From Prednisone to Morphine

[Chelseadog]

I was wondering if anyone had been offered Morphine as an alternative to Prednisone? It’s been suggested to me by my new Rheumatologist recently. He’s questioning my diagnosis of PMR & suggests the pain is due to “wear & tear”. My pain is symmetrical, in all the usual places (knees, hips, shoulders, neck) & feels more connective tissue (I think) than bone; so I’m doubting his theory. He also suggested I should have steroid injections in both knees. I’d welcome comments on this unusual approach. I’m currently at 5.5 mg of Pred & reducing very slowly. Pain levels are manageable but still evident - not helped with knee bursitis.

[SheffieldJane]

If I were you I would be seeking a more ethical doctor. Your relatively low dose of Prednisalone sounds like you are winning. I actually feel quite shocked, this is the first time in 8 years that I have heard of Morphine being offered for our conditions. Good luck finding a good Rheumatologist.

[piglette]

In my opinion anyone who suggests morphine as an alternative to pred must be a pretend doctor. What is his diagnosis to suggest morphine?

[Nextoneplease]

I agree 100% with the previous posters. Morphine is obviously not to be taken lightly and I’d want a very clear diagnosis before even considering it!!! Certainly not ‘wear and tear’.

As to the steroid injections, I’m about to have one in my shoulder. They’re not out of the question, but again, you need a proper diagnosis.

Good luck - is your GP maybe of more use than this rheumy?? x

[HeronNS]

Horrified. Where did this doctor get their training? Morphine definitely has its uses, but not here.

[Bcol]

Steroid injections can be fine, had a few in knees before replacement. Morphine, fair enough if it's needed and the appropriate treatment for what is diagnosed, but I would want a very specific diagnosis of something before even contemplating it, certainly not PMR. Not going to comment, in public, on the Rheumy!!!!

[LemonZest11]

🫣🤐

[random901]

Oh dear me NO! That's reserved for truly unbearable pain (the screaming in agony type) & is highly addictive.

[Numptybrain]

I’m on slow release morphine 2x daily, but that’s for spinal issues and arthritis I’ve had for a while which is excruciatingly painful, I’m actually getting a lot of nighttime pain still even now. I wasn’t too happy going on it but at the time it helped in fact I don’t know how I would cope without it now but that was pain management at the hospital. Please really think about it prior to going ahead with it.

Take care

Wendy x

[Chelseadog in reply to Numptybrain]

That’s very interesting. It was a slow release Morphine he’d suggested - whilst saying it wouldn’t be a strong enough dose to be addictive. From the responses here, it’s a definite no at the moment. He did say there were different types & different uses for Morphine now & that the side affects were favourable to Preds - so I guess I need to do more research. I think he’s pretty clued up to be fair & had time to talk about symptoms etc. I was very surprised he doubted the initial diagnosis - but still think he’s wrong as I can’t imagine “wear & tear” happens so symmetrically.

As an aside, does anyone have intermittent areas of pain alongside the usual ongoing pain? Yesterday both ankles were very painful but today they seem fine but both thumbs are painful. So frustrating!

[PMRpro Ambassador in reply to Chelseadog]

It is perfectly possible that it isn't PMR and you do have something else. But I would want a second opinion about the morphine.

However - your query about " intermittent areas of pain alongside the usual ongoing pain" does raise some questions. Please tell us more about that - how long has it been going on, which joints, are they hot, swollen?

There is a form of inflammatory arthritis that presents like that - PMR style presentation but with joint pain that varies and moves about. It can be in an elbow one day for a few hours and then disappear to reappear a few days or weeks later in an ankle or other joint. It is sometimes called migratory arthritis and also palindromic rheumatism:

versusarthritis.org/about-a...

We have a few members of the forum who have palindromic rheumatism.

