I think I've decided to come off the morphine.

I wasn't planning to, not yet anyway. I was planning to do the increase to 80mg next weekend, then just leave it for a month to give the side-effects time to settle down. But it seems like the decision has crept up and made itself behind my back.

I've had three days this week where the side-effects went right down; I wasn't dizzy, I could breathe, I wasn't sick, there was no rage, depression, nightmares or panic attacks. It was bliss! The pain levels seemed to drop at the same time so it was a double whammy – less pain and virtually no side-effects. I could think clearly, I could write, I could even sleep. I was still needing my arm in a sling in the evenings because the neck pressure was coming straight from my shoulder and causing migraines, but I cope with that. As long as I kept my arm still and supported, it was OK, and it wasn't a problem in bed, so it wasn't keeping me awake as it so often does.

Then on Friday, the side-effects started up again. I'd had panic attacks all the previous night, I was dizzy and couldn't breathe for hours after taking my morning morphine. I could feel the rage building in the evening, and that night was one horrible nightmare after another. So I knew the side-effects were back.

Now, ever since the last increase, I've noticed that the shoulder pain has been worse (up until the last few days); worse but different. It's been much more crampy than what I usually get, and I know from my spreadsheets (they may seem anal, but this is where they’re worth their weight in gold!) that it's happened before. Every time I do an increase of the morphine, the shoulder pain gets worse. There’s also a tendency for the anti-tramadol pains and the neck pressure to get worse.

All of that had eased over these past few days, but then on Friday night, it was back. I lay awake for hours, tossing and turning with the most awful the neck pressure, so bad that I couldn't find a position that eased the headache. I ended up having to get up at usual work time on Saturday, even though it's the weekend, because I just couldn't lie there any more. It carried on being bad all day, and I also had much more anti-tramadol pain than in the previous few days.

As I was lying there yesterday morning, I started to think what a coincidence it was that just as the side-effects start to ramp up again, so does the neck pressure. After a day of fighting with it, and as I was desperately trying to find a position that eased both the neck pressure and the anti-tramadol pains in the evening, I realised that more and more it seems to me that these two things are ALSO side-effects. It makes sense -- if opiates cause muscle spasms (which is what the anti-tramadol pains are) in my back, why wouldn't they also cause them in my neck? And why wouldn't those spasms potentially pinch nerves, so leading to the neck pressure that causes the migraines? The change in the shoulder pain shows that the same thing is happening there too.

For some reason, I'd always thought of the anti-tramadol pain as being somehow separate and different to the ‘side-effects’ – like the opiates caused a physical reaction that led to the pain, rather than simply being a chemical reaction, which I guess is how I've always thought of 'side-effects'. I guess it's because I've always viewed the anti-tramadol pain as being a sign of my body needing more of the drug, rather than reacting to it, because initially I only experienced it when I’d missed a dose.

But it seems to me now that there's no real difference. The muscle spasms are a side effect of the opiates, just like the dizziness and the trouble breathing. All of the side-effects have undoubtedly been worse this increase than the previous ones. It makes sense to assume that the next (and final) increase will be even worse. So I'm not exactly keen on the idea of increasing to 80mg.

What terrifies me most about coming down off the morphine, though, is those muscle spasms. All the way up, I've had periods where the spasms were so bad I just didn't know what to do with myself. I couldn't get rid of them, and there was no way to get comfortable. Nothing helped. But I kept telling myself that the next increase would sort it out. That's not going to be the case on the way down. In fact, it's going to be the other way around; each time, I do a decrease and experience those pains, I'm going to know that it's only going to get worse with the next change.

So what's the point in doing the increase to 80mg, when I know that all that’s going to happen is I'll lose a week to the dizziness and breathing troubles, the shoulder pain will get worse, I'll get a few days where everything is tantalisingly better, then the side-effects will kick in again?

My bizarre conviction that 80mg was the magic number, where the morphine would suddenly start to work, is looking increasingly that – bizarre. How could it possibly suddenly start helping, to the extent that these side-effects seemed acceptable, just by adding another 10mg? It can't. Instead, I'll spend the next four weeks cycling through rage, depression, pseudofeelings and oversensitivity; I'll have my arm in a sling to try and minimise the migraines; the shoulder pain will be different to the norm, but not noticeably better and the muscle spasms will cause as many problems as the shoulder pain itself. And at the end of it, I'll finally concede that the morphine doesn't work, and have to start decreasing it to wean myself off.

All that final increase will have done, then, is give me an additional painful and distressing decrease to do, because my body will have got used to that dosage and won't want to have less. I’d be better off just starting the decreases from here. So like I said, I seem to have decided to come off the morphine.