New Medication P.S.

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New Medication P.S.

Post  KimbaK on Sat 20 Apr 2013, 10:43 pm

I forgot to ask in my last post: do any of you have anything you can share regarding your experiences with morphine? I'm interested in thoughts, feelings, warnings, scary stories, happily ever present?

Please send me your thoughts.

Thanks,
Kimba

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Re: New Medication P.S.

Post  30yrsofheadache on Sun 21 Apr 2013, 5:37 am

I have tried it. It was fair for pain control, but I have a huge constipation issue (and very bad dreams) with it. I really prefer dilaudid for that reason. However, it seems to be very short lasting. Right now I have the "lollipops" and they work to keep me out of the ER most of the time.

I understand you being worried about using too much-I am very strict with myself about when I use it.I am only able to use this because I take Percocet daily for all over pain from Lyme and I cant take anti-inflammatories.
Hugs,
Cindy

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Re: New Medication P.S.

Post  7777Trinity on Sun 21 Apr 2013, 1:32 pm

Hate morphine, it gives me a headache and keeps a migraine burning instead of helping eliminate the pain.
I prefer Dilaudid or Stadol for acute onset when Relpax doesn't work.

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Re: New Medication P.S.

Post  tortoisegirl on Sun 21 Apr 2013, 1:43 pm

I've tried most of the long and short acting opiates for pain due to a headache I've had for 7 years. My big caution would be to only go down this route if you have exhausted all other treatments. Opiate pain medication is a last resort type of treatment. I've never been able to get the pain relief I got in the beginning from these meds due to tolerance. That said, they have been the only thing to significantly and consistently help my pain. I'm currently on Methadone with Dilaudid as needed.

Actually, you would be more likely to get addicted to a medication like Vicodin/Norco or Percocet (short acting) than long acting medications such as morphine. However, taken for legitimate pain, the risk of psychological addiction is very low. Folks who will have an addiction with opiates are likely to have showed signs before, such as with drinking or gambling for example. You will however become physically dependent on it.

There is a big difference between the two. Addiction is when someone craves more of the med to get high, and may go to the extremes of lying and stealing. Dependency means you will go into withdrawal if you stop taking it abruptly. You can be dependent without being addicted. Once you are taking an opiate medication around the clock for a period of weeks, you would then be dependent on it, and need to taper off (not stop abruptly) if you wanted to discontinue it. There is also a condition called pseudo addiction. It is when a patient has under treated and displays signs of addiction, but they are not addicted, only in pain.

Its important to beware of things that may be red flags to a doctor, such as asking for a medication by name, a specific dose (such as saying you think you need a higher dose, instead of saying you continue to have high pain levels), running out of your medication early, using more than one pharmacy, getting opiates from more than one doctor, etc. Some of these things could happen in the line of treating your pain but look badly upon you, often so much that you could be refused medications by this doctor and have it noted in your chart, making it difficult to get any opiate ever again (as pain specialists typically insist on having all your records).

Are you taking MS Contin, Kadian, or Avinza? They are the three types of long acting morphine. MS Contin comes in pill form, and is significantly shorter acting than the capsules (Kadian and Avinza). MS Contin and Kadian both have generic available. If you are on MS Contin only twice a day, if it doesn't last the 12 hours, definitely tell your doctor. It is common to dose it every 8 hours. I found it didn't even last me that long.

They may switch you to Kadian or Avinza if you do well on it. The longer acting the med the more stable relief you will likely get. Definitely also keep in mind they will start your dose low and increase it as needed, so its likely they expect this is not a therapeutic dose for you. It is also common to prescribe a short acting med for breakthrough pain in addition to the long acting med, whether it is a few doses a day, a few doses a week, or somewhere in between. If you do not have this and they do not offer it up in the next visit or two, if true, be sure to mention that you get spikes in the pain / migraines where the baseline morphine dose doesn't cover the pain.

A reasonable goal for pain management with long acting medications is to relieve 50% of the pain, taking a breakthrough pain medication when needed to try to maintain that. Aiming for 100% is likely to increase your tolerance even faster. Speaking of tolerance, it is expected that over time your body will become tolerant to the dose and it will be required to increase it, or try to switch to a different medication. This happens for some people quicker than others, such as those who are younger or who have been on opiates previously.

Side effects may take some time to develop (and subside) and are more likely with higher doses. Sedation and constipation are the most common. You likely will eventually need to start on something for constipation. Miralax is my favorite. Start at a low dose (less than the recommended full cap of the powder) and increase as needed.

Did they have you sign a contract? This is typical when a doctor is prescribing opiates. If so, read this very very carefully. Most contracts say you cannot receive opiates from any other doctor. Some may give an exclusion for ER visits, some not. Some say you need to contact them in a certain number of days after receiving a short term prescription, such as an ER visit or from a dentist. If they didn't have you sign a contract, you still want to beware of the sort of things I listed above that can be red flags. I actually like the idea of the contract as both sides understand what they need to do and avoid.

