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Original poster

Morphine, are the patches better than the medicine?

47 replies

onlyjoking9329 · 16/12/2007 14:55

Steve has been on morphine since thursday evening he is on the liquid oramorph, thing is he is needing it every couple of hours which seems a lot.and it makes him uncomfy for much of the night.
would he be better with the patches? are they slow release? or longer lasting?
he is totally out of it most of the time until the pain kicks in.
i am not sure why he is in so much pain he is on day 5 of chemo but chemo didn't give him pain last time just tiredness sickness and feeling crap.
anyone know about the patches?

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FairyTaleOfNewYork · 16/12/2007 15:00

Mb knows about the patch pain releif. not sure if its morphine based.

basically it a continual method of pain releif, and there isnt as much of a slow down from it.

he is on oral morphine, not the Iv then?

peter ws on continual morphine before the transplant. he had the ooxycontin twice a day, and oxynorm was every four hours as required, but towards the end he was on it every couple of hours. because if the pain is mroe under control then it gives the body time to rest a bit, readyfor the big fight ahead.

Wisteria · 16/12/2007 15:06

Hi OJ - sorry he's having such a rough time of it.

I have heard mixed views on them to be honest so not much help but I don't think they are as effective and are known to have less sedating effects. Can you contact the pain consultant at his hospital tomorrow to discuss the dosage and what the pain is attributable to? - my experiences of oramorph were quite positive but it took a while to get the dosage right.

What meds can he have as well? There are complementary pain relief meds that you can have as well as morphine but I am unsure about reactions to chemo........ sorry am not more knowledgeable.

Original poster
onlyjoking9329 · 16/12/2007 15:08

i know MBs DH was on fentyl? and had problems with overdosing on them.
yes steve is on the liquid stuff, i know the morphine is great for getting rid of his pain but he is so spaced out on it. and needing it so often i can't leave him alone at all.

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Original poster
onlyjoking9329 · 16/12/2007 15:11

i will speak to the Mac nurse tomorrow as she was the one who sorted the morphine for him. she didn't mention the patches but she did mention the driver but Steve not keen about having one put in and as he is now i am sure he would pull it out.

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dutchmam · 16/12/2007 15:12

hiye, the patches can be morphine too and longer lasting, but take a while to get into the system. So you would put a patch on and take morphine liquid for 1-2 days too. You can also have long acting morphine tablets, would that be any good? The morphine liquid is good for short term top up on top of long acting tablets or patches, but if you need top ups a lot the 'back ground' dose of morphine could be increased. Hope this helps, good luck.

FairyTaleOfNewYork · 16/12/2007 15:14

oxycontin/norm was pill form.

he also had the liquid as breakthrough dose as required. pain team were very gopod, can u get the mac nurse onto that dept for you?

its horrible when they are in pain isnt it

Original poster
onlyjoking9329 · 16/12/2007 15:22

he is on tramadol already the oramorph is to top him up, i will see if i can speak to Mac nurse in the morning, shes much easier to get hold of than the hospital.
he may be in less pain next week it is his last chemo day today so he should feel much better soon.

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Original poster
onlyjoking9329 · 16/12/2007 17:10

Bumping in the hope MB will see this.

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Blandmum · 16/12/2007 17:13

Right.

There are pros and cons to oral dosing, and there are pros and cons to patches.

The patches are Fentanyl, which is a synthetic opioid, and are good if there is a constant level of pain. If the pain fluctuates then there are times when the patient will have too much and /or too little depending on the pain level. The patches also go up in quite big 'jumps' and it can be difficult to get the dose right. They can also fall off/ bubble up, so that the dose can be variable.

the positives are that it gives a more even dose of drug, with less of the ups and downs of oral dosing. they also avoid the stomach, which is good if he is being sick.

In the end dh OD'd on the patches, and had to come off them. He was put on a syringe driver for a while and is now on oxycontin, which is a slow release preparation which atm is working very well. He has little drowsiness, and is pain free.

madamy · 16/12/2007 17:22

oj - I am an oncology nurse, but bear with me as have been on Mat leave since beginning of year and brain a bit addled!

Patches are probably fentanyl which is an alternative to morphine. each one lasts 72 hours and the main problem is that they are difficult to titrate ie get the right amount when starting off. The oramorph is so much easier to titrate. So long as he needs it for the pain, it should be fine for him to take as often as he needs it.

If he's going to need morphine for more than a few days, he can have MST which is a slow release morhine which you take 12 hourly. He could also have oramorph in between for 'breakthrough' pain. The MST dose is worked out by how much oramorph he's had over the previous 24 hours, so it's important he takes what he needs.

