Pain Management Community

Hi bOSSMUSTANG,
I am not familar with msir?What is it???But,I know alot about pain meds and Pain,also withdrawl!Your case sounds weird!Usuallyweek that you experience the worst of it!I don't know if they are in the same family of opiates?
I would ask my Dr. even though I know alot,I'm not a Dr.!
Hope you feel beter!
Blessings to you,77grace

MSIR is Morphine Sulfate Immediate Release.

Bossmustang, would you please provide your total daily dose of MSIR and your total daily dose of Oxycontin? I can take a quick look to see if you are on a dose of Oxycontin that is equivalent to the MSIR you were taking.

Oxycontin is about 1.5-2 times stronger than morphine so your total daily dose of Oxycontin in mg should be at least 1/2 what your total daily dose of MSIR was in mg? Make sense? If the mg dose is less than that, your withdrawal is likely due to not being dosed equivalency of MSIR through Oxycontin. If this is the case, it is not unusual as many doctors reduce the conversion factor by what is called, cross tolerance...25% is the approx. amount for opioid tolerant individuals. This is so that the side effects are minimized during the transition period and once you are fully transitioned (usually within 1 week sometimes less), the doctor can titrate your dose of Oxycontin up to a level that is equivalent to the MSIR that you were taking.

I could consume morphine all day long like candy and not achieve a good result. We're all different. What works for one pain patient does not for another. That's why chronic pain patients should try virtually every combination of long and short-acting opiates before making a decision. Yes, this is time consuming. It could take two years to determine which combination works best for you. You'll require a very open-minded physician for this.

I also stress the word COMBINATION. Research on chronic pain patients reveals that they do much better on long-acting drugs (Oxycontin, Kadian, Fentanyl Transdermal, etc.). You can then use short-acting drugs for breakthrough pain. Ask your physician about using a long-acting drug.

Good luck.

I am taking morphine sulfate 45mg 3 times a day,sometimes 60mg.Ill be changing to oxycodone tomorrow.Im already having anxiety about the change .Thanks for your replies.I tryed changing to fentyl and had the same problem.

Hi bossmustang,

Thanks for replying with dosages. Based on the mg amounts you have provided above, it appears that you are on morphine sulfate ER. I could be wrong and you could truly be taking that high amount of morphine in immediate release form as some people do.

In either case, 60 mg of Morphine, regardless of if it is long-acting or short-acting, is equivalent to 30-40 mg of oxycodone assuming a 0% cross tolerance factor. If your Oxycontin dose was less than that, this could explain your withdrawal symptoms.

Charles is right, you might have more consistent pain relief if you were on both a long-acting and short-acting medication not one or the other. Next, as Charles said, it is best to try out all the meds out there to truly find which one works best for you.

Furthermore, if you are only trying the initial dose of each different opioid, this could be the problem also especially if your doctor is applying a hefty cross tolerance factor. If you are having issues after switching to a different opioid...withdrawal, pain, whatever...consider giving each one a fair trial. You may do well on Oxycontin after 1-2 dose increases. If you are on the lowest Fentanyl patch (25 mcg/hr) and having issues, perhaps you and your doctor need to try 50 mcg/hr. Many patients experience withdrawal on the Fentanyl patch after 48 hours. Therefore, having your doctor change the instructions to apply a new patch every 48 hours vs. every 72 hours could help tremendously.

Bottom line is it takes time. Most chronic pain patients are not optimal after the initial switch from one opioid to another...there is some "tweaking" that usually needs to be done. So if you have tried out these options considering retrying some of the other meds like the Fentanyl and the Oxycontin, while keeping these principles in mind.