Undiagnosed Bone Disease. Was On Trans Dermal Patches. Started To Take Morphine. What Are The Side Effect?

Posted on Fri, 4 Oct 2013

Question: My name is XXXX. I am 62 years old and fairly healthy, as about anyone my age. I have an undiagnosed bone disease which started when I was 38 (at least when first noticed). While at Mayo Clinic in 1990, they dubbed it "Cyclic Acromegaly". To the point, I have been on TransDermal Patches for approximately 15 years. When I started through menopause the patches would no longer stick, as I had extreme sweats and flashes. At that time, I was put on Morphine pills. For the past three years, I have attempted to have my physician help me discontinue the pain meds., as my bone pain was coming through, even though I was on 180mg. of Morphine a day. Finally, in July, I was able to convince my doctor to assist me in discontinuing this medication. I have spent the last 2 1/2 months coming down off this medicine. I have had diahhrea most of this time, dizziness, the heebie-geebies, and an overall just awful feeling. (Like a real bad flu.) Some nausea also. But on Monday, I took my last 15mg. pill of Morphine. And the last two days, well, AWFUL! Can you offer any suggestions to help me get through this time...my doctor said that I got my self off Hormone Therapy (had complete Hysterectomy at 28yrs.) without his or any body else's help ... he was sure I'd get through this also.\!?? I am on a Beta Blocker for heart problem, Simvastatin for cholesterol and Trazadone to help me sleep at night. Though not doing the trick now. I also take a Lutein/Zeanthathin capsule as diagnosed a year ago with Macular Degeneration. I have taken an antihistamine as my pharmacist recommended---otherwise I am in misery--can you offer any other suggestions which might make this transition easier?? I was not an addict, but in light of test results on the incidence of Colon Cancer with Opiate/Morphine use; coupled with the fact that I was experiencing some intestinal and colon problems, I made the decision to get off the Morphine. My hope is the use Aleve or something similar to take the edge off the bone pain.

Answered by Dr. Preeti Parakh (8 hours later)

Brief Answer:
Try taking tramadol and taper it off.

Detailed Answer:
Hi XXXXXXX

Welcome to Healthcare Magic!

First of all, let me commend you for having the courage to try quitting morphine in spite of so many physical problems and in spite of knowing that it is not going to be easy. You are really a very brave person and your doctor must be proud of you.

Yes, it is possible for this transition phase to be made easier for you. There are two ways we can do this. The first one would be to ask your doctor if he can prescribe you clonidine in doses around 0.1 mg three to four times a day. This will reduce the yawning, sweating, watering of eyes and nose, diarrhoea and muscle twitches. This can gradually be tapered off in next five to six days. However, this will need close medical supervision and blood pressure monitoring as clonidine has a tendency to lower blood pressure and you are already taking a beta blocker which also does the same. Along with clonidine, you will also need to take an analgesic like paracetamol or diclofenac or ketorolac but again under medical supervision, as you have previously had renal problems which may be aggravated by analgesics. You will also need to take lots of fluids, preferably oral rehydrating solutions.

The second option is simpler. If your doctor agrees, ask him to prescribe you tramadol tablets. In my experience, patients feel much better with just 50 mg tablet three to four times a day and I think your doctor will agree with me. Since tramadol is an opioid analgesic, but far weaker than morphine, it will help with the pain and also reduce your other withdrawal symptoms. Every 3 to 4 days, try reducing tramadol by half a tablet. Tramadol comes in both capsule and tablet forms. If you can get the tablet formulation, you will find it easier to taper it off. When you taper it off, you will still have some of the symptoms that you are having now, but in a far lesser intensity than at present.

Since this method involves the use of only one medicine which is unlikely to interact significantly with your other medicines, in my opinion, this will be safer and more advisable for you. Please discuss both options with your doctor and choose accordingly. Whatever method you choose, remember to keep yourself well hydrated.

Although you are brave enough to do it yourself, there is no harm in our helping you to make the process easier and more tolerable. Just keep this in mind that the worst phase is already past and over the next few days, things will gradually improve.

