Opioids Morphine IR 15 is not cutting it for me - intense pain and pissed off

[Taz_Mania_Girl]

Hi all, newbie alert. Been reading here for a long time so joined. I will get to it.

Suffer from Multiple Sclerosis and have insane limb and face pain. Level 10, on the ridiculous pain scale. Have aggressive form of the disease, so VERY tolerated to opiates. I can take dilaudid 4 mg in portacath which give me amazing relief, and of course complete rush to the point I can't talk because it feels so good. The pain, and I, both drift away. I have nerve and central body pain, also horrid muscle spasms due to MS disease. It is daily and intolerable.

Went to pain mgmt. doc for first time and was prescribed:

Morphine 15 mg IR
Lyrica 75 mg
Baclofen 10 mg

VERY low doses. Doc informed me that I could "play" with dosages and we will meet every week until dosages are adjusted. Also said to call him if pain increased so he could give me a spinal injection and/or face injection when pain reaches level 10.

It did, yesterday. Was screaming in pain and crying, and hubby called to see if we could get it. We can get it Friday. Until then, get by as best as possible on meds. UGH.

On Friday I want to switch drugs to MUCH more powerful ones.

My question is for those of you who use a pain doc, do you have any idea what is more powerful? Morphine blows. I have tried different ROA, but nothing works. Feel drowsy, but cannot sleep due to pain. Lyrica seems decent for lowering nerve pain from 10 to 7 or so, but only for 3 hours.

Should I tell the doc what I think would work, or just describe the pain and let him decide? As a new patient, I tend to minimize pain because I think they simply don't believe you if you say 10 right off the bat. But it is a freaking 10!!

Any advise, at all, would be extremely appreciated. Love the site, and the posts have always been VERY helpful. Thanks in advance.

 

[Felonious Monk]

First of all, welcome. I'm sorry to hear you're in so much pain but it does sound like you have a doctor that is at least willing to work with you. Before I begin I also want to mention the chronic pain scale, since you refer to your pain as a "10" repeatedly; that's really at least a little exaggeration, since it can't be that unbearable all the time or you'd literally refuse to leave your bed/the hospital. Using it more fluidly won't diminish your pain, it will simply show you can honestly judge your own condition.

You should certainly look into getting an extended release medication like a fentanyl patch or OxyContin/Opana when you see your doctor next. For 24-hour pain a pretty standard PM technique is to use an ER medication along with an IR one for breakthrough pain. The patch might be best since it's the easiest to use, and you mentioned you were already opiate-tolerant. You could also up the Lyrica if it's helping, that's quite a low dose for severe nerve pain.

You should also consider, and talk to your doctor about, medical marijuana. Especially here in CA doctors are very open to it, and are informed about how the synergistic effect of opioids+cannabis can especially help neuropathic pain. If you don't like getting "high" there are plenty of tinctures or oils to look into that would be fairly easily tolerated, and often help people cut their dosages of opiates by 50% or more (I know of at least 2 people with MS who use exclusively cannabis).

 

[MrsMorphine]

Taz_Mania_Girl, only someone NOT in chronic pain would talk about "playing" with drug dosages... sheesh!

That said, in my experience morphine 15mg IR is what's given for breakthrough pain, not to address a baseline level of pain, or rather, lack of pain. Fentanyl patches may very well be a good option for you, and once you and your pain mgmt doctor have found a livable dosage for you, THEN you can "play" with how best to address BT pain.

 

[Taz_Mania_Girl]

Hi Monk! Thank you for your reply. When I say my pain is at level 10, I am not implying I am at that level continually. That would be impossible to tolerate. My pain does raise to a level 10 due to Trigeminal Neuralgia (aka Suicide Disease) that is known to be the most painful condition known to man. I should have provided the link, damn, but if you happen to be interested just google Trigeminal Neuralgia or Suicide Disease. It is called suicide disease for a reason.

