Morphine Patches

[meldav]

hi there

i have been on Phentenal (morphine) patches for almost 2 years now, having tries everything else morphine and diazapan is the only thing that helps the pain and sometime spasms.
I started on 20mg per hour but it went up to 100mg where i found i was extremely drowsy and simply cannot function anywhere near normal,however it is the best pain relief ever.
So i have found 75mg per hour the right patch for me, although i still live with the severe pain, at least im able to semi function. My husband puts a new one on me every 3 days - like are just like a nicotine patch.
Every 3 days I get a massive high(its like im full of energy,and cant sleep all night sometimes) and good pain relief (for about 8 hours) and then by the end of day 3 i can feel the pain getting worse again,
Today has been a very bad day and my pain is 9/10 so i have had to take oral Ormorph 10ml and a fresh patch of 100mg - i just need a few days off the pain,
I actually cried in front of my 3 youngest children today and i feel so angry with myself for letting them see me like that - i shouldnt of cried , i should of been stronger - but the pain got the better of me, and now i feel really low.

sorry to moan!

Question... does anyone know the LONG Term side sffects of Morphine patches? I keep asking the doctors but they never give me a straight answer

thanks mel xx

[Bagpuss-wheels]

Hi Mel,

I'm on Fentanyl patches too!

Sorry to correct you, they're actually not 'Morphine' but they are a 'synthetic' opioid (i.e. a man-made equivelent) as opposed to a true 'opiate' (i.e. Morphine etc). It's very confusing as they are all classed as 'opioids' but they work slightly differently in the body. Some people have better pain relief from 'Morphine salts', (and codeine etc) but other people have better pain relief from the synthetic opioids including Fentanyl. Other people find that both work for them. For example, my father cannot take Morphine, Codeine or Dihydrocodeine as they cause severe constipation (they stop his gut working completely) but he gets on well with Fentanyl patches and Pethidine tablets. Me, Fentanyl works well, so does Oramorph ('Liquid oral Morphine') but, like my dad, Codeine and Dihydrocodeine cause problems.

I understand what you mean when you say that the patches don't always last for the full three days. Dad was on the Durogrsic DTrans patches after major surgery and, after two days was not getting enough pain relief. The hospital were fine with this as they said that many patients have problems with the patches not lasting so they just told him to change the patches after two days instead of every three.

I'm on the 100mcg/hr Durogesic DTrans patches (the 'sticky tape' style ones, not the liquid filled ones) and I'm far from pain-free. I've just been prescribed Oramprph to use for the 'breakthrough' pain which goes over the pain I can cope with. (It's the 10mg/5ml bottles which are actually no longer on the 'controlled drug' list, unlike the higher doses or the Fentanyl patches which are on the 'controlled drug list'.) I get no side effects from the Fentanyl but I don't want to up my dose (not even by 12mcg/hr which is the smallest patch available) until I absolutely have to as I don't want to risk side effects and I can generally cope these days (my pain used to be 'out the other side' of bearable where I got about 30 mins-2 hours sleep in a 24 hour period and only slept when utterly exhausted) but I know that I can increase it if I need to in the future. If I get very hot and sweat, I often have to change the patch sooner than the three days as, if you get too hot, you absorb the fentanyl more quickly. I have problems with the patches sticking properly so have been prescribed "Tegaderm + Pad" dressings to stick over them to stop them peeling so much. (They look like a clear sticking plaster with a white pad. I find the Tegaderm+Pad are better than the 'Tegaderm' which doesn't have the pad as, if the Tegaderm peels off, you can carefully cut out the pad then peel the edges off without having to peel the patch off too. I use the Tegaderm + Pad 9x10cm over my 100mcg/hr patch. The "Pad" completely covers the 50 or 75mcg/hr patches but doesn't quite cover the 100mcg/hr patch - there is a border which has the sticky clear film on it but these are the nearest size.)

