Discussions that mention morphine

Arachnoiditis board

Hello Everyone,

I know I have not posted all that much on this forums but I do read every post on a daily basis and I fell like I have gotten to "know" quite a few of the regulars on this board, even if I haven't shared all that much about myself. I did post a couple times when I was going through some very hard times with a medication switch where I had terrible side effects, etc and received some very good advice from several of you.

As a very quick update of my situation for those not familiar, in Feb 2005, I had a triple fusion of the cervical spine (C4-7). While structurally, the surgery seemed a success, I did not receive a bit of pain relief and, in fact, over the 3 years since the surgery, the pain has now spread to include the entire length of my spine. Recent MRI's show severe degenerative disease and my neurosurgeon mentioned that my MRI looked like that of an 85 yr old man (I am 45).

My current PM regimen has me on LA morphine sulfate 30 mg 3x daily with IR morphine sulfate 15mg up to 2 x daily allowed for breakthrough...this regimen provides minimal relief. I also take 40 mg of Lexapro daily for the depression that has overwhelmed me in recent months.

I received some information from my doctor today that has sent me reeling and I do not know what to do. He told me that he would like to raise me to either methadone or the fentanyl patch. He said that, even if I did go up to either of these narcotics of last choice....that I would gain a year at most of mobility before I will have to quit working!!! This completely through me off the deep end. At 45, I am doing fairly well as a store manager of a department store, making a pretty decent salary. And now out of nowhere, the doctor is telling me that my entire career is doomed and that I have a year at best before I will no longer be able to stand for any length of time as is required for such a position.

I knew I could feel my condition gradually worsening. Things that I could do just 6 months ago are now at times very difficult. For example...getting out of bed. Some mornings, I absolutely cannot get up out of the ged due to the pain. I have to have my partner lift me up. Once standing, I am able to "work out" the kinks and hobble around the house. That is just one example. And now I have had it in no uncertain terms dumped in my lap on a platter that I will for all intents and purposes be disabled and unable to work within a year.
This completely terrifies me....in a financial manner and what sort of quality of life am I facing at such a relatively young age?

I am at a complete loss and would really like to hear from some others who may have a bit more experience dealing with disabilty issues.

Thanks in advance,
Hey Lou, Regardless of the relationship you have with this doc, All he is doing is giving you his opoinion. You can prove hime right or you can prove hime wrong.

I don't understand why you would need to change meds simply beause your not getting adaquate relief. You called meth and fent stronger drugs, but that's only on a mg to mg comparison. What's preventing you from increasing your dose of LA morphine? They make a 200 mg version of MScontin that works quite well for failed fusions. The only reason to change from such a small dose of morphine would be some kind of extreme or intolerable side effect you can't manage. If the only reason your changing is because the doc believes more morphine won't work without even trying, It makes HIS prognosis more of a guess with no basis.

How does he know you will respond better, worse or have less side effects with another med or that you can't increase your present med without intolerable side efects without having tried? How does he know you will only get a years worth of relief and that's it?

I've had 3 failed back surgeries over the last 15 years, The last a 6 level revision that left me bed wriden and That fusiion failed and this set of hardware is slowly breaking and bending piece by piece. Total failure of hardware and fusion and I'm some how improving. It's not because my doc or I believe I'll be in a wheel chair a year from now with no hope of managing the pain. The more I excercise, the more I'm able to do and the better my prognosis looks. A rod may snap and pop through the skin, But it wouldn't be much of a life spent flat on my back waiting for it to happen.

Since starting LA meds 8 years ago I've gone from being bed wridden 95% of the day to being stable on the same dose of opiates for several years. Then an implanted pump which allowed me to excercise and rebuild the toll being bed wridden and sedentary had taken on my body. After 9 months of 2 a days at the age of 42 I'm back to work part time. I say part time beause I can't do 9 hour days 2 days in a row but I can do it every other day. I have to conform to the disabllity regulations in order to work and find a balance between work level, feeling good about working and managing the pain. If your doc saw the doses I take he wouldn't give me a month to live. :confused:

I just spent a week in Cancun and had the greatest time of my life. Yes my life has changed , I am on SSD, I did loose my home, or had to sell it because it took 2 years to win my SSD case, But I'm glad I didn't check out when times were bad and I wasn't able to imagine the life I have now. How we deal with those changes is up to us, not a doc or some prognosis pulled out of thin air or some darker place. I don't mean to minimalize your condition, but given the info you have stated, how in the heck can he make that kind of prediction. Was their a top hat, crystal ball or magic wand involved? It honestly sounds like he isn't comfortable prescribing more than a 100 mgs of morphine a day?

I may not be able to work full time on my feet the way I used to, but I don't believe the rest of my life is just going to be one big downward spiral as more and more hardware breaks and my spine continues to shift. Personally I believe I can strengthen my core which will prevent this and So far I've been able too exceeed every prognosis and learn to accept what can't be changed.

