Discussions that mention morphine

Pain Management board

Hi Cindy.......

I'm sorry you are having to deal with all of this pain. Hopefully, you will get some help soon. The question I have for you is.....you stated that you take 1500mg of Vicodin 6x/day. Are you sure that is correct? 1500mg of Vicodin (hydrocodone w/tylenol) is equivalent to taking "300" regular strength (5mg) Vicodin tabs at once & repeating it every 4 hrs. The amount just caught my eye and scared me. The usual dosage of hydrocodone (what most people would be prescribed) can be anywhere from 5mg up to 20mg every 4-6 hrs (20mg is dosed using 2 Norco 10mg tabs usually.) The part that scared me is trying to figure out just how much acetaminophen/tylenol is in that large of a dose if the 1500mg is correct. The tylenol would most assuredly turn your liver into mush real soon from my understanding.

And the 'Demerol' patch that you have used....are you sure it isn't 'Fentanyl' instead of 'Demerol'? It has been my understanding that only 'Fentanyl' is made into a narcotic transdermal patch going by the trade name of "Duragesic". But, what do I know.

I am currently on the Duragesic (fentanyl) patch and have been all the way up to 150mcg every 48 hrs. Fentanyl is an extremely potent narcotic which is measured in micrograms (mcg) instead of milligrams (mg) which most other narcotics are measured out at because of the high potency. It has been a life saver to me in terms of helping control my pain which is located in my lumbar region. If your patch is in fact Fentanyl/Duragesic, then my suggestion would be to use a 25mcg, if you have any, along with your Vicodin for breakthru....that is if the 1500mg dosage is incorrect and just a typo. Most patch users are given breakthru meds such as Vicodin, Percocet, Morphine, etc to use in conjunction with the patch to help control the pain that the patch just can't at certain times. I would definitely check with either your pharmacist or the doctor on call this wknd before taking my suggestions or anyone elses who isn't a licensed practitioner. The tightness in your chest and trouble breathing is listed as a side effect that should be reported to your dr. But sometimes.....if the side effects aren't life threatening in any way....you need to let your body become acclimated to the new medicine. These side effects should go away in time....as I said, if not life threatening. If you can get thru the first few days of the patch and the effects go away, then you might be surprised at how effective the patch can be for you.....that is, if it's the fentanyl that I was referring to earlier instead of demerol that you had listed.

I hope you get some relief over the wknd because I most definitely feel for you right now. I know how frustrating the ER can be on pain patients. What is the ol' saying......"been there, done that".

Take care and everyone here has ranted at least once during their membership....myself included. I believe everyone should be entitled to rant on a weekly basis if it helps get things off their chest. I know my rants...usually done at home & directed at my family members...help me cope at times.

Dear cindyx4,

I don't understand why you are not going to continue to receive the patches. I use a 75 mcg patch that I wear for 2 days at a time. The 3rd day was always miserable.

Try to adjust to the patches, if you can. Fentanyl is a potent medicine, and the patch form provides sustained release of the medication. You might hear various opinions on which brand works and which does not. My opinion is that the Brand Name Duragesic works very well, and the generic that is made by the same people (Sandoz) also works very well. When I tried the Mylan brand, I went through a month of hellacious withdrawal symptoms. That's my opinion.

Since fentanyl is stronger than morphine, you might consider working with your doctor on toughing it out until you get settled with it.

By the way, ER's are always really helpful, aren't they??!! (SARCASM) I consider an interruption of chronic pain relief an emergency.

Keep us up-to-date on your progress.

Jon (Conductor)
Hi Kitt, I think everyone covered the basics, two weeks of duragesic may break the cycle of pain buyut if you having difficculty breathing ithe 50 patch is causing too much respirtory supression.

Obviously a big part of the problem s you have a GP prescribingmeds once reserved for cancer only, He's probably not even aware of just how potent Fentanylis. They do make a 12.5 ugh patch that you could wear with a 25, reducing your dose down to 37.5, if that still doesn't cut the pain the time spent on the dose would allow you to accomadte to the side effects before stepping up to a stronger dose, but since the 12.5 has only been around 9 months, I doubt a rep for a cancer med is calling on GP's to inform them of the latest changes and how to use and titrate the med properly. It's kinda like when GP's overstep their non specialty and start playing shrink and altering brain chemistry but can't offer counseling as well. Anti depressants used on their own are no more effective at treating depression than counseling on it's own. When you combine the two you get better reults. The same goes for PM, prescribing more than the max allowed dose of tylenol in the vicodin 7.5/750 is flat out dangerous and so is ignoring reported repirtory supression.