I'm surprised that you say that you only get good pain relief for eight hours and then it diminishes as, after applying a new patch, it takes around eight-plus hours for it to reach maximum benefit. It sounds as if the patches may not be the best thing for you (or at least the current combination/dosages) if you are having so many problems. Certainly you need to ask your GP or pain specialist to look at your pain relief again and at least allow you to change your patches every 48 or 60 hours (every 2 to 2&1/2 days.) for a trial to see if it helps. Are you always getting the same make of patches from your chemist? It may be worth asking to try a different make of patch if you don't get on with one type. I found the older style liquid-filled patches (available as 'generic' patches now available under the names: Tilofyl® and Matrifen® and others) gave longer pain relief for me but had a horrific effect on my skin whereas the newer branded, non-generic 'Durogesic DTrans'® patches (the 'sticky-tape' style patches) are much better for my skin but don't always last three days. If you are getting "massive highs", definitely talk to your doctor about this too. It may be that something like methadone may be more suitable as "Methadone is less sedating than morphine and acts for longer periods. In prolonged use, methadone should not be administered more often than twice daily to avoid the risk of accumulation and opioid overdosage. Methadone may be used instead of morphine in the occasional patient who experiences excitation (or exacerbation of pain) with morphine." (Quoted from the BNF: http://www.bnf.org It's the British National Formulary - the book doctors use to prescribe from - all you need to do is register for free then you can have free access. Also check out: http://emc.medicines.org.uk/ the "electronic Medicines Compendium" - you can read the patient info leaflets and look at the 'Summary of Product Characteristics' for most medications - no need to register for this site.) Methodone is not 'just' for drug addicts - it can give people better pain relief than other opioids. I know you said you'd tried everything else but wondered if you had tried it? I know what you mean about having tried everything - I cannot take other painkillers - I'm allergic to Aspirin and NSAIDs (it causes me severe asthma attacks), and Tramadol (it gives me weird sensations and I make no sense on it - it also does nothing for my pain. I'm also allergic to the non-medical ingredients (excipients)), Nefopam does nothing for my pain and completely dries my mouth out, Codeine and Dihydrocodeine cause me constipation (and I'm allergic to the excipients). Meptazinol used to work but no longer - it just gives me headaches now). I cannot have the Buprenorphine patches as my consultants were too worried about possible effects on my breathing and I cannot have the tablets because of being allergic to the excipients! Everything else is the same problem, because I'm allergic to lactose (and all milk products), it means that I can have very few medications because even a tiny amout of lactose causes severe asthma attacks. It makes life hell trying to find the right medications but leaves me with Fentanyl patches, Oramorph and Neurontin Tablets (generic name: Gabapentin - one of a few anti-epilepsy drugs used for pain). Have you tried any of the anti-epilepsy drugs too? If not, it maybe worth asking. Do ask what your local pain clinic can offer too. I was offered accupuncture - have tried it previously even though I hate needles - it didn't help me but I have friends who swear by it. It was when I saw the lovely consultant at my local pain clinic that I was put on the patches nearly three years ago.

Please don't feel bad about crying in front of your children. You cannot help being in pain, nor can you help it that your pain was out of control! If you feel bad and low because of it, it won't help you - it will add to the viscious cycle and make the pain worse which will make you feel even more low, making the pain worse and so on! (Ok, so I should take a leaf out of my own book and listen to my own advice, but I do understand that it is much easier said than done!) (X) - that is a 'big virtual hug' for you! :)

Long-term side-effects of all opiods are very similar. With the patches, you also have the likelihood of your skin being affected too, particularly if you keep sticking the patches in the same place time after time.

Long term, people on opioids are likely to become dependent on or tolerant to opioids. This is not the same as addiction! What it means is that your body becomes used to having the drug and, over time, you will often need more of the medication to give you the same level of pain relief. Tolerance means that you may notice some withdrawal effects such as sickness, feeling sick, diarrhoea, anxiety or shivering if you stop the medication suddenly. Some people can become psycologically dependent on opioid medications. This is all the info I know and can find about long term effects.

I hope that what I've written is of some help to you and that when you read this you are in less pain than when you posted. Do discuss things with your doctors, particularly trying changing your patch more frequently.

Best wishes and virtual hugs,
Cat
>^..^<

PS

A 'Cat' prescription for you:
"Take one virtual hug as required. Take as many as needed and as frequently as required. No possibility of overdose. No adverse reactions. No adverse side effects. No interractions with other medications. Endless supply."

