I have been on opiates for chronic pain x 8yrs. I had a posterior fossa decompression to treat a chiari I malformation and my spinal cord detethered in spring 2007 . IN 2008, I had a C 5-6 fusion. I still have pain. Since my surgery in 2007 I have been on 100mg of MSContin QID. I still have a lot of pain and am unable to work, however I am not tortured, I can get out of bed, use the treadmill at the gym, have a brief visit at a friends. Much more than I did before. Things are getting better. The question is would it be wise to have the morhpine decrease, as I still struggle and I am not close to "normal" and still suffer the pain or is this dose just ridiculously high. I am a RN and I know that the dose is high. I am torn with not wanting to rock my boat as I am improving and really truly hope to go back to work and be able to have a relationship (i am single now) and wanting to lower the dose which could set me back, . It is so hard to be a pain patient and have a compassionate Rxing Dr. and even harder at that dose. I was put on by a pain specialist but he doesn't do managment. My current Dr. is Rx this amount but he really doesn't like to, although he says he doesn't care as long as I am happy and have a life, and able to function to the best I can. I just feel like having the dose this high is going to make my life a pain in the butt, because of the situation regarding prescription opiates and doctors and how that relates to the pain patient.
Q: Appropriate dose of long-acting opiates
High doses of opioid medications like morphine can usually be avoided by attacking the pain with different types of medications because you can't build a house with just a hammer. Anti-depressants and Anti-convulsants both attack the nerve pain. Baclofen, a muscle relaxant, reduces muscle pain and can help opioid medications work better. Even, a combination of different opioids can be helpful because they all have a different footprints.
How much is too much? That usually depends on side effects versus benefits. If a high dose of morphine helps you get out of bed, exercise or go to work, then there is no reason to make a change, unless side effects like drowsiness became problematic.
Finding a doctor willing to continue a certain medication protocol can be difficult. Just remember that a successful pain management program is documented by real life activities like hobbies, work (even volunteer work), and good social support/connections. Any doctor would have a hard time denying success or continuing the successful program.
Dr. Christina Lasich, MD
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