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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Diamorphine?
        
(Message started by: paul.bowdrey on Sep 3^rd, 2004, 9:37am)

Title: Diamorphine?
Post by paul.bowdrey on Sep 3^rd, 2004, 9:37am

Does anyone else receive diamorphine, not continually, but as an occasional method of "breaking up" a cluster? After 13 months without respite from clusters (presume they've turned from episodic to chronic - being tested at present), and receiving between 6 to 8 attacks per 24hrs, I find the occasional jab by the Doctor, or using the diamorphine prescribed (10mg) an essential medicine to having a few days of "quality".

The drug takes away the pain within 30mins of being injected (intramuscularly into the bum!), and can give repreive from further attacks from 6hrs to 2 days. Any break is welcomed and in fairness it can sometimes take 20mg to achieve the 2 day break.

Can anyone else who uses this same treatment method please share their experiences? I feel very alone using "heroin" (that's what I'm told diamorphine is?), and at times worry about addiction. Having said all this, I would rather be addicted to the drug than suffer the daily regime of pain, pain, pain...

Paul Bowdrey (Male, Age 42)

Title: Re: Diamorphine?
Post by don on Sep 3^rd, 2004, 10:06am

Diamorphine is not heroin but is derived from the same source. It is an opiate.

Opiates are highly addictive but under supervision of a Doctor you should be fine. What surprises me is that you are not getting rebounds from it.

Or are you?

Title: Re: Diamorphine?
Post by paul.bowdrey on Sep 3^rd, 2004, 10:16am

Thank you Don. I do not get rebounds from the diamorphine as I use it very little, only to give some relief (maybe once a week/every 10 days). Thank you for clarifying what it is!

Title: Re: Diamorphine?
Post by pubgirl on Sep 3^rd, 2004, 12:21pm

Paul

Interested what "test" you doctor is going to be doing to see if you are chronic or not. Have they told you what it is?

Narcotics of any sort are not usually effective for CH, and I've never heard of them being useful for preventing attacks.
Have you tried the standard preventives for CH?

Wendy

Title: Re: Diamorphine?
Post by clavers on Sep 3^rd, 2004, 12:22pm

According to Medline Plus dictionary, diamorphine is heroin.

Title: Re: Diamorphine?
Post by Karla on Sep 3^rd, 2004, 4:41pm

I use dilaudid every now and then in the ER. It will not only stop the ha but will give me 3 or 4 days pain free. I usually get 4mg in the butt. It works fast. Just be careful the dr doesn't give ya to much of the stuff. I had a dr give me 6mg when 4 didn't work and I od on the stuff. Almost didn't make it because I had already been discharged from the hospital. Not a pleasent experience. But when used in moderation it is excelent for ha control.

Title: Re: Diamorphine?
Post by don on Sep 3^rd, 2004, 5:52pm

I stand corrected.

"A narcotic analgesic that may be habit-forming. It is a controlled substance (opium derivative) listed in the U.S. Code of Federal Regulations, Title 21 Parts 329.1, 1308.11 (1987). Sale is forbidden in the United States by Federal statute. (Merck Index, 11th ed)"

Title: Re: Diamorphine?
Post by Kris_in_SJ on Sep 3^rd, 2004, 7:52pm

Well ... that definitely means it's related closely to heroin. I've heard tell that the British Hospice system is far superior to ours because they use drugs like this for end-of-life cancer pain (which I applaud).

But, gotta tell ya folks ... I don't think I'd be wanting to take it for CH's. I've seen the "French Connection" one too many times!

Kris

Title: Re: Diamorphine?
Post by don on Sep 3^rd, 2004, 10:46pm

I think the closest we come to diamorphine in the USA is methadone. A synthetic heroin.

Title: Re: Diamorphine?
Post by pubgirl on Sep 3^rd, 2004, 10:56pm

Interesting that you don't have it in the US.

As Kris says, it is commonly used here for palliative terminal care.

Can understand maybe why the US don't allow it as the UK's most prolific serial killer, Dr Harold Shipman, used diamorphine to murder probably hundreds, (but we aren't really sure of the total numbers he killed- ?200? people)

Wendy

Very odd drug to be using on a regular basis for CH though Paul. Don't mean to hammer on about it, but there are so many other options available instead of an addictive narcotic like this.

Title: Re: Diamorphine?
Post by nancyc on Sep 6^th, 2004, 1:17am

Morphine ,period, gives me the worst rebound headaches I have ever had in my life...took me awhile to realize this is what was happening to me...butt, it was....Say the word, Morphine and I will run LOL. :)nancyc

Title: Re: Diamorphine?
Post by paul.bowdrey on Sep 6^th, 2004, 4:13am

Thanks for all the "dreivatives" of diamporphine - but my question remains largely unanswered?

Please note it is used OCCASIONALLY to give relief, not regularly!!!

Interesting the note on Morphine. I have also been on prescription MST (Morphine Sulphate) and the clusters have worsened under this medication. Surprisingly this was "introduced" by one of the UK's most senior CH Professors - and maintained by my GP. Only 3 days ago the GP told me to INCREASE this to 2 X 60mg daily. I had asked him to REDUCE this to 2 x 15mg daily. I took my own initiative to reduce it anyway - and surprise surprise, the CH's have dropped from 6 to 8 per 24 hours to 1 to 2 per 24hrs.

