Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in futre
Hi,
I desperately need advice and help.. I didn't know which board to post on -chronic pain or addiction/recovery. I'm a chronic pain patient who abused meds to get relief from pain [I haven't ever used meds to get high] - Since I used them illegally, or "abused" them since I didn't follow my P-docs instructions [If I'm fortunate enough to get pain management again in the future, I will never self-medicate again. I am in so much more pain now than I was when tried to relieve my pain.
Anyway, I am terrified - I need a serious Fentanyl detox but have no idea what to do because I will probably need pain management again in the future and I am worried about getting on a blacklist, not having my pain management history look right, where to go, whether or not I dare use my insurance and how to navigate all of this. If I'd had any idea that trying to relieve my pain more by taking more Fentanyl than I should have would completely screw up everything in my life and put my ability to get pain meds for serious chronic pain in future at risk, I would have just continued to put up with the pain and try to persuade my p-doc to give me more medication. I cannot believe I made such an arrogant and stupid mistake - but there's no pt. in raking myself over the coals anymore at this point - I need to get off this absurdly high dose and figure out how to not lose access to pain management in the future. I really need help. This is a LONG post – you can skip down to the questions at the end so you don’t have to read the whole post! I feel totally confused about what to do.
I now have a terrible tolerance for Fentanyl - the only med that was giving me good relief and am using used patches to stay out of serious withdrawal [At the moment my entire chest and upper arms are covered w/used patches and I am in mild withdrawal]. I have chronic pain from breaking several verterbrae, getting them fused and bad disc herniation in my c. spine. My greatest fear is that I am going to screw this up further by choosing the wrong way to get out the situation and that I won't be able to get a pdoc to prescribe medication that is strong enough to allow me to function in the future. I would LOVE to be off pain meds but really don't know if it's possible because I am in so much pain most of the time. I've read that suboxone is not very strong when it comes to pain.
I have already screwed this up since I am on far more Fentanyl than I was before and it is not keeping my pain under control. I am also running out of time to solve this problem as I cannot use my used Fentanyl patches indefinitely. I have no idea which ones I have used before, or for how long. I tried to detox myself but gave up pretty quickly because I really didn't feel like I knew what I was doing. I take benzos [don't abuse them but used some for w/d]. I didn't want to accidently increase my benzo dosage either and I sometimes couldn't tell if a withdrawal symptom was the from the benzos or from the opiates. One doctor I talked with told me that going up so high on the fentanyl had affected my gaba receptors and that I would basically go through benzo withdrawal if I tried to lower my dose of fentanyl. Obviously, this is dangerous, so I also began to worry about trying to do a home detox.
I was on a high dose of either Fent. or morphine for over 3 weeks [and now longer] which is enough time for my Gaba receptors to be affected. By high dose, I mean 1200-1500 mg of morphine/day. I somehow managed to double my dose which obviously was quite high before [I'm including the Fentanyl -rough conversion in here]. I actually do not know how much F I am taking now because I am on used patches [Before anyone points out that this is dangerous b/c of the potency of Fentanyl, I should say that I increased slowly and made sure I was in mild withdrawal the whole time. My tolerance skyrocketed in almost no time at all. A detox from morphine might not have ben quite as bad [this was before I read about Fentanyl detoxes] but since I had used patches [afraid I my meds might get lost or stolen at some pt., so was saving these - at this pt. I have no idea how many times I have used each patch or for how long - so I don't know how much I'm actually on or how much I have left to prevent severe w/d. I am probably on at least 300 mcg/day or more of F now and would have to cut that in half to get down to my regular prescription level - which would no longer treat my pain b/c my tolerance has gone up.
To make a long story short, I had some extra 25 mcg patches and they were far more effective than my morphine. I haven't had good pain control in close to a year and have been under serious pressure at work - enough pressure that I was afraid I was going to lose my job [which I now have b/c I have either been in pain and/or w/d for most of the last month].I substituted them for the morphine I had. I ran out of the extras, tried to go back to my regular prescription and was in horrendous pain. I had extra morphine so I took that but I was alarmed at how much I had to take to get relief from pain -- my body was now used to the fentanyl [or maybe I was in w/d from fentanyl b/c it it's in a different class than morphine]. At any rate, this was when things got really bad b/c I was popping morphine whenever my pain got horribly out of control, which was frequently. I was getting super worried b/c I was using so much and my pain was so bad. At any rate - it's now about 7 weeks later and I am beginning to run out of all extras and just have no idea what to do.
These are the possibilities I have explored
- do a Fentanyl detox w/o my insurance [possible they might object to pain mgt for me later]. I'm really low on money b/c of my injury but if I have to borrow money to keep it off my records so that I can get pain mgt. in the future, I will. If anyone knows about this, let me know....then go back to my regular pdoc in a month - I'll probably be in incredible pain - the plan would be to slowly and carefully go back on my meds after the detox. It would solve the detox problem but not the pain...Any recs [if that's allowed] for good places [pref. on W. coast] to do a F detox would be appreciated.
- do a taper to suboxone. The doctor [addiction specialist] insists that while it will be painful going down on my meds [I can't even imagine since I'm in excruciating pain now] and go on suboxone for my pain if I need it. I've read that suboxone isn't a good med for pain control. I'm stuck with a hole in my record of pain management doctors and I'll def. have to pay for the sub with insurance [I'm guessing its expensive] and I'll be on a registry of people who have taken suboxone - maybe I'm being too paranoid here but I'm really worried about not being able to go back to pain management and have my pain taken seriously ever again if I am tagged with an addict label.
- do something nutty and get off fentanyl and the opiates using ibogaine. Go to a detox clinic in Mexico and use ibogaine to get off.
ANY advice would be seriously welcome at this point. I am terrified that I won't be able to work or take care of myself if I can't get pain management in the future. I would LOVE to be off the meds, but have no idea if my body is too screwed up to go w/o pain meds.
Feeling desperate and confused. Also, in a ton of pain. If you were in my shoes, what would you do? I have to take action really soon. I am having trouble functioning right now b/c I am in so much pain. It was hard to write this post because of the pain.
Thanks in advance for reading a super long post and for any advice you can give. Advice on using insurance, slowly weaning of Fentanyl [given the amount of pain I'm in now, I really can't imagine how this would work since I would be in a ton of pain]. If my assumptions are wrong about needing a paper trail to follow my pain management, if anyone has an ideas about places to go for a Fent. detox [no programs - i don't have the money and at least at this point, don't need to figure out how to not use drugs though that could change with PAWS, how long it would take to detox, how lousy I would feel afterwards. HOw long it might take for my tolerance to drop. What I should do?! The depression sounds bad enough but my pain may be unbearable...Thanks so much for any advice or help you can offer. In addition, I don't have a lot of money - definitely no more than $10,000 [if I borrow money] and more like 4000 to 5000. Confused.....on the W. coast...Also, since I have never doctor shopped or gotten meds from anyone but my pdoc so I can't get any more. I honestly wouldn't have the first idead of where to go to get more Fentanyl or morphine.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
i really do feel for you,but what you stated above: i am desperate,confused and in alot of pain,really says it all hon. i think you simply need to come clean with your PM at this point. i too am in PM and also was in recovery before my need for heavy narcotics happened with a spinal cord injury so i do know where you are coming from. at this point i realistically just cannot see you doing this in any other way. you must also be carrying a huge load of guilt around too. it just comes with the territory. believe me,you are not the first person who became addicted to pain meds that started out with legitimate pain issues and you wont be the last either. unfortunetly you are dealing with the strongest narcotic out there and for some time and at large doses too. anything you do here could place your life literally in jeopardy in trying to actually detox yourself,or even with some of the other ideas you have come up with too. the thing is,with the type of pain and injuries you have you simply DO need some better help with controlling your pain right now too and in the future. without your PM actually knowing your situation,i really just cannot see you actually ever really being out of pain or even getting it to a tolerable level. you just need expert guidance here with PM and with how to detox yourself off of the fent. if this were any other med than the fent,things could be a bit different,but this IS what you are dealing with and it just really ups that need for expert care in coming off and also managing your pain too. when we are in pain,just trying to not treat it by trying to detox off of the only thing that even takes some of the intensity away is going to be a recycled relapse of sorts,you know what i mean? you need a pain plan during your detox or this will end up going around in circles.
