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Tapering Down From Morphine 60 mg twice a day to just Hydromorphone 2mg break throughs

Hi,

Over the past couple of weeks I have cut my Morphine dosage basically in half - fist by cutting out one of my ER 60 BID pills, then cutting both all Morphine (my long acting med) & just going on my break thru Hydromorphone 2mg tables - 8/9 spaced throughout the day - tapered down to 7 on an opiate calculate equals 56mg Morphine.  When I switched to all Hydromorphone, the withdrawal, spasms, horrible body sensations, almost like I was on stimulants, various areas of my skin burned, feet were numb, crying, basically I feel like I am in hell.

The sweats, chills, diarrhea keep me awake all night. I hate what I feel. To top it off, my surgeon called & they are concerned there might be a breakage in hardware in my lumbar spine causing R leg weakness. Could not be sure on MRI films, am scheduled for Myleogram on Aug 20. Family, RN daughter, Husband calling Primary & Pain Management doctor - they do not want me going any further down. I can't do this anymore. I do not like the feeling I am on with Hydromorphone? It is awful.

Terrible spasms set in R leg. My initial Pain Management doc said he will do anything to help! They had to fight Medicare but just got a script for 30ER Morphine BID & Baflocan 10mg TID for me thru. My son is picking it up. I can use the Dilaudid for break thru.

My question is has anyone been on straight Hydromorphone (Dilaudid) for pain & felt like they were on stimulants & just plain awful! I think many of these symptoms started & were from the change from Morphine (which has a sedating effect) to the Dilaudid. I am hoping they resolve when I am maintained on the lower dose of Morphine ER. I know I did a quick taper but does anyone think a lot of this is from changing from Morphine to straight Hydomorphone - especially like feeling you are on speed? This is awful. Has anyone changed meds & felt awful.

I plan to stay on this done of Morphine  for a couple of months & level out.  My Primary Doctor called me this morning & she agreed with this dosage & my decision to go very slowly now, especially since I have to see what the Myleogram shows. I feel like I have back sled physically the past couple weeks. I need to be doing exercises & walking with my upright walker every day & I am so bent over now. My walking is terrible.  Hope this dose of 30mg Morphine levels me out this month & I can catch up with therapy & walking. I am trying to slip in some home exercises, I can't stand this feeling like I am doing stimulants.... on speed? I am on Gabapentin. Topamax, Thyroid med, 150mg Wellburtim & have been on them for yrs.

Thanks so much for any imput you offer. Take care & God Bless. Mary Anne

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Comments

  • Mary Anne,  Bless your heart!  Changing from one opiate to another can cause withdrawals for sure.  I take Morphine ER, Percocet, and Dilaudid.  My guess is that to equal the dose of Morphine ER you were on, you would have to take two Dilaudid or 4mg doses.  I don't know about the stimulant effect as I have never taken just Dilaudid by itself, always in tandem with something else. 

    Thank goodness for your PM!  I would get acclimated to the two 30mg Morphine ER.  It shouldn't take long and use the dilaudid for breakthru.  Thats what the doctor said, right?  Then go as slowly as possible.  Would your PM be open to letting you slowly change over to Percocet?  I have done many drug holidays over the years.  For me what worked best was getting used to the 30mg Morphine ER then slowly change over to 15mg Morphine ER.  Then slowly change over to Percocet.  When comfortable with Percocet, then start weaning very slowly off those.  When doing that slowly, I had very little withdrawals.  I would hit a bump in the road here and there and I would just go back up on dose and try again.  

    If possible go in and talk to your PM about it.  I hate to see you in such pain and misery when I know most of it could be avoided if the doctor will just let you go at your own pace.  Everybody's system is different.  Please let me know how it goes.  I am praying for you!

    Cindy


  • Thanks Cindy,

    Boy did I get relief as soon as the 30mg ER Morphine hit my system. That awful feeling is better. I know my PM will do anything. He just said "What do you want? You know your body?"  I asked for the Morphine 30mg.  I am going to ask him for Percocet on my next visit as a break through med. to replace the Dilaudid,

    After some nasty kids thru a M180 at my Airedale pup from an overpass, a few weeks ago, while my hubby was walking the big guy, he started refusing to go for his evening walk. He would get to the end of the block &  pull my husband back back home   After I took the 30ER Morphine, I was finally well enough to use my upright walker with my son & daughter & law, We took a long family walk with both dogs & our Woofie went gladly on his walk thru the park, visited all his "buddy" doggie friends, both dogs were happy to be pet by little children.    It was about a mile. I died when I got home but I was so happy. I was straighter & was able to walk.

    That's what I wonder. After about 10 surgeries and total Cervical Fusion, fused T8 to S1, severe osteoporosis,  a really fused distorted spine that cannot be fixed - with extremely excessive kyphosis & a dropped head. How realistic is it that I am going  to stay off all pain meds? I think the tapering is really helpful, though & going off for awhile, if I can, would be great.

    Thank you so much for your prayers. I am going pray for you also. I hope you are doing well. God Bless you for all your kindness & you have a great weekend.

