Pain management for Pancreatitis

Pancreatitis
#1

Hello everyone,

I need some help/ info on pain management. Unfortunately I can not find a PM doc who will take me; so my primary care doc is treating my pain. Since this is not her specialty she asked me to ask all of you for some help. I am currently taking morphine sulphate extended release and morphine sulphate immediate release. The problem is my diarrhea is so severe ( 5-7 times a day) and everything goes right through me. I am not getting the relief I need because I think that the morphine is also going right through. I can not use the pain patch because of an allergy to the adhesive. Does anyone have any other suggestions for pain relief. Thanks for your help. Wishing everyone a pain free day!

Leanne

#2

Cindy,

Yes I take Creon 20 two everytime I eat, they think I might have
other problems ( like dupping syndrome) that are causing the diarrhea
in addition to the pancreatitis. Thanks for your help though.

Leanne

#3

Warren,

Thanks for the help. I will run your suggestions by my doc. Only
people dealing with this disease can laugh about diarrhea and the
uselessness of suppositories. LOL

Hugs to you!

Leanne

#4

Have to say this did make me smile, even after the very tough week I had…Thanks and Big Hugs to YOU, Hope your having a pain free day.

Mrs Barb

#5

Leanne,

Are you using enzymes everytime you eat? If you are, maybe it is not the right dosage and should be increased. That would probably help with the diarrhea, and allow the meds to stay in your system long enough to be effective.

Sorry I can’t be of more help, I only take Hydrocodone and have no experience with stronger narcotics.

Take care

Cindy in Ky

#6

Hey Leanne,

I’m sorry to hear that your pain and steatorrhea are getting the better of you. As for different options for delivery of your pain meds, there are definitely two and maybe three methods. The first method is an intravenous injection. This is probably the most common (other than oral) and also has several more drugs available in this form. A second method is an intramuscular injection. This is an injection that does not involve a vein. The shot is administered into a muscle instead. I believe the preferred sites are the gluteus maxima, thigh muscles, or biceps. I know for a fact that morphine as well as several other medications are available in this form. Another method is delivery through a mucous membrane with the nose being more common than the eye conjunctiva I am not really sure of all of the medicines that are available in this form. I did read about one called butorphanol which is in the opiate partial agonist class. I am sure there are others, but I don’t know any off the top of my head. I think that I have heard of some being administered via the eye conjunctiva, but I can’t think of any specific medications though. There is one final method, but I didn’t bring it up because your diarrhea would render it useless. This is anal suppositories. Many, many pills that are taken orally can be administered as anal suppositories. If you think that things are being emptied too quickly through your stomach, well a suppository would be emptied out even quicker! lol

Well, I just thought that I would throw out some ideas to discuss with your doctor. Best of luck, Leanne! I hope that this helped some. :slight_smile:

Hugs,

Warren

#7

Leanne,

I use liquid morphine and you can get the full dosage every time
without relying on it going to your stomach! I use .5ml of liquid
morphine and I know how it tastes and all that so I know what I am
telling you to do is not the most pleasant thing in the world, but it
works! When you drop your morphine in your mouth, don’t swallow it! It
will actually be absorbed into the blood vessels in your mouth if you
just keep it there for 5 minutes or so. THIS DOES WORK!

Take good care,

Anyse

#8

Thank you for the info. I am not doing so good today, waiting for the
doctor to call. I will probably be going to the hospital, because I
can not keep anything down and the pain is really bad. I hope that
everyone has a good Thanksgiving and a pain free one.

Take care,

Leanne

#9

Leanne,

Sending you wishes for a speedy recovery!
Hope you feel better soon!

Take care
Cindy in Ky

#10

I had the same problem for a long while and my DR. had me try acidophilus it is OTC and doesn’t cost much but maked a world of difference with me. I hardly ever had that trouble any more. My mother met a lady at church that had a son on the brink of death with pancreatitic and this drug has him now leading a somewhay normal life again… Best wishes

Bridgette

#11

Pain meds also come in a lollipop form (fentanyl) but are for opiate tolerant people (like yourself)

#12

Hey everyone, Julie is getting better!!! She is still in the hospital, but the NG tube is comming out today and she is starting a full liquid diet. The docs are telling me that the pain medications can also contribute to the pancreatitis. Has anyone else heard that? Now the word of the day is detox, and I don’t want to be a part of her problem, but if she us in pain all the time, then how does she detox, does she just live with the pain? I’m also told that if her panmcreatitis isn’t acute, then she shouldn’t be in pain, but you people are in pain? I’m confused. Please let me know how to answer the docs. Pain management was important before, now detox is important, and I want her to get better, I don’t want her sufferring needlessly.

