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Afraid to go from hydrocodone direct to morphine sulfate??

kathyykkathyy Posts: 580
edited 06/11/2012 - 7:57 AM in Pain Medications
I've read so many of the posts on this forum. I hope someone might have a suggestion for me. My problem/dilemma is that I've been on hydrocodone 10/325 mgs X 3 for basically 3 years since my surgery. I now have a major herniation the level above the fusion (L3-4) with lots of instability and am probably looking a second back surgery. The 30 mgs daily of hydrocodone aren't getting it. I am usually through the roof with pain by the afternoon (I have to sit at work lots.) I slap my tens unit on the second I get home! It does help.

Anyway, my pain doc tried to give me Exalgo but insurance said no. Now they are trying to give me Kadian. Or, my doc said I could just go to 40 mgs hydrocodone and see if that will help for awhile. I'm afraid to go to stronger meds like Kadian. Isn't that like skipping a few steps? Anybody have any other suggestions that don't take me direct from hydrocodone to morphine?

As always, I appreciate your insight. I know that we are all affected differently by different drugs. I'm just looking for some suggestions for a stronger regime that 30 mgs hydro but not so strong as morphine sulphate.
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Comments

  • Maybe the fentynal patch ? I am using the 25 mcg which hellps some along with norco. Norco alone just wont do anything anymore. Start off on the low fentynal patch. When they give me the 50 mcg i started itching but i am ok with the 25 mcg and when its still bad then i can always take a norco to help,

    I am prety sensative to most of the medicarions. But fentynal seems ok, maybe you can try that kathy
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Yes, I was thinking that may be the way to go but do you think that would be in addition to the hydrocodone? Unfortunatly for you, you have had a good amount of experience with pain meds so I really respect your posts and learn from each and every one. Thanks for the idea. I am trying to put together a less dramatic (than morphine) plan of action.

    Don't you think the morphine was a little extreme?
    alexhurting said:
    Maybe the fentynal patch ? I am using the 25 mcg which hellps some along with norco. Norco alone just wont do anything anymore. Start off on the low fentynal patch. When they give me the 50 mcg i started itching but i am ok with the 25 mcg and when its still bad then i can always take a norco to help,

    I am prety sensative to most of the medicarions. But fentynal seems ok, maybe you can try that kathy
  • When I was first injured, I was (after a couple of other trials on different meds) put on percocet. After awhile, 6-7(5 hydrocodone/325 tylenol) just wasn't helping my pain. I was started on MS Contin 15 with the percocet for breakthrough. I found that it helped me since it was long acting.

    I didn't have to take my percocet every three hours, on the hour. Unfortunately over time, due to tolerance and increased pain, I am now on 45 mg/3 times a day, with the percocet for breakthrough.Still at about an 8 on the pain scale.

    Being that it is time released, the 15 mg is really not overly strong and I did not experience any side effects when I started it.Seems to be a good first ER med. Everyone is different though, just my thoughts on it.

    Hope that you and your doctor are able to find something that helps you.

    >:D< Karen
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • When I first injured my back after one month of Percocet I was put on MS Contin. I hope it helps your pain. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Hi Kathy, morphine isn't that big a step up from hydrocodone really - it's about the same strength as oxycodone (allowing for equivalent oral dosage). It might work well for you if your current medication isn't cutting it any longer. Good luck in keeping your pain under control, whatever you and your doctor decide.
  • Well look at it this way. Fentynal i believe is actualy stronger then morphine, only good thing about the patch is you dont have to digest it, Fentynal patch also has i think hydrocodone in it and i think methadone mix or something like that. Hell of a combo eh? Lol thats why its ok to take hydrocodine with it to increase the affect as needed.

    I tried the morphine in a pill form but it was way diferent then when i had it in iv in the hospital in a pill. It realy messed with my stomach! Good luck,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Morphine and me get along, but I also get along with Percocet (and when the Pharmacy switches me...Oxycodone is fine too). Sadly I guess we have to try different meds to see what blends best?

    Morphine is not that scary. The doses change just like Oxy and other meds - weaker/stronger, don't let the "name" scare you. :)

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Exactly, Brenda! People often seem intimidated by the mere mention of morphine, but it's really no different from any of the other strong opioid agonist drugs.