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  • Mary Anne,  So glad to hear that the Morphine ER 30 is helping!  I know Morphine doesn't work for everybody but it works well for me.  And it is very inexpensive.  Plus it looks like it will be one of just a few long acting drugs available here pretty soon.  They took Opana off the table, its really hard to get Oxycontin anymore.  Insurance doesn't want to pay for it and pharmacies aren't stocking it.  Hysingla and Xtampza are super expensive as well so that really limits the options.

    You must have a good PM that really cares about his patients.  So glad he is letting you do what feels right for you.

    Sorry about your dog.  What a rotten thing to do.  Glad to hear he  is doing better.
    I get what you are saying.  It may not be realistic for you to stay off pain  meds.  I would do my best with the taper and if you get to a point where it seems unbearable, your doctor might just feel satisfied with your effort and let it go.  It will certainly lower your tolerance so there is a plus to it. 

    When I did my tapers, I did two complete tapers but was so miserable he put me back on after two weeks. It helped my tolerance.  After that, my doctor saw that it was not feasible for me to stay off opiates altogether so we started rotating meds to combat the tolerance issue.
    So go slow and PM me if you need some support.  Have a great weekend!

  • Definitely a good idea to get back on my extended release morphine you really don't want to fool with your pain medicines if you're comfortable with them I've had doctors full with my pain medicines now and I'm no longer comfortable I was comfortable before they cut my medicines in half here at this nursing home now I'm going to have to fight when I go back to a doctor to get it back to the normal setting so I understand your pain I'm having an increase muscle spasms extended Lee large amounts of pain so I hear you it's tough with these opiates they get a lock in on you and it's hard to get away from them but sometimes we really do need them as much as the medical community wants us to get off of them they have no idea of the type of pain were in I wish we could just touch their hands and they can actually feel the pain were in then they would realize what real pain is. also depending on your size medicines react differently I tried to tell them that the dosing of pain medicines is for a 150 to 200 pound person I myself and 370 lb so I'm almost double the rate of what they prescribed for you at the doctor still won't get it through his head it's extremely frustrating

  • Hi Cindy & Richard,

    My PM is really good about opiate meds with me. He does think I will need to be on some kind of pain management for the rest of my life, probably Morphine. He has recommended I supplement with Medical Marijuana, but I have to save to get the money up for that. To be honest, in this state, Medicare doesn't cover the cost & it is very expensive. Some MM doctor's are 2 hundred - some 3 hundred to approve you.  A doctor could look at me and approve me. The card is 50 dollars. Then, the dispensary is ? at least 60 - 90 dollars. I don't know how long whatever they give you lasts. My girlfriend is on it & she said it does help with pain, so why not try it..

    I am so much better with the Morphine, but I don't know if I can go much lower. My pain doctor may not want to me to either. I have been still having withdrawal symptoms & having to take breakthrough Dilaudid twice a day. I am going to stay at the 30mg twice a day for a couple of months & evaluate.  Even at my last visit with the surgeon, he said, take your pain med & enjoy your life. I have the Myleogram & see them on Aug 20th. Have been having some Neurological Symptoms also that are not withdrawal. My Kyphosis is so bad, I def am having spinal cord dysfunction or have some age related neurological stuff going on.

    Cindy, I think your PM sounds like an excellent doctor. It is a good idea to taper, especially if you can before a surgery. I tapered from Fentanyl Patch - think It was as high as a 100mcg at one time - down to the Morphine 60. They still had trouble controlling my pain post op. I was in terrible pain in ICU - still remember it. Am afraid to have another surgery. Although, they were extensive spinal surgeries, they would be painful for an opiate tolerant person or not.

    Cindy, you are right about the pharmacies. I remember trying to switch to CVS a couple years ago, & they would not accept me because I was on Fentanyl. They had too many patients on the patches already & would not have enough to be able to fill my prescription.    Think Morphine is a tried & true pain reliever. But, everyone's body is different. And the trick is to change medications so when the Morphine stops working, you go on something that does for awhile. Then, you can return to the Morphine later.That's why it isn't fair of Medicare D plans to drop every pain medication from their Formulary. So. only the rich can get relief? I am afraid we are headed to a 2 tiered system of  medicine. One for the wealthy - private pay & one for everyone else. 

    Cindy, Can I ask how old you are? Was it you or Joanne who is 70? Did you have any surgeries?  Dear Richard, I feel so sorry for you. You must be experiencing what I felt & more. Can your doctor give you any medication for the muscle spasms? If you want to talk, we are here for you. Nursing homes have a lot of  Govt regulations, could that be the problem? Are you getting physical therapy? I only know myself that when I lost about 25 pounds, I felt that I was falling asleep on my stronger dosage of Morphine. So, I wanted to cut down the dosage. So, for me, my weight & dose were related. And, it is a vicious cycle. If you are in terrible pain, you can't move around. You are immobile. So, you can't loose weight.. Maybe the physical therapist/doctor can order comfort/pain measures for you such as heat, ice, bio freeze, a tens unit, Lidocaine patches, massage. Please let us know how you are making out. I will be praying for you. 

    Cindy, Thank you so much for all your support throughout this time. It is really appreciated. You were a Gem! God Bless You!!!

    .

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