Morphine - does it work for everyone??

Hi there, firstly to keep to the rules, I am not looking for dosages etc, but I have an appointment at the doctors on Tuesday and I'm quite embarrassed.

I have been on MST 30mg twice a day and take approx 3 x 5ml of Oramorph a day, this has been upped from 6 weeks ago when I took just 10mg of MST ( plus full dose of Cocodamol), the thing is I am now taking a lot more "painkiller", but I have seen no relief in pain (in fact I think I am worse at times). I think I was just the same before when I was taking Cocodamol full dose, topping it up with tramadol.

Does morphine work for everyone?, is it good for all types of pain? I am just embarrassed about continually going back to the doctor saying things are not working (although I am waiting for my pain clinic appointment). I just thought that morphine was the gold standard of painkillers but it just does not seem to cut it, ebpven when I take the Oramorph, I don't even notice any difference.

I just don't understand it.

32 Replies

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  • Interesting, I seem to be intolerant to so many painkillers, when I say that, it's as though I've not even taken the painkiller, and worse still some of the side effects are awful, so as I'm not benefiting from the painkiller keep going back to GP and pain clinic to try different things.

    Sorry don't know about morphine - have asked about it, but not actually tried it.

  • Hi thanks for the reply. I'm lucky that I do not seem to get any side effects to drugs, not even the good ones (like euphoria from morphine!)

  • I can't help about the morphine bu I just wanted to say-never be embarrassed about going back and saying things aren't working. If you don't do that, they won't know it's not working. They will think it is! Remember your GP is paid to help you. I really hope the pain clinic helps. I too am frustrated by the fact that painkillers just don't seem to work. But I haven't tried the big stuff as I work and can't functionon the smaller stuff like tramadol.

  • Don't let that be a major issue in getting proper pain management. Ability to work is more likely to be affected negatively by lack of management than with the RIGHT stuff!

    I was more affected (hyper and "dithery") by DihydoCodeine than I have ever been on stronger opiates since! Plus, I don't feel any more side effects than I did with Codeine phosphate years ago (now on Buprenorphine), and I have far LESS than I ever had with Tramadol! OK, everyone' mileage varies, but the generally principle stands.

  • Morpkine isn't the b all but for pain relief but often used in conjunction with other drugs. David has 75mgs patches which last 3 days. Topped up with coco plus muscle relaxants. This works for him and with a flair up can have an extra 12 1/2 mgs patch.

    It is the complete package which has to be looked at and this is where your Pain Clinic works.

    Some people who are allergic to morphine use different cocktail of drugs.

    Oh yes he does find acupuncure helps - every 6 weeks for upper back diseases and spinal blocks.

    If he could jump up and down he'd rattle.

    Use your GP - he is the first line of help.

    Good Luck - you'll get it right.

    Pat x

  • Thanks Pat, has David found any muscle relaxants which work better than others? I had acupuncture last year, but it was difficult to say if it helped ( as my pain levels were not too bad last year). Was David prescribed the patches due to not being able to take oral drugs or do patches just work better?

  • Amitrip and bacclofen which he's been on for years. Seem pretty good and work for him.

    He was on oramorph but was self medicating so had to stop that. Too dangerous and he was very bad at that time. From what I have heard it seems a fairly low dose. But any more and he's not allowed to drive. car is his legs and you have to find a balance that works for you. That's what Pain Management is all about.

    Sorry but can't spell the drugs names!

    Pat x

  • Hi Paton' I have just read your post on Davids medication, Do I understand that he is on Morphine patches called Fentanyl which is changed every 72hrs, If so the dose is 75 micrograms and not milligrams, That would be a massive dose There are a thousand

    micro grams in one milligram, It is an easy mistake to write mg, instead of mcg,Does he have any thing else for break through pain eg Oromorph. I am sure he has tried the lot.

    Thank you for the information about the meeting in the Scottish Parliament on wed about Pain. Will you be there? I have got myself an invitation, so am going to come home with a cure for all our Pain !!!

    Kind Regards Moggiemay

  • Hi Moggiemay

    Oopsy! Yes 75 micro of morphine - with another 12 and half in reserve. That really does knock him out anf rarely uses it.Tops up with cocodramol.

    You bet we'll be at Holyrood this afternoon along with as many as we can get in. It is hude and don't think there has ever been anything this big before.