    The fentanyl patch contains just fentanyl, no hydrocodone, methadone, or anything else that isn't fentanyl. ;-)
  • The first time I had morphine (IV btw) was back in 2002, and I was totally happy! I (unknown to me at the time) had a strangulating tumor of an ovary! I was lucid, but the pain, wow...dropped big time! I was given the tablet form after surgery - not that good, but not bad. "Names" of certain drugs even freak out us chronic pain types...

    Sad huh? :) Grrrrrr....

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Kath,

    From my experience we tried morphine and it did little or nothing for me, personally, I prefer percocet over morphine. I too use fentanyl and had no issues using it in the 25 mcgs, along with percocet for break through. I was told the fentanyl was in the same family as perc so sense I have done fine on it for so long was the easy switch. We talked about something else but is in the vicodin family and I don't do well with vicodin makes me sick to my stomach. But personally I found that is the mix of medications overall that help. So while I do have those medications I also use lyrica and soma. Now it didn't happen all at one time, but rather over a period of time. Be sure whatever you do, to only change one med at a time, so if you have any ill effects you know which one is the culprit.
  • Great advice! And yes, the name "morphine" has caused a negative impression and scared me to death! Plus, suddenly my insurance (BCBS GA) is making it unbearable difficult to get anything but generic drugs. Keep in mind that my hub and I (self-employed) pay nearly $2k a month for insurance and STILL they keep bugging me. They gave me a list of "preapproved" generic drugs and MScontin as well as the fentynl patch are on it. I've already had them turn down 2 drugs - 1 was a patch but I can't recall it's name (hugely expensive) and the other is Exalgo. Now my doc wants to prescribe Kamdian but I know it will be turned down as well!
  • Isn't percocet stronger than hydrocodone? Maybe I should suggest that? Is there such a thing as a time-released percocet? One of the things my pain doc wants to try to do is get a level amount of meds in me so I don't have these "episodes" a few hours after taking my meds.
  • Time released percocet would be Oxycontin......perocet contains oxycodone /tylenol...Oxycontin is oxycodone with no tylenol in the extended release form.
    I don't know if I would go to fentanyl right now for pain management, but maybe try percocet or the next step would be Oxycontin if you really are uncomfortable with morphine.
    I've been on many different pain meds over my 16 plus years in pain management, including methadone, fentanyl, Opana ER and IR, Oxycontin, oxycodone, and several others.....fentanyl is usually reserved for pain patients who have tried most of the other pain medications or have been in pain management for a long, long time and have tried and failed to successfully treat their pain levels.
  • I went straight to Kadian from LorTab and have had great results. Now I take 30 mgs of Kadian 2x a day and 1 10/500mg LorTab at lunch and so far it's a major improvement! Hope you have major pain relief!!
    Hugs~
    Dusty
  • Kadian - I have a prescription ready for me at the docs office but I haven't gone to pick it up because 1) it "looks" so strong and 2) I'm afraid my insurance won't pay for it after 2 drugs being turned down already. You have encouraged me so much, especially because you made the same "jump" that I am looking at. Ya know, I have many years of education and many years of work experience but this medication maze is so frustrating! That's why I LOVE this website. I feel like you guys are my family. I don't have to keep "apologizing" for not being "normal" when I am here.
    dustygal said:
    I went straight to Kadian from LorTab and have had great results. Now I take 30 mgs of Kadian 2x a day and 1 10/500mg LorTab at lunch and so far it's a major improvement! Hope you have major pain relief!!
    Hugs~
    Dusty
  • After having a 2 level ACDF (5-7)four years ago I was put on Percocet. That only helped for a short time. My pain management doctor then put me on Fentanyl patches and oxycodone for breakthrough pain. I was very pleased with the results. The patches are changed every 72hrs. Fentanyl is a very strong drug, it's approximately 100 times stronger than morphine and absorbs through your skin. My dosage started out at 12.5mcg and I'm up to 100mcg and changing the paches every 48hrs rather than 72hrs.I will have to go through rehab to ever get off of this drug even though I get very little relief from it now.
    I would try any other drug but Fentanyl. You may get relief from your pain but it is very addictive. I wish I had never started on it.
    Best of luck, I hope you can find something that will relieve your pain.
  • Kathy, I'm on morphine and have been for three years now. It seems to work well for me and I havent had any bad side effects from it, other than it seems to cause more constipation than percocet for me (with senna I'm fine) and it makes me sleepy (if I'm up and about I'm fine).