Lesson here - we know our own bodies!!!

Paul Bowdrey

Title: Re: Diamorphine?
Post by pubgirl on Sep 6^th, 2004, 4:55am

Paul

I suspect the reason why you feel your question has not been answered lies in the fact that the large proportion of people who post on here are from the USA and as Don posted, diamorphine isn't used in the US.
I don't think you'll find anyone on OUCH UK either who has any feedback for you as I have never heard of anyone else here being given it either.

You are of course right, we all know what works for us, but it does no harm to consider other options. I have no idea whether you have done this or even wish to. It is surprising indeed though that a CH expert in the UK has prescribed diamorphine as the leading CH expert in the UK (and one of the most respected in the world) Prof Goadsby as you may well know says:

"Opiates, non-steroidal anti-inflammatory drugs and combination analgesics have no role in the acute management of CH"

It is a topic much argued about on here though as there are those who follow this latter advice and those who have found, like you, that an opiate works for them.

Glad you have found something that helps, but it isn't an option for many or possibly even most of us

Wendy

Title: Re: Diamorphine?
Post by paul.bowdrey on Sep 6^th, 2004, 9:37am

Wendy

It was Prof Goadsby himself (whilst an in-patient in hospital under his supervision) who started the MST (Morphine Sulpate) - and suggested the diamorphine. I am aware of his giudelines and you are 100% right in saying different things work for different people. Maybe it's 33 years of suffering - and trying EVERYTHING on the market that has led to this being implemented?

Paul

Title: Re: Diamorphine?
Post by pubgirl on Sep 6^th, 2004, 9:57am

Aha, now I understand Paul!

That explains it.
I'm very, very sorry things have been that bad for you.
Couldn't see why anyone would go that route unless all the usual options had been exhausted.

Pretty ironic that it was PG himself, considering his statement, perhaps we'd better all stop quoting it to people on here who use narcotics (still think with most people, not you of course that it is sound advice that narcs ARE one of the really last resorts)
There are still doctors around, here and in the UK who prescribe them (not diamorphine though, normally pethidine or similar) as one of the first options, which is insane.

Are you on the ONSI list by any chance (understand if you can't answer this one)

Even more glad you have found something that works for you and brings you some relief

Wendy

Title: Re: Diamorphine?
Post by nancyc on Sep 7^th, 2004, 7:14pm

Wendy, I do believe that there are some folks here that have tried every avenue and unfortunately have had no other option but narcotics....But, it is interesting that some narcotics like Morphine Sulfate do cause some terrible rebounds and increase the chs....While there are other narcs that may not do this...One thing I do know is that when I was episodic, I would never have considered trying the long acting narcotics on a daily basis..the dangers are just too high for that ..As far as using them to "break" a cycle...I would do so with care.... :Dnancyc

Title: Re: Diamorphine?
Post by paul.bowdrey on Sep 16^th, 2004, 11:33am

Thanks everyone for views and opinions. It's been worth asking the question!

Will report back in few weeks time after another appointment with PG and update on the medication issue.

Can report though that over the past 2 weeks, cutting the Morphine Sulpahte down by half, the clusters have also halved to 2-3 daily. Must be something in this?

Paul Bowdrey

Title: Re: Diamorphine?
Post by nancyc on Sep 16^th, 2004, 4:33pm

I truly believe that morphine is not the drug for chs..it causes an immediate release of histamines which are potent vasodilators...why would I want my blood vessels dilated???? This only makes my chs worse...The complete opposite of what imitrex is doing for me....I am very confused at why Doctors are using morphine at all for ch attacks...AM I all wrong about this or what? Now, I am unsure about the process of fentanyl but I do know it has been effective in a slow release for me...Need to research this one more... :Dnancyc

Title: Re: Diamorphine?
Post by Jimmy_B on Sep 18^th, 2004, 2:24pm

on 09/16/04 at 16:33:02, nancyc wrote:

Now, I am unsure about the process of fentanyl but I do know it has been effective in a slow release for me...Need to research this one more... :Dnancyc

There are different structures to opioids...Fentanyl which belongs to the phenylpiperadine structure causes less of a histamine release then morphine which belongs to the phenanthrene structure. This could be one of the main reasons for Fentanyl helping while morphine does not. All opioids are not alike.

Nancy..a good place to start your research, would be this site
www.all-science-fair-projects.com/science_fair_projects_encyclopedia/

Then type OPIOIDs into search.

Regards,

Jimmy

Title: Re: Diamorphine?
Post by Renee on Sep 19^th, 2004, 10:50pm

I too have found pain relief from fentanyl when all else failed including DHE, triptans, etc.

I've also had the occasion when even the fentayl didn't help and nothing would break the ch. [smiley=huh.gif]

Title: Re: Diamorphine?
Post by nancyc on Sep 20^th, 2004, 12:31am

Jimmy B, thank you so much for your info...I will research it... :Dnancyc