[meldav]

Hi Bagpuss,

many thanks for your extreemly detailed reply, you have made my 'drug taking' much clearer - i havent even had some of that info from Consultants or Doctors!
You certainly know your suff!

How long have you been in pain ?
and, why ?

how about if you tell all, 'your story' in the correct forum section? Its good,
i think to read how others became chronic pain suffers.

Yes the pain flare seems to of died down for today, although i've just sat down and i think i might of overdone it a bit today - trying to catch up with 'household things' for the past 2 days - fresh patch day today so i should this evening,get a bit better.

Im on the Tilofyl® patches, no i havent tried Methadone - i think when i see my consultant next (soon i hope as ive just had a MRI which took 6 days to arrange! And i shall be seeing him for the results) i will talk to him again about the patches/methadone etc and see what he can come up with.

Many thanks for you interst and reply,
hope to read 'your story' soon !

love mel xx

[aacouriers]

I am in extreme pain most of the time..doc put me on co drydamol ..2 tabs 4 times a day...then triptyline and diazapam at night to aid sleep....He told me that they are not allowed to prescribe patches anymore.....had xray . showed spondylosis..waiting for MPT3 asessment which is new to my area ...Wales..
to see if i need physio or whatever else.....
ANYONE LEND ME A PATCH...lol

[sue]

im on a vast amount of pain medication, morphine in tablet form, dhydrocodene, bupernorphine, and soduim valprote, all which makes me very tired, i actually work part time but when i come home need to sleep for a couple of hours, come the weekend im too tired to go out socially, its true that being depressed can make the pain worse even though its the pain that makes you feel that way, iv been on my medication now for 13 years and can never imagine being pain free, no one really understands what you go through, you become very angry and bitter and wonder why it has happened to you,.

[Rangdrol]

Thanks for your help. I am trying to find a primary care who will put me on the patch because my constipation on time release and PRN morphine is horrible.

This is my first entry here, and I am so happy i found this place. I have hip dysplasia for 25 years but been able to manage with occasional bouts of pain and Vioxx but when i went off of Vioxx I started having more problems. I also developped discogenic degenerative disk disease and ive been on Morphine time release for a year now. Unfortunately i am stuck in Canada and the health care system here is a nightmare and the simplest thing like trying to get pain medication is complicated because the province of Quebec has a shortage of 600+ MDs, which means many dont have primary care physicians. This means, for the most part, that I had to go door to door to get RX refills.

At times I saw MDs who didnt even look at my medical folder and prescribed a months worth of medicine, and then MDS who did look at my folder and who were scared to lose their license for RXing morphine! Several months ago I ended up going to the ER which in Montreal means 4-12 or more hours, on average, and Ive had to do that just to get refills, every month. And this means that I have to schlep out in sub zero weather, braving the slippery ice-encrusted sidewalks so that I can have my RX filled!

So, you Americans ( I was one of them) who think that Canada has a great, free, healthcare system, dont kid yourself. Its fine if you arent really sick, but when you have any serious illness and it requires xrays, blood tests, MRIs, or operations, you are screwed. The last time I needed an operation for my shoulders, it took me a year to find a doctor to just diagnose it! In the US they simply took a month and took xrays, and within two months I had two surgical procedures and I was fine. I was told that I would have to wait a year for that procedure, here in Montreal!

What a nightmare. Right now I am suing the Quebec welfare (Emploi Quebec) because they wont give me disability!, so it means I am not only in pain on a daily basis, but I cannot work, and am broke! In any case, it helps to moan and groan a little because I dont know anyone in Montreal and I often feel its just me against the world—or at least me against the Canadian Health Care system! Michael Moore didn't do his homework when it came to Canadian healthcare, that's for sure! In any case, if anyone from Montreal reads this and knows where I can get into a pain clinic, please let me know.

I had to wait a year to see a back doctor because there is such a shortage and he told me that I am not a surgical candidate...that basically means that I am not dying and unless I am dying, like from a car crash, i go to the end of the line...that's how busy they are here. I also had to wait a year to see the hip doctor, who also told me that I am not a surgical candidate, and she said there is nothing she can do for me! That is medicine in Quebec!!

