[wenlock00]

Long-term opiate use for pain in multiple myeloma

by wenlock00 on Thu Aug 31, 2017 4:53 am

I was diagnosed with multiple myeloma in March 2016, with a paraprotein (M-spike) of 49 g/l (4.9 g/dl) and sig­nifi­cant back pain. I started treatment with cyclophosphamide, thalidomide, and dexamethasone (CTD) and experienced worse back pain, spasms, etc. An MRI suggested no vertebral damage, no lesions, etc., but my spine apparently is a bit spongy around L4.

I have now completed the CTD treatment and have had two bone strengthening infusions. I have recently undertaken a stem cell harvest and I am undergoing heart/lung tests, and will be under­going a stem cell transplant hopefully in a few weeks.

For the last four months or so, I have been taking Zomorph (slow release morphine), 30 mg twice a day, and after missing a dose found myself in a full cold turkey morphine withdrawal that was / is horrendous. The original intense low back pain was no longer present, I am assuming this is due to being clear of treatment and the bone marrow settling down.

My paraprotein is now around 4 g/l (0.4 g/dL). I now seem to have neuropathic, myofascial, and other skeletal pain that is somewhat unbearable, particularly at night. The morphine withdrawal brings a host of other problems such as RLS (restless leg syndrome).

After further research, I am starting to think that perhaps long-term opiate pain killer use is just part of the game in terms of multiple myeloma?

My options for pain management at the moment going forward seem to be:

1. Continue with the morphine withdrawal and see if the bone pain subsides further.
2. Use some other form of pain control (other drugs, e.g. gabapentin)
3. Go back on the slow release morphine (perhaps a lower dose?) and learn to accept long-term dependence.

The slow release morphine was very good at reducing my blood pressure and overall bone pain, though the constipation is a drag and I don’t like the idea of being a long-term addict, or the thought of going through morphine withdrawal ever again.

Any thoughts, e.g., do people just accept morphine dependence? Is long-term opiate use for pain common in multiple myeloma?

[Taff]

Re: Long-term opiate use for pain in multiple myeloma

by Taff on Thu Aug 31, 2017 8:55 am

I've been on slow release morphine since October 2016 and carry on with it. I also have Oramorph (oral morphine), which I often have to take before bed, as leg pain from neuropathy and back pain are often worse at night.

We're not addicts, though we are physically dependent on morphine. As it's taken for pain relief, it's not addictive, which would be a psychological problem.

I agree that withdrawal is horrible, as happened to me once when I was without for a few days, so I have no problem with taking it long term.

It's a different life with multiple myeloma, and thus different things apply. A new normal. Whatever medication applies, so be it.

Regards,
Taff

[wenlock00]

Re: Long-term opiate use for pain in multiple myeloma

by wenlock00 on Thu Aug 31, 2017 10:08 am

Update:

I visited my haematologist yesterday for my monthly myeloma review, and explained the mor­phine situation and my views on it too him. I said to him that my preferred pain management option based on some research was for me to use paracetamol (Tylenol / acetaminophen) 500 mg and codeine sulphate (30 mg) several times a day only when needed, backed up with regular use of gabapentin (300 mg x 3). If the new approach did not work, I would use a lower dose time release morphine (10 mg) if absolutely necessary.

He agreed with the plan. Last night I had a pretty good sleep, with very limited RLS (restless leg syndrome) left over from the morphine withdrawal. Gabapentin is recommended for RLS. Today, (so far) I have not needed to take any codeine or paracetamol (Tylenol), and the gabapentin certainly seems to be taking the edge off any skeletal neuropathic pain, though I can tell it is there. Hope­fully, things will improve in the next few days and weeks, as I titrate up to the full gabapentin dose of 3 x 300 mg per day.

It is probably 9 days since I stopped taking slow release morphine. I did take some codeine (creates some morphine via the liver) and paracetamol (Tylenol) on days 7 and 8.

My back was a bit unstable during induction therapy and I know that it would be quite easy for me to put my back out again by attempting to do something silly such as heavy lifting, and thus end up back on morphine, so I remain careful.

Once I am over the stem cell transplant and the associated recovery, I am looking forward to going swimming on a regular basis to help strengthen my back.