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Chronic Pain
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Posted 5/1/2012 3:48 AM (GMT 0)
Back in February, I posted that my Dr. had started me on hydromorphone 2X daily for my chronic pain. Several of you responded to my post with some good information that helped me learn what to expect while taking this drug. For about 6 weeks it really worked well and then all of a sudden, there was little, if any, relief. My Dr. upped me to 3mg 2X daily for a couple of weeks, but the relief was minimal. For the past 10 days I have been taking Motrin 800mg and the pain relief has actually been better than what I was getting on the hydromorphone for the last couple of weeks I was on it. Btw, I had no trouble quitting....no withdrawals or anything adverse.

I started taking the Motrin on an interim basis while I waited for the other to clear my body before starting a new narcotic. The Motrin is strictly a band-aid as it doesn't remove the pain. It just takes enough of my pain away that I don't feel like screaming every time I move.

This coming Thursday, I will be starting 30 mg morphine sulfate time release capsules. According to the Vaughns painkiller strength chart, it appears that I will actually be stepping down a couple of notches from what I was on. What is the difference in the hydromorphone and the morphine sulfate? Is the morphine sulfate not as strong as the other? I really hate that ecstasy feeling that percocet and vicadin gave me. I hope this new one doesn't give me that feeling. Is there anyone on the board that can give me a heads up on what to expect.

Sorry my post was so long.
Posted 5/1/2012 4:43 PM (GMT 0)
IMHO ignore those strength comparison charts. They really are only good for giving the doctors a guide on where to start when going from one pain medication to another. Since everyone reacts differently to any given medication there is no way to know how something will effect you, how strong or weak you will find it until you try it.

Odds are though you probably won't get any kind of "high" off the morphine extended release pills as it is designed to enter your system slowly over the course of many hours, unlike immediate release medications which enters the system basically all at once. Just be sure to swallow the pill/capsule whole.

Most likely the biggest difference you will notice between the morphine ER and the hydro IR is that it may take a little longer to notice any reduction in pain. Once it takes effect hopefully your pain relief will be more steady and longer lasting than with the hydro IR.
Posted 5/1/2012 6:11 PM (GMT 0)
Ludlow,

I'm sort of w/ Jim re: the comparison charts.... re: "stronger" meds and all that. A lot depends on a person's system; how many milligrams and so forth.

Extended release morphine sulfate can be a really good medication. From my personal experiences... and reading those here on the board.... it goes into your system pretty easily and offers a smooth pain control. The good thing about a long lasting med is that you don't get the "highs and lows" as you do w/ short-acting meds (like Dilaudid, etc).

I hope your experience w/ the morphine is a positive one and that it ends up really helping w/ your pain issues. Let us know how it goes.

--Tina
Posted 5/1/2012 7:13 PM (GMT 0)
Hi Ludlow, when my pain pump was first implanted I was on 2mg of Hydromorphone and it did nothing for my BT pain. This was all my PM dr would rx, so I refused it. I took OT and got more relief. Later when I had to get a new PM dr she immediately switched me to 4mg and said no wonder I refused the scripts because 2mg was like nothing. In fact she did not know it came in such a low dose. I am now on 8mg every 6 hrs for BT pain, even at this dose it does not last long. To me it seems to peak out in about two and half hours and then its done. I will be honest I did not realize they had it in 3mg either.

I would think you would get much better pain coverage with the ER med than what you were getting with IR. The two drugs are very similar so hopefully you will do well. I don't put a lot in those conversion charts either.

Take care.....Susie
Posted 5/3/2012 10:50 PM (GMT 0)
It all comes down to a term called "bio availability"

Bio availability is the degree to which a drug or substance (the pain medication in this case) becomes available to the target tissues after administration.

hydromorphone aka dilaudid, is great when administered through IV, because all of the medication reaches the target tissues without first having to first go through the journey oral meds take, namely our stomach acid being the biggest hurdle.

However, in pill form , dilaudid doesn't have very good bio availability, in other words it doesnt hold up very well and your stomach acid eats most of it before it can be absorbed.

So you're only actually getting a fraction of what you're prescribed. That's why the low doses don't seem to make a difference...

With the morphine sulfate aka MS Cotin, that pill is designed to hold up in your body and release over time, so its bio availability is much better and you get a lot closer to getting the full prescribed dosage.

I've been on both, I had the dilaudid first, which did nothing, and then was switched to the morphine sulfate which worked okay for a short time but I've now switched to something else.
Posted 5/4/2012 9:44 AM (GMT 0)
Hi Ludlow, 

It's good to see you again (but sad that your meds have stopped working as well as before).  I had the same issue witht the hydromorphone.  Despite several attempts to up the med to cover the pain, it just seemed to stop working completely all of the sudden.  I didn't have any problems quitting it either.  Then the dr put me on oyxcodone, which worked sooooo well for a while, but no so well after some time had passed.


Now he has added MSContin...(same thing you are taking) twice a day and i still take all of my other meds for pain.  I use Xanax XR 3 mg, Robaxin, Ultracet, and Oxycodone along with the MSContin.  The combination has been the best for me in a long, long time.  I can't say that the Robaxin is very good, but I could not take the Baclofen and the DEA decided long term use of SOMA was no longer OK, so my Dr changed everyone to another muscle relaxer.

I also had another RFA (nerve ablation...where they burn the nerves that are causing the shooting pains...ie nerve pain).  It works great for me and this one gave me relief so much faster (weeks faster) than the last one...but it was more painful to get.

Finally, I am getting trigger point injections (for me, that's a very large number of shots into the most painful muscles in the back in a series of injections...one after the other).  It also hurts to have it done, but the relief is very good for me.  Some others here share the relief from these procedurs and others don't.

I have already had the surgery (I believe you are trying to prevent that....if I'm not mistaken).  These are certainly only a few of the options available, but I have been trying to find relief for years now and this is the first time in years that I feel like I have a life.  Don't get me wrong, the pain is there, but so is the relief in this med combination and with these procedures to suplement the meds.

I mention all of this because it too so long to find something that offered relief for the long term and you are so new to the pain med thing.  I can remember how you felt abou dilaudid when you first started taking it.  MSContin works well for me as a supplement to my other meds, but alone would not be a very good med for me (at least not at the low levels I am currently taking ).   You may want to ask for something for break through pain (or at least get the OK to continue the motrin).  I'm sure it's probably fine, but I'm a worrier and I alway check to mae sure my Dr is OK with me adding anything over the counter or not....just to make sure there is no reaction  between the meds.

Good luck!

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