Morphine and paradoxical pain…

Increasing my Zomorph from 100mg to 130mg b.d. (in 10mg steps due to the risk of catastrophic respiratory failure if I hit the full 30mg increase all at once), has resulted in much more pain, not less. This, to my surprise, is not entirely unknown, though the research was relatively recently published on January 6, 2013.

Anyway, those of you who, like me, are dependent upon morphine for the treatment of severe, intransigent, pain, might be interested to learn that instead of making you feel better it can make you a hell of a lot worse.

This is why.  See this also

It might, of course, be some time before it results in a fix for the problem, but it can’t hurt to make your doctors aware that you know about it and will be keeping an eye on developments. This is where we, the patients, have an edge over our doctors as we – those of us unable to work, anyway, and have computers – have more time to keep an eye on the research fraternity than they do.

I’m due to start the full 130mg dose tonight. Whether this will change things, for good or ill, I have no idea right now. The weird thing is, though, that increasing the dose of Zomorph in the past, and initially this time too, has made Oramorph more effective. It still is, it’s just that I have far more pain without it that I had previously, which is unfortunate as my GP expects my Oramorph use to fall.

On the current showing, that simply is not going to happen.

Update: For the second morning in succession I managed to get back to sleep after taking my 06.00 meds. Only for another hour, but better than nothing. 



8 thoughts on “Morphine and paradoxical pain…

    • Hi Jayne. I’ve made a couple of changes to the post as I’d managed to overlook the fact that it was from 2013. It doesn’t affect the main thrust of the post though.

  1. Ron I have read your post with interest my husband is also on morphine. The research that you mention was released in Jan 2013,i can find no mention of the research on the UK sites.Sometimes for him morphine has had little to no effect.

    • Yep, it was 2013 – don’t know how I missed that. In research terms, though, it’s pretty much yesterday – the wheels grind exceedingly slowly.

      As for your husband, I have the same problem, even with the increased dose – some days it just does nothing. There’s also the half-life problem – modified-release morphine (Zomorph in my case), is prescribed 12-hourly. A pity, since it’s out of my system far too soon, leaving me in extreme pain most evenings from about 21.00 on.

      If my experience is at all typical, morphine simply doesn’t live up to its publicity, though taking Paracetamol with it can help.

      Amitriptyline is an essential adjunct in pain management – if he’s not already taking it he needs to talk to his GP. Dose is usually 10mg to 30mg at night. Over 30 and you start getting into psychotherapeutic territory, and while that’s not, of itself, a problem, it’s also the point at which unwanted side effects kick in for many people, including me. Ami also shuts down the pain-generated nightmares.

  2. I’m on 100mg/day of MST continus now and the oramorph feels like it works better, but is that because of the extra slow-release morphine?? I take the oramrph as and when I need it… aprox 10ml a time.

    I have to admit to being confused about it myself, but when the MST goes up, my gp also expects the oramorph use to drop. But it doesn’t seem to work quite like that does it!

    • No, it doesn’t work like that!

      The point of Oramorph is that it works quickly, and it’s a valuable adjunct to modified-release versions like MST or Zomorph. Bear in mind, though, that the standard Oramorph has 2mg of morphine per ml of solution.

      Your baseline morphine intake seems very low. The thing about morphine is that your body can adjust to it quite rapidly, so it constantly needs to be increased.

      The main benefit I get from even my current increased dose (130mg every 12 hours), is that Oramorph works faster. It does not, though, reduce my need for Oramorph, and never has, and I foresee a battle with my GP over that.

      Like many drugs, morphine has a way in which it’s supposed to work, arrived at during trials, which is often in conflict with the way it actually does work for us poor buggers out here in the real world. But just try convincing a GP of that!

      • I know but I think my gp is ok with the morphine. She was ‘happy’ to prescribe it and I haven’t been on it that long. I’ll be seeing about an ‘upgrade’ soon though, as I get through the oramorph quicker each time I open a bottle. But needs must.
        Our pharmacist in the village also says he thinks I’ll need an upgrade. He’s very old school and definitely knows his stuff. A ine of useful information. But not *always* right!

        • My Zomorph increase has got the Oramorph down to 2 shots a day, morning and evening, but using my chair indoors has also played a major part in that. Should have done it much sooner.

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