    Love to meet you but know idea who you are! If you ask someone for Pat Onions hopefully you'll find David an me!

    Big article on BBC Wales today about increase in prescripption pain killers and lack of pain clinics.

    Catch you later

    Pat x

  • Hi Pat

    I was at Holyrood today for the debate on Chronic Pain and then on to the Cross PartyGroup meeting and discussion afterwards.

    i went looking for you and asked a lot of people are you David and Pat. Could not find you. I was sitting at the top of the Table next to Heather Wallace, My name is Helen. Kind regards Moggiemay

  • Am so sorry we couldn't make after the debate. David did so well to get to Holyrood but he ran out of steam. Heather W knows us well she should have known? We were sitting just behind Susan A durin debate - she was almost in tears bless her.

    And on the BBC Scottish news there was David and I sitting in the gallery!!

    Let's hope those NHS mentioned as doing little or nothing for chronic pain sufferers get a rocket behind them now.

    Now have one very sore husband who'd better have a quiet day or I shall nail him to his chair!

    How did you think it all went?

    Pat x

  • Hi Pat I wasnt home in time to see the news,I was Speaking to Susan and we left the building together, I did say to Heather i was looking for Paton and her husband, I am always wary about giving to much away

    It was good and I had an oportunity to talk and ask questions

    I mentioned that a DR Campbell from the RIE had retired and was not replaced, He was a Muskculo Skeletal Specialist well , the cat was out of the bag, The MSPs new nothing about this and a nurse who works at the RIE said this was true. I think someone at RIE will be in trouble

    I don;t like the thought of you treating your husband to Accupuncture on his rear !!

    Take care Pat and David

    Regards Helen Moggiemay

  • Hi,i have been on morphine patches for over five years now due to back pain and iv got to say to start with they were great but its a case of once you have got used to one dose you have then got to move up to te next to cover the pain and up and up and at my highest I was on 220mgs and the side effect were so bad I just coldnt function and was lik a zombie,I have been trying to reduce the patces as the side effects were worse than the pain and now im down to 150mgs.My advice would be to try everything else before.Good luck.x

  • Thanks Sharonbag, 220mg does seem like a high dose, I'm on about 90 in total. I just don't know what my options are, I have heard of drugs like palexia, but nit sure if they are well rated. The pharmacist did say that 90mg of morphine is not a huge amount for severe pain, but I do worry that I am at that dose already after only being on it for 2 months.

  • The thing is, it doesn't matter whether it works for anyone else, it matters if it works for YOU, and not everything works as well for everyone so it's more a matter of finding something that does!

    In my own case, after "moving up" from Tramadol, I was finding a relatively large amount of Tapentadol was doing NOTHING at all, and after changing, Fentanyl wasn't doing much either, plus not lasting long, yet a much smaller equivalent dose of Buprenoprphine works MUCH better!

    Morphine is not really any sort of "gold standard" at all, just for historical reasons the one that other opiates are measured against, and MANY Opiate medications are far more powerful than morphine.

    I get the feeling that your GP is not exactly going out on a limb or putting much thought into sorting analgesia for you...

    For one thing, I am not convinced that using weak opiates eg. (codeine based) in conjunction with strong opiates (the morphine) is any sort of good practice anyway, although many seem to do this. Secondly, Oramorph is a short acting opiate, dosages are normally every 4 hours (although if like me you metabolise it quickly, it will not even last that long!) so 3 doses a day is going to leave you very up and down in terms of level of pain control, even if it does hit the spot, and because of it's short action it is more suited to breakthrough pain management than as a background, and my own experience of this type of opiate is not very effective for this reason.

    Thirdly, it isn't as powerful at that dosage as you might think, although I am also very aware that it's not a good idea to rush to higher dosages if you can possibly avoid them!

    Make sure you Doctor is on your case, Oramprph's best feature is it's extreme cheapness, not it's perfection in providing superb universal pain relief!

  • Hi many thanks for your very informative reply, I really appreciate it. I'm not dpsure if my post was clear, I now don't take the Cocodamol, just the MST and Oramorph with paracetamol.

    I guess I'm just not clued up on opiates and what else might be available. My doctors are all quite old (not that I am saying that's a bad thing), but I don't know if they are clued up on newer medicines. All they have ever offered me is the Cocodamol, tramadol and MST and the last time I saw him I think he felt that we were now at the end of the road in terms of what he can do for me.

