin which is time-released oxycodone. There is Duragesic patch which is Fentanyl (very potent med). Methadone is another treatment.

The nice thing about pure opiate meds, is that there is not a ceiling. Meaning, you can take whatever your body can tolerate to get out of pain. Of course under your Dr's supervision. But he can give you for example 40 mg of OxyContin three times daily. This is 120 mg a day. Then maybe you can reduce the amount of Dilaudid you take for BT. Some people find that they don't need BT meds at all or very little. This is due to the constant levels of medicine in your system.

Short acting meds like Dilaudid, Vicodin (Hydrocodone), have many ups and downs. They spike quickly and the fall off quickly. The longer you are on them, the quicker you build tolerance meaning you will need more of the med. It will also get shorter in duration. With a long acting med, it is released slowly over period of time and you are able to get longer relief.

If you have chronic pain you can't expect 100% relief. The goal is to reduce you pain 40-50% so you can at least be comfortable. By combining the long acting meds with a short acting when needed for BT pain, you can achieve this better.

Dilaudid is a strong pain killer, but not the strongest. And right now you're taking a short acting med, so by the time it starts to work, it is already metabolizing and getting out of your body leaving you in pain. By the time you are ready to take your next dose, your pain is out of control and you may end up in the ER. Long acting meds, help to keep the pain manageable throughout the day and when it starts to get a little too much, you have a BT med to take but at a smaller dose.

I would talk with your Dr about LA meds. You're right, some Dr's are reluctant to prescribe meds like OxyContin, but a lot of that is thanks to the media. LA meds are a great way to control chronic pain. Not eliminate it, but reduce it.

Good luck at your Dr's appt. Take Care
Hi Heather, As far as Dilaudid being better at preventing pain then treating pain, that's pretty much just the physlosophy that pain is easier to keep in check then it is to bring a high level down. There isn't one specific opiate that is better at relieving pain. As far as what works, tolerance will happen to anyone with any pain med and there simply isn't an extremely potent SA med other than Aqtiq, but I wouldn't recomend it. I know folks use it and I'm sure it's effective, but it leaves absolotely nothing stronger to try and I'm presuming you will be with us for a while. It's 10 bucks a dose and insurance doesn't like paying for it when your using it for anything other than malignant cancer.Folks using Aqtiq have the same problem switching to another short acting med, there just isn't anything that strong in a single dose.

As far as strength, The doc would be saving you at least 50% by prescribing twice as many 4mg dilaudid as he would 8mg tablets. They come in 2,4,and 8mg. Is it worth twice as much to take 2 tiny pills instead of 4 tiny pills. Dilaudid doesn't have a long half life so other than continued drip I wouldn't choose it. Oxycodone works better for me but you have nerve pain and I have back pain. Oxy does have a longer half life than hydromorphone and morphine. It comes in 15mg and 30 mg tablets but if your used to taking 24 mgs of dilauid at a time, your going tohave to take 5 30mg Roxicdone at a time and it's about 4 times the cost.

Everything is compared to morphine in strength. Dilaudid is lets say 5 times stronger than morphine. IF your taking 24mgs at a time that would be like taking 220mgs of morphine. Morphine instant release only comes in 15 and 30 mg tablets, Again you would have to take at least 8, 30mg morphine capsules to get the same relief. If you use Oxycodone, it comes in 15 and 30 mg tablets but is only 1.5 times stronger than morphine. So you would have to take 5 or 6, 30 mg oxycodone tablets to equal 24mgs of Dilaudid. Oxymorphone comes in 2 mg tablets and suppositories, you would need 10 of them to equal 24mgs of dilaudid.

As far as long acting Vs short acting, although your pain is chronic in the sense that you have MS. It's going to flair and get worse at times. Do you have pain all the time, or just during flairs, how long does a flair last? If your talking 2 to 3 flairs lasting 4-6 weeks each, using Long acting meds may not be apropriate. You don't need meds when you're not in pain. You can certainly achieve and maintain higher doses with LA meds, but you will be using multiple pills 3 times a day plus break through meds when the LA isn't cutting it.

LA meds aren't the answer to not wanting to take 6 pills at a time because when your tolerance gets this high, they don't make a suer strength LA med either. The likelyhood of dependence, not addiction is much greater with LA meds in your system around the clock. It really doesn't take long and you don't want to be taking LA meds for weeks or months if you don't need them, because when you do flair, they won't be effective..

So LA meds may not be the right choice, it means you have opiates in you 24/7 and the goal is to maintain a level to prevent the pain from getting out of control, if it does, then SA meds can be added but if your pain isn't constant, it doesn't make sense to use LA meds and then withdrawal at the end of every flair.

It's really up to you and how you want to pursue pain treatment. I'm sure you can find a PM doc to prescribe LA meds, but do you need them year round. Going through withdrawal 1 time is more times than anyone wants to do. If using short acting meds has prevented that when or if you DC meds after a flair, I wouldn't use LA meds. With short acting meds you have more control over the dose and can decrease you dose in smaller incremants to prevent withdrawal. Your need more or smething stronger to manage pain during flairs, but you are kinda maxed out in strength these meds come in.

Needing to take 4 pills is just a consequence of being very tolerant, To sustain roughly the same level , you would have to take 200mgs of LA morphine 3 times a day, 120-160 mgs of Oxycontin 3 times a day, 2-3 pills 3 times a day plus BT meds. Having to take several pills at a time is a pretty small price if the med works. Folks on higher doses of methadone need 15-20 10 mg tablets a day if their insurance won't pay for the name brand alka selzer size 40 mg diskekettes. When your higher dose, you have fewer options.

You really just need to tell your doc that 4 pills isn't helping any longer and go from there. Not knowing more about your pain patterns, I can't say LA is better for flairs that only last a month. SA would be much easier to taper off or increase quickly if you need to. Long acting is better for pain that isn't going to get better and you need to keep it in check. Once you're accomadated to that LA dose, a flair is just as hard to deal with, or may be even harder if you taking meds when you don't need high dose around the clock pain control.

Can you tell us more about how long a flair lasts and how often it happens? Do you have a constant level that sometimes spike, The treatment really needs to suite your pain and we don't know enough about your pain. If steroids help, I'm not sure your doing yourself a favor by not treating the inflamatory response and just the pain. Your tolerance isn't low and you have to think about where you will be in 5, 10 or 20 years. So anything in addition to pain meds that helps , you really need to condsider.

I understand the meds make you feel bad, but what's worse? The pain or feeling bad for a few days.

I kinda doubt a GP is lookng to break his all time opiate dispensing record, so your really putting him on the spot when asking him to prescibe something stronger than 16mgs of dilaudid at a time. His only option is more dilauid , or 3 or 4 of something else at a time. Your asking a GP to prescribe something 10 times stronger than the Vicodin he's used to prescribing? That's why he refered you to specialists.

Good luck, Dave