Morphine vs Fluoxetine

I've been wanting to post something about this for days, but I haven't been able to because it's all so confusing. So I thought I'd chew it over, as it were, on here, in the hope that the answer would come to me. Or it would come to someone else and they could tell me.

So, here's the situation:

Ever since I started the morphine, I've still been getting the 'anti-Tramadol' muscle spasms in my back. I thought it was because the 10mg morning dose just wasn't enough to last the day, but even on 20mg, it was still happening. So I started to think the Fluoxetine was inhibiting it, and I moved that to the evening to see if it helped. It did, but then I was so off my face that I could barely remember my name. I talked to my doc about it, and he said it sounded like the morphine was just too much for me, and suggested a different one. His only thought about the back pain was that my back's now really weak from inactivity.

A friend, though, said she'd had similar problems when she'd tried taking Fluoxetine in the evening instead of the morning, and she wasn't on pain meds. So rather than immediately change the morphine, I decided to try putting the Fluoxetine back to the morning, but stagger it and the morphine, instead of taking them together, to see if that made any difference. The first day I had really bad muscle spasms till a couple of hours after the morning morphine, but I wasn't as spaced out (I actually managed to write an article!). The shoulder pain wasn't great though, and I lost most of the morning waiting for the morphine to kick in. I had a pretty bad headache by the evening too.

The second day (today) I took the morphine a bit earlier, though still after the Fluoxetine - the spasms were a bit worse, the shoulder pain was a lot worse, I've been more out of it and I developed a screwdriver headache tthis evening hat required a morphine top-up (so 45mg today) and still hasn't gone. It didn't help that the voice activation software was totally offline today, so I've had to type everything. And I walked further than I should have (will I never learn!).

My questions from all this were:

Why am I still getting anti-Tramadol muscle spasms, even though I'm not on Tramadol?
- Because morphine is also an opiate and that's the cause (hence the second dose of morphine eases it)?
- Because it's actually caused by Fluoxetine inhibiting the pain meds? BUT I had those pains long before I started Fluoxetine - when I tried to stop Tramadol and when I was late with doses

Why am I totally spaced out if I take the Fluoxetine in evening, but not if I take it in the morning?
- Because the morphine is uninhibited and it's wiping me out? BUT it didn't happen from the evening dose when the Fluoxetine was in the morning
- Because of the Fluoxetine itself? BUT I had similar to the zonkage on the immediate release morphine (which always happened straight after taking a pill, so that was definitely the cause)

I could draw some conclusions, but they didn't actually solve the puzzle:

Taking morphine first thing, with Fluoxetine:
- gives the morphine time to kick in before I get up - better for my shoulder
- means the muscle spasms build throughout the day so they're really bad by the evening
- I have no muscle spasms at night
- I'm less spaced out all day

Taking Fluoxetine at 7am and morphine at 9am:
- means I lose most of the morning waiting for the morphine to kick in
- the muscle spasms only ruin half the day
- I get bad headaches
- I get bad muscle spasms in the night

Taking Fluoxetine in the evening:
- means I get no muscle spasms in the day, but they're bad at night
- I'm off my face all day

I'm a very 'visual' person - I need to see the patterns behind things in order to be able to understand them, and I realised that just writing about all this wasn't helping - all I was ending up with was a list of facts / theories that meant nothing. I needed some sort of visual representation. I've always used Pro/Con lists to organise my thoughts (I am the consumate Virgo!), but there were too many variables here, so it had to be a spreadsheet.

Now I know it sounds supremely anal to be using spreadsheets to figure out what's happening with my meds, but you can laugh all you want, because it worked. I think, I think, I've cracked it:

Morphine makes me zonked, but Fluoxetine can also make you zonked if taken at the wrong time of day; taking it in the evening is a double whammy - Morphine Zonk + Fluoxetine Zonk.

Tramadol is an opiate, just like morphine. The muscle spasms are triggered by my body's opiate-dependence; when levels run low, the pains start (either that or it's actual pain that only the opiates are strong enough to deal with, but I don't think so).

The Fluoxetine affects my body's ability to absorb the opiates (I started it a couple of months before I stopped the Tramadol - I think it contributed to, though didn't cause, the Tramadol failure). If I take them together, I'm therefore only getting partial benefit from the morphine and THAT'S why the spasms are bad until I take another dose. Taking the morphine after the Fluoxetine helps, but the latter's presence, fresh in my system, still limits what I can get from the morphine a couple of hours later.

The net result of all this is:

a) I have to take the Fluoxetine in the morning, so I need to find a way to make the morphine work around that
b) any morphine is an opiate, so the muscle spasms are likely to persist
c) any other type of morphine could be affected by the Fluoxetine in the same way
d) before changing morphine (and getting a whole new bunch of SEs), maybe I should increase the morning dose of what I'm on now, to offset the loss of absorption caused by the Fluoxetine
e) any increase has to allow me to take the Fluoxetine and the morphine together, because losing half the day waiting for the morphine to kick in is not an option; it's much better if I can take it, then get up an hour later when it's already working. Otherwise, I can barely even get out of bed.

And if you think all that sounds complicated, imagine trying to work it out when you're drugged up to the eyeballs!!!