    Do you know if there are any alternatives to Oramorph for breakthrough pain as it just does not seem to help? Also the MST, I can take it and within 4 hours I can be in intense pain. Thanks again for the reply.

  • There are lots of alternatives, and my experience is that one piate can have surprisingly different effects to another. If it was me, I would be asking about long acting pain relief option... now I know more than most that 100% pain relief all the time is NOT going to happen, and would suggest that expectations of that sort are not going to be met, but that doesn't mean that things can't be reduced to a lower overall level, and then short-acting relief available for those inevitable times when you can't sleep with it (my usual problem!) or it flares up for whatever reason (trip over or overdoing things or just one of those days.)

    I had very poor results from a Pain clinic due to a Prolotherapy type procedure that made me VERY much worse, but that doesn't say it isn't worth asking for a referral for some sort of longer term strategy, and a look at some more specialist options too but in the meantime, there are lots of longer acting preparations in terms of tablets and patches that offer a means of lowering pain for much longer periods without the big ups and downs that shorter acting drugs have, and interspersed with short acting ones for that breakthrough pain. Generally it is easier to maintain a reasonable level of pain relief than get a severe pain spell under control once it has become very severe.

    As an example (and I don't reckon I am typical, just to illustrate my "path" over a few decades) I started off on NSAIDs, (decades ago!) then added paracetamol, then CoCodamol, then due to some liver damage by the paracetamol in them I got rid of the paracetamol in the CoCodamol and used just Codeine phosphate on it's own, then Dihydrocodeine Tartrate, then Tramadol which kept me ticking for MANY years, (although it has a lot of side effects and a peculiar type of addiction!), moving on more recently from weaker opiates such as those, I moved to a drug not dissimilar to Tramadol... that is Tapentadol, but for whatever reason it was very poor with me, and I was needing Oxynorm all the time too, so then straight on to to Fentanyl patches, which worked but was problematic to keep stuck, and worked only for about half of the time it is supposed to! I them moved to BuTrans patches (Buprenorphine) which I found MUCH more effective, even at significantly lower equivalent dose, and it allowed me to get rid of the Oxynorm, and just have Temgesic (same drug in sub-lingual tablet from) for breakthrough pain. Generally I manage now with relatively few extra Temgesic, and sleep moderately well a lot of the time, unless I overdo things.

    Others find a totally different route, but just suggesting that there are different things that can be tried, and some surprising effects, such as me cutting equivalent dosages by more than half when I moved on to BuTrans, yet getting better pain relief, proving how individual such things are! I can cope with much more pain during the day, but need better relief to get any sleep, so tend to adjust any dosing with this in mind, so I rarely use extra during the day, but do much more frequently a night. I am ever conscious of not upping dosages without a very good reason, as unfortunately we all are aware that you become tolerant to opiates!

    My own experience of Opiates hasn't so much been one of them not working, more a case of the long term ill effects they have had :-(

    I am no fan of TENS, which some people seem to love, and actually gave my last machine away, the fiddling about with electrodes wasn't worth the minimal effect it produced - but have recently bought a new one (easier to use now, and much cheaper!) for certain occasions when if nothing else it acts as a distraction, whilst the Temgesic kicks in!

    I USED to get good results from a Chiropractor, (it kept me working for some years, and got me moving in some bad times) but now rarely go as my arthritic spine seems to not respond the same way any more so the recent benefit hasn't been worth the cost now (the suggestion has been that some parts of my arthritic spine might have fused now!), but it does give me some benefit for other areas when needed.

    My other suggestion to look into where pain is concerned is Magnesium levels. (I was suffering EXTREME cramping fr decades, and a degree of restless legs and jolting whist sleeping too which is why I supplement, but it did help my pain control a little too, as well as overall sleep) You may well have to pay for testing, or do as I did, just supplement at a relatively low level, I wouldn't go to extremes of supplementing anything without tests proving it necessary (inc. Calcium). I use a solution of Magnesium chloride (crystals via eBay!) rubbed into the skin, but there are other methods she suggests. Dr Myhills site has some good info: drmyhill.co.uk/wiki/Magnesi...