    With any of these meds they always correct for strength differences when changing between them so its not like you will be overwhelmed by a change in meds. You will feel the effects the first week or so, just like starting any new med, but your body will get used to it fairly quickly. So really it comes down to how the drug works for you. There is a generic for kaden (ms contin)in case your insurance doesnt cover the name brand.

    It takes time to figure out what is the best for you and many people often change over time due to building up tolerance. Good luck which ever way you decide to go, but I wouldnt let a drug stigma influence your choice. Good medical advice and what works for you is much more important.

    Mitch
  • Thanks so much! And I am sorry this patch has had such an addictive affect on you! I am always worried about physical dependence. I appreciate your response and thank you for taking the time to give me your experience!
    beverly62 said:
    After having a 2 level ACDF (5-7)four years ago I was put on Percocet. That only helped for a short time. My pain management doctor then put me on Fentanyl patches and oxycodone for breakthrough pain. I was very pleased with the results. The patches are changed every 72hrs. Fentanyl is a very strong drug, it's approximately 100 times stronger than morphine and absorbs through your skin. My dosage started out at 12.5mcg and I'm up to 100mcg and changing the paches every 48hrs rather than 72hrs.I will have to go through rehab to ever get off of this drug even though I get very little relief from it now.
    I would try any other drug but Fentanyl. You may get relief from your pain but it is very addictive. I wish I had never started on it.
    Best of luck, I hope you can find something that will relieve your pain.
  • Thanks for the encouragement Mitch. I really, truly appreciate my doctor. He cares about me and does everything he can to help me. That being said, there is no substitue for personal experience. One thing I have learned is that nobody understands how disabling chronic pain is unless he/she has been there. My pain doc has never taken these meds personally so I also rely on folk like you to give me their insight. 4 years ago, before my grade 3 spondy and spinal cyst was discovered, I used NO drugs except occasional ibuprofen. I was a runner for 25 years! I am still trying to learn this pain relief thing and it is hugely intimidating to me. I am soon to be 60 and have had a successful career, 4 children and 5 grandchildren. I still manage to work 50 hours a week. But this is the toughest thing I've ever had to deal with. Losing your health is a death in and of itself. I can't tell you how much I appreciate your advice. Thanks. Kathy
    neednewback said:
    Kathy, I'm on morphine and have been for three years now. It seems to work well for me and I havent had any bad side effects from it, other than it seems to cause more constipation than percocet for me (with senna I'm fine) and it makes me sleepy (if I'm up and about I'm fine).

    With any of these meds they always correct for strength differences when changing between them so its not like you will be overwhelmed by a change in meds. You will feel the effects the first week or so, just like starting any new med, but your body will get used to it fairly quickly. So really it comes down to how the drug works for you. There is a generic for kaden (ms contin)in case your insurance doesnt cover the name brand.

    It takes time to figure out what is the best for you and many people often change over time due to building up tolerance. Good luck which ever way you decide to go, but I wouldnt let a drug stigma influence your choice. Good medical advice and what works for you is much more important.

    Mitch
  • Great advice! Don't take more than you should though, I have seen plenty of people get addcited to pain meds and they suffer for the rest of their lives.
  • Well, I now have a prescription for 15 mgs mscontin every 12 hours and I'm going to give it a try. My insurance company has gotten bad about approving anything but generics! In the process, I ran across a good (I think) narcotic equivalency chart on the internet and following is the link for those interested. Will let you know how the new drug is working....