I am currently bedridden, and wheelchair bound. Pain level hovers around 7ish. And as I stated 10 on bad days. When TN hits, I go to ER and am usually admitted for a few days to be treated with massive narcotics and steroids to stop the MS flare. I am having brain surgery to remove the Trigemenial Nerve permanently in early Feb, which has about a 70% success rate.

Thanks for your information on the patches. I also feel that medical marijuana would be beneficial.

I appreciate you took the time to respond! I don't get notified of responses, so just looked up my post and saw I had a couple of replies. I'm sure there is a way to set it to notify me if someone responds to the thread.

Hey, I found the link. If your interested, this is the info on TN from wiki. It's very scientific, but gives a good description of the condition. It is one of MANY of the awful symptoms of MS, but definitely the most intolerable.

http://en.wikipedia.org/wiki/Trigeminal_neuralgia

Cheers.

Take care, and thanks again.

 

[Taz_Mania_Girl]

Haha MrsMorphine, (great name btw), seriously..I was trying to hold back screams and expletives, while he casually mentions playing with dosing. At that time, I was in such pain my playtime would have been to take the whole bottle. But obviously not a realistic choice, as I have a beautiful family and even when in pain I want to stick around.

Thanks for the information! I am meeting my PM doc today, so will mention the patch that you and Monk brought up, and the morphine for the breakthrough pain. Also, since Lyrica trumps Neurontin for treating nerve pain, I will ask him to bump the dosage.

I'm sure he can't just give me major narcs and high level of Lyrica on our first visit, but it's been 3 visits now so I'm sure he will be more amenable to asking for stronger drugs.

Thanks to you both. I still have a lot to learn, and was so nervous to post. I know a lot of people are here for recreational stuff, which is fine I'm no angel..but if I can be pain free that will be a euphoria I haven't had in 11 years!!

 

[MrsMorphine]

Today is Friday, Taz... how did that appointment go??

Speaking of involuntary waiting for medical attention, here's an East Coast anecdote for you. I had an 8:30 a.m. appointment on Tuesday at my pain mgmt group near Baltimore. It was snowing when I left, but I arrived at 7:45. After waiting around and conferring with other would-be patients who had showed up on time, everyone whipping out cell phones and then telling the group what they'd heard, we learned that the office was closed for the day and we could call for appointments on Wednesday. Almost everyone was flat out, or nearly so, of their medication.

So after a grim Tuesday night, I presented on Wednesday, got my scripts, and made my January appointment THREE weeks later, not four. Now, we had a dusting of snow on Tuesday, not a blizzard or an ice storm... and I spent the first half of my life (to date!) in California. So I figure if I can learn to drive in winter weather, so can other folks.

At least you don't have that as a brick wall standing between you and your provider, Taz! Check in and tell us how it went.

 

[Morphling]

You could try plugging them, morphine works much better that way, than oral or intranasal!

 

[Felonious Monk]

I am currently bedridden, and wheelchair bound. Pain level hovers around 7ish. And as I stated 10 on bad days. When TN hits, I go to ER and am usually admitted for a few days to be treated with massive narcotics and steroids to stop the MS flare. I am having brain surgery to remove the Trigemenial Nerve permanently in early Feb, which has about a 70% success rate.

Thanks for your information on the patches. I also feel that medical marijuana would be beneficial.

Ok, with a little more explanation I understand what you're talking about a little better. You'll understand my initial response as many people simply say "10" without really considering they could theoretically be in more pain, but being bedridden and having to get ER treatment as you described is pretty awful. The surgery you mentioned sounds like it might be your best course of action, but obviously that's an end-of-the-line treatment if nothing works (which it sounds like is the case).

I hope your appt today went well, please update us on how it went. You won't necessarily get the cannabis recommendation from your PM doc (probably not in fact), but there's plenty of good clinics around that write them (including an especially professional/efficient/established one up in Santa Ana). If you need any help with strains or delivery services feel free to PM me, I live quite close to you in OC. And I understand what you said about your doc not prescribing you the whole pharmacy your first visit, which is to be expected. Even if you're in serious pain they have to build a relationship with you, which is what you're doing--it promotes responsible care as well as working closely with a doctor, which will produce better results in the long term.