    I also supplement vitamin D3 with some overall benefit, including pain. No miracle cure of course. There is lots of info out there, eg. ncbi.nlm.nih.gov/pmc/articl...

    I take 5000iu daily, others suggest less, others a lot more, but again don't' overdo the calcium that is in some supplements! (See Amazon for cheapest current 5000iu capsules!)

    Vitamin B12 is another area that some suggest as improving pain symptoms eg. ncbi.nlm.nih.gov/pubmed/115... make sure you get the **Methylcobalamin** type if you do, the cyanocobalamin is worse than useless! (Try 5000mcg sub lingual at Health Monthly for price, not customer service!)

    There are probably loads of other things to look at, and I am sure others will suggest some.

    Research is king... there is a load of info out there, GPs generally know very little about much worth knowing, so it pays to have some idea what your options are, and who to see.

  • Hi morphine can actually cause 'hypertonia', 'muscle weakness' and 'spasms' according to the SPC. I took MST and had very bad muscle pain, it felt like I'd run a marathon the day before. My GP and Surgeon were not aware of this, I find I am ok on oromorph. Since your morphine increase have you got more muscle pain? I find differentiating the pain can help. For example for nerve pain (shooting, burning, stinging pain) amitryptiline type drugs, TENS machine and acupuncture help, whereas muscle and bone are better with codeine, paracetamol and morphine. It is trial and error and everyone is different. Good Luck x

  • I have actually heard this and I did wonder. I mentioned it to my local pharmacist and he did not see to know. He said his book said it may cause slight tremors or muscle twitching. Did you have muscle pain all over? I don't have that, the pain is in the same place (my lumbar), sometimes my legs after walking but not in my arms or anything.

  • If your pain is trigger pain it will not respond to any medication. A good sports physio will be able to check you out, and show you how to treat yourself. G Ps don't often know about trigger pain.

    Morphine, like any pain killer will build up resistence - become less effective over time. Then you keep needing more and more, eventually the pain you feel is withdrawal and not the original pain. Then you are a legal junkie. And then there is no escaping from it.

    To put it into context you get morphine when you have surgery, when you have been cut open and had bits removed or repaired.

    Its very sucessful with cancers but it is part of a carefully balanced plan.

    Gps have a protocol to follow when giving out painkillers. Its only if you report things that they will know something is not working. Then they try something else. Pain is fickle its not like a broken bone that in 99% of cases just needs resetting and casting for a few weeks. People with the same diagnosis feel pain differently, in different places and different intensities. Peoples pain thresholds are different, someone may find a 3/10 impossible to live with while someone else may find a 5/10 bearable. This is the problem for gps pain is way too complex for a one drug wonder fix.

    If you have back pain, it may be worth asking for a course of augmentin. Its recently been found that alot of back pain is caused by bacteria (the report is here on another post). And logical thinking suggests that pains in other bones, joints and muscles may also therefore be due to bacteria.

    Keep pestering the gp thats what hes there for. The more info you give the more helpful he can be. You can always see a different gp within the practice, just to get another opinion. Or see if one has a special interest in pain.

    Make an appt with a pharmacist and they will run through your meds scientifically, and they may be able to suggest a better combination, which you can then ask the gp for. Gps and pharmacists work quite closely together.

  • good answer Zanna, im with you on this x

  • Thanks for your reply, it's really helpful. My NHS physio tried to do a bit of mobilisation on my spine and done a bit of trigger therapy on noticeable spasm areas on my back. I have to say that I felt worse after this, for days - but I think that that was do do with the pressure she was putting on the vertebrae rather that the muscles.

    I absolutely get the whole pain thing, I have always felt I have had a good pain threshold ( I used to opt for getting fillings etc without anaesthetic!). I had managed my pain well for 8 years taking just Cocodamol and the odd diazepam, but this time is different.

    I am really interested in the Augmentin as I do have some of the "criteria" such as slipped discs, and modic changes - although I believe the trial was modic type 1 changes and mines are modic type 2. I can't see the doctors hear prescribing it yet though as I don't believe it has been cleared by the NHS.

    I will get myself prepared for my GP appt for tomorrow with a list of questions for him

  • Don't be embarrassed. Just about every pain medication I tried didn't work for me. We are all different in how we respond to things. hopefully the pain clinic will have other suggestions.