i really do think getting yourself into a good rehab program that is run by an addictionologist would be your best bet. there are simply reasons that you ended up with this addiction that HAVE to be dealt with or you will end up right back where you are right now,even after suffering thru all that you have or will at some point. its just simply the nature of addiction. it IS evil,and alot has to do with the mind,and behaviors that are there now and will not go away without you taking control of this and getting the proper help for yourself. this just has to be done in order for you to even begin to try getting back onto some sort of real pain plan. if you don;t address the underlying reasons for the addiction in the first place,what is going to stop this from occuring again,you know what i mean? and since you stated you are also depressed,this just creates a bit more of a dire situation for you too right now.
the big thing here is that you are desperate and people who are in desperate situations do not always make the best possible decisions for ourselves. you simply do need to change from the inside out in order to really be able to get a handle over this situation. you need help with this hon,its simply way too big for you to try and handle on your own. coming clean with your PM is just the first step in really actually taking control over this. if you don;t do this,i really just cannot see this ever really getting any better. you have simply reached your 'bottom' here right now,but you can pull yourself up with being honest and doing the right things for yourself hon. it just has to be done at this point. you are not even getting any real pain relief right now from what you stated,just staving off the WDs to some degree. this is not how you want to keep living,right now,you are just "surviving" life ya know? asking for help and admitting we screwed up is not an easy thing to do,believe me i have been there,but at this point,it IS in your best interest to do. any doc that is going to be treating your pain at some point just simply needs to be aware of the addiction history so this will not get retriggered again at some point,and you can be much more closely monitored. i have to be and i LIKE that fact that they do do this for me or i would never have been able to do this alone. i need direct guidance and the accountability that my PM holds me to just to stay compliant. and so do you from here on out. that doesn't mean you wont get pain relief at all,it just means it has to be done a bit differently.
no one deserves to have to suffer with severe chronic pain but you are suffering here way more than that hon,and in alot more ways too. do you see that at all? believe me,thoit will be hard,you simply have to do the right thing here in order to really be even able to manage your pain and your life right now. you are not in a good place right now and that needs to change and you do too. just taking that first step is the hardest(but the biggest one you will ever take),but you CAN do this for yourself,you simply have to if you really want to get your own life back. cuz right now,that fent just 'owns" you.
i know this is not what you really wanted to hear(i did not want to hear it either),but this realistically is the only true way you will ever be able to get out of this situation and be able to try and live a normal life again hon. i know how scarey this is,espescially with the thought of having to deal with the pain and the fear of not being able to get it properly managed,but where you are at right now,you are no where near "managed" either ya know? your life and your pain are both just way out of control. but you can get that control back by taking charge and coming clean with your PM. i simply cannot see you really getting to that 'good' place again without doing this one thing first. this just has to be done before anything else will actually fall into place for you hon. and its just the right thing to do for you right now.
i really honestly do feel for you and wish you all the luck in the world with this,but taking that very first step here is really the only way you will be able to get out of this cycle from hell you are now in. once you do this,you will be taking that first step in regaining some control over your life,your addiction and your pain too. PLEASE keep me posted on how you are doing. Marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Confused:
I have no pearls of wisdom to offer. Just wanted you to know that I'm thinking and praying for you. Please take feelbad's words to heart. She's a wise woman. I too am a CP'er though I'm not an addict. I come here to read and get support for a brother who is an alcoholic.
I DO know Fentynal is dangerous!! Withdrawl from it requires expertise or you can risk seizures! I don't mean to scare you, but you do need professional help here. Like feelbad says, any other narcotic, and it may be a differet story and a program you could do on your own with support from these wonderful people.
I'm pulling for you sweetie. Good luck and many blessings. At least you've taken the first step in getting off this roller coaster.
~!~ Becky ~!~
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12/10/04 MicroD & Hemi Lami 100% Success
09/05 Re-injured post Katrina
06-07 In Pain Mgmt. trying to deal
3/9/07 2 Level PLIF due to CES
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Dear fellow board member friend,
First know, you are surrounded here by a group of members who really care and know what you are going through.
PLEASE, call your pain doctor today. Did he fire you as a patient? You are on a very serious path to distruction. You have to face it as you said, " Abuse, Addicted". You are not the first patient who has deviated from the prescribed dose. Your pain doctor can be a good resource for you if you are HONEST. Honesty will set you free. Recognizing you have a problem is the first step. Attempting to do this on your own is not an option as dealing with the high dose of fentanyl is very serious. Secondly, you are taking your life in your own hands by using old patches. As you know, the patch releases a dose over 3 days and right now you have no idea just how much your getting. Thirdly, old fentanyl patches are tremedously dangers because the chemical changes.
Please call your pain doctor today. You will not be banned for pain management, neither can you be denied future pain management if you go into a program. However, if you are not honest, the very thing you are most afraid of happening will. Just be honest- your pain got away from you and now your in serious trouble. Sit down with your doctor, have a treatment plan, a goal. Do not leave anything out as it will only hurt your recovery and future pain control. Yes, I beleive you are in pain, but it has turned into an addiction as you now abuse.
Please keep us updated. We are here for support. We do care what happens to you. I will pray for you. Please, please, please do not be afraid to take that first step as it may set you free.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Hello
There has been wonderful advice posted to you and I hope you heed the words given from these caring people.
I am going to keep my thought short and sweet... you are in way over your head and in no position to play doctor to yourself at all. Get to the doctor, spill the guts and get on your way to getting better. There is no time to sit and ponder... it is simply time for honest action.
We will all be here to support you... pick up the phone and put in an emergency call right now to your doctor.
Hanging with you
reach
The Following User Says Thank You to reachout For This Useful Post: Patches30 (11-18-2011)
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
I agree with Reach and feelbad. Listen to what they're telling you. You really need to get to your doctor, tell him/her everything and work together to figure out a good plan.
Using "used" Fentanyl patches is extremely dangerous regardless of your tolerance.
You're in my thoughts a prayers. Keep in touch and let us know how everything goes.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Hi, I just logged back in.
The last time I checked no one had posted a response. I am, of course, still struggling with what to do and read the posts with a lot of sadness. I am scared to death of telling my PM though I could tell he was already suspicious when I saw him for my monthly appt - I have now been in this mess for 6 weeks. Before I go on, I read everyone's posts and just felt truly sad and more hopeless since I so want a solution that doesn't carry lifelong consequences.
I want to thank everyone who responded. I really appreciate it. It's true, it's NOT what I wanted to hear - I wanted to be able to solve this myself. I don't want a mistake like this to have the ramifications that it does and I have been trying to figure out some other way. I really want to hear from chronic pain patients who have had done something similar - who were in too much pain, scared they wouldn't be able to to their jobs/work and took more meds than they should have. If it hadn't been Fentanyl I guess it might not have been so bad. And, I wouldn't have even gotten into the used patches if I had known that I was about to make my problems so much worse.
I just couldn't get my work finished with the pain. I can't do normal things like clean or household things without stirring up severe pain that lasts at least a day. It completely screwed up my return to work b/c I couldn't perfom in the way I did before I became injured and my boss did not care why I couldn't perform, he just cared that I wasn't performing as well. So, the more trouble I had, the more he upped his demands for me to perform. I am revealing a lot more of the details, but I'm still afraid that pms may read these boards. I've probably given enuf details at this point to be recognizable to my PM.
I know I screwed up and am continuing to screw up but how, honestly, how does that make me an addict? I have never used the meds for getting high. When I first took fentanyl I felt high and I took off a patch for a day until I felt normal again. I feel like I was arrogant [thinking I could swap F for for my other meds using conversion tables and then go back to my regular regime when I ran out of extra patches] and that I made a bunch of cognitive errors as I tried to figure out what to do -- with more arrogance b/c I knew that if I was in extreme pain, I would not OD on the meds.