 

[Taz_Mania_Girl]

Hi Mrs. Morphine. Monk, and all,

Well thank you for showing interest in my post. It helps a lot to know others go through similar experiences and get to complain here and laugh at docs.

With that said, I had a great appointment. But first, I have to comment on Morphine's anecdote. WOW! That blows snow (and NOT the good snow) that you all showed up to find that your pain doctor's office was closed. Are they clueless about what happens to us when we run out of meds? It sucks enough that most of us have lives that revolve around pills. Definitely not what we envisioned as children. But it is what it is, and withdrawals from just about anything your body expects just to feel normal is possibly the worst feeling (physically and mentally) that one can experience. UGH. Sorry to hear you had to endure a bad Tuesday, but at least it was just a day TG. Glad you got your scripts. YAY! As for driving in snow...you are my super hero! I get tense in the rain, but then again YOU know what it's like in CA. We freak out when it rains. hahaha. Spoiled as hell out here in the sunshine.

Okay, as for me. I had a superb appointment. Was at about a level 8 pain in my right leg due to spasms. He could visibly SEE my leg was a rock, and when he flexed my foot toward my body. the right leg started shaking and freaking out.

He talked to me a long time, listened closely to my current and past experiences, and showed compassion and interest. WTH? I was truly surprised, since most of my appts with doctors are 10 minutes in and out, and I'm lucky if they make eye contact.

That said, he suggested an adjustment in my meds. In addition to increasing the morphine from 15mg to 30mg, he said I could take it 4 times a day as needed. He added Opana 10mg for extended release, which lasts 12 hours. No idea about Opana, never heard of nor tried it. Not sure if that is a tiny dose or not, but assuming it's pretty small since he's still learning about my pain. Additionally, he upped the frequency of the Lyrica to 4 times daily, and added Cymbalta. He said the two work well together to treat nerve pain, which is the hardest to treat and doesn't respond well to narcotics. He also prescribed klonopin and ambien, for relaxation and sleep.

But the BEST part of the appointment was he did a spinal block to treat my right-sided leg pain that was causing me enormous discomfort. He injected (something) into my spine which numbed the right leg....and I experienced IMMEDIATE relief. I had tears, and I hugged him. Had no idea how much that leg was hurting until it stopped. Now I feel human again...lol.

So this grumpy, pissed off poster is now a happy girl again. The spinal block will fade within a few days to a week, but can be redone as needed. And the pills will help in the interim. We have a follow up in a week, and I am documenting what I take and how often on an index card, which I update with the med, what time I took it, pain level, etc. He was amazed at my organization. A bit of a detail oriented person, haha.

Monk, thank you so much for taking the time to read and understand the situation I'm facing. I appreciate your input very much. After I re-read my initial post, I can totally see how it could be misunderstood, because I said I was at a level 10 pain, failing to mention I was sometimes at that point. Need to learn to type slowly and think more I appreciate your input to my post and would love to hear your story, if, as I told the Mrs, that you have told your story countless times. I am still learning to navigate the system here, which seems pretty easy.

Thanks again for interest. It made me happy to read your post. Would love to hear your story, unless you've gone over it a million times and I can find it somewhere. You made my day girlie

Have a good weekend. Think I'll sleep like a baby tonight. (wake up crying every 2 hours, lol).

Talk to you soon I hope.

Taz

 

[Taz_Mania_Girl]

Up the butt? Yeah, thought about it because I read that oral morphine is terrible due to low bio-availability. But with hubby and kid home with me, could be difficult, not to mention highly embarrassing if caught mid plug. Ewww. With that said, I have no weird moral objection whatsoever. Relief is relief. I will never stick a needle in my arm, mostly because I would lose my family. I want a semblance of a normal life without dependence on any substance, but just about everyone on this site knows that is easier said than done. Thanks for reading and responding!

