Long story short: I have head/neck cancer. Oncologist is currently prescribing Mrophine Sulphate (10mg/5ml) for pain. Lately, the effect hasn’t been potent enough for my liking; I assume I’ve built up a tolerance. I asked about this and he suggested Fentanyl patches, but I’ve tried those already and the side effects rule those out. His next suggestion was to increase the strength of the morphine to 20mg/5ml, which may be fine, but I doubt it. I’m already taking more than I’m supposed to be taking so I doubt that that will be of any benefit. But it might. IANAD.
Does anyone have any insight into pain management strategies? I don’t know much about the field but I’m learning. Are there any alternatives to the morphine? And I suppose that I should be asking this in a long term frame of reference. Any help in this matter is greatly appreciated.
Your oncologist should know of a reputable pain clinic in your area, and refer you there. These places are not “pill mills”, but are run by board-certified anesthesiologists and they try to avoid the use of narcotics unless absolutely necessary, which is the case with you.
That’s a good idea. I’ll see who/what’s available or ask Dr. He doesn’t seem to be very well versed in this particular field, but that could just be my pain talking. Thank you.
There are other opiates you can try. I don’t know about non opiate stuff for cancer pain, but in general - different people react different to different opiates. I think 10mg/5ml is the lowest dose for oral solution - but not sure.
All opiates have some cross tolerance to each other unfortunately - but it isn’t 100% - which might be why your doc was trying to rotate you to a different opiate.
I do hope you can find someone to help you - try to always take the minimum amount you need - as prescribed or not - you’ll develop a tolerance based on what you take - and you can’t get that back.
Thank you also DataX. That’s what I was afeared of…my tolerance level. I’ve been taking more than prescribed for about a month now and the only thing that’s changing is the amount of pain that I’m in. *That *keeps going up. I’ll see Doc on Thursday and see what we can come up with. I appreciate the time spent in replying, both you and nearwild…thank you.
You should also probably be on a long acting opiate of some sort, OxyContin, methadone, etc (this is what a fentanyl patch accomplishes) and using short acting meds like morphine IR, oxycodone, etc for breakthrough pain.
The “sulfate” part bothers me. Nearly every medicine I have taken having a sulfur
component causes a negative side effect of some kind. The exception is SMZ
(Sulfamethoxazole) for Helicobacter Pylori attacks. SMZ should NOT be taken with any
diuretic except coffee.
Ask the sawbones to give you morphine or codeine in a compound without the S word.
My OTC drug of choice for pain is diphenhydramine (aka Benadryl). But it’s not something
you should take habitually. ditto for Ibuprofen, Tylenol and Aspirin and all NSAIDS.
Interesting - I haven’t heard of people using diphenhydramine for pain. I feel compelled to point out to the OP - or others - that many opiates are packaged with Tylenol (especially hydrocodone and oxycodone) - and you can easily give yourself to much Tylenol if taking both. I’m sure most know this, but…
I found switching medicines often helped more than upping doses after a while. I was emphatic that my pain meds didn’t contain Tylenol mixed in them. Tylenol could always be added individually if you found it of any use. I doubt you would if Fentanyl patches are being advised. The Fentanyl patches do even out the swings, but you do need to be more careful with them than when you’re taking pills as the patches will last longer than pills including if your dosing is too high. Some factors can make them release at a higher dose over a shorter time. What I’m saying is the Fentanyl patches are better in someways, but you need to be more careful when using them than when you take a pill. Don’t be afraid to switch to a similar medicine as it often gets past your built up tolerances and you can use lower doses again. I’m over the problem that I needed the meds for and once the pain was over I didn’t have the craving for it like people seem to think everyone gets. I was in the fortunate group I guess on that point. I can not say that is how I felt when in severe pain, as at that point I didn’t care what happened so long as the pain reduced. My opinion is that switching to different medicines is the most helpful, and months later the previous medicine works at lower doses again. Be very careful if you use the patches, as they are strong and can release medicine faster than predicted if certain conditions happen.
On some days, this is where I find myself. Those days have been creeping up on me lately. I tried another Fentanyl patch the other day and the same side effect (vomiting) returned within 8 hours, so I tossed it as soon as that started.
Background information: I suspect that I’ll be on long term pain relief because as of right now, my only road to success goes thru chemotherapy. Surgery has been ruled out and radiation failed. Oncologist is making me drink Erbitux (450cc) on a weekly basis to keep things in check until a miracle arrives. I can’t swallow anything and haven’t in 9 months, so everything needs to be water soluble to go into my PEG tube.
