Morphine, Fentanyl, and other alternatives for pain relief

Discussion in 'Fentanyl' started by bob78, Sep 7, 2006.

  1. bob78

    bob78 Silver Member

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    Hi swim suffers with Chronic Pancreatits and takes 30mg MST twice daily along with 20 mg Sevredol. I have been taking this for a while but now his surgeon wants him to try Fanantyl (patches and lozenges) rather than upping the dose of morphine.
    I wanted to ask if anyone can suggest other options swim can suggest to the pain clinic when he visits them next week.
    Swim likes the pain killing effect of morphine (he's in a lot of pain some days) but also likes to take morphine for recreation (but not IV).
    Swim thought some people might gave some alternative suggestions to Fenantyl.

    Cheers,
    bob.
     
  2. acexnx316

    acexnx316 Silver Member

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    Fentanyl is a great drug if used as presribed. Why not stick with the Fentanyl? It is great at pain relief. If you are absolutely totally against it though, then maybe ask for him to put you on a low dose of Methadone (Also work wonders if taken as directed). I would start with 10mg-20mg a day and see how that works.

    Everyone's body chemistry is different though. If it were me, I would go with the Fentanyl for pain relief, but like I said, Methadone is also great for pain and also has a much longer half life and will last you anywhere from 24-36 hours per dose as long as you keep taking it as directed.

    Just my 2 cents.

    Pz.
     
  3. Forthesevenlakes

    Forthesevenlakes Platinum Member

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    swim cant really think of an alternative to the fentanyl aside from methadone. sometimes swims are put on fentanyl patches with hydromorphone (dilaudid) for breakthrough pain but thats somewhat rare. it would seem to be more common to try to use methadone based on the longer halflife like acexnx said. but also, I would just stay wiht the fentanyl. it works very well for many lab rats.
     
  4. bob78

    bob78 Silver Member

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    Thanks for the replies, I think I am going to give the Fenantyl a go. After asking a few people the majority suggested sticking to Fenantyl.

    Cheers.
     
  5. acexnx316

    acexnx316 Silver Member

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    Yeah, good choice. I think Fentanyl will treat you right. Basically you put a patch on your skin and keep it on there for 72 hours (3 days). This will control your pain throughout the day for 3 days. And then you just take off the old patch and put on a new one; repeating the process every 72 hours.

    You also said you were getting the Fentanyl pops (Actiq). This will help you out immensely because while the patches will help you throughout the day, if you happen to experience any breakthrough pain, you just use a pop and that will be fast acting to help satisfy the breakthrough pain.

    I think you will be all set and this will help with the pain greatly.

    If it does not at first, give it at least a week or two since the patches need to build up the medicine transdermally so that you will have a steady amount of the narcotic in your system at all times.

    Also if you do not seem to be getting pain relief after a few weeks, let your doctor know. He may need to up the dosage amount of both the patch and the pops. Keep in mind, the highest dose that the patch comes in is 100mcg/hr (Micrograms per hour). Where as the pops come in a highest dose of 1600mcg (Micrograms). The patches release the amount of micrograms per hour for 72 hours and the pops release the amount of micrograms instantly until the entire pop is completely dissolved. And if you happen to get to get up to a 100mcg/hr patch and a 1600mcg pop and it still isn't completely helping your pain, multiple patches may be used at once (I.e. applying 2 or more 100mcg/hr patches or any combination of patches; i.e. one 100mcg/hr patch and one 50mcg or one 75mcg patch on your body in different spots at once). The same applies to breakthrough pain with the pops. If 1600mcg pops were not helping, you could use more than one 1600mcg pop or any combination of dose sizes, i.e. 800mcg pop or 1200mcg pop.

    They may start you on a lower size patch and pop to start and see how you respond, but I just wanted to let you know what the highest dose of each was, just in case your doctor tries to give you a 25mcg/hr patch and a 200mcg or 400mcg pop and tells you that that is the highest amount out, trying to screw you out of adequate pain relief.

    However, I don't know your background, and depending on it, the doctor may start you on the lowest doses possible and work from there to see how you respond. Some people are content and pain-free with the lowest amount, where some people need multiple doses of the highest. Everyone and every situation is different.

    Good luck and I wish you many pain-free days ahead. Feel free to ask if you have any more questions and I will be happy to answer them for you. Also let us know what happens when you see the doctor, what he says, and what he prescribes you to keep us updated and let us know if it ends up working for you. If you have AOL Instant Messenger, feel free to IM me any time, my screen name is NEADmike.