 

[N3DIVWNOJI999]

Opana= Oxymorphone , Much stronger than morphine sulfate, and the shot could've been cortisone?

 

[N3DIVWNOJI999]

Damn that sounds painful, but at least you found a good Dr, he hooked it up!

 

[Snake_Eyes]

I hope you find the relief you need but damn that's a lot meds to be prescribed at once, be careful.

 

[Cuhpcakes]

Morphine's bioavailibility is so low orally(most is excreted) compared to IVing it.

 

[N3DIVWNOJI999]

Yeah definetly be careful, i would start off with the opana only, and see if that keeps the pain at bay, cause it should.. I forget the exact ratio, but oxymorphone is something like 3-4 times as potent as morphine when taken orally, there are opioid conversion charts you can check out, but just keep in mind the ROA will affect the bioavailibility..

 

[MrsMorphine]

The drug regimen prescribed by your doctor sounds like a safe 'n sane one, Taz, and one that has worked for others that I've read/heard about.

What made me hap-hap-happy above all, though, was the caring attitude of your doctor. It's a sad thing that we can't take eye contact as a given, but at least you got it!

Keep up posted, m'dear... I'll be thinking of you, and pulling for you!

 

[Rybee]

Yeah the shot sounds like cortisone, it's usually pretty damn good, although short lived in some instances.

I really do sympathise with how you're feeling, I'm so sorry to hear how much your life's been affected.

That said, it does sound like your in good hands. All the decisions that the doc made sound like a good step in the right direction and it's brilliant that you had a good rapport with them. I've had too many doctors look at me with a glazed look with little or no interest in what I've got to say and go on to prescribe me something which is probably insufficient. I take oral morphine for sciatic nerve pain and tbh it's pretty shit. As you said, morphines bioavailability orally is rubbish, and it's not even that good for nerve pain. I've just been prescribed fentanyl patches and gone back on pregabalin so hopefully can numb some of the pain. What dosage of pregabalin are you taking now? I used to take 600mg which was pretty decent, though it made me very slow in the head and I found myself very dumbed down.

Big hugs for you though, I truly hope you're feeling better.

 

[Felonious Monk]

Glad to hear your appt went well, it sounds like you have a good doctor. The treatment plan sounds good, I would just be really careful mixing all of those. Opana is strong stuff, so you should be set with just that usually.
Of concern is really the opiate/benzo mixture, which would be Opana or morphine with the Klonopin (or Ambien to a lesser extent). You'll almost guaranteed get noticeably drowsy if you mix them, possibly dangerously so. So if you need to use both make sure the first time you're not alone.

 

[Taz_Mania_Girl]

Thank you N3, for the information on Opana. Had never heard of it, nor tried it. My pharmacy is currently out of it, so won't be able to start until Monday. But at least I'm out of the severe pain for now. I think the shot was a combo of cortisone, lidocaine, and steroids. But I don't know for sure. I just know they used that combo for my face once at it worked as well. But just speculation on my part. Next appt I will ASK. Duh on my part. Thanks for your response!

 

[Taz_Mania_Girl]

Thank you Monk! I was looking for that kind of info and even called my pharmacist and was told basically the same thing you just mentioned. What they failed to tell me is that I need to take a stool softener along with pain meds, which cause noticeable constipation. Also to take fiber, walk if possible, eat veggies, etc. This sounds gross, but I haven't had a healthy bowel movement in 5 days!! I think the morphine, even at such a low dose, caused it, along with MS which causes weakness in the bladder and bowel muscles. Yikes. You would think they would tell me this at the appointment. I guess since I described myself as being opiate tolerant due to Norco, they assumed I knew this. But after years of Norco 10/350 4 times a day, it was literally like popping a tic-tac. My tolerance came from hospitalizations that treated me with steroids and 4 mg of IV Dilaudid. I think since it's been 5 days, I probably need a laxative. Do you take any stool softeners? Sorry for the question...as I'm not familiar with your specific drug regimen. I do appreciate your informative responses. Will be careful not to take all of the meds at one time.