    The suggestion that you see a pharmacist is a good one. There's one at my pain clinic who gave me some really good advice, but even the local pharmacists have been helpful.

  • Hi thanks for the reply, I hope you did find something eventually to help with your pain.

  • It's surprising how many professionals don't know about the potential affects of morphine. It gave me muscle pain in my gluteus and thigh muscles exactly like I had been to the gym. It was supposed to help lumbar and hip pain.

  • Hello

    We all need to understand the position that can find ourselves in. It can take a long period of time to find the right medications that you will need to take, it took the medics about two years to sort me out.

    When you have your pain clinic course, they will help you with your tablets and other ways to control pain.

    Several years ago I had a gallstone operation, they give morphene and the dose needed to be lifted to compensate for my tablet regime.

    All the best

    BOB

  • its a very complex subject and the simple answer is that it is a very potent pain kiler when used for the right type of pain but even when it works well, the body becomes tolerant to it over time so tha it takes bigger doses to achieve the same effect. but the biggest thing is that there are many differnt types of pain and one of the impotant roles of a nulti disciplinary pain unit, is to help work out the best type of treatment. if the pain is neuropathic or neurogenic type pain then there may be other types of medicaions that are useful including some of the medication originally designed for epilepsy. its important to realize that there are pain clinics and pain units and they are not all the same- some of them are basically just doctors (often anaesthetists) with a special interest in pain while others are what are referred to as multidisciplinary pain units where you are seen by a team of helath professionals from doctors from different backgrounds, physios, OT's psychologists and psychiatrists, social workers etc. so they each look at your problems from the poin of view of their expertise and then get together to compare results and come up with plans- it can be a daunting process but they also will help you leanr to deal with pain better and i know that is not what we want to hear- we want the pain gone but sometimes that is not possible but it is amazing how with some basic changes pain can be easier to bear. so i would be hanging in, waiting til you get to the pain clinic, if i'ts not a multidisciplinary clinic then i would ask for a referral to one but also remember that it takes time to get to a place where you can say the pain is controlled for most of us- originally i was close to doing something very silly, i could not face ongoing pain anymore and big doses of opiates were barely doing anything, i was eventually fitted with a pump that gives morphine and these days also clonidine direct to the spine- that and some lyrica and endep to help with neurogenic pain and phantom pain from a limb amputation (the pump helps me deal with severe low back pain but the lyrica also helps the back too)- i have had the pump for 12 yrs and now mostly things are manageable despite having developed ms and also having had a serious fall that led to spinal fractures.

    don't be made to feel like you are complaining too much by going back saying you are still in pain, it is possible to get the pain under control or at least improved it just takes time sometimes and there is no magic formulae that tells the doctors what is going to work for you, while there the knowledge about chronic pain is growing there is still no easy way to make it fit your pain so it is common to have to work with the doctors until you get some positive effects

  • Hi charles,

    How did you get on at the drs? hope you got some sound advice.

  • yes it does I take MS and it takes the edge off

  • Hi Zana, for some reason it is not letting me reply to your post on my thread, the reply button won't work! Anyway the doctor up my MST to 40mg twice a day, he also said to start taking diazepam 3 times daily (I only take it once at the moment). I have upped the morphine and do actually feel better during the day, then from around tea time, the pain kicks back in, it's really odd as I take my MST at 12pm then at midnight so it surely cant be waring of by 5pm?? I think I need to see a specialist, hopefully they will have a better understanding of what might be going on. Thank you for asking, and I hope you are doing good. Charles

  • Picton, did you get my reply to your answers, they are not showing up and you gave such a fantasiptic answer with so much information, I really am very very great full. It has given me a lot to look into. Thank you so much

  • Hi Charles in my experience it depends how bad the pain is. I normally take full dose of Solpadol 2 x 4 times per day which if I've been resting controls it. Then sometimes it get's far worse (don't know why) I then have to take solpodol and Tremadol, until pain eases off. Then if I've been pain free and get bored I get a bit over confident and do a little gardening sitting on a chair, Compost, Plants, and Pots all at eye level to avoid bending. For the next week cant move without really bad pain take both drugs sprays, rubs e t c to try and stop pain. I am having surgery next month so hope it gets sorted.

    Best of luck with your pain. Have a good pain free xmas

    Jamie

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