hydrocodone vs morphine

[lindalou1947]

i have degenerative arthritis in my spine.i take up to 4 hydrocodine-acetaminophe 5-325 per day have been on it for almost 10 years only recently have been taking 4 per day mostly2. now my dr wants me to go on morphine i dont want to but he says it will manage my pain better i am 67 and still work cant i refuse and stay as things are? is there anything less adictive to take? i need to work and dont want to get hooked on anything stronger. his reason was that 4 pills a day is too much.

[philnoir]

Other reasons I keep coming back -- I miss solving the medical problems of my veterinary practice, so considering problems here is my kind of fun (not that I giggle over other people's suffering.)

I've been kicked off many other back and spine sites because I hold strong opinions about pain treatments, for instance, I've seen too many people opt for surgical treatment too early in a treatment plan, and have bad results accordingly. I warn people about this, and in other places that are owned by surgeons and hospitals, I'm always given the bum's rush. Here, MedHelp allows me to apply my knowledge to answer people's questions without being accused of "practicing medicine."

And, there's another big benefit for me -- when I'm thinking about other people's pain syndromes, I'm not focusing on my own.

[ChristNonsense]

Also off the original poster's post... sometimes I get very angry that I spend a great deal of time composing posts, and *never* hear back. No 'Thank You's' or... well... *anything.*

And, I've only made a handful of posts.

So, hats off to the long-timers (Remar, Phil) who have the patience, and kindness and tirelessness to post here every day, for years, for a seemingly 'thankless' work.

I resolve this, in my own mind, by using introspection.... e.g. WHY do I post? Why do I answer questions? What, exactly, do I get out of this. And, the answer that keeps coming back to me is that when I am 'truly selfless' then I don't care whether I get thanked or not. It is only when my 'ego' gets involved that I expect some accolades.

And, further, people come here to the Pain Forum because they are in excruciating pain, and it really is wrong to expect them to have to come back and *thank* people.

However, I will say one thing... many many posts sort of reflect a "gimme gimme" attitude, or, "the world owes me...because I have pain" attitude. And, perhaps one of my faults is that I ALSO have this attitude sometimes (they always say that the faults we recognize in others are actually our own faults).

I guess, plain and simple, it's kinda fun to answer questions, maybe it's my way of saying "look at me, I'm not really the dummy everybody says I am"
:-)

[philnoir]

I think people do come back, whether or not they comment (otherwise, why waste my time?)

But I do appreciate the ones (like you) who have said to me -- thank you, that information really helped.

[remar]

Off of the original posters subject for a second, and I hope that's alright. I just wanted to say I learn something new every time I come to this forum. I've learned to be more open with my own Dr and let her know my pain levels instead of playing it down. By doing this I think we both feel more comfortable with each other and now she knows what was not working for me and what is working for me now.
Communication is so very important. I'm really hoping the original poster will come back and read what was written. Maybe they will feel more comfortable talking to their Dr now.

[ChristNonsense]

I have an idea... (just came to me). Don't skip ahead, though, if you haven't read PhilNoir's entire post, go back and read it, you'll be all "set to go" because he put everything you need to know in that one post!

I got to thinking.... a lot of physicians pay particular attention to what is called, "Opiate Guidelines." Some states have people that sit around and do nothing but create "guidelines" (and they word them so they look more like LAWS, rather than guidelines... but that's another story).

Anyway, some of these 'Guidelines' say (this is from memory, I'm paraphrasing), say unless you have terminal cancer (are on death's doorstep), opiates should only be given for Short Term pain (e.g. broke your arm, knee surgery, dilaudid cough syrup for that nasty cough, etc. LOL). However, they provide some exceptions. For example, if the patient demonstrates that long-term opiate therapy helps them be more productive ("Doc, I can chop more lumber when I take these pills"), or, if the patient demonstrates continuing *improvement.*

THEN, the guidelines go on to suggest that for chronic pain, longer-acting opioids (e.g. the "*-Contins") are preferred over short-term pills (e.g. your hydros). For example, instead of a patient taking 6 Percocets every day, a couple Oxy-Contins would be better...