#13

Hurrah that sweet Jill is getting better…what an answer to prayer!
As for the pain meds contributing to the pancreatitis…I dunno about that. I know that if you are on liquid diet, immobile, and on pain meds, that bowels can become sluggish and backed up, which can contribute greatly to a general unhappiness and intestinal inflammation. (to put it very simply - why does everything come down to so much about poop?)

In that case, a reduction in pain meds would be a good thing. See how it goes.

However, a pancreas that is not acute, but that is chronic…absolutely can cause pain. Have they determined that the pancreas is the problem? I would ask them to explain to you their theory on the source of her pain…ask them to back it up, not just tell you “It can’t be.”

Remember, the adage "What do they call the guy who just barely graduated Medical School?"
Answer: Doctor.

I will be keeping your family AND your doctors in my prayers as you tackle this difficult situation-I will hope for wisdom, strength and insight - For you, the doctors, and your precious daughter.

Be strong.

Susan

#14

Hi Jill,

I’m glad Juliette is coming of NG tube. She must be so uncomfortable with that. I don’t understand about detox. Pancreatitis can be acute with the levels going high, that’s when we go to ER. But after we end up as Idiopathic Chronic Patients, the pain is constant and is controlled or suppressed by medication. Sometimes even with all kinds of pain medication also the pain goes down only little bit. They always ask is the pain level 10 or less number? After taking all pain medications my pain level everyday used to be 5 now slowly it’s coming to 4. That’s because I’m trying to rest and not worry too much kind of stuff. WE are all Chronic Pancreatitis patients who suffer with the pain most of the time. I did not hear anywhere that Pancreatitis can be caused by pain meds. But Pediatric Pain specialists and the doctors we see are different. Maybe for the kids and teenagers case it happens, I’m not sure of it.

Are you taking good care of yourself or not? Please take good care of yourself. You have to commit to your health too. Hope she feels better and you too.

Lots of love and hugs,
Durga.

#15

I am sooo glad to hear your Daughter is doing better, HOORAY!!!

My Pm Dr. has been tossing around ideas on why I still have daily pain, despite taking 4 hydrocodone 10’s a day. He mentioned Opioid induced hyperalgesia, which to me is a crock of BS, cuz if you have OIH, you have increased pain when taking opiates. I don’t, the effect just wears off too soon.Another thing he mentioned was that some people have spasms in thier digestive track when they take narcotics. I don’t have that problem, either.

When I questioned my GI about the daily pain, he said, you have CP, it is a painful condition. The Chronic part means your pancreas is chronicly inflamed. He explained to me in a way that I completely understood, now if I could get my PM Dr. to understand. He is wanting me to cut back on my meds and I haven’t been able to. I have an Appt with him tomorrow, and I don;t know what he is going to say, because I didn’t follow his orders. I hope and pray he doesn’t drop me as a patient, I would really be up the creek.

Please take care of yourself, too. Now maybe you can take a deep breath and relax!
Cindy

#16

Thank you so much, if I didn’t have this forum to post on, I think I would havew gone crazy by now. I wish I could find another pancreas doctor for my daughter. We are too financially strapped after months long hospital stays to leave the state, and Julie’s doc may be great, but he is so busy that her has seen her twice in the last two months, so what we get are hospital staff. I should have left the ICU doctor in the ICU, she is telling Julie to just learn to live with the pain, that she is addicted to the meds (she doesn’t take an etra pill at home!) and she is comparing Julie to someone that has had their leg amputated, telling her that if someone had their leg qamputated they don’t keep comming back to the hospital demanding it back. So what is she supposed to do, stay home and die if her pancereas goes acute? I’m going to excuse her from my daughter’s case today. She is still in major pain and even chicken broth is difficult to keep down, it hurts her, but I imagine after two mo9nths of nothing by mouth it may be hard to have anything in her stomach? This doctor wants Julie to go to NA, and she has never displayed a drug or an alcohaol problem! What she has is a pain problem, and I still don’t know how to help her. I called the panc doc and he is too busy to see her in hospital, and the team isn’t listening to his directions, so I think its time toi go somewhere else. We live in S Caslifornia, not Timbu 2. Anyone have any ideas?
Jill