[I know I repeat this many times! It's my greatest fear, I think] I cannot see how the PM or any other PM would ever want to treat me again -why in the world would they take the risk of treating a patient that put their license at risk? I haven't been able to get my pain adequately treated yet [except for the brief period of 8 months. Why would someone actually "believe" me in the future when I tell them I am in excruciating pain and can't afford to pay several hundred dollars/wk for acupuncture to keep the pain under control? I haven't known this PM long - perhaps if I had been his patient for years he might be less inclined to show me the door and blacklist me, but I don't know why he would help me now.
From the person who said she was a chronic pain patient and was carefully monitored, what does that mean? I have no extra money, just lots of debt from my accident. This is not something I would do again - I didn't do it because I lost control or because I craved the drug. I think as I said earlier, I was arrogant and under incredible pressure to perform as if I didn't have any problems w/ chronic pain - In some ways I have had to prove that I am as fast or better than someone w/o chronic pain at work.My entire career has been on the line since I started again after my accident but the last 3 months and the next 6 months are critical and basically determine my career trajectory for the rest of my life. Right now, that is not looking great. Since I have been dealing with this, I have made the situation far worse since I have not worked much - at the time, of course, relieving some of my pain seemed like a good thing and I was so focused on work that I truly did not think through the possible consequences of my actions. I feel like lots of people make mistakes [like this?] - patients often don't completely comply with their doctor's orders and people make cognitive errors and mistakes because they don't think about the consequences of their actions] you just don't get to make a mistake like this w/ chronic pain, and my entire focus was on my pain and my work.
At any rate, I do not feel like I know more than the doctor when if come to pain meds, esp. Fent. - I may understand that fentanyl is far more effective for me than than the other pain meds I was taking but I don't know anything about how my body is responding to all of this - in theory, and it was stupid not to check, I should have been able to switch back from 50 mcg of Fentanyl to more other meds. Maybe it is b/c Fentanyl is in a different class and affects different receptors. I honestly don't know. I do know that I seem to have blown my tolerance for Fentanyl now though and that I am not EVER going to do something like this again. Given the number of patches I am having to use to stay out just a little out of w/d, I am virtually certain my GABA levels have been affected - so I think that a taper from Fentanyl would be risky in the same way that Cold Turkey from benzos would be. If anyone [lay] can confirm this, [if that is allowed], I would be grateful. But, I can't imagine that it wouldn't. Even if I tapered down on the Fentanyl I might go too fast for my GABA receptors. For a while I was having wd symptoms and could not tell whether or not they were similar to benzo wd or opiate wd - I realized some of them were benzo symptoms [tight band around my head, blurred vision - this was def. worrisome since I took my benzos as prescribed [I might have taken less while I was taking the higher dose]. At any rate, my pain levels are going too high again as I am trying to taper down on the patches.
But, yes, I feel incredibly guilty. I like this PM and I feel incredibly crappy about lying to him. Either way, I am probably going to lose everything I have worked for over the last 10 years -- I'm under incredible pressure to finish "work" by mid fall - I'm still sort of paranoid?? about posting here and am concerned that someone - my doctor?? who knows might read my post and recognize me so until I feel more comfortable, I don't feel like I can say more about what I am losing b/c of my mistake [and now continuing mistakes]. I worry that I am putting the doctor's license at risk by not using the meds correctly; I worry that if I were in an accident, he might get sued; I also feel like I am screwing over other pain patients. I used to feel incredibly ****** off at people who abused opiates b/c they made it hard for pain patients to get medication. This is not a mistake I would make again. I have gotten through my head that I may know more about small pieces of medicine than many doctors but that I am not a doctor and do not have the big picture. And I am not going to do something illegal and buy off the street. I wouldn't even have a clue as to where to go.
I don't recall what I said in my original post, but I have considered trying to slowly taper down but it seems like it would probably take a year since my tolerance went up so fast. And, as I said, my pain is a problem.
I have also considered getting detoxed somewhere and then coming back and going back on the meds very slowly - but of course, that is more of the same. I would be self-medicating and I wouldn't have a clue as to my tolerance. It could easily be far riskier than what I am doing now. This plan also bothers me because I would have spent a ton of money to get detoxed [I can't very well tell a detox place to stop at my normal dose - my tolerance is screwed up anyway so my pain would probably be out of control at a normal dose] of course. If I'm going to detox, I want to try to get off or way down on these meds. I don't want to be up at the high med dose I have been at in the past. I don't have the money in the first place,so If I'm going to borrow money to do this, I would really like something good to come out of it.
Ironically, all of this means that my job/career are most likely history. Everything I have been working 12 + hrs. a day to recover since my accident is going to be lost, which is incredibly depressing.
I heard people telling me to tell my PM, I would really like to hear stories of people who have serious chronic pain that prob. has to be treated w/ narcotics [I'm hoping maybe there is another way but every doctor I have seen [pain, anyway, has said I am stuck with the meds for the rest of my life - I am too screwed up to not have pain meds].
I would really really like to hear from anyone who has done something similar OR who talked to their PM and what the reaction was. I have read the chronic pain boards though and people have been dropped for having their meds stolen or for the slightest infraction. I am in a ton of debt b/c of injury and I have to be able to take care of myself and work and I really cannot see why a doctor would take me on after this. If they did, I assume that they would want to do a urine screen or whatever frequently and I have SO little money.
The only thing that seems remotely plausible, and this is a *big* stretch is to wait a month or two and tell my pdoc that I want to get off the meds [I do - I don't think I know any chronic pain patient who wants to be on this stuff] and what would he think if I did a detox and tried to get my tolerance down and try alternative pain control methods? If anyone has any thoughts on this particular pipe dream, let me know. I would still be using more patches for several months than I am supposed to - I am basically putting them on and not taking them off for a week and then supplementing with a used patch if the pain or w/d gets really bad. My current plan is sort just to wear the patches I am prescribed ALOT longer than normal until I figure out what to do.
I talked to a dr. who would taper me down to suboxone, which he said would work fine for pain. I've read enough to know that there is a really good chance sub would not cover my pain. I would have a break in my pain management that I wouldn't be able to explain as well. Plus, if I put the sub on my insurance or took sub, I think I would be part of a database right?
I am just really scared of not getting adequate treatment for my pain since that is what started this in the first place. I really do not see myself as an addict since I am not using the meds to get high. I see myself as someone who made an arrogant and stupid mistake and is scared. I take the meds so that I CAN function not to avoid life. I feel a little frustrated that I can't post to the pain management board. Addiction is a pattern - I guess I getting into a pattern of misuse but it isn't to get high, so??
At any rate, I would really really like to hear from people who have debilitating chronic pain and may have made a mistake like I did. I feel like I have to know that my chronic pain will still be treated if I confess. For teh PM, wouldn't it be better if I simply left teh practice and went to an addiction specialist who prescribes sub? Then his records don't get screwed up and he also isn't more suspicious of his pain patients -- ie I don't want my mistake to have repercussions for him or his other patients. On the other hand, I know I am not being fair to him right now. I know I have an insane tolerance-- I can't even feel [before] a 25mcg patch and 50 mcg. made a dent in my pain but still didn't get it under control the way it was before. Nor did I feel a "high" when I added the 50 mcg this time.
Ok, would love to hear more, especially from chronic pain patients who have to take meds to function. The best possible outcome of all of this would be to find out that I don't need meds for my pain but I really think that's pretty unlikely given my fusion, disc disease and pain.
And, btw, how likely is it that pm doctors read these boards?
Thanks for the support. Still trying to find a way out without paying a huge cost for my mistake. If anyone thinks I can slowly detox tho, pls. do tell. Of course a drug test will be the end of the story as well.