If the morphine is making him drowsy etc, there are alternatives. There's oxycodone which is a synthetic morphine which alot of people find has less side effects and there is the fentanyl too. There are also a number of drugs which can only be prescribed by specialist palliative care specialists.

God - sorry this was so long! I've lurked on your threads and felt it was time to contribute!

madamy · 16/12/2007 17:23

sorry, xpost with others as it took me so long to write whilst getting dc's tea!

Original poster
onlyjoking9329 · 16/12/2007 17:36

thanks MB, i think Steve would have constant pain if he weren't on the tramadol which is four times a day he is having the morphine as a top up in between the tramadol.
i will ask about the patches as could probably get awy with putting them on his back, it's hard to get much info out of him as he is so confused alll the time so i am having to guess a lot of stuff.
the oxycontin sounds better i will ask about it, thamks for all your help MB and glad to hear your DH has got something that works well.

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Blandmum · 16/12/2007 17:39

The patches worked very well for us for a year, which isn't bad! It was only in the last moth that things went pear shaped.

You need to have a chat with the Macmillan nurse, and don't be scared if they sugest a short stay in the hospice to sort out the symptoms if needed. Doing that gave me DH back!

We saw Santa with the kids yesterday, and spent this afternoon trimming the tree. A month ago I thought he was dying.

Original poster
onlyjoking9329 · 16/12/2007 17:42

Madamy, thanks for your help, Steve has his treatment at the hospital near you begining with "C" thanks for the info,seems like pros and cons to everything we may be best to stick with a oramorph for now and make a note of how much he is having. i feel happier knowing what the other options are and what peoples experiences are with them.

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Original poster
onlyjoking9329 · 16/12/2007 17:50

am concerned about the level of pain he has, he had pain at the begining and when on radio but has been fairly settled until last week. it probably just needs tweaking a bit, he has no quality of life at the moment as he is so confused and can't stand up without help, he has loss of hearing & sight too but is in no pain once the morphine kicks in.
its his last day of chemo today so i am sure thing will improve in the next week.
i am not sure i will get Steve back his brain is very affected by it all.
glad you got to do some nice christmas stuff as a family

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Blandmum · 16/12/2007 17:51

God OJ, your shouldn't have to cope with all this. I'm just so sorry.

Hugs

Original poster
onlyjoking9329 · 16/12/2007 18:02

the Mac nurse did say that brain damage was fairly standard with brain tumours and also radiation to the brain kills off brain cells. so we were kinda expecting it, well i say "we" steve doesn't have much awareness of anything that is happening too him and neither do the kids. you don't need to be sorry MB i value your input as i know you are in a similar situation.

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Blandmum · 16/12/2007 18:18

Oh, crappy as things can be for dh and me, it isn't so bad, because dh is still dh most of the time.

I just wish I could make it all right for you OJ. neither of you deserve this

Original poster
onlyjoking9329 · 16/12/2007 18:32

i think Debbie the mac nurse was spot on when she said "the package looks the same the contents are altered beyond recognition, and it's the contents that you grieve for." she is spot on really.

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Blandmum · 16/12/2007 18:34

Yes.

The worst thing over the OD period was that dh wasn't dh. and that was killing to cope with.

I don't know how you cope sweetheart, I really don't.

Original poster
onlyjoking9329 · 16/12/2007 18:39

well we have am odd sense of "normal" in this house
looking on the bright side {i am now singing monty bloody python} it was my birthday yesterday and i have lots of wine/rum and chocolates so thats me sorted for a few hours days

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Blandmum · 16/12/2007 18:48

belated happy birthday!!!

madamy · 16/12/2007 18:49

oj - am going back to work at said hospital in chemo clinic in Feb. Think that's why I've 'kept away' from your threads as wary of possible crossover into RL. I was going to go back this month, but decided to take a couple of months extra!

FairyTaleOfNewYork · 16/12/2007 18:51

oh belayed happy birthday from me too OJ.

i really feel for you both, i know i have been withdrawing sliughtly from your threads, as i feel an odd guuilt that i have my dh back (with a dodgey memory and steroid rages), and you two are still fighting

Original poster
onlyjoking9329 · 16/12/2007 19:20

Thanks MB
we never went to chemo clinic as steve is on the tablets type chemo. ,ada,y don't feel you have to keep away thou i understand it might be tricky for you when i rant about the registrar and stuff but its nothing personal just letting off steam really mostly about our situation.
MD you have nothing to feel guilty about i am really really pleased that peter and you guys have a much better life now and i hope you know that. both of our families lives were changed massively on 15th august, you have kept me sane many evenings on MSN and i thankyou for that.

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