Discussions that mention morphine

Pain Management board


We need to get straight on this matter of receptors.

There are three main opioid receptors, mu, kappa and delta. All full agonists (morphine, hydro, oxy, fentanyl) these are all full agonists at the mu opioid receptor. A few of them also partially occupy one or the other of the other two. But the mu receptor is the main player, and, along with pain relief, it is also responsible for tolerance and dependence. This is opioid receptor 101.

Many don't realize how potent hydrocodone is. One to one it is equal to morphine. All the main tables will tell you this. Izzy is taking 4-6 15mg LA hydro caps daily. That's a lot of hydro. Plus, she takes up to 4 10mg hydro BT caps as well. That's about 130mg of hydro daily if she uses the full allotment of BTs daily. The 12mcg/hr patch is nothing next to the hydro. I believe that 130mg of hydro daily equals more than a 100mcg patch. In addition, as Ex pointed out, Izzy is probably getting the purest hydro on the planet by getting it compounded. So it's easy to see why loss of hydro is more troublesome than losing the 12mcg patch, or even a larger patch.

Even though the mu receptor is the main player, these various opioids 'activate' different descending pathways for pain relief. Hydro is conspiuous in its activation of an 'excitatory' pathway. This causes many to get all jacked-up on hydro. Oxy and Demerol also activate this excitatory pathway. This makes getting off of these opioids that much harder, and causes withdrawal from them to be that much more difficult.

Hope this helps.

Steve
According to Janssen, the maker of Duragesic, each 12.5 patch is equivalent to 45mg of morphine. They do not have a conversion table for Hydrocodone, unfortunately.

Ex
cmpgirl,

It depends on what you mean by 'better off.'

Ex hit the jackpot regarding the mixing of opioids. It's called 'polypharmacy,' and the very latest research is bearing this out. There's even one drug in phase 3 human testing that has oxycodone and morphine combined. The hypothesis is that by taking smaller amounts of each and combining them the synergy is better than by using either one alone in larger amounts.

In your case it really depends on the level of pain you are experiencing and how much more med it's going to take to get you to the level of relief desired.

The increase in LA med is pretty substantial. So is the proposed increase in BT meds. If you want to be a bit more conservative, why not try the hydro at 10mg first (along with the inc. in LA) and see how you do? Have an agreement with the doc that if the 10mg hydro doesn't cut it, then you'll step up to the Percs.

We'll call this Polypharmacy 101 and I'll go now and try to fit my ever-growing head through the door. :)

Back to try sleeping again - knees are really yellin' at me and it's only 3:50am!!!

steve