I know I'm in denial one day and then out the next and then back in denial. I don't know what is left to treat my pain anyway,auge ,etjpdpme I haven't even fully accepted that I am "disabled" tho enuf time has probably passed since the accident that I should be in the acceptance phase - it's just that I don't have money and my career has been going downhill because of my pain...Ok well, enuf rambling. Obviously, I'm still on the fence. If I tell my PM, all he needs to do is give me meds for 30 day detox [which would be pretty horrendous given the amount i'm on] and show me the door. Oh, and blacklist me as well. Why in the world would he help me when I have put his career at risk AND lied to him?! And why would another doctor help?
[Still] confused...And far far more confused now cause the withdrawals are back. .. .Not too horrible yet, jus cannot think or spell very well. Gotta go...sorry if ay of this is unintelligible - I had such a hard time writing the last part while in w/d.
Last edited by Confused089; 07-04-2008 at 05:01 AM.
Reason: unfinished sentences, decided to shorten a little and also take out some of the repetition...
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Hi, this is really to everyone
Just wanted to say again that I am listening even if my post sounded like more of the same. Physically, I am feeling mild wds. I think I just don't want to face this and I really really need to hear from someone who has serious chronic pain and used meds for pain and didn't lose their PM. I feel frustrated that I can't talk to people in the chronic pain forum now.
I haven't seen any posts from someone who was in pain and misused or abused their meds for pain. I really want to hear from someone who has gone through a similar experience. I agree that others in pain must have taken more meds than they should have but I haven't seen any posts. In chronic pain I see posts about one mistake and you are finished.
I have suddenly gone from being a legit. pain patient to an addict (?) in one attempt to reduce my pain? I guess I feel frustrated that not following the doctor's instructions [patient compliance is an issue for all doctors] somehow has these incredible ramifications that it wouldn't in any other medical situation. So many people with other diseases do not follow their doctor's orders to the letter and don't get labeled an addict, don't have to go to a treatment program for not doing exactly what their doctors said to do, and don't have to be monitored for the rest of their lives. I'm just not ready to be labeled as a "bad" patient [again, if you read my earlier post though I really do think this doctor is far better than the other doctors I have had in the past].
I'm angry with myself, and feel guilty, but I am also very frustrated by what chronic pain patients have to go through to get treated and function. This is not directed at you or anyone who is reaching out to help and offer advice to talk to my PM. I simply have a lot of feelings about all this and while I do not blame anyone for addiction or think that addicts are "bad," I do not feel like what I did makes me an addict. If the system were not going to label me as an addict and if I didn't feel like being able to take care of myself were at risk here, I would have talked to the doctor immediately. It's so different with chronic pain - you can't make ANY mistakes. I think the system needs changing so that it is easier to talk to your doctor if you mess up. I feel like I am risking everything! And yes, of course, I should have thought of that at the time but I didn't.
If a diabetic doesn't comply with her med regime, she doesn't have to go to a treatment program and no one questions her need for medication in the future; she probably gets a really strong reprimand from her doctor. I understand this is NOT the doctors' fault - they are under serious scrutiny and have to protect themselves and their practices. But, I am truly frustrated by the whole experience. I hate having to take meds and be dependent on doctors so that I can function like everyone else - or not anywhere close to everyone else... I would have talked with my doctor immediately if I had not been so scared of the consequences. I have followed instructions to the letter until 6 weeks ago. It's just a really crappy disease or problem to have. I so wish they could make painkillers that weren't addictive, stigmatized, dependency forming and that the DEA wasn't involved in patient care. I realize that people DO get addicted from these medications and that it is a huge problem but I'm just really frustrated that trying to get enough pain control so that I can actually support and care for myself has huge consequences. This just wouldn't happen with any other disease. I don't crave opiates or anything. When my pain control was good I didn't even think about them. I just took them. It only became a problem when I discovered that I could relieve my pain and function more like a normal person because the fentanyl actually worked. I should not have played doctor and shouldn't be doing it now. I'm not going to say that I am "forced" to play doctor b/c that isn't true and it would be irresponsible of me to say that. I'm really frustrated though by a system that takes one mistake and makes it a lifetime problem. I know that someone said she was glad her doctor checked her meds. I don't care one way or the other. I am not going t abuse the medication if my pain is under control. I didn't abuse it when it wasn't [tho that probably had something to do with the fact that abusing it would not have helped my pain since I have always needed a lot of medication to keep the pain under control. Doctors get nervous when they are prescribing such high doses to a patient like me and they undermedicate b/c to really take care of my pain would put them under higher scrutiny from the DEA. I guess this is a place where I want to be able to express some of my feelings about what it means to be a chronic pain patient and how screwed up it is. I realize I raised a red flag by asking for a drug that worked for me - in what other disease would a patient come under suspicion for asking for a drug that seemed to be working better than another for them? I would LOVE to be off all this stuff and have no pain. I'm venting and I'm sorry....There has been a lot of support and kind words. I'm angry, sad, scared, frustrated, confused and a little hopeless right now. I'm literally upset that I can't post on the pain management board. Anyway, that's it for tonight....I will check back...thanks again to everyone for their support and their thoughts.
Hmm, one more thing - I presume that detoxing from Fentanyl and the seizures are from raising GABA levels too high b/c of Fentanyl potency? Or do you know [again, this is a post to everyone]? Also, I had not heard about the chemical changing in Fentanyl [I have tried to do as much reading as possible in med journals etc.] - could the person who mentioned that be a bit more specific? I am wearing patches for a week - Impossible to tell right now if all teh med is gone after a week. I'll only know after I start taking some off. Still adding one or two old ones to keep w/d to a minimum. BTW, you might ask why I kept the old ones. I was terrified of ever losing my prescription and thought I should try to have some kind of back up supply. I wasn't planning on using them like this tho!
Last edited by mod-anon; 07-04-2008 at 09:25 PM.
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Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Hello Confused
All these thoufghts are tormenting you and I am sorry for the emotional upheaval. I don't know whether or not you are an addict. There are some addictive behaviors showing.... self-medicating, misusing prescribed meds, crossing lines that should not be crossed.
I recognize these things because I am also a chronic pain patient who has displayed the same behaviours. I took it a step farther and crossed the line into using pain meds for emotional as well relief and that is where I probably crossed into addiction fully.
I think as chronic pain patients, we are always in danger of addiction. I believe that part of it comes because after long term use, we become unable to deal with any degree of pain. That was sure true of me. I reached the point where I was taking pain pills by the clock, not by the pain. This happened early on. It was so easy to just pop a pill and not take the time to use resources like heat, cold, massage and rest. It was so easy to anticipate pain and try to prevent it with the pills. I pushed my body to perform by disguising the pain, hiding it, stuffing down my body's signals to take time out when my brain said "You have to go to work."
Well, that worked for a long time.. quite a number of years. I worked and caused more and more damage to my injured leg because I pushed way beyond the limits of what my condition was by disguising all the symptoms I could. I worked. And eventually that was all I did. Work. I used pain meds during work to keep functioning and after work, I took to my bed and used pills to escape the physical and emotional pain it was causing me to live like this. ANd I continued to ignore the signs of my falling into addiction.
Two years ago, it all came to a screeching halt. I was experiencing excruciating pain physically and emotionally. And the dam broke when I fell into a total breakdown physically, emotionally and spiritually. Total eclipse of the mind, body and soul. I couldn't work anymore. Actially, I could not function anymore period. My fight with pain turned into a fight for my life.
I couldn't hide from my use, misuse, abuse and addctive behaviours anymore. I was self-medicating beyond reason. I went to my doctor (family) in a sobbing mess and spilled the guts. We developed together a plan to taper down from Oxycodone and then from Xanax. It took me nearly a year to accomplish. And during that time, I discovered that my life was much more than just working and hiding.
I did have to retire. And today I am on Disability. It sure was not the plan I had for my life, but it is what life brought to me. I have learned to deal with life on Life's terms.
I am happy today. Poor, but happy. Smiles. I do not use opaites or benzos anymore for pain relief. I use rest and ice and heating pads and sometimes Aspirin. I can think straight again and I am calm. I am participaing in Life again at a much slower pace that my condition demands.. at Life's pace for me. I am no longer licving a life of torment and angst.
So, there are no covert messages here for you. Just a sharing from another Chronic Pain Patient, my own story.
