Pain management

[hollieb1986]

Hi all I'm new to this and would just like some advice, iv got problems with my back that leads to trapped nerves and numbness my doctor prescribed me oramorph for the pain and now wants me switch for morphine patches and still use some oramorph for break through pain. I just wanted to know if anyone had been through the same thing and had unpleasant side affects, I have tried every other painkiller possible so morphine is my last resort. Any advise would be greatly appreciated thanks

They are generally better than using oramorph because they release medication at a constant rate, rather than having the big dose of oramorph which then wears off. So generally a lower likelihood of side effects such as drowsiness, itching and nausea. What your GP is suggesting is good practice and should help you achieve better pain management overall. Do you take any analgesia specifically for nerve pain as well?

How do you feel on the oramorph? If you feel ok and are not badly affected by side effects such as nausea, vertigo and tiredness then you will probably do well on the patches.

I am on a cocktail of painkillers for back and other pain. I take slow release oxycodone and have drops for breakthrough pain. I have fewer side effects on that than on morphine (it's a synthetic opiate). I have also tried morphine patches but as well as not feeling well on them I developed an allergy to the adhesive. I also take lyrica for nerve pain. Have you been offered that or something similar? Often getting pain meds right can take a lot of trial and error. I just wanted you to know that there are other options if you don't get on with the morphine.

Sorry I just reread and saw that you have tried everything else. Really hope the morphine works for you.

Iv never heard of lyrica what is it? Iv had things like amatriptaline and nortriptaline. They didn't really have any affect on my pain, at the minute I'm taking diazepam 2 5mg a day and they do help a little. I have to take an anti sickness tablet with my oramorph

What do you mean as in any other analgesia for pain.

I have tried the slow release morphine tablets but they made me feel awful, I was constantly sick and they gave me really bad headaches but something needs to be done because at the minute I'm taking 95ml oramorph a day that includes rescue doses I know it's a lot but my doctor told me to take as much as I needed to feel comfortable and keep I diary. So on Monday he can work out what strength patch I need

A physio is probably better help. I had a badly broken spine a while ago and keep going to a physio. I try and minimise pain killers. I'd also recommend keeping active but with a physios advice. Pregablin and gabapentin are nasty. They never agreed with me and tured me into a zombie. My consultant has just said get on with it and take pain killers. Surgery won't correct the pain.

Do you have damaged discs ?

Have you ever been referred to a chronic pain clinic at your hospital? If not, ask for this.

I go to physio too. I agree a pain clinic appointment would be a good idea. Have you had an MRI? That might help the doctors or physio to see what they are dealing with.

Lyrica (pregabalin) and gabapentin are drugs which are usually prescribed for epilepsy but are also prescribed for nerve pain. They are not for everyone but they can be very effective and made a big difference to me. Sometimes taking a combination of medication means you can take a lower dose of opiate, eg morphine. The anti-depressant duloxetine can also be effective for pain but I had bad side effects on that. Have you tried oxycodone? I do find the side effects on that much more tolerable than morphine.

Are the patches you're going on to definetely morphine, not fentanyl? I ask because if you don't get on with morphine tabs in terms of sickness, the patches are unlikely to be different for you. Could you ask your GP about fentanyl? It's an opiate like morphine but can be better tolerated. I used to be on it.

I've been on loads of different painkillers because of chronic illness. Would recommend pregabilin or gabentin - these work very well for nerve pain. They are in the same class of painkiller as amitryptiline and nortryptiline but can be more effective.

*gabapentin

Get a good physiotherapist to teach you appropriate exercises and do them every day.

There is good evidence that longterm painkiller (of whatever kind) don't actually help chronic back problems, so I'd be careful there.

Pregabalin/Gabapentin are not painkillers, they are antiepileptic meds that work very well for nerve pain, so worth a conversation with your GP about.
Nortriptyline/Amitriptyline are tricyclic antidepressants that in low doses can work for nerve pain - if they have not worked for you, it is still worthwhile thinking about Gabapentin or similar as they work in quite a different way.
They take a bit of time to get in to your system, and you start with a low dose building it up slowly to the point where you are getting relief - the final dose can vary quite a bit from person to person.

I'd be careful with strong painkillers on a regular basis.

Gabapentin worked really well for me but I became tolerant to it very quickly, my dose was having to be increased every month, and with each increase I had awful side effects of suicidal intentions.
I'm taking zomorph, oramorph and strong codeine, I used patches when I first broke my back and can't remember side effects.
Have you heard of pacing for pain management. This is a post I made
www.mumsnet.com/Talk/general_health/2846842-Chronic-pain-and-pacing and in the replies are excellent links.

I take pregabalin, Naproxen, oramorph and zapain. I use fentanyl patches. I started on 25mcg then moved up to using 25+12. I found the side effects very difficult to deal with and keep working. I get a fuzzy head and just don't feel sharp enough for my job.

I moved down to 25mcg 2 yrs ago and down again to 12mcg 3 months ago. I am in more pain, grumpy and just about coping but my head is clearer. I would recommend going on the lowest possible patch and only moving up if you really feel there are no other options.

It is a good effective pain relief though, so depends if you can get in with the fuzzy head thing.