So... moving right along (to my point), maybe your doctor just got through reading one of those Guideline Brochures, and decided that he wants to get his patients on those Short-Term meds moved onto Longer-Acting meds, so that he can show/demonstrate that he is "doing a good job complying" with them Guidelines.

Does that make sense? I hope so, I'm not going to edit it  :-)

[philnoir]

20mg of hydrocodone / day (4 Vicodin 5/325) is NOT a large dose, and because you don't always take 4 tablets a day, some days you're getting less. You are what I would call a stable pain patient who is using the benefit of chronic opioid therapy to improve function and quality of life.

So my attitude is, if it ain't broke, don't fix it.

But, there's just no telling what an individual physician will do when it comes treating a pain patient with opioid medication (most feel a strong desire to run away). I don't really understand your doctor's motives -- they don't seem to be medical, but that's another issue. Let's deal with your particular dilemma. Information is the greatest equalizer in the doctor/patient relationship, so listen up.

Morphine, when given as injection, is a much stronger medication than hydrocodone. However, when taken by mouth, morphine's strength is greatly reduced, and 20mg of oral morphine has the same pain relieving power as 20mg of hydrocodone -- they're equivalent in strength.

But, oral morphine comes only in pills of 15mg or 30mg -- there is no 5mg dose -- so I wonder how he plans to accomplish this?

Perhaps he plans to rotate you to a long-acting, extended release formulation of morphine. This medication, called MSContin, slowly releases morphine over a 12-hr period, so you have to take it twice a day.

But again, the smallest formulation of MSContin is 15mg, which would give you 30mg of oral morphine / day -- 50% more opioid analgesic than you're currently taking, and therefore, your risk of opioid dependence increases.

OK, he is still your doctor, and you're going to have to work with him.

Whenever a doctor changes a patient from one opioid to another (a process called opioid rotation) that doc needs to titrate the new dose. Titration consists of finding the minimum dose of the new opioid for adequate pain relief, while at the same time avoiding any symptoms of opioid withdrawal.

Titration requires close doctor/patient communication during the first month of finding this dose. So, you'll need to keep track of dosage, effective pain relief (by pain score) and note your side effects during this process. You write this down every day at regular intervals, for instance, before you medicate, and a couple of hours after you medicate. If your on the long-acting MSContin, note your pain levels at 6 and 12 hours after medication.

This "pain diary" provides the information needed by your doc to do the titration properly. If I were you, I'd be sending weekly pain diaries to the doc, and if you're feeling any negative side effects, I would call and ask for directions on how to adjust your dose.

All opioids have the same side effects, but the one that may trouble you the most, with your active lifestyle, is somnolence -- morphine is known to cause more sleepiness than hydrocodone.

Everyone metabolizes these medications differently -- you may not experience any negative side effects. But since you're still working, this may be a problem so be aware of it.

Good luck with this -- feel free to ask questions during the process.

Best wishes.

[ChristNonsense]

Thank you, Remar, for softening what I had said, after I made my post, it kinda looked 'harsh' and I wasn't trying to be harsh, just trying to get some points across (playing the 'devil's advocate' type of thing).

So, I certainly 'second' what Remar says -- keep the lines of communication open, and, again, apologies if I lack the right words to use and sounded rude.

[remar]

You've been on the same medication for almost 10 years and you're doing well on it? I'm wondering why your Dr is recommending a change too.
I'm fairly new to being a chronic pain patient so I'm still learning about the pain medications. I was on the same one for almost a year and the dose I was taking was just not helping much at all anymore. I did sit down with my Dr to tell her about this and we decided to try something else which is working great.I liked the idea too that she is trying me on something that does not have acetaminophen in it. Something you may want to think about and talk to your Dr about. If I'm not mistaken, your current medication does come without acetaminophen in it.  
You do have some choices here. You can ask for a dose increase, stay on your current dose or give the morphine a try, a very low dose to start off with.
Do you have a good relationship with your Dr? That's so important. They need to know how well you're doing on your medications and what your pain levels are. If you feel like you do not need anything stronger than what you're on then you can tell your Dr you would like to stay on your current medication and if you get to the point that it's not working or you've increased your dose and it's not working then you will be willing to try Morphine.
I really hope this all works out for you. We're always here to listen and help anyway we can.

