Discussions that mention morphine

Pain Management board

Hey Jim, You do still have options with LA meds which is where most PM docs are going to be more comfortable with a patient with higher dose needs. Duragesic transdermal delivery of fentanyl bypasses the need to keep a pill in your guts for 8-24 hours.

Methadone is long acting by virture of it's half life, not by virtuue of staying in your bowels for an extended period of time to absorb it completely. Meth delivers it's dose in the same amount of time the roxi does but because it has a 20-30 hour half life your serum level continuse to rise for 5 days before leveling out while taking the same dose every 6-8 hours. You also don't see the rapid tolerance develop with meth that you do with oxycodone.

AS far as the pump, over sedation just means the dose is too high, the biggest advantage of a pump is a clear head you get when using 1/50th to 1/100th the oral dose reqiuired. It mewds stay in your spianl canal where you have exponentially more opiate receptors. Unfortunately Oxy isn't available in a preservative free formualtion suitable for IT pumps.

They can use dilaudid which is very similar, in the same class and isn't as initially sedating as morphine or meth. Part of pump trials is also finding the righ med. The dose can be adjusted as long as you can obtain 50% relief from whatever test method they use. Longer trials just allow adjustments to be made, but when you start out over sedated, a couple days isn't enough time to grow acustomed to a drug more sedating . 50% relief is considered a sucesful trial and working dose. That's what they shoot for with a pump. I don't know what your shooting for with Roxi, but with Roxi the only thing they can do is slowly increase the number of pills you have to take every 4 hours for the rest of your life. I would think the clock watching and living in 4 hour increments would get old after a while, even if you could find a doc willing to keep pace with growing tolerance and write scripts for hundreds of high dose short acting pills a week. This method of pain cotrol is so unconventional it draws a tremendous amount of attn to your docs prescribing practices.

Normally you become accomadated to the sedating effects of morphine, but if they start you too high on a pump dose, you won't have the time to become accomadated to a dose too high or simply a drug more sedating than than Oxy during a pump trial.

Oxy is a pro drug and stimulating, where morphine and methadone can be very sedating at the initiation of therapy, but that usually deminishes wihin days or weeks. The easiest thing to do is continue to titrate the oramorph. Name brand oramorph has a differnt delivery system than MSContin and the generics available are modeled after MSContins delivery. MSC uses a dual phasic release which means half the dose is delivered at 1 hour and the other half at about 6 hours.

Absorption and keeping a med in your guts long enough to make that second release would be the obvious problems with Crohns', The advantage of Oramorph is it's slow and continous release rather than a double bump release. If it's not overly sedating and your just not gettng relief there is no reason not to continue to titrate the dose upwards. To replace the roxi and give you a slight increase, you would need roughly 100 mgs of Oramorph every 8 hours, you have plenty of room to adjust the oramorph. You woudn't have the ups and downs short acting meds creae that allow pain to grow unmanagebel between doses and would have complete coverage through the entire day and night.

It's going to be a constant battle to find a doc willing to treat you with around the clock high dose short acting meds. It goes against all the arguments and benefits of using LA meds. Changing a docs POV on this would be just as hard as changing the POV of an opiate phobic doc.

AS far as pump trials, they can also do a single blous injection right at the office and just have you hang around for 4-5 hours to see how you respond. My first in patient trial was flop. I had a spinal fluid leak the entire time and spent more time throwing up than anything else. It took a good 6 months to work up the courage to try again, but the single injection was effective and the pump has been a godsend as far as clearing my head of the opiate fog.

Good Luck, Dave