You really are better off finding an Infectious disease doc, specifically one that specializes in Lyme disease. From what I have read it's very difficult to treat, you have to catch it and treat it agressively with long term antBiotics and it's not uncommon for standard testing to produce false negatives for the titer. The negative testing leaves a GP dumbfounded and not knowing what to do next. An infectious disease doc that knows a bit about pain management would idealy be the specialty to seak out, but we don't always live in an ideal life.

You do have some options but the important thing is to be aware of your GP's limitations, whether he/she wants to admit it or not, find an Infectious disease specialist to manage your problem. The longer Lyme goes untreated the more it spreads into uneffected areas and the more devestating the disease becomes.

It's your life and you're the one that will have to live with the results of not treating lyme properly and destroying your liver with toxic amounts of tylenol that are in some pain meds. They do make norco which is higher dose hydro/lower dose apap combination. It's safer and more suited to treating higher levels of pain. 2 weeks on Fentanyl patches is just long enough to make you go through withdrawal after round the clock fentanyl use. It's no different than coming home from the hospital after 2 weeks of IV morphine or dilaudid and then expecting Vicodin to prevenet withdrawal.

Don't be afraid to stand up to a doc and demand a referral to the specialist you need to be seeing. It doesn't matter that he can prescribe anything the specialist can, the problem is prescribing the right dose, the right amount and the right duration. Also, doing more specific testing at forensic labs if you repeatedly test negative for a diisease you have every symptom of.

It's your body, you have to live with the results of your GP playing guinea pig with your future just to see the outcome.The pain is just a symptom and even a PM doc is out of his specialty when it comes to prescribing an 18 month course of IV antibiotics you can do yourself at home after a pick line or port is placed. If the ID doc can't manage the pain then I would look into PM, but PM docs aren't looking to cure, their goal is to improve function and manage pain when other methods have failed.

As long as the disease goes untreated, masking the pain will just have consequences down the line as lyme spreads through every joint and every other system of your body. It's no joke if you live in Lyme or RM spotted fever territory. If you picked up the disease on vacation and then return to an area that doesn't deal with these on a regular basis, you're not likely going to get the best or proper care. Pain meds may make you more comfy, but what about the disease?

Good luck, Dave
Quote from cindyx4:

Thanks for the reply. My bottle says: Vicodin ES 7.5-750 TAB Quantity 120. I last refilled it on 8/28 and when I went to the pharmacy on Friday wit a new script I was told it was too early to refill. I can't have a refill until 9/25. I barely had enough to get me through the weekend.

Hey Kiddo........

Just a suggestion...before you refill your latest script for the 7.5/750 Vicodin ES, (remember the "750" is the Tylenol, not the Hydrocodone) it may not be a bad idea to talk to your dr today ( i think you said you had an appt this afternoon?) about reducing the amount of Tylenol as Dave & I have both suggested with the use of Norco (same med as Vicodin, just more hydro w/less tylenol). The dr will be doing you a great disservice if he is not in agreement with this. Your liver will love you forever for the change:D !!! In fact, there are other 'break-thru' pain meds available to use in conjunction with the Patch that are pure forms of narcotic w/o any fillers such OxyIR (oxycodone instant-release), MSIR (morphine instant-release), etc. But I personally would only use those if my patch dosage was higher than 25mcg. Just recently, I was up to 150mcg every 48 hrs, but after my lumbar surgery, I was able to reduce it down to 50mcg every 72 hrs w/in 4 wks on my own. ***just can't seem to convince my pain level to go along with lowering the dosage even more, but I take a 66% decrease over an increase anyday.***. And using Dave's suggestion of adding a 12.5mcg patch to the 25mcg is a great idea if you can get the idea across to your dr. You would probably have better pain control than just the 25mcg, but less problems than with a 50mcg. (GREAT IDEA DAVE!!!)

While you have been upset (and rightly so when in pain) about your dr telling the ER to 'just make you comfortable, and then send you home', that wasn't a bad idea. The ER is not the place really to look for a definitive diagnosis. To get something to try to break the pain cycle is first and foremost the best thing to do at that particular moment. Let a specialist do the diagnosing like Dave suggested. I haven't heard many pain patients that have had their personal physician actually contact the ER to leave orders to make their patients comfortable. If it helped in the interim, then they did their job, IMO....which doesn't really count for anything or good for anyone besides myself;). Unfortunately, this is only a short term fix for a long term problem. My thoughts are going out to you to be able to find the perfect diagnostician who will give you the answers you seek to help you soon.

Take care......Kitt