I have literally been on every narcotic out there at some point in the last 30 years. Since insurance has narrowed the long acting drugs they will cover down to very little, I take long acting morphine and hydrocodone for breakthru. When I start seeing signs of tolerance, we switch to xtampza and Oxycodone for several months then right back to my usual. Works great.
If I had to guess I would say 15mg long acting morphine was not enough for you. 30mg would be worth a try. I know lots of people do well on the fentanyl patch. For me it didn’t feel consistent. I felt like I used to when only taking short acting meds. You know, the rollercoaster. Up and down. The whole purpose of the long acting med is to stop that. Long acting morphine(MS Contin) does that pretty well for me. Any one who’s been on narcotics for a time would probably have to start out at 30mg twice a day.
Also on the patch same thing. 25mcg probably wouldn’t be enough. I started at 50mcg and ended up at 75mcg.
I just wanted to encourage you to keep on trying. Many doctors want to titrate your dose up slowly so it may take awhile to get to the dose that works best.
Let us know how things work out for you!
Unfortunately- taking more than prescribed only serves to increase tolerance and medications lose their effectiveness over time.
I am not that far in years behind you and have multiple spine surgeries, def arthritis in entire lumbar spine and spinal cord damage.
No doctor is required to continue medications or dosages given by a previous provider and with the current attitudes and concerns about opioids - even less likely to give patients that many norco -Tylenol and hydrocodone at the dosages you were taking it previously.
If one opiate is not helpful- you may need to try different ones under the supervision of your PM doctor to find one that works.
PM is about reducing pain to tolerable levels but it is not going to eliminate it completely. There are topical creams and ointments that may offer some relief as well, used in combination with oral meds.
The thing you are going to keep in mind though is that extended release meds don’t give you that feeling you get from norco- they deliver a consistent level of meds for a set time frame - and some of them require that you take them as directed for several days before you notice a reduction in pain levels.
For fentanyl patches- there are cover tapes called tegaderm or opsite that you can place over the patch which helps keep it in place. It is also important when placing them that you choose an area of little muscular movement- shoulder blade, upper arm, lower calf muscle- and hold it firmly in place for about a minute.
I think you may be confusing not ‘feeling’ the onset of the medications and misinterpreting them as not ‘working’ because you aren’t getting that feeling many get from immediate release meds.
Because extended release deliver a steadier blood plasma level as you continue to take them and once you reach the steady plasma levels- there is a noticeable decrease in overall , every day pain.
The norco now appears to be used only for breakthrough pain- and either the morphine or fentanyl is your main pain medication. The nice thing about the fentanyl patches is once you adjust to them- you’ll come to enjoy not being tied to a pill bottle all the time and the overall pain control is far more stable and less.
Hydrocodone is an immediate release medication- meaning that most ‘feel’ it kick in after taking its within half hour/1hr. It is also short acting- meaning as 4-8 hrs pass- those using it notice the effects lessen over the time frame.
Morphine ER is an extended release- most taking it don’t feel it ‘kick in’ like the immediate release options and often believe because they don’t ‘feel it’ it’s not working. Extended release meds are meant to deliver a steady blood stream level of medication over its dosage time.
Fentanyl is hundreds of times MORE POTENT and powerful than other opiates and is absorbed through the skin- over three days. When using fentanyl patches- you won’t feel it immediately since it takes time to reach a steady blood plasma level - for new users- typically two or three patch changes.
With extended relief and medications like fentanyl- instead of noticing it kicking in- most patients notice an overall decrease/more consistent leveling of pain.
IMPORTANT- NEVER allow anyone to touch fentanyl patches and once removed- put used patches in coffee grounds or used cat litter to prevent someone from using or touching them.
There is a VERY real danger of accidental overdose for someone to come in contact with fentanyl or opiates they are not prescribed.
I think you need to give either the fentanyl or extended release morphine a longer trial period before discounting them as ineffective. Both medications are the most potent available.