#17

Morphine, for a very small number of people who take it, can cause the common duct for the pancreas and gall bladder, to go into spasms, cause pain and cause acute pancreatitis. It happened to me!!! and caused the worse case of acute pancreatitis I ever had…lasted for months. I have two conditions which cause me chronic pain…one is chronic pancreatitis. I have been taking anti pain meds for over ten years. A few years ago a new pain med Dr. put me on Kadian (sustained release morphine) and Instant release morphine for break through pain. I started complaining to him almost immediately that something wasnt right with me and the morphine. He kept upping the dose. After maybe three months, i really started feeling ill…he kept saying it wasnt the morphine. I knew my body better, quit the morphine becuase my pancreas and the pain were out of control, went back to my regular Dr. and went back on percosette (which I think should only be used short term because of the tylenol). I was very ill (spasms, diarrhea, nausea, weight loss, sweating, etc.) for a long time. I researched morphine and found in the very very small print that morphine can cause pancreatitis. After 2 years I went back to that same Dr. who originally prescribed me the morphine and he then admitted to me that morphine can cause the pancreatitic duct to go into spasms (I felt at times as if i had a cellphone on vibrate inside of me). Needless to say I didnt let him write me any more presciptions (he had horrible bedside manners, didnt seem to believe his patients, counted pills, urine tests, and I honestly do not know why he is in this profession of helping people).

On the good side, I now have a new pain med Dr. who is not afraid of dealing with my dual chronic pain problem (he believes me, trusts me…it makes me smile), is writing me presciptions (sustained release and instant release oxycodone…no acetophenomen and defintely no morphine) that are actually working (for the first time in 12 years!!!) and I feel like there is hope - atleast for pain control. It is horrible, as many of us know, to be treated like a drug addict or seeker, let alone living in pain which can control our lives. It must be very tough to be a teenager and have these problems and have these stereotypes put on them. I know how hard it is as an adult. Eric

#18

Hi Pippy440

I am so sorry to hear that you are still having major issues with the doctors and nurses their at the hosp. I was going to ask you if you have ever went to the Childrens Hosp. in Omaha, NE??? It is wonderful, and they are very very supportive if they can’t figure out what is wrong they will find a doctor that can… Also I forgot how old your daughter is, but if she is 19 or older she can’t apply for medical assist through Social Services, and also apply for Disability/SS. If she is younger then you need to apply for these two things for her, if you are denied appeal appeal appeal, I am still fighting SS and its been almost 2 years, yes it’s a financial hardship but what else does a person do!!! Ok good luck to you and Julia and your family. Let me know how things are going and if you need numbers for the Childrens Hosp. I can get them, and also find out where there are other Childrens Hosp. in your area…My prayers go out to all of you, thinking of you…

Big Hugs,Barb :slight_smile:

#19

I am so sorry you are having such a bad time. My acute pancreatits bout in 2000 rendered me completely lactose intolerant. I hear this isn’t that uncommon. Why don’t you remove dairy from your diet and see if that helps. I just had Celiac Block Injections for my pain control. Anasthesia and steroids are injected in to the base of your pancreas and the relief can last a year! This cut my pain in half, so ask your doctor if you are a canidate. I really hope it gets better for you! Pam

#20

Hi, Leanne–

On the patch issue… I have a problem w/adhesives and wear the patch (12 years now). What I do when I’m having a problem with it is spray a steroid inhaler (like Flovent, NOT a powdery one) on my skin first, then spray Skin-Prep (I like the one made by Smith & Nephew), which acts as a barrier between the skin and tape (a good thing for under any adhesive if you have an allergy-- and you can get little Prep pads to carry with you) and then apply the patch (covering it with a hand for about a minute or so to make sure it will stick better).

The other thing I do is to use it on the front of a lower leg, which for me hasn’t been as sensitive as when I use it on my chest or arm or back…

There’s some controversy over if the patch works down lower (it’s transdermal… through the skin… either way, but may take longer to start working initially) and also in using the Prep, that it may block the med’s effectiveness. I haven’t noticed much difference, except that I CAN use it when I do these things.

Also, if you’ve used the “patch,” I’m assuming it’s Fentanyl… and there’s a “lollipop” version which is transmucosal and won’t get lost in the GI tract. Its brand name is Actiq, but there’s a cheaper generic which is the same med from the same company although it’s labeled as a generic and under a different manufacturer’s name. There’s also another form that dissolves immediately in your mouth and goes through the tissues, not the GI tract.

A lot of us seem to be taking Viokase instead of Creon for enzymes. The docs and many users here have said that the Viokase helps more with pain than Creon.

Everyone else’s suggestions are also great!

Hope this helps–

Hugs,

Lisa