Opioids and breakthrough pain

[TessaBella]

My doctor switched me from hydrocodone 10s to MS Contin ER yesterday. I have transverse myelitis or inflammation of the spinal cord and the burning plus electric shocks, sparks, and spasms are savage. I've always been undermedicated for this condition due to the so called opioid crisis. Recently, the pain has increased intolerably. Doctor said he would add hydros if the morphine isn't enough but I can't wait till Friday when I'm supposed to call him and report. The hydros must have worked better than I thought because without them, my lower body is screaming! I want to take some hydros now, not wait till Friday, and I couldn't reach him today. Does anybody have an idea what is a safe amount to take with my 30mg MS Contin? I've taken 6 hydro 10s a day for 7yrs so I have a tolerance. I'm just nervous since I've never taken morphine before and I take other meds that can cause respiratory suppression too. It's crazy but despite this pain that humans weren't meant to feel, I don't want to die. Only 2 in 5 million people have this condition and it's brutal. I took one hydro earlier but it didn't help. I used to take 2 at a time. Shit, I think I deserve a high but I only get a 30 day supply. I'd appreciate any suggestions about how many hydros would be safe with the morphine every 12hrs. Chica Tessa thanks you.

 

[SpiralusSancti]

It’s very ungrateful job to advice someone about such measures, can be even for specialists. Also I’m not sure I understand you right. So you’ve taken 30mg of morphine orally? That’s really not a lot, in fact more like minuscule dose for some kinds of serious pain. It’s a pretty general rule that mixing more downers in equipotent doses can be more dangerous than taking just one in equipotent dose. You also didn’t name what other drugs do you take? That’s main reason I ain’t going to say what I would do if I was you, as well, I have no idea if that would kill you with unnamed medicine you also take.

 

[negrogesic]

If you were previously taking a total of 60mg of hydrocodone per day and switched to 30mg/day of morphine, then your total dose of narcotic went down 50% (since 60mg of oral hydrocodone is roughly equivalent to 60mg of oral morphine).

So, at least in terms of equivalency, a total of 30mg of morphine plus 3 10mg hydrocodone tablets (through the course of a day) would be equivalent to the 6 10mg hydrocodone tablets you were taking before.

 

[TessaBella]

It’s very ungrateful job to advice someone about such measures, can be even for specialists. Also I’m not sure I understand you right. So you’ve taken 30mg of morphine orally? That’s really not a lot, in fact more like minuscule dose for some kinds of serious pain. It’s a pretty general rule that mixing more downers in equipotent doses can be more dangerous than taking just one in equipotent dose. You also didn’t name what other drugs do you take? That’s main reason I ain’t going to say what I would do if I was you, as well, I have no idea if that would kill you with unnamed medicine you also take.

Sorry, I take 600mg of gabapentin every 6-8hrs and baclofen, 20mg, with the gabbies. I don't recall if I said that I was taking 6 hydrocodone a day for 7yrs before it completely stopped working for me. My doctor said to just take tylenol for breakthrough pain. Tylenol?? He said that to add any hydrocodone would be too dangerous but he's the one who brought up the possibility when we spoke Monday. Today was day 3 on the 30mg morphine every 12hrs so 60mgs total daily. Is that equivalent to 6 hydro 10s. My saddle area and my legs and feet are on electric fire with shocks and sparks. At this point, I'd say that the hydros worked better. I think my dose of the new med might be too low. Shouldn't I feel some relief after 3 full days? I want to take a hydro but the doctor scared me. Dammit.

 

[evo4ever]

If its nerve pain your experiencing (neuropathic pain) then opioids aren't the best solution. Ditch the Gabapentin and try switching to Pregabalin. Duloxetine and Amitriptyline are meant to be good as well.

 

[SpiralusSancti]

Sorry, I take 600mg of gabapentin every 6-8hrs and baclofen, 20mg, with the gabbies. I don't recall if I said that I was taking 6 hydrocodone a day for 7yrs before it completely stopped working for me. My doctor said to just take tylenol for breakthrough pain. Tylenol?? He said that to add any hydrocodone would be too dangerous but he's the one who brought up the possibility when we spoke Monday. Today was day 3 on the 30mg morphine every 12hrs so 60mgs total daily. Is that equivalent to 6 hydro 10s. My saddle area and my legs and feet are on electric fire with shocks and sparks. At this point, I'd say that the hydros worked better. I think my dose of the new med might be too low. Shouldn't I feel some relief after 3 full days? I want to take a hydro but the doctor scared me. Dammit.

That doesn’t sound really dangerous to me, if doses are kept low enough. It should be less dangerous than combo with benzos, I assume a lot less dangerous but don’t take my word as a guaranty to go “all in”.

60mg of morphine, divided in two doses is still nothing for a serious pain, more so with your previous tolerance. If I was you I would first try out higher doses of morphine rather than a combo with another opiate. 100 or 200mg of extended release MST along 2x 30mg IR might do the trick.

As for Tyenol, that’s paracetamol right? Yes add it! No matter what opiod I take paracetamol helps with pain on top of it and allows me to keep dose sub-recrational or at least not-so-recreational.

