Morphine Equivalent Chart by the CDC

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Tux
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Has anyone seen the chart put out by the CDC that shows the different opiate medications with doses, and what the equivalent dose of morphine would be? There is a column for people with cancer pain, and a column for people without cancer pain. The non-cancer pain column has a lower dose of morphine than the cancer pain.

The government is still trying to practice medicine, putting many restrictions of prescribing opiates. I was shown this chart by my doc. After looking at the different doses, the thought occurred to me: how did they come up with these equivalent doses? It's very hard to manage chronic pain. I recently wanted to stop my opiate that had been controlling my pain level fairly well. I still need a breakthrough med, but not daily. This was due to cost. I went to morphine, my doc said the "latest" study was that short acting meds worked best (huh?). Was going to put me on 15 mg of IR morphine. I asked for ER (extended release), so it was 30mg twice a day. I called a week later, it wasn't working, told me to double it, said I was close to the maximum dose. When I called 2 days later, I asked for more time, called back in 5 days, said I needed a slight adjustment. He said I was at the maximum dose. I then requested to be put on my previous med. He agreed.

Here are my thoughts on this... First, when I saw that chart, I wondered if they talked to people in chronic pain to compare. When he told me I was at the maximum morphine dose, I asked him if the chart was a scientific comparison, he said it was. (Each opiate binds to different receptors in the brain, that's why you can't go from one high dose to a different opiate high dose, you have to titrate up), he said it was scientifically proven that one med binds to this receptor, and another binds in this amount to that receptor, and because that's known, that's how they compare. Things like metabolism, body weight, and other physical traits apparently don't come into play.

I did ask if they surveyed or interviewed people in chronic pain to see how that worked out. I couldn't help it, but I had to ask. I, like many of you, can't see reducing my dose because the government says it should be lower. The answer was no, no chronic pain patients were consulted. Why are people in pain treated like they aren't honest with their doctors? Why does the government treat doctors like they don't know how to practice medicine, or write prescriptions? Why is it when the media makes a big deal about one person dying of an overdose, or a famous person is involved in an overdose, everyone is automatically a suspect in using drugs??? Seriously, wtf? I gotta say, the people who do mis-use and abuse pain meds make it worse and harder for us legitimate pain med users to get the proper dose of medication! That gets my goat (no pun intended, Goat). But here's a question, how many legitimate pain med patients couldn't get their pain managed, and had to resort to other means of acquiring their pain meds? How many of those people were either able to go to another doctor (not always possible, many of you know this), or manged to stop their mis-use on their own. How many of these patients have become addicted? Once they are able and willing to come clean, how many can get back into pain management? How hard is that to do, once you have become addicted ( which is not the same thing as becoming physically dependant). You are now known as being morally flawed because you became addicted. It's a physical problem. How messed up is that?

My pain level on the morphine was at an 8-1/2 to a 9, when increased, it went to a 7 to 8. My usual pain level was from a 5 to a 6. Pain is relative, at the smaller dose, I couldn't sleep due to a high level of pain. I could barely function, get out of bed. I continued going to physical therapy 3 to 4 times per week, but lowered my workout. When the morphine was increased, I could sleep for almost 2 hours but still woke up in pain, I could get up, but moving around was painful, walking to my vehicle hurt. I can't imagine being in that kind of pain all the time. My pain wasn't a level 10, because I'd have been in the hospital if it was. But now that I've felt that size 9 pain, it won't be a 9 again. It'll be about an 8-1/2 probably.

In a different thread, Munchkin had shared her story about how she was in pain management, her pain increased after I believe 8 years, and her doc wouldn't increase her pain meds, and she then went into addiction from there. Pain is no longer considered the 5th vital sign. Am I supposed to live my life in excruciating pain? Am I expected to grin and bear it?? 

If I was someone's pet (dog, cat, horse, you name it), I WOULD HAVE BEEN PUT DOWN BY NOW. How's that for perspective??

Why is it impossible to get the required amount of medication to manage my pain? Now I feel the need to justify my use of pain meds, so here goes.. I have tried all the non-opiod meds, like Cymbalta, Savella, Zoloft and more, Topomax, Neurontin, more anti-depressants, more siezure meds. I had bad reactions to the class of meds cymbalta, savella, etc. are in. I tried. Or I'm allergic. I've gotten epidural injections into my spine, they weren't effective. 2 neurosurgeons, surgery is not an option, it wouldn't stay stable and probably fail. I go to physical therapy 3 to 4 times a week, plus exercise at home. I do what I can, physically, however, I am afraid of injuring myself, so I am very careful with what I do. I've been in pain for more years than some of you are old. PM for 13 years.

What do we do about people who were in pain management for a long time, who's pain started up again, or is no longer controlled, or what if you were dropped from your PM's office? You have to make a choice, right? Do I control my pain as much as possible, or do I live in agony? Why do people who's pain is no longer controlled, or managed, get dropped or don't get the help needed from their doctors? Why is this a choice being made? Who makes these ridiculous rules??

What about the other meds, the benzo's people take for various reasons... in my case, the one I take helps to control the muscle spasms in my back, and is the only thing that works. Muscle relaxers either don't work, or the ones that do work, I can't take. My doc told me benzos increase your chance of stopping breathing by 10 times. So, I had a decision to make. Do I control my muscle spasms, and get some pain relief? Or do I worry about dying, because it could make me stop breathing... I thought about that very seriously for many days. And I came to this conclusion: I would rather take the chance of dying, or stopping breathing, rather than suffer through more pain due to spasms in my back.

When I realized that conclusion, it was sobering. I just made my first deliberate, conscious, quality of life decision. And I'm sure I will have more decisions like that to make. But this is what it comes down to:  I can either suffer (like cancer patients do). Or I can get some relief, and feel better. Who says I have to live in agony?

Many years ago, my fiance died of cancer. Through his journey, I learned the true meaning of the word "suffer". And the CDC has a chart comparing cancer pain pain med doses to non-cancer pain pain med doses. How the heck do they know who is actually suffering?? I know people with cancer whose pain was nothing like their chronic pain. And others who had a lot of pain from cancer. Why does the government think they know better?? Please.

Long post, I know. I'd like to read your views.

I have full confidence in my doc's ability to treat me. I do not have confidence in the cookie cutter approach the government is telling doctor's to treat their patients.