I am hoping the best for you in whatever your own story is meant to be.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
I'm very sorry to hear about your troubles. You have gone to great length to talk about your feelings & etc....Which is good. However, to be very candid and honest, you seem to be talking in circles, even rambling. I don't mean to be critical, but rather honest in my assessment as a way to help.
Before I, or probably many others, can help, we need to know what happened. If you don't want to go into a lot of detail, then don't....But please give us a general idea what happened and how. Have you been fired by your Doc? Are you going back to see him at some point? Do you have another appt.? All of these questions are very important. I, for one, cannot give advice on what to do until I know what happened. You've talked very candidly about your pain, and the root cause....And, I believe you are in pain....But, what has happened to get you in this state of partial WD? How bad was your screw up?
I look forward to hearing from you and I will help as much as I can.
No, haven’t been fired. He does not know what I have done. I have another appt. with him.
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Are you going back to see him at some point? Do you have another appt.?
Yes, still have regular monthly appts. with him.
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All of these questions are very important. I, for one, cannot give advice on what to do until I know what happened.
What happened in a nutshell: I had extra 25 and 50 mcg patches – you get a supply of 30 each month and see your pm dr. every 28 days. I have never taken more than what was prescribed, so I had built up extras over time. When I added the 50 mcg patches, I dropped the 300 mg. of morphine I take regularly.
When I ran out of extra patches about 2 weeks later, I tried to go back to my regular prescription of morphine and fentanyl, but something had changed in my body, and I was now in excrutiating pain. I couldn’t function and I began taking far more morphine that usual [1200-1400/day as opposed to 300 mg./day] in order to function. This went on for about two weeks. Saw my PM and he raised the Fentanyl dose [if only I hadn’t been impatient or made so many mistakes afterwards]. I hoped that putting the new patches on would fix the problem – it didn’t of course, b/c I was taking so much extra morphine and I went into withdrawal. I then, not very brightly, started using used fentanyl patches to preserve some of the dwindling supply of morphine. This is when I lost track of how much I was on – I probably increased the total amount of opiates I was on as well though I tried to stay in mild withdrawal so that there wouldn’t be a problem w/ the patches. I am now keeping my “new” patches on for a week and trying to wean myself off of the used patches. I am worried about the increase I gaba levels – since some of the w/d I experienced was similar to benzo withdrawal, not opiate withdrawal and I did not use extra benzos – if anything, I believe I cut back slightly on my prescription during this time. So, I am stuck with a lot of extra Fentanyl patches on and, as I have mentioned many times, a legitimate concern about talking with my pdoc about the problem since I am very concerned about my ability to function without pain medication in the future given my injuries [broken vertebrae, fusion, degenerative disc disease, etc.]. I am concerned I will be shown the door and blacklisted. I do not have any solution right now except to keep cutting back slowly on the patches. If more details would be helpful, pls. let me know.
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You've talked very candidly about your pain, and the root cause....And, I believe you are in pain....But, what has happened to get you in this state of partial WD? How bad was your screw up?
Seems like it was pretty bad if I am supposed to be wearing two patches and am wearing 8 [haven't taken any new ones off since last Thursday + 2 used patches and am in mild withdrawal.] Since the patches still have up to 60% left in them when removed on the 3rd day, and I am on a 48 hr. schedule, I have A LOT more fentanyl in me than I should. Once I get to the point where I am not using ANY used fentanyl patches and am stable, I will start removing the "new patches I have been wearing for longer than I was supposed to wear them - starting with the oldest one. Until I hear from some chronic pain patients that they went through something similar and that their pdoc continued to treat their pain [I cannot see why a pdoc would do this since I have disregarded my pdoc's instructions and put her practice at risk, I do not feel that talking with my pd is an option. I have to know I can take care of myself and not be in terrible pain for the rest of my life. Certainly open to suggestions though, an very grateful for the support I have received here.
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I look forward to hearing from you and I will help as much as I can.
Thank you!
Last edited by mod-anon; 07-04-2008 at 09:24 PM.
Reason: edited quotes for readability
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
reach,
Thank you for your reply. I hope to talk with more chronic pain patients [current or former]. May I ask what kind of injury or disease you had/have? I suppose I watch the clock, but it is to take long acting meds on time. The work load has been terrible, but right now, I have serious financial concerns. I have a lot of debt that has to be paid off, so my performance at work is important. And I am relatively young and a satisfying career is quite important to me at this point in my life. I realize disability is an option, but I would never be able to pay off my loans with a disability payment. Some of these are student loans and it is extremely difficult to default on them. I think the way I am seeing it is being arrogrant and thoughtless about taking my meds. and then being so afraid that I will not be able to care for myself or make a living if my pain isn't manageable. I'm not married and don't have anyone [other than friends] who can help take are of me. So, I am very much feeling that I need to care for myself. Thank you for sharing your thoughts.
Last edited by mod-anon; 07-04-2008 at 09:19 PM.
Reason: removed quote
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Reach, sorry, I realize you said you had injured you leg. I had not thought about the possibility that I was further injuring my spine my masking the pain with pain medication. That was helpful to hear - I obviously need to think about my long term health. Sadly, I am still trying to recover from my accident and get back on my feet financially. As I think I said, I cannot repay my loans without work and must be able to care for myself. I am not just having a pain crisis, I am also having a financial crisis which is from not working for a long period of time and from high medical bills. I am trying to "prove" that I am not disabled and can perform as effectively as I did before I was injured. I don't see too many other options as a disability payment would not come close to repaying my loans and debt. Thank you for sharing your situation with me again.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
MarieCan,
How do you know I will not be banned by pain management? I didn't say addicted, I said abused since I think that is the term for using medication improperly. Addiction is a lot more loaded. Also, I was curious by what you meant when you said that the chemical changes over time. I'm not sure what you mean. I heard everything else you said, I do not feel ready to talk to my PM. It would be a huge relief to get it off my chest, but I worry very much about the consequences, which are out of my hands.
Last edited by mod-anon; 07-04-2008 at 09:18 PM.
Reason: removed quote
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Hi Confused
I am signing off for the night but wanted to stop by and let you now I am thinking of you. I know the issues you are facing are overwhelming. perhaps tomorrow we can share and see if we can break them down into manageable portions. When we are emotional, overtired and overwrought it is hard to see our issues in pieces and then tackle them step-by-step.
Please try to take a long, hot bath and relax as much as you can. Tomorrow is abnother day and another chance to try to see it all more clearly.
I will be thinking of you and wishing you some peace and rest.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
i am kind of wondering when you pain became worse,why you did not simply speak to your PM then and see what else could have maybe been added or tried since there are other types of med clases that can help with even very severe pain and many many other modalities that you can use that do not even invlove taking any actual meds of any kind to help keep things better controlled. this is what i have kind of had to do since no meds can help with some of my worst pain syndromes that just do not respond at all to narcotics. i also keep trying to find other options such as topicals and my TENS unit that seem to work much better for the harder to treat hell i have burning into my skin. i have just had alot of major side effects with things like lyrica and cymbalta and other anti S meds that are normally used for this type of pain.
what other meds have you tried before you went to the MS and the fent? anything? is having surgery to at least try and fix some of the more profound pain genrators possible? i know with DDD,which i have very heavily in my c spine among other issues there can create its own type of pain issues.believe me, only you really know whether or not you have become addicted or not,but you were and still are way out of your docs Rxing guidelines. in my PM,considering the contract i signed when i started there and my past addiction issues,i would most likely be terminated if i decided to change my own Rxing schedule. its just not acceptable in the PM world to even go there,which i know you do realize now,but you had to have a clue that this was not the norm in what you decided to do back then either ya know?