I forgot to wrote that in previous post, try adding some strong NSAID! Some of prescription ones I tried work better than low doses of opiates or weaker opiates, even much better. Thing is you have to have stomach for those and sadly I don’t so can’t use them regularly but maybe you are of better luck. If you can’t or don’t want to acquire prescription ones than try ibuprofen + paracetamol combo, for some it does wonders even without opiods on top.

If its nerve pain your experiencing (neuropathic pain) then opioids aren't the best solution. Ditch the Gabapentin and try switching to Pregabalin. Duloxetine and Amitriptyline are meant to be good as well.

And also what this person said! But, be careful and consider it good as pregabalin is a whole different beast. I only tried pregabalin not gabapentin so can’t comment a lot about difference but it’s surely stronger in just about every aspect and almost certainly more problematic too.

Also since you take opiates for a long time and they did work that means they can work again with some interventions. So maybe pregabalin for some time while lowering dose of opiods to reset tolerance to same isn’t a bad idea.

 

[Señor Moreno]

If its nerve pain your experiencing (neuropathic pain) then opioids aren't the best solution. Ditch the Gabapentin and try switching to Pregabalin. Duloxetine and Amitriptyline are meant to be good as well.

This.^.
I am sorry to hear you're in that condition.
You touched me with your

but despite this pain that humans weren't meant to feel, I don't want to die.

I know nerve pain as I have trigeminal. It's simply too much. When someone post about some levels of nerve pain I just have to chime in as I know what kind of evil reality they are enduring I can't help with the hydro as I never had it, but what @evo4ever and @ Spiralusancti have said is what is the right answer here.
Opiates are useful and sometimes totally needed, but not enough for a serious nerve pain.
Fist thing would switch to Lyrica, but I very honestly thing that you would benefit from a lidocaine pumping device. They are also using Conus regio, a very promissing sea scrub and another treatments.
I think that you should try and do a research on the matter and specially on who are the docs with real experience on the subject and where are they.
Believe me that I know that you are undergoing hell itself, but even in hell you may find angels that can make your path across it not so cruel and painful.
I wish you the very best.

 

[Señor Moreno]

Oh, I forgot about opioid hyperalgy inducing effect. The more opis you take, the weaker you get to endure pain. That is just a weel known universal fact, the bare truth, not like some random reaction on some particular patient here and there.

 

[LoveTractor]

Another pain patient here - what Negrogesic wrote it accurate, but it seems you’re on an equivalent dose with the MS Contin to where you were with the hydros.

It may not be truly equivalent in your situation. What the others wrote about nerve pain can certainly be true but you reported success with hydros and it seems its tolerance that is getting to you.

With what you have on hand and your need for relief I would do this - add a hydro and see how it goes, maybe one every six hours or as needed (prn). It won’t harm you b/c you have a tolerance but take one at a time or add just 1/2 a tablet at first, to be safe.

Hyperalgesia is a possibility but it is rarer than the medical community makes it out to be, still its a thought. But usually lowering the dose will help with that. DO NOT suggest this to you physician they may use it as an “Ah, ha! Yes that could be it”, and then you’ve lost control. In my opinion gabapentinoids (Lyrica, gabapentin) and maybe clonazepam (with medical oversight) are worth looking into.

I could be way off on this, as always it’s hard to give solid advice not knowing you and your case better - take the sum of the advice here and give it your best. But yeah if I were you I’d take the hydro - 1/2 to 1 at a time and see it it helps. If it makes the pain worse than hyperalgesia (“OIH”) may be the problem, but I kinda doubt it.

@negrogesic - we need you to chime in again here if you would please review what’s been suggested and comment I’d appreciate it. Thanks. Best wished to the OP.

 

[Señor Moreno]

Hyperalgesia is a possibility but it is rarer than the medical community makes it out to be, still its a thought

It is much more than a possibility when you use them for many years,decades. It was waaay before than any doctor told me about hyperalgesia that I felt it. I mean, I am not saying that 100% of the cases will result in it. Some people don,t get serious constipation, but I would say that opioid constipation is much closer to a certainity that to a possibility.
It's reversible with a dose reduction... to a degree. It sure will help but it won't erase it, not at all. As long as you are using " outdoor" opioids you are inibiting and jeopardizing your capacity to produce natural "indoor opis".
Even if you were to quit after long tine/ high dose things would take many time, years to improve. and pre opiate use baseline is a high expectation, not unreal, but sure high.
Sure the OP got some benefice on hydros, but her/his overall life perception is far for wellbeing. This person is clearly in need of a wider relief and it won't happen only with gradual opi dosage increasing or by making 200 opi rotations.

That's only my opinion based on my experiences. I am not a versed guy, let alone a doctor. But being a trigeminal patient and being on opiates from an ashaming amount of time, you end up with some perspective of this particular scenario.

Sorry for my English, I don't seem to be able to improve afer a ceilling point. I am a partial agonist English speaker, I guess

 

[TessaBella]

If its nerve pain your experiencing (neuropathic pain) then opioids aren't the best solution. Ditch the Gabapentin and try switching to Pregabalin. Duloxetine and Amitriptyline are meant to be good as well.

I've tried those meds, plus others, none of which helped. More recent studies indicate that opioid pain meds do work for nerve pain and overall decreased the pain by 33%. The Mayo Clinic has also done and is doing studies that show the same thing. Opioid pain meds do indeed work on nerve pain. Hallelujah, someone is doing studies!