    Take care and have a wonderful day!

    Pz.
     
  6. bob78

    bob78 Silver Member

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    Thanks acexnx316, I will let you know what he's been prescribed next week after seeing the pain clinic. In the mean time he's thinking about potentiating his current pain relief.

    Cheers, :)
    bob78.
     
  7. Fantasian

    Fantasian Gold Member

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    Just another note, Have you tried other forms of pain relief that arn't Opiate/narcotic based. SWIF has an ongoing condition that gives me severe abdominal pain and he was on morphine and other strong opiate for long periods of time. This significantly reduced his quality of Life as he was constantly doped up which he didnt like. I can imagine that a chronic condition like Pancreatits is similar.

    Just wondered whether You had tried the following:

    2 Anti epileptic drugs that effects nerves controlling pain.
    Gabapentin
    Pregabalin

    Combining Benzodiazepines to potentiate opiates:
    Diazepam
    Lorazepam

    Tricyclic antidepressants affecting nerve endings:
    Amitriptyline.

    Non opiate alternatives:
    NSAIDS - Diclofenac (among others)
    Nefopam

    I just feel that prolonged strong opiate therapy is very unpleasent and can lead to quality of life deteriorating rapidly. Opioid therapy in my oppinion for pain should only be used as a final and last resort.

    On a side note you should also beware of you's recreational use as using high doses of opiates every so often for a high will reduce their effectiveness at theraputic dosages for pain.

    Whatever happens Good luck and feel free to ask about any of the information above and ill answer to the best of my ability.
     
  8. Forthesevenlakes

    Forthesevenlakes Platinum Member

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    to the starter of this thread:

    please read swiF's response very carefully. swim realizes he knows another lab rat with chronic pancreatis who does not take any narcotic pain medication at all. he does carefully have to manage his diet and take a proton pump blocker, but he does not regularly use opiates. this lab rat occasionally takes them for breakthrough pain but for the most part manages to do just fine with small amounts of benzodiazepines (2 mg xanax), the proton pump inhibitor, and cannabis. I believe there may be another drug like gabapentin that he uses. so talking to the doctor about different options is worth a shot too. there is no ceiling for opioid tolerance, and while You definitely wants to be pain free, there may be ways to assist this than simply taking increasing levels of opiates. best of luck to swiy.
     
  9. jesusfreak666er

    jesusfreak666er Newbie

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    as said in above posts, fenatyl patches are really a miracle drug for chronic pain suffers, that is if used as directed, fenatyl is something like 100x more potent than morphine I think more so abusing and extracting usually leads to nothing but ods some say smoking is safer but thats a different thread, fenatyl is a great alternative to daily morphine.... I say listen to swiys surgeon he knows wat hes talkin about.
     
  10. bob78

    bob78 Silver Member

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    SwiFantasian - I has never tried anti-epileptic drugs, he used to take 2mg Lorazepam but the GP stopped it when the pain relief was increased, he has been given diclofenac (voltorol - it worked really well) as a suppositary in hospital and was given the tablets to take when he went home but they did not work as well. Swim's never taken Tricyclic antidepressants either.

    forthesevenlakes - Other people with chronic pancreatitis may have a different experience. Until July of this year I was doing ok and only taking Codeine every now and then, he was diagnosed 5 years ago. But after having a very close call in hospital in July his pain has been constant and he's already lost over 2 stone. Usually a couple of weeks after a bad flare up he's back to normal and not in pain, but the doctors predicted it would get a lot worse and it has. His pancreas is nearly destroyed and swim sometimes wishes they would just whip it out.
    Swim wishes he smoked cannabis but he can't stand the stuff.

    It would be good if the pain clinic prescribed something with not as strong side effects as morphine that actually worked. And after reading up on Fanantyl I do not like the sound of it, as he does not want to take something stonger than morphine for fear of getting addicted.
    Do you think the doctor at the pain clinic would mind if swim suggested some of the pain relief members on this forum has suggested?
     
  11. jesusfreak666er

    jesusfreak666er Newbie

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    dont fear that, its absorbed very slowly lasts usually up to 3 days... ppl extract to get high, but if used as directed its a good alternative to "pill a day" drugs like cotins (ms and oxy) and much better of an option that something as short acting as perks or plain morpine sulfate.... its really a less addictive alternative if anything, though saying any opiate is less adictive is kinda kidding yourself.
     