doesn't your PM ever require the suprise UAs or pill/med counts at times? i am asuming you signed a contract with this facility that gave then that right to do this as they felt it could be needed? the thing is,with me anyways,it IS those two big things that help to keep me compliant. i am under a bit more scrutiny and have no problem if my clinic calls me up and asks me to bring my meds in for a count or ask me to pee in a cup within the next 24 hours. this just is part of the program in most PMs. over the past four yaers since i started there,i have never gone out of my PMs guidelines with out being okayed there first for whatever reason. i just have that responsibility to my PM and his other patients if i should decide to create my own dosing schedule. hon,this IS why those rules are in place to begin with,so peole do not do what you decided to do and end up where you are right now. whether you were in just alot of pain or whatever the reason,a phone call should have been made to your PM at that point and a plan discussed as to how to go about getting better relief. that is where you made the bigger mistake. just not being honest with your PM about your true pain needs and the fact that the control,for whatever reason just was not working for you. you just cannot blame it on the pain hon,you made that choice to go this route ya know what i mean? i have pain,alot of people have very over the top types of pain,but we try and use as many little other tools to just keep it better controlled so we are not just relying on meds to do that for us. sometimes i cannot simply do the other things and i do have to rely more on my meds,but in most cases,this is never my first choice for enhanced pain control. like i mentioned above,finding other ways of handling the pain when its just simply gets way too out of control for you is just something you need to have in place. the more options you can find that actually work for you the better.
believe me,i am not judging you or reprimanding you in any way shape or form,but this did happen by choice not because you 'had to",that is an active choice you made instead of just doing what any PM would want you to do in that situation. there is just a reason,many reasons why,espescially fent is not up to the patient to decide how to dose,and you are finding that out right now unfortuently the hardest way possible. knowing just what other methods,meds,modalities you have actually tried would help alot in seeing the whole picture here. and the possibility of a surgical intervention that could at the very least,lower your actual pain to some degree. for me, i am never ever pain free or in some areas,very intolerable levels are there that my brain has thankfully started to kind of accomodate since my original spinal cord injury created not only RSD but another nasty pain syndrome called central pain. its an actul compenasory thing that your brain does when you experience something 'noxious' that is continuous and non stop 24/7. but my other pain is very wide spread from many different injuries and a kidney liver disease that is creating huge *** kidneys for me an adding to my already severe c spine pain. this is what my oxycontin responds to the best. six surgeries later,things are still not good,but the ones i have had have also helped reduce at least some of the intensity of them. i am just wondering about that herniated disc and how much a possible surgery could realistically help you.
i still believe honestly,telling your pain doc what happened with the fent and why you did this would really be in your best interest,now and espescially for your furture. since you do have obvious pain generators that can be docmented,i really cannot imagine that your doc would just drop you in this situation. but giving him that chance to actually help you with this i really think you do you best here. you are not perfect and you did something that becasue of pain and feeling desperate you just did. its done and you cannot change that part,but you can be honest and forthcoming and hope he takes that into consideration. this doesn't actually really "sound" like an addiction issue but you were not able to realistically control your pain at the dose you were at. i don;t know why you didn;t just speak to your PM tho,that part i really don't understand since when things are not working for you in most medical situations,changes are usually made and med adjustments,you know what i mean? if you had spoke to him aboutthis when it started becoming ineffective,alot of this just could have been avoided ya know?
there is just a certain level of trust that has to develop between any doc and the patient,not being up front about your pain just will not give you the pain control you need in the first place. i would honestly sit down and speak with him about this situation,and admit you did something without really understanding the consequences of it. you were just in pain.but you do need to explain at least to him,why you did not tell him when it happened that your pain was getting too out of control. given the fact that this IS fent,i just would be very concerned about you trying to do this without his expert supervision and help. you just need his help and i do think if you apprached this from that angle he would see you in a different light than someone who actually was simply looking for that high. you are only dependant right now from what i can see from this,but that is something,like i said earlier that only you know yourself. there may be much closer scrtiny with any continuation of him still keeping you as his patient,but if he will still treat you,it just has to be done. you just owe that much to the PM and the other patients he has too. my monitoring is just a bit more than others,but i have passed every test and pill count so they do trust me at this point i think. given the over four years i have been there,it has proven out over time that i am totally compliant with my meds despite my past history. most of that is absolute fear of having to feel the full impact of my whole pain issues if i should decide i should 'need' tommorrows meds today kind of thing? i simply NEED every dose to be there for me on the day and time i need it. i was also only allowed two weeks worth of my meds at a time for about the first six to eight months after i started there. i had to "prove' something to them before any level of trust was going to develop. i have just been totally honest with my PM from the start as well as my primary doing his own oversight too. but i really liked the fact that all this stuff was in place. this kind of thing not being there before,with an as needed Rx,just set the stage for me to end up where i did. no real oversight or defintie rules or direction.
when i really started looking for bettter ways to manage my pain using therepies and other modalities,i didn;t feel so afraid of the next pain flare since i do now have many other options to try before ever going to the only two alloted BT meds i have during the day. simply trying to manage very severe pain only using narcotics really does not work for most peoples pain. its a combination of things that really gives you the best coverage and management. instead of having to keep raising your intake or the strength of the narcotics,it helps alot to reduce the level of tolerance too. narcotics are simply another adjunct to manage pain. part of your pain plan and should never be totally relied upon for total pain control. it just creates alot of problems that would not be there if other methods were also being used. one BIG problem with fent is that delivery system that cannot be altered or cut in half or taken as needed,its a whole nother ballgame that just come with its own types of problems,that are just not really there as much with most other meds.even the LA narcotics.
but given your current situation and the type of med you are currently on,you simply have to speak up to your pain doc and just be completley honest about everything. you just really do need his help with this type of med and coming off and then obtaining pain control hopefully with something other than fent. you self medicated for a reason other than addiction,he should know that among other things that you have mentioned here too.
i realize this is very scarey for you to have to even think about doing but you DO owe it to him and yourself to just be honest here,or your pain will never really be well controlled. he needs to know what your true fent levels have been so he can help you thru this.
i really am sorry for where you are at and having to find this all out in a very tough way, but learning from this and just moving thru it and past it,i really do think you can do this. your choices in all this are just very very limited. this is all just simply in your best possible interest right now,even tho it may not actually feel that way to you right now,it is. you simply screwed up,and hopefully he will understand this. asking about other options when you speak with him would really help. tell him about the fears you have had about all this and how really hard it has been trying to just figure out the best way to tell him and being honest about it. just tell him i really NEED your help. you just really need to get this resolved as soon as you can in order to get things back on track and actually find a tolerable pain level right now,using as many different modalities that actually work for you.
i am kind of suprised that your doc had you on that much MS along with the fent patch,those are two very strong meds,thats all. not knowing just what other methods or meds you had already tried really kind of is a disadvantage as to try and see where you were and how you got to the fent in the first place,you know what i mean? any info there you could provide would be helpful. do you have a current MRI report that states just what level of damage is there in your spine? any cord contact or compression anywhere? where is the herniation located and the fractures that were there? FB
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
Yes, I realize I am rambling. I am w/d and my thoughts are not clear or focused. I realize I have been repetitive. I have not been fired by my pd though I have now seen him twice since this began. I believe he is suspicious but I'm not sure what he thinks I have done. Yes, I have another appointment to see him. The screw up was quite bad though it has been difficult to assess just *how* had because it is impossible to know how much Fentanyl is coming from the used patches. I have [now] read that they often have as much as 50-60% of unused medication in them after use, and I switch every 48 hrs, not every 72, so this would suggest that I am getting even more than 50-60% from the used patches.
Quite simply, I had extra 25 and ?50 mcg patches - about two weeks worth. Morphine does not work very well for me now, but Fentanyl does. I was in a pain, not fully aware of the potency of the patches [unusual, b/c I usually research and think things through carefully before I do something. I was under a lot of pressure at work to perform and was thinking about that more than the potential ramifications of my actions]. I also had a prescription for Fentanyl which I had been slowly titrating up on [in addition to the morphine] for close to a year. When i used the new patches, I did not think my PM was going to raise my dose since he didn't seem enhusiastic about putting me on any more medication than I already had. I take 400 mg of morphine.
