![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by kerria on October 22, 2006, at 8:58:45
Hi Everyone, hi Ed uk,
Soon i'm having surgery for the terrible nerve injury- pudendal nerve entrapment. Things fell apart with my T and everything is a mess with my life now . This surgery isn't always successful to help pain but drs expect me to try - i have appt soon to talk about the surgery with one dr- another possibility is traveling to Texas.i ran out of breakthrough oxycontin - late for appt for meds because i forgot to call for appt-and have morphine breakthrough instead that i'm using. 15mg tabs from last year when i used that after the dr became upsetn before i hadd a diagnosis for pain.
Either it's not good anymore because of being a little over a year old or morphine is so much weaker for the pain i have. Why isn't it working?
i never thought i'd have to suffer with so much pain. i thought that the morphine would work simularly but it doesm't . Why do you think not?Is a year too old for this morphine breakthrough medicine? i know oxycontin is better for nerve pain and i have enough to last until my appt but i thought that i could use the morphine breakthrough with better success in an emergency. It doesn't work. i'm in pain now and can't take anything more until noon. Not even advil because i'm scheduling surgery soon:(
It's so hard to be in pain now- so triggering- it's making me a mess. i wonder why this morphine breakthrough isn't working.
thank you for your thoughts,
kerria O
Posted by Phillipa on October 22, 2006, at 12:16:26
In reply to Difference between morphine and oxycontin- ed uk?, posted by kerria on October 22, 2006, at 8:58:45
Kerria good question. At first I was going to say that morphine is stronger than oxycodone but then you said that for nerve pain the opposite? So I have no idea. Can you call you doc? Love Phillipa
Posted by Racer on October 22, 2006, at 12:35:46
In reply to Difference between morphine and oxycontin- ed uk?, posted by kerria on October 22, 2006, at 8:58:45
I don't know enough about the mechanism of action of oxycontin to tell you for sure, but morphine acts by suppressing Substance P, which makes it very effective against dull pain, but not terribly effective for sharper pains.
Sharp pains are communicated by glutamate pathways, dull pain by glutamate and Substance P. Morphine doesn't necessarily do much for the sharper pains associated with the nerves using only glutamate. Aren't you glad to know all that? I'm sure it helps a lot with your pain, knowing something about the nerve pathways that communicate it to your brain... (Not.)
As for why the Oxycontin worked and the morphine isn't working as well, my guess is that, if you've been using Oxycontin for a while, you've become accustomed to it. Oxycontin is one of the most effective pain relievers known to modern medicine. Morphine is very effective, too, but it's not necessarily *as* effective. If you're used to using a backhoe, a shovel won't seem all that effective.
I'm sorry. The only thing I can suggest is to call for that appointment as soon as you can, and maybe ask for a partial prescription you can pick up in the meantime. Good luck, both with getting the drug and with your surgery.
Posted by ed_uk on October 22, 2006, at 12:43:55
In reply to Difference between morphine and oxycontin- ed uk?, posted by kerria on October 22, 2006, at 8:58:45
Hi Kerria
I'm sorry to hear you're still not well. Morphine isn't particularly well absorbed orally - oxycodone is more potent than morphine when given by mouth.
>Is a year too old for this morphine breakthrough medicine?
No, I'm sure the morphine is fine. The dose you're taking for breakthrough pain probably isn't high enough to be effective though. Even so, oxycodone has a reputation for being more effective than morphine for nerve pain, so it might not work as well as the oxycodone even at a higher dose. I hope you can get some more oxycodone ASAP.
Ed
Posted by ed_uk on October 22, 2006, at 12:45:51
In reply to Re: Difference between morphine and oxycontin- ed uk? » kerria, posted by Phillipa on October 22, 2006, at 12:16:26
Hi Phillipa,
>At first I was going to say that morphine is stronger than oxycodone
No, morphine is not stronger than oxycodone for any type of pain.
Ed xxx
Posted by Phillipa on October 22, 2006, at 12:58:20
In reply to Re: Difference between morphine and oxycontin- ed uk? » Phillipa, posted by ed_uk on October 22, 2006, at 12:45:51
Ed why do they give morphine IV when the orals have not worked or in cancer or post op via a pump? We had to keep all kinds of records of breathing etc when someone was on morphine. Must be cause it's IV and it is delivered directly into the vein and bloodstream bipasses the stomach? Love PJ O
Posted by notfred on October 22, 2006, at 13:04:51
In reply to Re: Difference between morphine and oxycontin- ed uk? » ed_uk, posted by Phillipa on October 22, 2006, at 12:58:20
Must be cause it's IV and it is delivered directly into the vein and bloodstream bipasses the stomach?
Correct, GI acid makes esp. morphine less effective.
Dose for dose morphine is stronger than oxycontin,
but less effective than oxycontin when taken by mouth. morphine effects breathing more than many
opioids.