I asked doc again today and again, he wasn’t very helpful in regards to pain relief. I’ll wait another couple of weeks and see what develops. Maybe some other kind doper will pass along information. In the meanwhile, thank you dopers. You are all far more informed than I am and I appreciate not only the information, but the perspective that brings about the information. I appreciate your experience too is what I’m trying to say.
Diphenhydramine is mildly sedating, and can be useful as adjunct therapy to reduce the need for pain medication. It also has a mild anti-nausea effect.
To be honest your oncologist is undertreating your pain. Fentanyl patches are a good option, but if you can’t tolerate them there are strong oral meds you can take. If he doesn’t feel comfortable managing you appropriately, tell him you want a referral to a pain management specialist.
You are way beyond OTC meds. Cancer is the one thing that green lights almost any narcotic. That being said, 4 grams of Tylenol a day can augment narcotic regimens fantastically.
I have been on fentanyl pain patches now for over 5 years, I use mine due to a car accident. I had been on many other pain medications, before my Dr. placed me on the patches. He had tried almost everything, including, Morphine and oxycontin. They did not control the pain I was in, even though my dosage had been increased several times. When he placed me on the fentanyl patched, everything changed, to where I could live with the constant pain I am in, in my legs and hips, making it possible for me to walk once again. Like I said I have been on this medication now for over 5 years, over these years, he has increased my dosage until I am up to 100mgc every 72 hours. I do not take anything else for my pain. The increases came over several years with me starting with a 50 then a 75 them a 100mcg. Which I have been on now for almost 2 years, and it still controls my constant pain, and I can still walk. I know that by now, I am prolly hooked on this, as nothing else has ever worked to take away the pain I was in. We have never discussed, either taking me off of them or trying to ween me off of them. Or even trying to get me into a pain control management program. Or even a different type of the new medications. He is like, it works so why take a chance of putting you on something that is gonna leave you bed ridden or in a nursing home, and go back to where you were before you started taking them. I feel the same way myself. Why after laying in the bed for almost 2 years and sending a year in a nursing home why would I want to go back? To taking pain medication that did not work or should I go back to it and living in a nursing home. I for one totally believe in the fentanyl patches. I never have abused them in any way because, I have no need to do so. I don’t believe in that, as for myself they work, without over using them. I am however off of ever other narcotic that I was on before I started using them. He weened me off of them many years ago, and I was on several of them. I now just use the patches to control my pain, and use a medication to control my seizures, that were brought on by the car accident, where I suffered a severe head injury. Outside of those two I also take a antidepressant to control my PTSD, which also came for the accident. I have read in several other post, about the use of grapefruit juice, to enhance the drug and make it last longer,if anyone would care to share, I would love to here about this. Thanks, to Straight Dope for allowing me to post and become a member of this group, I have really enjoyed it, even though it is not just about 'DOPE" I really enjoy all the post that are made. I read alot and spend most of my time here reading. Instead of me going to other sites, I generally find myself back here. Sincerely, Larry
Last Jan I was diagnosed with soft cell sarcoma in the right side of my abdomen. As time has gone by the pain has increased to almost unbearable levels. My doctor started me out with Percoset which worked for awhile. I’m currently on morphine slow release. The dosage has gone from 30mg twice a day to 100mg three times a day now. Even at this level of pain meds the pain never really goes away.
Surgery was first planned after radiation but the cancer has spread to my lungs. Surgery has been ruled out and chemo will be started this week. I have been referred to Mass General for treatment. It turns out that I’m eligible for a clinical trial of new drug so I’m hopefully that it might give me a chance.
I’ve been referred to the palliative care unit at Mass Gen. They have taken over my pain Managment and agree that the morphine doseage appropriate. They have also prescribed 30mg morphine quick release for break thru pain. Their mission is to alleviate pain and suffering. Be it physical or emotional.
My advise would be to look into palliative care for their input. They be able move you to a more realist approach to pain Managment.
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I tried another Fentanyl patch the other day and the same side effect (vomiting) returned within 8 hours, so I tossed it as soon as that started.
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Have you tried Zofran to combat the nausea/vomiting? Otherwise, there’s not much to go with for pain that isn’t some form of oxycodone, morphine or hydrocodone. There are other drugs that cross over into anaesthesia territory like propofol and ketamine, but they’re not safe for self-administration.
How many oncos do you have? If you’ve got one for chemo and one for rads, which one claims to be your go-to guy? Whoever you’ve been dealing with is seriously deficient in pain management - when my husband started his treatment plan, the nurse navigator at the chemo guy’s office said if you’re in bad pain or vomiting, they’re not doing their job right.
For a roughly three-week period, he was on a mix of Fentanyl, Dilaudid, Vicodin, naproxen (Aleve), diphenhydramine (Benadryl) and Zofran.