If I recall correctly, for several weeks I put on 50 mcg in extra patches and dropped my dosage of morphine by 400 (at least that is my recollection - I may have used a small amt. of my morphine during this time, especially at the beginning before the fentanyl took full effect. I used conversion tables to make sue I was ok, as well as how my my body felt I ran out of extra patches after a couple weeks [also, rather unlike me not to plan, but I almost all of my attention was on my work]. I had plenty of extra morphine at this point. Since I have always taken my meds as prescribed, I had a lot extra meds [see my doctor every 28 days and get 30 days of pain meds - so I had all of the morphine I did not use while I was using the extra 50 mcg of fentanyl + perhaps somewhere close to a month's supply accumulated over the years of taking pain meds]. My pain was greatly relieved by the addition of 50 mcg of fentanyl and I was highly productive at work. My boss was actually happy with me since my production was at the level of other people [and I was also as productive as I had been before my accident] and our relationship improved. I was not in a good position with with my boss at that timebecause I could not produce quickly enough with my pain. Adding the 50 mcgs did not "cure" my pain and I still did not have the level of pain control I had during the period when I had a high level of pain control. I.e., I still had flare-ups whenever I did a task that I did not do everyday, but the duration and intensity of pain was significantly lower. I am in a terrible position with my boss now since I have lost a month's worth of worktime and he is waiting to hear from me about when I can begin working again.
The problem [obviously this was not the start of the "problem," since that occurred when I self-medicated and did not follow my doctor's orders] occurred when I tried to go back to my prescribed dose [when I ran out of extra patches midway in the month] and switch back from 50 mcg of Fentanyl to 400 morphine when I ran out of the extra patches. Something had changed in my body and at this point. I experienced EXTREME pain - pain at a level where I could not function. I began taking large amounts of morphine to function [not from withdrawal (at least not to my knowledge, I did not feel like I was experiencing any w/d symptoms. Apparently the conversion was fine, but analgesically, the two medications had very different effects in my body. Of course, I knew this, if Fentanyl had not worked better than morphine, I would not have made a temporary switch. But my pain was much higher than it had previously been before I temporarily substituted the fentanyl for the morphine. The same prescription had allowed day to day functioning and had allowed me to work, just not as productively as other people or as I had worked in the past. I literally did not feel like I could function on a day to day basis. I added advil and tylenol, which did not make a dent. I began to take extra morphine - I was surprised and dismayed by how much morphine I had to take to function at all - in contrast to my normal 400, I know needed to take closer to 1200-1300 to function and I was still in far more pain than I had been in before. During the time I continued to take my "regular dose" of fentanyl - again, I'm concerned about giving the exact details since my situation would be recognizable to my pd. When I went back to see him over 4 weeks ago, I suggested we convert from morphine to fentanyl. He was reluctant and I didn't push. In the end, he decided to raise the dose by 50 mcg, exactly what I had done [which makes this situation even sadder - if I had been more patient [though it had been a year since I had what I considered good pain control], none of this had to happen.
I immediately upped my dose of fenantyl but found that I was in withdrawal since I had been taking so much extra morphine to keep my pain under control. At this point, I felt worried that I might not have enough extra morphine to do a decent taper [I probably did, but I instead started using some old used patches to slow down the withdrawal]. I honestly did not have time with work [or so I thought b/c I have now missed my deadlines b/c of all of this to taper then and tried to do my work. However, I was in withdrawal and the quality of what I could accomplish was extremely low. I told my boss I was having a pain crisis. My hope was that once the new dose of fentanyl got up to a normal level and I tapered, I would be ok again. I apparently made my mp suspicious by picking up my meds five days earlier than usual b/c I wanted to start on the new fentanyl dose immediately. I ws truly hopeful that the additional 50 mcg would cover the extra pain meds I had been using to keep my pain under control. I was now using "used" patches and staying in a low level of withdrawal mot of the time to try to stay safe [tho I understand I was not being completely safe b/c fentanyl takes a while to build up to a normal level. My body was definitely confused since I was putting on and taking off, old used patches I had saved in case of an emergency. I realized relatively quickly that this was not working well b/c there wasn't any way to tell how much fentanyl I was getting. If I felt like I was going out of mild withdrawal, however, I took off a patch. I began to slowly take off a lot of used patches. However, if I had to go out for food or anything else, I put used patches on again and/or took extra morphine. I continued to do this for the month between my two visits. For my last visit, I wore a lot of used patches the day before my appt. and supplemented w/ morphine to ensure that I was not in w/d for my appt. I would not say I was my normal self at the appt. - there is a lot happening in my life on top of this and I felt guilty and scared. I am beginning to run low on extra morphine, and all of the used patches have been used more than once,sometimes two or three times. Still, I seem to be getting something from putting on old patches. I am also wearing approximately 8 patches that "were" new - ie I simply haven't taken them off after the two days. I have a hard time believing that I am still getting medication out of a patch on the 8th day but I am in w/d and don't feel like now is the time to test that theory.
At his point, I am wearing about 150 mcg in used patches tho I doubt I am getting much from these since they have now been "used" several times. I have not taken any more of my "new" prescription than I have been prescribed. If I had "extras" I would test to see how much fentanyl I am actually getting at this point.
Currently, I am taking valium and clonidine to help w/ the withdrawal that began last night. I worn extra patches for a couple days so that I could shop, see PM, etc. I am hoping this 2nd, larger wihdrawal[but not hue] will enable me to stop using any of the "old"used patches and just wear new ones for extneded periods of time until I can figure out how to handle this situation. I'm also hoping that it will give me a little better idea of how much F I am taking, though I will really only have an approximation.
I am not sure if that answers all your questions. And I apologize if I am rambling and repetitive. It is difficult while in wd [though the wd is not bad right now] and when I can't see what I've written w/o scrolling up. The first problem I have i w/d is losing my ability to focus and concentrate well. This has made record keeping difficult. Regardless of the solution to the problem I choose, I may need to find a new PM because I hate the fact that I have not been honest with him and have betrayed his trust. With the amt. of fentanyl I am on, I do not see any easy way to taper if i can get to the point where I have stabilized my body by keeping new patches on for far longer than they are intended. I have called a few detox places but I don't know that they really have a plan for people with serious chronic pain. There are appear to be different camps of belief - that suboxone or even advil will work just fine once my receptors have down regulated. This would, of course, be wonderful. But no pain management doctor I have ever seen thinks I can go without meds. Of course, this is also one school of thought. But, really, if I were to detox, I would want to try to take advantage of the detox and lower my horrendous tolerance and try other methods of pain control before going back up on such a high dose of meds.
I suppose my fairly dream right now is that one or two more mini detoxes will bring me the pt. where I can get back to work [not lose my job -which is seriously at risk now b/c of the time I have lost in the last month] and then suggest to my PM that we try a detox. It would make little sense for me to suggest this now. Sadly, just about every plan I have though of entails more deception. I hate this idea and I am also lousy and inexperienced with lying - I would probably trip myself up fairly quickly. Perhaps not if I was really careful.
I think my Pm doctor would be angry and alarmed that I used "used patches" and that I am wearing so many. Obviously, this would kill most people, and it put him in jeopardy. So, I am sitting here without a good solution to the problem, other than the one that has been suggested, which is to talk to him. I honestly think I would be shown the door and that I would have great difficulty getting someone to treat me in the future. My PM already cautioned me about the dangers of the patch. I have another appt. to see him.
I am not feeling clear- my mind is pretty foggy right now so I am not sure how clear or cogent my post is.
Thank you for your advice and help.
Confused
Last edited by mod-anon; 07-04-2008 at 11:07 PM.
Reason: removed quote
Ok....I'm here to help.....But, I still don't fully understand what's going on. Let's back up.....What are you SUPPOSED to be doing? What is the exact prescription? What level patch does he have you on now? What was it previously? Is the Morphine for BT or long acting?
To be honest, I would post on the pain mgt board because there are many very intelligent people over there than can help in addition to me. But that's up to you.
Let's back up and keep this simple....Tell me what you were taking (exact script) and what are you now taking (since the Doc increased it).
Ex
Last edited by mod-anon; 07-05-2008 at 03:53 AM.
