Treatment Morphine added to methadone ORT cause of serious chronic pain. Need some advice.

[Pain_in_vain]

I am a former BLer comming back forom BL detox. But cravings for BL and BLeres became too strong so I caved...and here I am.

I need insights from other people so I can better understand my predicament. I don't see what I don't see and more views I get better understanding I will have. So please don't hold back.

First I want to state that 'pseudoaddiction' was certainly overplayed by big pharma to sell as much opioid medication as fast as possible. But I have come to realise that my problems with opioids were created exactly cause of dynamics explained by 'pseudoaddiction'. For many years my problens were ignored by my GP and it took me several years before I was X-rayed. There were visible problems with my back and same happened with MRI...and in the end with EMG/EMNG examination. In the end the whole host of problems were found from inborn pronlrms with my back, spinal stenosis, demineralisation of lower spine, polyneuropathy, neuralgia...and it took years for all this tests to be completed (lousy medical system). But I had to work and function so I started to take opioids (pharmaceuticals) on my own as my GP didnt want to prescribe anything except tramadol up to 150mg.

I will cut to the matters of my question. As I couldnt pay for morphine and oxycodone tabs on the street (less offer, higher prices and higher tolerance) I transfered to nethadone. So now I was, and am, registered as an opioid addict. Nevertheless I tried all SSRIs/SNRIs/tricyclics , gabapentinoids and every kind of non-pharmacological therapies - excercise, magnetic therapy, acupuncture, trigger point...you name it.

Few weeks ago addiction psychiatrist that I go to prescribed morphine on top of 50mg of methadone. I was surprised, but at the same time confused. See I got 12h slow release morphine but only one 60mg tab. I didn't think it would be useful with 50mg methadone but hopefully this is just to test the waters and I msy have start the journey of transition ftom methadone to morphine.

This 60mg SR morphinpe even helped me as I was able to sleep better since I started to take them in the afternoon.

My question are:

1) Can I get propper pain relief from morphine if I stay on 50mg of methadone?

2) How much of morphine (oral, slow release) would bring truly felt benefits if I was left on 50mg methadone but morphine was raised.

3) From your experience (as web calculators are all over the map) what amount of oral morphine would actually be needed to replace methadone all together?


Thabk you BLers for existing and replying.

 

[cdin]

I feel like question one you answered - because you got relief.

question two - that is something you would have to work through - each body/metabolism is different.

50mg morphine oral is approximately equivalent to 10mg methadone. so your baseline dose is somewhere in the 4-500mg of morphine range, which would be crazy to switch to, and i don't think they can even write enough to cover it.
That being said - if you are feeling and getting relief from the extra 50mg it suggests to me that the methadone is not covering something with the pain that may be better treated by conventional opioids at a lower dose.

 

[Pain_in_vain]

Thank you for the reply. Yeah we are all different and I will have to wait and see what happens. I just dislike methadone so much...

Neither I believe that I could get whole methadone dose replaced by morphine. But I do believe that it is possible that I will end up on 20-30mg methadone plus 2x100mg SR morphine. That would be very acceptable.

One more thing. Web calculators range from x3 to x8 multiplication (methadone to morphine). Most have cut off points at 20mg,40mg...at which multiplications rise from x3 to x8 t x10..., while some use different formula and some just multiply it by 3. It is a mess.

Can you just tell me have you made a mistake when writing:

50mg morphine oral is approximately equivalent to 10mg methadone. so your baseline dose is somewhere in the 4-500mg of morphine range

Because if methadone PO is 5 times stronger than morphine PO wouldn't calculation lead to 50mg methadone PO = 50 x 5 = 250mg morphine PO. Or did you take into consideration that progression from 10 to 50mg is not linear? Sorry for bugging you but this is something that is capturing my attention and would like to know what people actually think.

Thank you man!

 

[cdin]

Thank you for the reply. Yeah we are all different and I will have to wait and see what happens. I just dislike methadone so much...

Neither I believe that I could get whole methadone dose replaced by morphine. But I do believe that it is possible that I will end up on 20-30mg methadone plus 2x100mg SR morphine. That would be very acceptable.

One more thing. Web calculators range from x3 to x8 multiplication (methadone to morphine). Most have cut off points at 20mg,40mg...at which multiplications rise from x3 to x8 t x10..., while some use different formula and some just multiply it by 3. It is a mess.

Can you just tell me have you made a mistake when writing:

Because if methadone PO is 5 times stronger than morphine PO wouldn't calculation lead to 50mg methadone PO = 50 x 5 = 250mg morphine PO. Or did you take into consideration that progression from 10 to 50mg is not linear? Sorry for bugging you but this is something that is capturing my attention and would like to know what people actually think.

Thank you man!

no i don't know much about methadone conversion specifically, it's one of the only opes I have never been on, so yeah that could be incorrect - from a web calculator, let me run a few others -
ran another, this seems to account for non-linear dosage progression:

PREVIOUS CHOICES:​

MME= Morphine Milligram Equivalents

Methadone PO 50 mg - Morphine equivalents: 500 mg
Additional data/calculation:
Calculation: 50 mg x MME Factor(10) = 500 mg.
Derivation of MME factor:
1- 20mg: 30 / 7.5 (Methadone equiv to morphine 30mg) = 4.0.
21-40mg: 30 / 3.75 (Methadone equiv to morphine 30mg) = 8.0.
41-60mg: 30 / 3 (Methadone equiv to morphine 30mg) = 10.
Greater than 60mg: 30 / 2.5 (Methadone equiv to morphine 30mg) = 12.
Note: these factors are adjustable - see previous page.

Still comes out at 500mg.

then another:

There is limited evidence and no consensus on the conversion factors to use for methadone. We use a 3 to 1 ratio that is consistent with CMS, the State of Oregon PDMP, and research studies by Von Korff (Clin J Pain 2008;24:521-7) and Krebs (Pain 2011;152:1789-95). The WA State AMDG calculator uses higher conversion ratios that increase at higher doses (0-20 mg 4:1 ratio, 21-40 mg 8:1 ratio, 41-50 mg 10:1, over 51 mg 12:1 ratio)

For the dose entered, these two conversion ratios are:

150mg
(this calculator)

500mg

ok, so somewhere between 150mg and 500mg

 

[Pain_in_vain]

Now you see my doubts and why I hoped thst someone who had similar situation has some answers.

I guess that life will show me what is actually true and I will ride the waves as they come.

Thank you for your time and effort!