[ChristNonsense]

Many MANY people feel that hydrocodone is not a very good pain reliever. Other than providing a 'buzz' (i.e. "euphoria"), it doesn't really mitigate pain that well.

Perhaps that is why the entire world (except the USA) has BANNED its use!

Whereas morphine is the mother-of-all opiates, the prototype opiate, the 'original' opiate! Morphine can mitigate just about any kind of pain (that's why it's been used in the battlefield for decades).

Some say hydrocodone is more addictive (all it does is provide a buzz, but no real pain relief), while others say morphine is the "sledgehammer to kill a fly," not much of a euphoric buzz, but will kill pain, maybe overkill in your situation.

With all that being said, your post has me a bit confused -- some things are contradictory.

You say your doctor says Morphine will manage your pain better, but you are implying that your pain doesn't always require 4 hydro pills (that sometimes you only take 2!). So, which is it? Is your 4 pills not enough? And you are wanting to take more? If so, why are you only taking 2 pills?

Conversely, if you are finding you usually only need 2 pills, then why is your doctor saying "4 pills is too much," if all you're needing is 2?

See what I mean? Something doesn't make sense. Have you been not counting them too well and running out early? Are you just 'thinking' that you're on 2 pills a day, but when you add them up, you sometimes take 6 or 7 a day?

I'm not trying to pick on you, I'm just trying to figure all of this out, because the Answer to your question is different, depending on your specific circumstances.

I would NOT worry that morphine is "more addictive." No, that's just these "preconceptions" we all have, that Morphine is this big ol' scary drug that turns everyone into an addict. In fact, realistically speaking, morphine has LESS of those desired "addictive euphoria buzz" effects than hydrocodone! You almost NEVER hear of someone breaking into a pharmacy demanding morphine! haha.

Now, morphine, although an *extremely powerful* pain killer, has its own spectrum of side effects which many find annoying/irritating:
1.) constipation (prepare to stock up on Miralax)
2.) sedation (prepare to not want to get out of bed too much)
3.) itchyness
4.) flushing
5.) pinpoint pupils
.... the list goes on.

AFTER an initial "getting used to" period of time (a few days, weeks, or months), MOST of these side effects will either disappear, or, become tolerable.

If it were me, in your shoes, I would NOT blanketly "refuse" to try your doctor's suggestion. I would at least try it for a few weeks, and then if it's not working, THEN I would complain. In fact, I'd complain after about 7 days, but leave a message with the nurse, "Hey, it's me please tell the doctor that I don't like the morphine, but I'm happy to give it another few weeks."

But, if you refuse it outright, if I were a doctor, I would wonder what your motives are. I mean, isn't your goal Pain Relief? If it is, wouldn't you want to try anything that could help?

My guess is that if you are only needing 20 miligrams of hydrocodone, you'll be put on a very, VERY low dose of morphine, so that would mean A LOT LESS side effects, and great pain relief.

Now, I cannot conclude this post without throwing my opinion in there somewhere (haha), so, here is my OPINION:

If you are only needing 2 to 4 pills of 5mg hydrocodone a day, then for goodness sake, throw 'em ALL out, and just take an advil, and stop narcotics, they mess with mood, they ARE addictive, and after a while, you'll need more and more and more.... it's just not worth the hassle, risk, visits to the doctor, the pharmacy, blah blah blah.

But, good luck to you, I hope I was "straight-forward," without being too rude or anything, I'm just being blunt, but also respectful at the same time.