Reason: removed quote
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
My pain became much worse over a year ago when I had an interaction between two meds - before that I was on a constant dose of oxy that worked exceptionally well. I actually felt close to "normal." I had a different PM then in a different city - he told me he understood the interaction but I later learned that he did not understand it. When I talked about my increased pain from the interaction [my understanding from reading med. jounrals is that is raised my dose by 10-15x - I had mini-withdrawals as the med left my body for close to two months [it had a very long half-life]. This is really when the pain problems got terribly out of control. Since that time, I have struggled a lot with pain and with work. I'm not sure how much I'm going to be able to type right now b/c my pain level is pretty high - it could be the withdrawal or it could be going down on the meds - really no way of telling right now except that the pain is only in the area that I usually have it - I don't know if that means it's w/d pain or not.
I have tried oxycodone, which, as I said worked well before I had an interaction. After my accident I was able to control the pain with relatively low doses of oxy - I'm pretty afraid of surgery again since my pain went way up after my fusion, which was to stabilize my spine and [the doctor did not tell me this] apparently to treat my pain as well. I needed a much higher dose of meds after the surgery. I know the fusion is putting pressure on the discs below - I did not know [tho I knew I had a lot of back pain before my accident] that I had degenerative disc disease in my c-spine until they did MRI's and cat-scans when I had my accident.
I really do not believe I have become addicted but I understand I was not thinking responsibly or about the possible long term effects of my actions on myself or others when I took my meds into my own hands. I was thinking about money problems and the need to perform at work so that I do not lose my job and have a financial crisis [I already have a financial crisis with my debt]. The pace has been relentless and I have worked 12+ hr days since I returned. I have felt like I was fighting for my survival. I think this is my explanation for what happened tho not an excuse. The PM has recognized this and has been very respectful of my financial constraints as well as the pressure on me to perform. Lack of money and no time off [tho I have essentially taken the last month off w/o permission since I have not been in any condition to work] is one of the reasons we haven't changed any meds or tried anything really different. The hope is that if I can just get through this period at work - which lasts roughly thru the fall, I may have more flexibility afterwards.
The in my PM,considering the contract i signed when i started there and my past addiction issues,i would most likely be terminated if i decided to change my own Rxing schedule. its just not acceptable in the PM world to even go there,which i know you do realize now,but you had to have a clue that this was not the norm in what you decided to do back then either ya know?
My new PM was quite relaxed and I didn't actually sign a contract. I have had one urine test and no pill counts since I started PM two years ago. But he does have a contract now and pill counts and UA's. This means I am actually short two patches, which is serious problem since we now need to bring unused meds to each appt. This wasn't in effect [tho of course I knew that wasn't something I should do, when I used extra patches. And, of course, my greatest fear is that I will be terminated and blacklisted. I definitely had a clue and have tried to do everything by the book up until now. I don't think I would have crossed the line w/o all the pressure but I am definitely not trying to excuse what I did - explain it would be more accurate.
Not until this month did he implement pill counts, a contract and UAs. But, of course, I understood those were the terms and that I needed to abide by them. May I ask why you are under a bit more scrutiny?
i am under a bit more scrutiny and have no problem if my clinic calls me up and asks me to bring my meds in for a count or ask me to pee in a cup within the next 24 hours. this just is part of the program in most PMs. over the past four yaers since i started there,i have never gone out of my PMs guidelines with out being okayed there first for whatever reason. i just have that responsibility to my PM and his other patients if i should decide to create my own dosing schedule. hon,this IS why those rules are in place to begin with,so peole do not do what you decided to do and end up where you are right now. whether you were in just alot of pain or whatever the reason,a phone call should have been made to your PM at that point and a plan discussed as to how to go about getting better relief. that is where you made the bigger mistake.
I really was honest w/ my PM about my pain problems and I think he was trying to address them. But he didn't have much room to manevuer with my financial and work stituation. When he upped my morphine dose by a very small amt., I felt kind of hopeless b/c I knew morphine wasn't making a big diff. for me and that a small increase wasn't going to make any difference. I could not even "feel" the difference with a patch increase.
I would much rather be approaching my pain from a multi-disciplinary approach - my insurance company will only pay for the meds. I have a huge deductible to do anything else. In addition, there has been *no* time as I have been working constantly.
I think I'm going to have to finish this later b/c my pain is really getting to me and I have some mild nausea as well right now. This is day two of my 2nd [small] taper and I suspect things are just going to be worse tomorrow, but we'll see. I am trying to at least stop using any old used patches tho I am still way way out of bounds on the amt. of meds I am taking since I am leaving the new patches on for a week. I have to be at more than double my correct dose. I am kind of hoping that the patches just don't give anymore after 5 days but I really don't know. The fact that I now have to come up with two patches I don't have is going to make this a lot more difficult. I was at least trying get on a stable dose so that my body is not constantly adjusting to different amounts of medication and so that I am not using old patches with absolutely no clue as to the amount in them. So, thank you very much for responding. I'll be back on tomorrow and respond more, provided I am doing well enough to sit at the computer. I expect tomorrow to be tougher. I am now wearing only one used 50 mcg patch [in addition to all the new ones I have left on]. For myself at this point, I really want to stop using the used patches which is why I am doing this taper. After that, I need to assess the situation again, especially given the fact that I am short two patches from last month [not this month - honestly, it depends on how far back he is counting - I may be short a lot more.] Good night and happy 4th...thanks again.
there is just a reason,many reasons why,espescially fent is not up to the patient to decide how to dose,and you are finding that out right now unfortuently the hardest way possible. knowing just what other methods,meds,modalities you have actually tried would help alot in seeing the whole picture here. and the possibility of a surgical intervention that could at the very least,lower your actual pain to some degree. for me, i am never ever pain free or in some areas,very intolerable levels are there that my brain has thankfully started to kind of accomodate since my original spinal cord injury created not only RSD but another nasty pain syndrome called central pain. its an actul compenasory thing that your brain does when you experience something 'noxious' that is continuous and non stop 24/7. but my other pain is very wide spread from many different injuries and a kidney liver disease that is creating huge *** kidneys for me an adding to my already severe c spine pain. this is what my oxycontin responds to the best. six surgeries later,things are still not good,but the ones i have had have also helped reduce at least some of the intensity of them. i am just wondering about that herniated disc and how much a possible surgery could realistically help you.
Sorry, read some more and your injuries/disease is far more extensive than what I am dealing with.....As far as surgery, I know a surgeon might promise that by fusing another level [which would reduce my mobility substantially] and perhaps by dealing with some of the herniated discs, I might get better, but I am really wary of the cost and the possibility for even greater pain from surgery. I really do not want another surgery nor do I have any idea how I could afford it given my current levels of debt. Ok, *now* I am going to bed...It's quite late!
One last comment, I really was upfront about the pain...it's just that he is a new PM for me and I am already on high doses and he has to work within constraints that most docs. don't have because of my work and financial situation. In a way, his hands were a bit tied.
when i really started looking for bettter ways to manage my pain using therepies and other modalities,i didn;t feel so afraid of the next pain flare since i do now have many other options to try before ever going to the only two alloted BT meds i have during the day. simply trying to manage very severe pain only using narcotics really does not work for most peoples pain. its a combination of things that really gives you the best coverage and management. instead of having to keep raising your intake or the strength of the narcotics,it helps alot to reduce the level of tolerance too. narcotics are simply another adjunct to manage pain. part of your pain plan and should never be totally relied upon for total pain control. it just creates alot of problems that would not be there if other methods were also being used. one BIG problem with fent is that delivery system that cannot be altered or cut in half or taken as needed,its a whole nother ballgame that just come with its own types of problems,that are just not really there as much with most other meds.even the LA narcotics.
Re: Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in f
Confused089,
Please use the Post Reply Button at the top or bottom of the list of posts. Please do not use the Quote Reply Button, as there is no way to tell which responses belong to the quote and which belong to your answer. I have tried to wade in here and delete the quotes, but I will not do it in the future. Thank you.
Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in futre 
