Wanted – information on possible morphine resistance in ME/CFS
MAY BE REPOSTED
Information on possible morphine resistance in ME/CFS required
I have recently been discussing the cases of a small number of people with ME who form part of the database operated by the UK charity CHROME (Case History Research on ME). This small group of people appear to have a degree of resistance to morphine - a very potent analgesic that is occasionally used for the management of severe pain.
The pharmacology of morphine resistance is interesting in that the drug is broken down by enzymes in the liver into two metabolites known as morphine 3 glucuronide (M3G) and morphine 6 glucuronide (M6G).
M6G may be even more potent than the parent morphine whereas M3G antagonises the action of morphine and M6G and so is known as an anti-analgesic.
The individual response to morphine therefore depends on the balance of activity between these two metabolites with an excess of M3G producing varying degrees of morphine resistance or intolerance. This aspect of morphine pharmacology may also help to explain the presence of the paradoxical pain that people sometimes experience when given morphine.
Morphine resistance is very unusual and I have only come across one person with this reaction so far in my whole medical career - that was in hospital practice and did not involve ME/CFS.
If anyone has further information on possible morphine resistance or intolerance in ME/CFS I would be pleased to receive it.
And if morphine resistance does appear to be more common in people with ME/CFS than the normal population, then this could link in to some of the research work currently being carried out in the UK and USA into abnormal gene expression.
Please email ME Connect putting FAO Dr Shepherd in the subject line.
Dr Charles Shepherd
Medical Adviser, The ME Association.
Information on possible morphine resistance in ME/CFS required
I have recently been discussing the cases of a small number of people with ME who form part of the database operated by the UK charity CHROME (Case History Research on ME). This small group of people appear to have a degree of resistance to morphine - a very potent analgesic that is occasionally used for the management of severe pain.
The pharmacology of morphine resistance is interesting in that the drug is broken down by enzymes in the liver into two metabolites known as morphine 3 glucuronide (M3G) and morphine 6 glucuronide (M6G).
M6G may be even more potent than the parent morphine whereas M3G antagonises the action of morphine and M6G and so is known as an anti-analgesic.
The individual response to morphine therefore depends on the balance of activity between these two metabolites with an excess of M3G producing varying degrees of morphine resistance or intolerance. This aspect of morphine pharmacology may also help to explain the presence of the paradoxical pain that people sometimes experience when given morphine.
Morphine resistance is very unusual and I have only come across one person with this reaction so far in my whole medical career - that was in hospital practice and did not involve ME/CFS.
If anyone has further information on possible morphine resistance or intolerance in ME/CFS I would be pleased to receive it.
And if morphine resistance does appear to be more common in people with ME/CFS than the normal population, then this could link in to some of the research work currently being carried out in the UK and USA into abnormal gene expression.
Please email ME Connect putting FAO Dr Shepherd in the subject line.
Dr Charles Shepherd
Medical Adviser, The ME Association.
posted by ME Association at 11:12 AM
3 Comments:
I believe I have an intolerance to morphine and other opioids. After majory surgery, I requested that the morphine pump be removed because the drug was keeping me awake and didn't touch my pain.
I have had similar reactions to Tylenol with Codeine and Percoset for other, minor surgeries. I would always try one does, then flush the remains of the medication.
I have never been a drug user or abuser and have always wondered why opioids have the opposite effect on my than they do most others.
The strongest medication I have used for pain is Advil and Aleve.
Thank you for your time.
Camille C.
I had a similar experience. I was in a hospital recovering from ankle surgery and was given a morphine drip. The only affect was a slight headache.
I have a similar resistance to codeine when it was prescribed for a bronchial ailment.
Interestingly, twice during the ankle surgery I woke out of surgery perfectly lucid.
Before being diagnosed with CFS, I found I had NO reaction to morphine. I was in the hospital for a kidney infection and they were giving me morphine through IV, but not in a bag, by push, (straight into my veins) and it did nothing at all. the nurses were stunned that after the max dose they could give me, I was still awake, clear headed and in the same horrible pain. Ive also experinced the same senario with subseqent kidney infections twice more. But on one occasion, the Dr chose to give me demerol, which with a normal dose worked perfectly as it does in anyone else. Now I have both CFS and chronic pain. the pain is from deteriorated, bulging and torn disks in my lower back as well as increasingly severe sciatica...and I only just turned 25! so for this pain, i am given morphine tablets. 75mg MS contin twice a day and 10-20mg statex morphine for pain spikes (PRN) these medications have only a slight impact. the statex has none at all. With the CFS and pain, I am unable to work or go to school. so how can i get my pain under control so I can have a life again, when Dr.s label me as a "drug seeker" because Im young, also if in hospital, I try to explain this resistance to the dr and ask if demerol can be used instead of morphine....I always get the same response...NO! part of me wonders if its because the DR wants to see someone be immune to morphine. Ive never used street drugs or any medications improperly, so why am I denied pain relief or control?
Also i should mention I am a natural red head, and have had issues with anesthetic too. when i had my wisdom teeth out, i woke up after they only pulled 2 teeth! I was awake and lucid for the last two, which hurt like hell! I walked myself to recovery and later was told I was given twice the normal dose of anesthetic and that the pain was "imagined" I found that "imagined" pain and real pain feel just the same!
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