MSIR and Spasms; MRCP

[Robin]

Hi Dr....

I have a question about MSIR (Morphine Sulfate Immediate Release) and intense belly pain.

Whenever I take MSIR for breakthrough pain, I get intense belly pain identical to that of an attack of pancreatitis (I have Chronic Pancreatitis from an ERCP done in 1995 for evaluation of elevated LFT's).  I was reading on the internet from a person posting on a Pancreatitis board that Morphine can cause spasms at the Sphincter of Oddi.  Is this true?  I did speak with a PharmD at length and he said this is possible, but wanted to ask what causes this to happen.  I can actually feel and see swelling in the epigastric area when this happens.

Also, my GI Dr. has talked about doing an MRCP.  He doesn't want to do another ERCP (unless he absolutely has to)due to the fact that is how I got the Pancreatitis to begin with.  How is an MRCP done (I have searched the archives but there is nothing...this might help someone else interested in knowing the procedure)?  I am very interested even though I can't have one due to a Spinal Cord Stimulator that I have implanted for pain from RSD(Reflex Sympathetic Dystrophy).  Also, what are the chances of having another acute attack of Pancreatitis if he should do an ERCP since this is how I developed the Pancreatitis to begin with.  He said a long while back that he doesn't want to do the ERCP unless he absolutely has to, but I am extremely hesitant do have another one done due to my history.

Thank you so much for you time!  Any information you can give is so much appreciated.

Robin

[HFHSm.D.-Gastro-rf]

Dear Robin,
Morphine is indeed reported to cause contractions of the muscle cells of the sphincter of Oddi.  There are opiate receptors on these muscles to which the morphine binds.  It is interesting that other opiate compounds do not have the same magnitude of effect.

An MRCP is a radiologic test similiar to an MRI (magnetic resonance).  X-rays are taken of the bile duct after administration of a compound that will selectively fill the ducts.

It is difficult to predict whether you are at increased risk for another attack of pancreatitis with ERCP.  Approximately 5% of patients undergoing ERCP will develop pancreatitis.  It is thought that overfilling of the pancreatic duct during injection or inflammation of the sphincter of Oddi is the precipitating cause.

[Tammi...]

If you could email me your email address, I will be glad to share those sites with you.  The main one I use is on AOL.

Thanks a bunch...my email is ***@****

Robin

[Elizabeth]

Dear Robin,
    I am very glad that you asked about an MRCP as I am having one done this Friday. I have no idea what it involves. I've had MRI's before so I know about that. I just don't know if you get injected for the MRCP or what.
    Could you share some of the pancreatitis message boards? I am in the process of being diagnosed with chronic pancreatitis. I would like to read what other people have to say. I also wonder what I have to look forward to.
    I also had an ERCP back in August and ended up with acute pancreatitis. I am wondering if another ERCP would cause acute pancreatitis too. I don't think I would ever let anyone do another ERCP though.
    Thanks for your time.
    Elizabeth

[R]

Elizabeth....

Sorry that I called you Tammi...that was a mistake.  I had seen the name in another post just below mine, and that is how I picked it up....

I apologize...it was a mistake.

Robin
***@****