Keep in mind that if the medication was lost of stolen, they are unlikely to replace it. You would go into withdrawal. So, you need to protect your medications. I use a safe (large enough that it can't be carried out), and only keep a small amount out. Always keep opiates in their original prescription bottle, especially when you take them out of the house. You may also want to consider trying to stash away some extra in case you do ever have a problem getting your script on time.

Who knows when there will be a natural disaster or something. On another forum I read of someone dropping their pills down the sink by accident. Stuff happens. Your having extra pills is not something your doctor should know about, as odd as that sounds (it can be a red flag). They assume that you will be completely out of medication on your refill date. I accumulated extra by delaying increasing my dose for a couple weeks. Saving some extra short acting meds is a little easier though.

Keep in mind this can also be a risk as come contracts allow you to be called in mid-month for a drug screen, although uncommon (they would likely already be under suspicion of someone to do this). You definitely want to be on the full dose at least a week before your appointment, where they are more likely to drug screen.

There was one time I did have a delay over a weekend in getting my meds, and I was so so glad I had extras. My doctor had forgot to put his DEA number on the script and my pharmacy wouldn't fill it. It was on a Friday afternoon, so he didn't get to fix it until Monday.

Morphine is actually one of the weakest pain medications out there, which means that mg for mg, you would take more of it than with other meds to obtain the same relief. Norco is several times stronger than it for example. It isn't something to be scared of if it is something you need to function, you have a specialist prescribing it, and you follow their instructions. A long acting med should give you stable relief without the ups & downs of short acting meds.

There is some sort of general perception that morphine is the strongest med out there, but its far from the truth. Not to say its a bad med by any means though. Its also considered the gold standard. Often the strength of other meds will be compared to it in literature.

Once you are on it for a week or more, you likely won't even feel a dose kick in or wear off (assuming it is dosed often enough). Long acting meds shouldn't have the risk of euphoria that the short acting ones have, but nonetheless, be careful about driving and similar activities, especially this first week, and then the week or so after any dose increase. Pain doctors want you to be on the long acting instead of short acting meds as they have a lower risk of addiction, will give you more stable pain relief, and may be less likely to build fast tolerance.

Sorry this turned into a long post, but hopefully its helpful! Feel free to message me. Best wishes.

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Morphine and pain

Post  KimbaK on Sun 21 Apr 2013, 9:15 pm

I woke up at 3 am this morning with a horrific migraine. I took a dose of Dilaudid and tried to go back to sleep. At 5:45 I got up and took a double dose of Norco and Flexeril. I slept a bit then woke up around 9. It was time for the morphine again so I took that and my daily meds. I tried to go back to sleep but I was so afraid I'd stop breathing from all the meds I couldn't let myself relax.

It has been a miserable day. I've been dosing myself all day and resting. I don't know what to think. I know it takes more than 2 days to determine if a med is working yet. I hope it works though. I think the Norco is making me itch. I know codeine can cause itching and when I take more than 1 tablet I notice a constant itching sensation. Its not anaphylaxis but its still annoying.

I have IBS so I take stool softener and a mild laxative every day. That should keep the constipation issue under control. I don't want to "need" any medication but that is not my choice. Migraine makes that decision.

I just miss the old me. The one who was quick to laugh, who came and went as I pleased. The one who did not have to miss family events or socializing.

Kim


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Re: New Medication P.S.

Post  Platypus on Mon 22 Apr 2013, 1:48 am

Morphine is available in both long acting and short acting form. It doesn't touch my headaches, even given IV. The only thing that works for me is Demerol which is a short acting opiate that many migraineurs find useful. I've never tried Methadone.
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Re: New Medication P.S.

Post  milo on Mon 22 Apr 2013, 8:39 am

Great post TG.

I personally have no effect on my migraines with morphine. If I were in a candy store-like pharmacy and had freedom to choose my own meds at any amount, I would still stick to my emtecs (Tylenol 3 without the caffeine).

I have been given everything oral and almost everything available IV. My pain does not respond to most. (I do get drowsy and sleep from some though which can help).

It's weird. Even after all these years, codeine still works the best for me.

I hope it is helpful for you.
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Re: New Medication P.S.

Post  sconesail on Mon 22 Apr 2013, 5:25 pm

Hi,

I was on both short and long acting morphine for about 4 years. I have been on most of the long acting pain meds for migraine- oxycontin, duragesic, dilaudid,- but Morphine actually worked best for me. I was on MSContin. I think the highest dose I ever took was 60mg 2/day but that was for about a month when the stimulator brokee. otherwise I was on 30mg 3/day, which helped a lot. I had to stop it to prove it wasn't causing the fainting. I am now on tramadol and Tylenol 3 for pain. They work, but there are days when I wish I had the morphine.

So, I think go ahead and try it. it is the oly way to know.

Pain free days,
sconesail

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