The back doctor did send me to a pain clinic and I am no a two-year wait...I dont think I can wait that long, that is crazy! The alternatives are to return to the US and live in a shelter for a few months until i can get disability...that idea isnt very fun, but time will tell... I know the only way I will get medical attention is if I go back to the US, and unfortunately that means I will have to live on the streets!

In the meantime, I try to remain positive and try to get as much out of life as possible. That is all we can do, isnt it?

[annc]

I have arthritis in my spine and also piriformis syndrome, as well as polymyalgia rheumatica. I get almost no effect from most painkillers, so have just started Buprenorphine patches. The first day was good, but then I had some awkward travelling and Saturday night I was practically crying with pain, and it took ten minutes to walk the length of a railway platform. I had permission to put a second patch on, but even now it's not good. I see my GP in 10 days.

[Rangdrol]

Hi, I am sorry to hear about your back pain and illness. It is obvious that you have tried certain things and the only way to find something that works for you is to keep trying.

Have you tried the Fentanyl patches? That is what works for me, however, i started at the lowest dose and now am at .75 mcg, which is just short of the highest dosage, .100 mcg.

However, I also take morphine, because the pathces are not enough. I take 10 mg. States ( a form of morphine) and I take it PRN, but usually one pill four times a day, and sometimes, 2 pills at a time, up to four times a day.

Neither the Fentanyl or the morphine make me sleepy or drowsy, so that is pretty good. I also had a prolapse, slipped disk, incident, again this week, and I average one a month, and this basically sounds like what you might have had, all that pain, and unable to walk to the railway.

See your doctor and insist on pain medication. I don't know what piriform syndrome is but if you are in pain, the doctor is there to relieve your suffering, and if you don't have a doctor who is willing to manage that, ask hi/her to refer you to a Pain Clinic. That is where most of us end up, and they are very skilled at handling, treating and managing patients like us. Unfortunately for me, Im still in Canada and waiting, some two years later, to get access to a pain clinic...

Best of luck to you.

[Vid]

Hi everyone,

I have just come across this site as I have just heard about morphine patches and was wondering if they would benefit me.

Mine is a long story but so that i dont send everyone to sleep, I wont bore you with it lol.

As a result of my life being the way it is, I am now in constant pain after having my left epiphasis removed from my hip over 30 years ago, although I was in constant pain after having it done. I now have one leg 2 inches shorter than the other and a slight curveture of the spine so as you may imagine the pain is quite intense.

I am asthmatic and find it difficult for my doctors to prescribe me any form of painkiller other than codeine, which is of no use to me at all, so having read your reviews and comments, feel that it may pay me to see if my GP will issue them to me.

I know by reading your comments, that most of you may be in more pain than I am but I still feel that any pain by anyone is never nice, so I wish you all the best in dealing with it however you can.

The person who cried in front of their children, I totally feel for you as it is always hard to control your emotions at the best of times, but it doesnt make you any less of a fantastic person. Only yesterday I cried in front of my fiancee, and as you may have gathered, as a bloke, its not something that people see very often, but I understand totally how hard it is.

I will keep an eye on what anyone else says about the patches, but I finally think its time for me to go and see what my GP will do.

Thanks everyone for your views, it has helped me see that I do not suffer alone.

[tara]

hi there i have been on butransdermal morphine patches for 8 months now following a bad fall down the stairs i injured my left knee,i have had an mri scan done which shows a medial meniscus degeneration,i am also on lots of other medication including gabapentin 600 mg 3 times a day i am waiting to see an orthepiedic surgeon ,i am restricted to what i can do ie walking sitting etc extremly painful i noticed by you article that u are on 100 mg morphine my doctor told me that im on the highest dosage 20mg per hour my patches have to stay on for 7 days im finding now they seem to come off and im in excruciating pain can u advise me please on whether i should be given an increased dose or something else to help with pain i am also a single mum of 4 children and have not much support if any one can give me advice i would be most grateful tara