Clarification: morphine dosing effects vs diazepams

April 23, 2005

In my last post, I said:

" I can take three times my current dose of morphine and not have

respiratory distress, but I get it almost immediately if I take a

benzodiazepam. "

I also said that I'd never taken more than twice the total daily

dose (30mg x 2 = 60mg) at ONCE.

This might sound like a contradiction, but isn't:

When pain is unbearable I usually opt to abbreviate the interval

between doses, taking the same amount more frequently.

I have taken as much as 180mg in a day, by reducing the dosing

interval to 4 hours. Again, my respiration was fine. How maddening,

then, that tiny doses of Benzodiazepams have this horrid effect of

triggering " air hunger " (and did, even before I started the

Gabitril, which makes them even worse).

The short dosing interval works brilliantly for controlling pain. I

can't do it long term because I would run out of morphine quickly

and I am not willing to face the ER again anytime soon (think

disgruntled, overworked staff who assume medically indigent patients

who have pain are all junkies).

I was able to make the experiment because I had over a month of

lighter pain, when I had an actual respiratory tract infection

(separate from Lyme, CAP was running rampant in Santa Cruz) in late

January, all of February, and the first part of March.

Neuropathy actually still got bad, but disc and joint pain were much

eased, so the same dose of morphine went a lot farther. I reduced my

morphine to 30mg a day during that time, which made the pain come

back like holy hell in the last half of March but gave me some extra

meds to experiment with as I tried to combat it.

I think vitamin D at VERY high doses, under close monitoring for

hypercalcemia, could be good. I'd have to be careful, because my gut

does not do a good job of absorbing calcium. When I tried

supplementing with calcium, I got so constipated I had to take

insane amounts of magnesium to compensate, which meant that I was

never really able to absorb medications properly, bad news for oral

abx and pain meds.

BTW, everyone should know that I was in agonizing pain for several

months before ever starting morphine - it took that long just to get

it prescribed, and the stress involved nearly killed me by itself.

Getting a feeling yet for why I'm such a delight to treat?

Scha

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