    http://www.rphworld.com/pharmacist/viewlink-23077.html

    Kathy
  • I am now on 15 mg ms-contin every 12 hours. How long does it take to reach full strength in the body? Do you just stop all hydrocodone the minute u start taking ms-contin?
  • Hi Kathy,
    I think we both started taking MS Contin the same time, I am on day 5. Anyways I called my doc office to ask them if I could take any percocet 10/325 as rescue medicine (I was taking 6 percocet a day, one every four hours) when my doctor switched me from my IR medicine to ER medicine. Anyway I never got to talk to the doctor but the receptionist told me DO NOT take any percocet with my MS Contin but that is me, check with your doc this morning and please post back what they told you. I think some advantages of not taking any hydrocodone is you lessen the chance for overdose and do not build up a tolerance your doctor wouldn't be aware of.
  • Painfully. Most times when you are changed over from a IR (immediate release medication) to an ER (extended or sustained release) medication, doctors expect their patients to give it a fair trial to see how it is working for you.. This is anywhere between two weeks and a month, although with most of the pain medications, once a steady blood plasma level of medication is in your blood stream (after a couple of days), you start to see the pain levels dropping, Patients new to the continuous medication delivery that ER meds give often think that the meds aren't working because there is no onset of pain relief like there is with the IR versions. Most people can "feel' the meds release with the IR meds but not so much with the ER versions so they believe they aren't working.
  • The MS Contin ER was not working but I am going on day 6 and it seems I am in a lot less pain most of the day. Would love to hear from those in the community who have experience with MS Contin?
    Thanks,
    Scott
  • scinmyheartsscinmyheart Posts: 79
    edited 09/25/2013 - 7:43 PM
    Painfullyhappy1121 said:
    The MS Contin ER was not working but I am going on day 6 and it seems I am in a lot less pain most of the day. Would love to hear from those in the community who have experience with MS Contin?
    Thanks,
    Scott
    Scott, up until a month ago, I was taking generic MM Contin 30mg three times daily with 10mg oxycodone for breakthrough three times a day. Twice a day with the extended release was never enough, and I found every eight hours worked so much better. My Florida dr told me up to 30% need it every eight hours. Due to a situation at my most recent pain management facility, I was in the process of being weaned off where I was taking 15mg twice a day and no oxycodone. I will spare you that horror...fast forward to now where I am taking 15mg MS Contin three times a day and three 10mg oxycodone, and I feel about the same pain relief. Personally, I would not want to be without the breakthroughs, but doctors seem to have different opinions-the only constant is that none have walked in our shoes to truly understand...all they go on is "studies" and xxxx like that.

    Dropping the oxycodones cold turkey, even while having some morphine in me, was no picnic, so I feel for you...I still had the overall anxiety and restless legs/arms when laying down that allowed less than two hours light dozing the whole time close to a week..then my muscles were so sore from tightening them up trying to get rid of that feeling...my loose stools were only for a few days and no throwing up

    I am going on almost four years with the MS Contin, so we will see how long it keeps up...I have had no side effects from it that a good dose of Miralax won't cure

    Good luck getting everything under control

    Post Edited for Inappropriate Language by The Spine-Health Moderator Team
  • Yea, not taking the percocet 10/325 IR six times a day, every four hours to MS Contin 15 mg X 2 and titrated to 30 mg X 2 is very uncomfortable. I just posted a thread looking for an October tapering buddy because on my current medication I would rather try living with the pain then feeling like this. When you tapered what did you find useful? Also anyone else have anything to offer?
    Thanks
    Scott
  • I notice this subject is a few months old but I could not resist replying as I just had Morphine Sulfate ER 15mg added to my Hydrocodone 10/325's today. I was a little nervous about adding the morphine, but I have a high tolerance to opiates after 6 years of pain management. I also took the Fentanyl patch, Butrans patch, Oxycodone, you name it. So far I have received much relief today. Granted I am a little drowsy but I can still function and spell words here, LOL. Just always be careful with dosage. So many people over do the prescribed amount and I am guilty of this at times myself. Like others have said, don't let the word morphine scare you, If you really are concerned simply call your doctor!!
  • The use of extended release medications is meant to replace the use of the short acting or immediate release meds you were taking. If you absolutely do not need the short acting versions, then don't take them.
    Extended release versions of opiates are meant to handle your day to day, normal amounts or baseline amounts of pain levels, notice that I did not say eliminate it, but handle it......breakthrough meds are meant to be used on those days when the pain levels flare significantly, and the use of other methods of dealing with the increased pain fail....then and only then are breakthrough ( short acting meds to be used) to treat those flares. If you use them with any regularity, they simply add to the amount of baseline opiates in your system and leave nothing to treat those flares .
  • I had a double mastectomy Jan 28 2014. I have also had chronic back and nerve pain. For the last 4 months I have been on Dilaudid 8mg. After the surgery he added MS Cotin sulf we 60mg. It works so much better then Percocet ever will. If your medications aren't working to control the pain then change it. The morphine is long lasting.
    Female 44 survivor of thyroid cancer...just had two surgeries for breast cancer and chronic back pain. Live in upstate ny. On 8mg dilaudid 6 a day and 60mg morphine sulf er 2x day
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