  12. bob78

    bob78 Silver Member

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    Hi jesusfreak666er, I suppose being a patch it takes away some of the potantial for abuse. I find if he takes 20mg pill of sevredol and it does not work he may be tempted to take another half pill. With the patches that would not be an option.

    Thanks for the replies.
    Bob78.
     
  13. Forthesevenlakes

    Forthesevenlakes Platinum Member

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    bob78, You should be fine suggesting some of these options to a surgeon. the fact that You would be suggesting an alternative to (or additions to) fentanyl would signify to them that You is not just drug-hunting for opiates. they may even have not have considered some options that may come to their mind after suggesting something. You has nothing to lose. good luck.
     
  14. Fantasian

    Fantasian Gold Member

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    Bob78: I suggest that you mention to your pain clinic how well Diclofenac suppostries worked. They and you should be much happier using NSAID's than strong opiates and they can give you rectal admin for use at home SWIF used these for a while but they wern't that effective for him. SWIF's most effective pain killer was pregabalin however it is quite uncommon, gabapentin was always the more commonly used. It might be worth mentioning this too. Both NSAID's and anti-epileptics dont have much if any abuse potential.
     
  15. flyingscotsman

    flyingscotsman Newbie

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    tell swim he can have both

    bob tell swim he can have both morphine and fentanyl patch as they stat you of at 25 to steadly up it till pain is gone a friend of mine know what i mean get morphine and fentanyl patch his patch is up to 125 in matter of 2 weeks
     
  16. Forthesevenlakes

    Forthesevenlakes Platinum Member

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    hm, I has heard of morphine and fentanyl concomitantly, but its a bit more rare. morphine has a much lower safety margin than fentanyl, even though fentanyl is the stronger drug. this makes mixing the two somewhat dangerous, and many doctors prefer to err on the side of caution and prescribe both fentanyl patches and lollipops to treat chronic and acute pain.

    flyingscotsman, please have You clarify swiy's statement. although tolerance to opiates builds fast, it does not build so fast that one would go from needing 25 mcg/hr of fentanyl to 125 mcg/hr in two weeks. nor, I think, would any doctor be so rash as to up the dosage so quickly. usually it takes a couple of months to make the transition from 25 mcg/hr to 50 mcg/hr. sorry if it sounds like I am in disbelief at swiy's situation, as he doesnt know swiy's whole story, but that increase in fentanyl so quickly would be very lethal to most people, and its best not to ask for an increase in dosage unless absolutely necessary.
     
  17. bob78

    bob78 Silver Member

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    swim also thought that going from 25mcg to 125mcg in two weeks sounds a bit mad, but i guess I will find out tomorrow if I am to try out the Fentanyl or stick with the MST/sevredol combo.
     
    Last edited by a moderator: Sep 14, 2006
  18. Fantasian

    Fantasian Gold Member

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    Please keep us informed on SWIBob's progress.

    I am interested to see how your doctor feels about giving alternate pain killers and how effective they are...
     
  19. bob78

    bob78 Silver Member

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    Swim seen the pain clinic last week and there doctor wanted swim to have his MST dose increased to 60mg twice daily and swim can take the quick release morphine as normal (and double if needs be). He knows swim's surgeon suggested Fentanyl, but he thinks as soon as I find his right dose of MST he will be feeling a lot better.

    Swim mentioned the alternative pain relief but he dismissed using benzo's due to being on morphine. He didn't like the idea of taking Amitriptyline so did not ask about that, and he would not prescribe anti-epileptic drugs either but gave no reason as to why. But swim can try the Voltarol (diclofenac) in suppositary form if he likes.

    Now if he would only write to swims G.P so swims G.P can up his dose. My doctor said he won't increase the MST dose until the pain clinic confirms that he can take the higher dose. Which is fair enough, but swim wishes they could get a move on.

    Cheers,
    bob.
     
    Last edited: Sep 20, 2006
  20. Fantasian

    Fantasian Gold Member

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    Good to hear your at least moving forward, it's a shame to why he didnt offer reasons to not using the other forms of pain medication. SWIF if looking for genuine pain relief would choose NSAIDS (like diclofenac) over an opiate very day of the week. Especially if they are equally or more effective!
     
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