[Chelseadog in reply to PMRpro]

Thanks PMRpro, that’s very interesting & something I’d not heard of before. The link really does highlight my symptoms I think. My pain occurs usually in one ankle, thumb, wrist or (rarely) elbow. There’s never any swelling or redness but it’s tender to the touch & very painful whilst it lasts. Fortunately that’s usually only for a few hours & then it’s gone - as in without trace. It may come back a few days later or not for a few weeks - it’s a strange thing. It started about a year ago - although it’s hard to pinpoint really as it’s been embedded in the PMR pain I guess. I’m going to research a little more & see what I can find. As for the Morphine issue, I’ll be rejecting the offer for now at least. It’ll be interesting to question my Rheumatologist further on the subject at my next appointment in 3 months time. Like I said before, he does seem a reasonable & knowledgeable guy - easy to talk to & he did say he was always at the end of the phone if my pain became unmanageable. I think that’s the first time a doctors ever said that to me & highly reassuring to be honest. I’m reducing my Pred slowly following your method & all seems to be going well. The Rheumatologist didn’t argue with me either when I told him what I was doing - & actually seemed supportive. I think he’s one of those who appreciates his patients having a background knowledge of things rather than feeling threatened by it. That can only be a good thing!

Thanks again for your response - my world makes a little more sense after reading it.

[PMRpro Ambassador in reply to Chelseadog]

Sounds very suspicious to me ...

[Chelseadog in reply to PMRpro]

The symptoms or the Rheumatologist?

[PMRpro Ambassador in reply to Chelseadog]

I meant the symptoms - but not very impressed with the rheumy! Did he give you his personal mobile number? Because otherwise his promise is rather empty ...

[Numptybrain in reply to Chelseadog]

I get bilateral pain but my spine is different, currently it’s affecting more my left side and I have bad left ankle swelling. I had bilateral fractures of s1/l5 they noticed when they went in to do TLIF surgery to stabilise my spine.

[toots1951]

I find that quite frightening - what on earth was the doctor thinking of !!

[Flipper12345yellow]

I don't know about morphine as a substitute.I have both but steroid injection in knee certainly helped me.

All the best.

[Viveka]

Have you had x ray and scan to see if there is significant wear and tear in your joints? I would start with the worst knee. I suggest you need evidence before treatment like steroid injection and, of course, morphine is wildly inappropriate. If it is W&T doesn't mean it's not also PMR, of course.

Can you get another rheumy?

[SnazzyD]

I would want very very solid reasoning or evidence for changing diagnosis less than 2 years in for removing an anti inflammatory in favour of an opiate. Not even a PET scan? It isn’t as though you are stuck on 15mg either. Since you are on a lowish dose and in pain (not necessarily unexpected) things may get worse as you reduce if you’re not dosed adequately. Time for second opinion sharpish.

I looked at your bio and considered your knees and weight loss. Most people are not able exercise with this so control their weight with a very low carb diet. It is very effective and I can attest to that having started on 60mg and was unable to do very much at all for months.

[PMRpro Ambassador]

Crackers! I mean REALLY?

At the dose you are at you have to taper very slowly anyway to allow adrenal function to reestablish but to be so scared of pred and offer AN OPIOD makes me seriously doubt his credentials. I have quite severe back pain that we were struggling to manage and the PAIN CLINIC doctor wouldn't offer anything like that. Is he not aware there is a massive addiction problem?

I would be seeking a different doctor - I'm horrified.

[sdowney717]

Somehow prescribing morphine makes me think also how some doctors will prescribe euthanasia for pain management.

[sdowney717]

People can have PMR and also damaged joints for other reasons.

I am very aware of my body and I could tell my pain was not actually within my joints it was in the tissue surrounding my joints. My PCP back then kept telling me I had arthritis wear and tear on shoulders, hips and knees and said could give me steroid injections like for my knees which I refused, and finally he made the right connection to PMR diagnosis.

One major clue for me was the pain was sudden onset. If it had been genuine joint damage, and PMR does not damage joints, I would have noticed it slowly getting worse, not like sudden onset of pain. But that PCP looked at me being 64 and all he thought was arthritis joint damage, not the RA type as tests for it were negative.

I kept disagreeing with his diagnosis, so I was glad when he finally got it right, I got prednisone and very quickly the pain was gone. Then a referral to a rheumy which also happily gave me METHOTREXATE which for me got me off the prednisone, good thing as I take INSULIN.

My plan was to slowly taper off prednisone and I was actually completely free of PMR in a year and now take nothing.

[Nagswoman]

During my misdiagnoses (yes, plural) up to 2016, I was put on morphine patches for 2 stretches. No effect on the pain whatsoever but caused hellish constipation with splits.

[nottowell]

I have had a cronic cough all my life which nothing would cure not related to Athsma i have tried everything. My consultant recomended 5 mg of morphine within a week my cough was gone .with very little side effects. It wont hurt just to try as you can stop it straight away