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Hi, I have a question about pain management. I have been on Morphine for quite some time. I've been taking Morphine Sulfate Extended Release 60mg every 8 hours, and Morphine Sulfate Immediate Release 30mg for breakthrough pain.

On Saturday morning I tried to fill my script for the Extended Release Morphine, and it was not available. We tried all the local pharmacies, and they were all out, and the pharmacists all said it was a manufacturing issue and they have ordered it but have not been receiving shipments. I called my doctor and was advised to go to the ER because I had taken my last Morphine ER around 11pm Friday evening and was completely out and unable to have my script filled.

The ER doctor contacted my doctor and he advised them to give me clonidine and a fentanyl patch until I could get a script for fentanyl from my doctor on Monday (since he was unable to phone in a fentanyl script for me, even as a one time emergency script).

The doctor at the ER, from what I was told, ordered the 75mg fentanyl patch which my doctor had suggested from the hospital pharmacy, but the pharmacist said that's very high, and it seems like they allowed the pharmacy to make the decision, and so they ended up only giving me a 12mg fentanyl patch (not a script, but just 1 patch which they applied right then), and one clonidine pill.

They made me wait an hour to observe me after applying the patch, and my pain was only worse, not better, but they said they don't usually get involved in chronic pain cases and I was lucky to have gotten even what I did. I came home and called my doctor and he wasn't happy, and said that was a wasted trip to the ER because the 12mg fentanyl patch wouldn't be enough to help me, so he called in some hydrocodone and some clonidine for me and said if that wasn't helpful enough I'd just have to be admitted for pain management.

I survived the weekend (barely) and Monday afternoon I saw my doctor. He wrote me a script for 75mg fentanyl, and I still have the Immediate Release Morphine for breakthrough pain. I got the script filled and applied the first patch (and removed the 12mg patch I'd had on since Saturday morning) around 4pm Monday. It's now 6am Tuesday, so I've had it on for about 14 hours. It is helping, but my pain is still much worse than it had been prior to Saturday when my Morphine ER ran out.

I don't want to be impatient and complain that it's not effective before I even give it a chance, but to be honest I've been unhappy with my doctor for a while now and I question whether I am getting the right care. In your opinion is the fentanyl the best option for me to replace the Morphine ER, or would nothing work as well as the Morphine?

How long would I need to wait before being able to tell if the fentanyl is as effective? On Wikipedia it says, "Full benefits of pain relief from patches may take 4 to 10 days, although "relief" can be felt within hours." Would you agree with that? Like I said, I am feeling much better with the patch on, but I am definitely in more pain than what I have been prior to running out of Morphine ER on Saturday morning. Should I just be patient and count on this fentanyl kicking in more over time or is this not going to help me as much as the morphine?

Answer
Hi Bethany,
Firstly I am sorry to hear what you have been going through. Let me recapitualte your experience, you were on morphine ER and morphine IR for pain control. You ran out of morphine ER and could not get any, in the emergency you were given Fentanyl 12 mg patch, later increased to 75 mg patch, there is some control of pain but it is not as good as morphine.
I would personally agree with your experience, this is what I would have expected.
Fentanyl is not a really good analgesic and at any time it is quite inferior to morphine. I dont know the costs in your country, in my country fentanyl is about 200-300 times more expensive than morphine and it does not have the same capacity to control pain. I would choose morphine every time over Fentanyl.
My suggestion- move back to morphine as early as possible.Ensure you do not run out of morphine.
If there is anything else I could help you with, please let me know.
Best wishes
Ravi Ghooi

Pharmacy

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Dr. Ravindra Bhaskar Ghooi

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I can provide information on drugs and medicines, their actions, uses, interactions and adverse effects. To avoid confusion, generic names of medicines may please be provided. I am a pharmacologist, having worked on animal and human pharmacology, and presently I am the Dean of Bilcare Research Academy, where we teach courses on clinical research. We dont work on saturdays and sundays, hence questions reachng me on these days will be replied on Monday, please bear with me.

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