Posted by ed_uk on October 22, 2006, at 14:38:50
In reply to Re: Difference between morphine and oxycontin- ed uk? » ed_uk, posted by Phillipa on October 22, 2006, at 12:58:20
Hi PJ
>Ed why do they give morphine IV when the orals have not worked or in cancer or post op via a pump?
Morphine (and oxycodone, diamorphine etc) all work well when given by injection.
>We had to keep all kinds of records of breathing etc when someone was on morphine. Must be cause it's IV and it is delivered directly into the vein and bloodstream bipasses the stomach?
Yes, that's right, and the doses given postoperatively may need to be high - which is important in patients who are not used to receiving high doses. Residual effects of anesthetics may also be important. Respiratory monitoring is not necessary when morphine is given by mouth.
Ed
Posted by ed_uk on October 22, 2006, at 14:44:50
In reply to Re: Difference between morphine and oxycontin- ed, posted by notfred on October 22, 2006, at 13:04:51
Hi
>Dose for dose morphine is stronger than oxycontin
Morphine and oxycodone are similar in potency when given by injection. Oxycodone is more potent orally.
>morphine effects breathing more than many
opioidsMorphine, oxycodone, hydromorphone and the other potent mu agonist injectable opioids all appear to affect breathing to essentially the same extent when given at equianalgesic doses.
Ed
Posted by madeline on October 22, 2006, at 14:49:26
In reply to Difference between morphine and oxycontin- ed uk?, posted by kerria on October 22, 2006, at 8:58:45
Have you and your doc considered neurontin? It can have an affect on neuropathic pain.
Also, one thing you have to consider when dealing with the opioids is tolerance. The more you take, the more you need over time.
I'm not saying you need to run out and take a bunch more morphine, simply that tolerance could explain it.
M
Posted by notfred on October 22, 2006, at 15:11:16
In reply to Re: Difference between morphine and oxycontin, posted by ed_uk on October 22, 2006, at 14:44:50
>
> >morphine effects breathing more than many
> opioids
>
> Morphine, oxycodone, hydromorphone and the other potent mu agonist injectable opioids all appear to affect breathing to essentially the same extent when given at equianalgesic doses.
>
I took care of my father for the last few months of his life due to lung cancer. Morphine has a property for improving some efficencies in breathing that other opioids do not have. It is an effective treatment for bronchialspasm/dyspnea, thought it does slow breathing. The hospice doc, oncologist, and pain meds doc all indicated Morphine was the drug of choice for treating bronchialspasm/dyspnea in end stage cancer.I had to keep close watch on dads resperations per min, as he was at about 5 breaths per min. Morphine had a greater effect on depressing resperations than oxycodone or fentanyl, at least in my experience. None of them helped with bronchialspasm/dyspnea
Needless to say one will do almost anything to stop bronchialspasm/dyspnea in a loved one who is only getting 5 breaths a min.
Posted by ed_uk on October 22, 2006, at 15:19:48
In reply to Re: Difference between morphine and oxycontin, posted by notfred on October 22, 2006, at 15:11:16
> The hospice doc, oncologist, and pain meds doc all indicated Morphine was the drug of choice for treating bronchialspasm/dyspnea in end stage cancer.
Morphine is the traditional choice for dyspnea, but other opioids are also used. The degree of respiratory depression depends on the dose and the degree of tolerance, as well as other factors. I'm sorry for what you went through.
Take care
Ed
Posted by Phillipa on October 22, 2006, at 19:36:55
In reply to Re: Difference between morphine and oxycontin » notfred, posted by ed_uk on October 22, 2006, at 15:19:48
Me too notfred so sad and a helpless feeling. Love Phillipa
Posted by MidnightBlue on October 22, 2006, at 20:19:03
In reply to Re: Difference between morphine and oxycontin- ed uk? » kerria, posted by ed_uk on October 22, 2006, at 12:43:55
Ed,
Just a comment. I had a shot of demerol a few weeks ago when I had some tests done, and for the first time in a LONG time I didn't hurt. So if I'm struggling to make it on Celebrex (a very low dose) and Tylenol, what type of med (other than the "big" guns) would help?
MB
Posted by ed_uk on October 24, 2006, at 15:36:33
In reply to Re: Difference between morphine and oxycontin- ed uk? » ed_uk, posted by MidnightBlue on October 22, 2006, at 20:19:03
Hi MB
You could try a low-potency opioid such as codeine (every 4 hours). Codeine is available alone or in combination with acetaminophen.
You could also try hydrocodone. Hydrocodone is a high-potency opioid which is available only in combination with acetaminophen (eg. Vicodin etc).
Before you take any opioids though, make sure you're taking 1000mg acetaminophen every 4-6 hours (up to 4000mg per day).
Take care
Ed
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.