I do believe that if someone believes something to be true, they can certainly make it happen. Either by excepting it as truth or by taking ownership of such a pesamistic outlook. The only way I see this comeing true is if your doc tries one dose of fentanyl and it doesn't work so he switches to methadone and adjusts it once and then refuses to adjust any further even if your not experiencing negative side effects.

Some docs have limits on what their comfotable prescribing, just like some docs wouldn't prescribe you or me a single vicodin. Is it your decision to give up on morphine because the side effects are overwelming and the drug is hindering more than helping, or is your doc simply not comfortable prescribing a stronger dose. You could suport that weak crap with the idea of opiate rotation, but 30 mgs aint squat if your toelrating it well and the only problem is pain relief. The weakest version of LA morphine is 15 mg, your only on the next step up and a very long way from a 200 mg dose which isn't the max dose either.

I didn't even begin to get relief from 200 mgs of LA morphine a day, 300 mgs was no better, but at 400 I finally started noticing some relief. At 600mgs a day, 200 mgs TID I get about 50% relief which is about the best I can hope for given the instability of my spine. No doc can say you will be a cripple in 12 months or you will be cured in 12 months. Medecine is trial and error, When you reach this docs comfort limit as far as what he is willing to try, it doesn't mean there isn't any more hope or someone else with a better understanding of opiates wouldn't be willing to increase rather than change at such a low dose. The only max dose is the one a patient can't tolerate or that hinders you more than it helps.

When or if this happens get a different opinion when you resach this one docs comfort level. Honestly I think i would be more prone to believe that prognosis from a fortune teller than I would some doc that obviously hasn't seen the benefit from what he may consider high dose opiate use. At 300 mgs I really didn't care if it took 600 or 1600 mgs, It simply becomes a number during the titration phase. The only thing that mattered was relief and side efects. Nobody knows how much it will take to manage your pain 5 years from now or even a year from now. Nobody but you knows how much you can tolerate as far as pain and side efects to make that kind of prediction.

Untill you reach a ceiling yourself and can say If I increase the dose i will have to wear a catheter or will have to surrender my driver licence because I can't stay awake. Untill you know from triall and error an increase would cause more problems than solve, there is no reason to believe this guys is doing anything more than pulling a number out of the air because he's already uncomfortable with your dose, as little as it is.

The prognsosis I see is this doc saying increasing won't help once you reach his comfort level. Then you simply get another opinion and when you tell another doc you never tried anything greater than 30 mgs of morphine TID they might just be willing to give it another try at a different dose. Do you care if it's 30 or 300 as long as you don't feel impaired and the side efects aren't an issue?

If the only reason your changing meds is because your not getting the relief you used too, The correct definition for this occurance is tolerance, not apocolypse. I understand the stress and worry and depression, but I don't understand doctor doom and glooms' prognosis. Is telling you his opinion going to help you in any way, or is he just giving you signals that he isn't comfortable with high dose patients?

There is always another opinion out there. I don't believe every PM doc is going to see 30 mgs of morphine TID as a point where meds must be changed, rotated or given up on.

Don't give one docs opinion that much power over your future. There are other docs with different opinions that could be far more agressive.
Good luck, Dave
Thank you to all those who responded and gave their advise. Shore....I might have mislead partially in my original post. My PM doctor just started me on the morphine...starting at 30 mg 3 x a day. I see him again next tuesday for assessment on how the meds are doing and will most likely be titrated upwards, in an effort to gain more pain relief.

The doctor I saw yesterday who gave me this sort of "doom and gloom" scenario of a future is the pain psychiatrist that I also see weekly to help me cope with the emotional aspects of dealingwith severe chronic pain. He and my regular PM doctor converse back and forth regularly regarding plans for my future care and med needs. It is the pain psychiatrist who told me that it looks as though I will have to be on either fentanyl or methadone before very long to get any sort of relief (since I have already tried Oxycontin and Opana with terrible results). And, based on the MRI imaging and the fairly rapid reduction in mobility and ability I have in completing physical tasks that were simple as recently as a month ago were the basis for making that statement about likely needing to quit my job where I am on my feet at least 10 hours a day, sometimes having to lift heavy store fixturing during store resets etc.
Unfortunately, I only have STD at my job which covers you for 90 days. At open enrollment anually, I have the option to opt in on a LTD program. I just NEVER imagined I wouold ever face something that would have me out of work longer than 3 months!!! Open enrollment comes around again in November. I do not believe there is any sort of preexisting limitation to enrolling in the program (fingers crossed). It pays 60% of your normal salary indefinitely.

I have been an emotional mess the past 24 hours, worrying myself sick. My greatest fear is the financial impact. I make the majority of our household income. If I lose my job, we would stand to lose everything, including our home. I don't even know how to begin facing that monster.