Hope this helps you. Please feel free to ask if you need any clarifications.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Preeti Parakh (9 hours later)

Thank you for your answer. My doctor doesn't seem to have much empathy for going through withdrawal. I have asked for his help and/or suggestions several times for how to deal with the withdrawal symptoms; and gotten no answers at all. He was helpful in prescribing lower and lower doses of the morphine sulf ER; I was taking 180mg. 3 months ago and had gotten down to 15mg. a day-finishing the last tab on Monday. But queries for assistance with symptoms, have gone unanswered. On-line I found suggestions of using Hydrocodone - I discontinued Hydrocodone 5-325 during the first month of going down on the Morphine. I had been taking two Hydrocodone per day, along with the Morphine Sulf ER 60mg. three times daily for bone pain. Last night in desperation for a little relief, after going to as many sites on-line as possible for withdrawal help, I found the Hydrocodone suggestion. I still had 10 pills left from stopping it two months ago(approximately). I took one tab at 9 p.m. and took a very long warm shower, along with Waldryl (antihistimine) for the crawlies. I found this helped, symptoms though not gone, were significantly better and I was able to get some sleep (which was a God send). Is this an O.K. way to deal with the withdrawal? I have left a message for my doctor requesting 60 tabs of Hydrocodone 5-325, explaining my reason for the request. That was at 9 a.m. and I have yet to hear back. My plan is to use the Hydrocodone twice a day (9a.m. and 9p.m.) along with the Waldryl and warm, long showers for the next 4/5 days and then to wean off the Hydrocodone, hopefully by going to one daily for approx. a week, and then score the tablets in half dose, once a day and then every other day and then off. Does this seem doable?? Thanks for your help.

Answered by Dr. Preeti Parakh (14 minutes later)

Brief Answer:
Yes, this is fine.

Detailed Answer:
Hi XXXXXXX

Thanks for writing back.

What you have suggested is fine as hydrocodone is also an opioid analgesic like tramadol. You can use it to control the withdrawal symptoms and then gradually taper it off. Just go slow and do not overtax your body. Take as much time as is needed and taper it off. You can take the antihistaminic if it makes you feel better.

Please remember to keep yourself well-hydrated. It is just a question of few days and then, you will be out of it.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (59 minutes later)

Thank you Dr. Parakh. Your prompt answers have been very helpful. Looking at the messages/replies of persons on your site has also been helpful. I know that 23 years of Morphine/Opiate whether by Prescription (as mine has been) or by addiction, is not going to take a few hours to get full relief. But can you tell me, I see lots of folks talking about the effects lasting for months or more -- after being on these meds for 2/3 yrs. -- should I expect lasting effects (depression, etc.) for some time? I do not crave the medication mentally, though the withdrawal certainly is my physical body wanting the Morphine. AGAIN--Thank You for your answers to my queries....I wish my own doc was as kind and considerate. It is hard to find a doc willing to take on a patient with an unknown bone disease-I know this for sure, so am willing to put up with his indifference to me. I am certainly a dollar sign in his eyes, not a person he cares about. I miss my old doc-he retired-and few in my small town are taking new patients, especially someone like me with a few medical maladies, especially those with a weird disease such as my bone disease. You make me happy that there are still some docs out there who are in it because they are "called" and care about people!!!

Answered by Dr. Preeti Parakh (7 hours later)

Brief Answer:
Protracted withdrawal is unlikely in your case.

Detailed Answer:
Hi XXXXXXX

Many thanks for your kind and encouraging words.

It is true that some people have protracted withdrawal symptoms which lasts for months. This happens because brain cells need a lot of time to get back to their previous levels. Rarely, some symptoms last for a year or so, for which the biological mechanism is still not well understood. Again at times, people get symptoms or diseases which end up getting labelled as withdrawal related even though they happened independently but after quitting.

In your case, I do not expect a protracted withdrawal syndrome for two reasons. Firstly because in my experience, this happens more in people who took substances for a mental high, not for pain relief. Secondly because you have technically been in withdrawal for the last three months, when you have been gradually decreasing the dose of morphine. So, if you have not had such symptoms so far, it is reasonable to expect that you won't have them now too.

Please do not worry. I am sure you will do well. Take care.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar