Pain Concern

Reducing morphine intake

Hi All,

I have been taking large ammounts of Oramorph and Tramadol for nearly a year and think it is time to reduce. I am due for an operation which will relieve the pain somewhat but there is no hope for an introduction to the pain clinic for months. I am sure that with some help and advice from you lovely people on this site I can manage it on my own so I would be elatedto hear what you have to say.

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Can you get another GP? He/she ought to push for the referral. About the meds you should have a med review anyway.

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I would say firstly that you should always do things like changing the dose of meds with your doctor’s knowledge / assistance (disclaimer!).

That said, in the past when I have reduced opiates (full disclosure - I don’t always discuss reducing meds with a gp, increasing dose is a different matter), what I have learned is to do it slowly and you will minimise the nasty withdrawal effects.

That should be pretty easy with oramorph, just take less and less each dose until off It. Reducie by approx 10% and wait until you feel that you are settled on the new dose, then repeat until off.

The tramadol will depend on what dose you are on, and what form the tablets are in (capsules or tablets) but the same principle applies. Tablets can be cut / crushed and split to ensure you aren’t dropping too much in one go. Capsules can be opened, pour out the powder and remove the required amount. Either refill the capsule with the dose you want, buy some empty capsules if required or just neck it and chase with water.

You may not need to do that if the tablets are a small enough dose already.

You might be able to reduce faster than 10% in one go, people react differently when reducing opiates and some find it affects them more than others.

Personally I would reduce the morphine first and then the tramadol.

As you have surgery planned, reducing the dose is a good idea as it will mean that they can temporarily increase it again for post-surgical pain. Last tine I had surgery I was on such a high dose of morphine they were wary of giving me much more after surgery.

Good luck.

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Hi, when reducing your meds, please tell the doctor first as you can get very bad side affects, it’s not just a matter of cutting down by this much or that much! And opening up capsules is a daft idea as you really then wouldn’t know how much your taking as they are a measured dose originally so to open them up and take a bit out won’t work as you may take less on one occasion than another! The only way to reduce medication is with medical help! If YOU wish to reduce your meds then the doctor will help as it is your decision not theirs!

Also reducing the meds may give you more pain than you can handle and in that case the doctor can up them or change them. So my advice is to seek the proper advice. Good luck

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Ok, I did say first off talk to doctor.

With some meds I agree, such as treatment for a long-term condition such as RA / lupus etc where you should never reduce without discussing with a doctor. With opiate painkillers, I don’t agree. Stopping cold-turkey - whilst incredibly unpleasant - won’t kill you. And I’m not suggesting doing that for one second.

Resucing by 10% as I have suggested is probably way more conservative than a doctor would recommend. I have reduced many meds, many times. Sometimes I have talked to a doctor first, sometimes not - it depends what the med is. I, personally, wouldn’t take up a valuable doctor’s appointment purely for them to tell me what I already know. And when I have reduced pain meds myself and told my doctor after the event - I have never once been told that I should have told them first. In fact when I reduced a dose of morphine from over 100mg a day down to about 10mg I was congratulated for doing something that “we usually struggle to get patients to do”.

Splitting tablets / capsules is a perfectly valid method of splitting a dose - and it is perfectly easy to remove (close enough for it not to matter) half of the contents of a capsule. It isn’t rocket science.

If absolute precision is required water titration is available (empty contents of capsule into say 10ml of water - take required amount). With some meds, regardless of what the medical profession tell you, it is the only way of doing it without a lot of strife. Pregabalin, for example, only goes down to 25mg capsules. Going from 25mg to zero is not nice for many people, hence split the capsule.

I understand your concerns, but stand by the advice I gave.

Regards

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I completely agree with everything you've said. I have found it is much more beneficial to reduce slowly on my own, than to talk to the Dr about it. Most of the time they reduce you way too fast and you end up suffering. Then if you feel like it'stoo fast, you have to call them and have them call in more meds ect.... if you do it yourself you'll have it all there and can just go slower. Plus it seems that if you tell them you want to taper down, they assume your pain isn't as bad or you don't need the medicine. It's much more comfortable and less of a hassle to do it on your own. Like they said, it's not going to kill you if you do it on your own. With other meds for potentially dangerous conditions, check with your Dr first.

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A good point was brought up.... if the pill is extended release or anything of that nature, cannot be crushed, cut, or altered in any way! That IS dangerous. I shouldn't of assumed everyone would know that. It should have a warning label on the bottle telling you if this can be done. If you're not sure, ask your pharmacist. I have to cut most of my pills in half anyway because it's hard for me to swallow them if they're too big.

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Yes, good point.

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Hi you should reduce .I'm surprised your on oramorph .depend diagnosed.when I was in hospital rumatologist gave docs a row for giving me it .I was on strong painkillers said not for that pain.id speak to gp to come of slow and maybe increase other meds

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I was taken off tramadol, methotrexate, prednisolone, salphasalazine, naproxen and hydroxy chloroquine in one go due to liver failure. I was pumped with steroids introveniously and off all Meds for nearly a year. I decided to refuse to go back on those drugs when the steroids wore off. I had to loose weight and change my diet to a paelo diet. I only eat gluten free foods and I'm vegetarian due to the inflamation causing foods in meat and fish. Now my pain is much better. It depends on your condition but with determination and the world wide Web I'm surviving on one tablet a day..hope you find your way as I think the medical drugs we take has so many side effects it's sometimes better to go back to eating fruit and veg and excercising regularly. Medical professionals won't tell you that due to risk of being sued. You Tube and Pintrest has a lot of information. I would research your illness and try alternative remedies before going back to pain or those drugs....our bodies were not meant to sit watching TV eating sandwiches and taking tablets but when we are ill that's what we do to get better..I'm guilty but since changing my lifestyle I'm better..not cured but much better. I hope you have a sucessful operation.

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Depends on what kind of pain you are in? I was on morphine and percocet and gabapentin........changed doctors and now see a neurologist. He upped my gabapentin to 800mg and fixing to put me on cymbalta to go along with it to help manage pain. Before, I did take percocet, but only needed, when the pain got too much. Percocet works...but I don't know the long term damage it might do. The stigma that opiates are getting these days...I prefer getting off myself. But, the big question is do they have something else that is strong enough to deal with the pain that is a non opiate? One doctor I remember called all the other pain medicine sugar pills or salt pills that do no good for pain. That quak doctor had a temper tantrum problem....problems with his wife...so that he took it out on his patients.......got so bad had to leave him. Drug addicts are the ones who have created a stigma in world about opiates so badly, but are they bad for patients who have real pain, who are not street addicts? Big difference between street addicts and patients with real pain

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It's not safe to break tramadol or crush them as it causes stronger and dangerous side effects that's why they have a coating on them. Never do this without help and medical support everyone is different and it certainly isn't a waste of doctors time. I found a local charity who advised me about coming off oramorph and zomorph and gave me amounts and timeline also l met them every week and could phone too if needed. They were connected to NHS as we met there couple times just see how l was. No one on this site should give out advise or instructions about anything to anybody...... it's irresponsible and dangerous! Pray your op goes well and you get to where you want be regarding your meds. Just go gentle on yourself.

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Ok, with the exception of extended release tramadol tablets then. And I didn’t say to crush anything. Splitting an extended release tablet, whilst not advisable won’t release the entire thing in one go, it isn’t just the outer coating of a pill that makes it ER, otherwise once the outer coating had dissolved it would all suddenly release.

It isn’t dangerous to do anything else I said.

As jame5263 says above doctors (in my experience and that of thousands of other people - just try searching for any withdrawal info online) do not understand what it is actually like to taper from countless medications. The number of times I have been told to “reduce it over a week and then just stop” is unbelievable.

I have been advised by a doctor before to reduce sertraline over a week and then just stop. Even said to take it every other day which is just crazy talk. Having done some research it took me over 8 months in the end to taper as slowly as possible and was still an absolute nightmare. And that was after I followed my doctor’s advice and spent 2 weeks feeling like killing myself before I went back on it and did it slowly by cutting the tablet into increasingly smaller doses.

Same with pregabalin, took me 2 years of capsule splitting, water titration etc and was still a nightmare. There are groups dedicated to the process of getting of this drug but according to a gp I could reduce it over a week or two and just stop. Now that is potentially dangerous, can cause convulsions, suicidal ideation / activation and many, many other problems.

Same for morphine and dihydrocodeine. In both cases a doctor will almost always reduce it too fast.

In fact the only thing i’ve ever been advised to take my time with was prednisolone and that’s only because it can kill you if you withdraw too fast.

Sorry but I disagree that it is irresponsible and dangerous to advise people to taper slowly. Pain meds are only needed when you’re in pain, once you feel that you can reduce them there’s no reason not to.

Everything I said above is information that is freely available through a simple google search, and after spending most of the last 3 years (in fact 20 years on and off) tapering off one thing or another and suffering for it I would rather tell people to do it slowly on their own than go to a doctor and be given the same advice I (and countless others) have been given to do it too quickly.

If I had a pound for every post I’ve seen along the lines of “told my doc I wanted to reduce X and they stopped my script - now I’m in agony what can I do?” I’d be a wealthier man than I am.

Again, I appreciate your concerns (and good point about ER formulations), but respectfully disagree.

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Reduce the tramadol one tablet at a time, I was on 8 a day for a year, didn’t feel well one day so went to bed early, missed a cpl of doses thinking nothing of it, spent 2 nights seating badly, 8 hours in a&e, they thought I had a viral infection, it was withdrawals from the tramadol, realised that once I got home as sweating started again, took 1 tramadol & it stopped, so I started reducing a pill at a time, I steer well clear of them now.

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Thank you all for your advice..........as always many sensible and sensitive replies. Starting on the morphine very slowly confident that it will not be a problem.

Best wishes to all

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