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Old 03-09-2009, 07:56 AM   #1
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Concern about how quickly dependence can develop

Hi All,
I first posted here about a year ago. I'm a 46 yr old male who's been dealing for years with fibromyalgia and chronic lower back pain due to L5 disc problems. Up until a few months ago, my neurologist was primarily handling my pain management which consisted of a megadose of Neurontin and 30 Tramadols a month. Last Fall, I asked my PCP to take over my pain management since he was at least willing to give me up to 120 Tramadols per month. At first, it was great. The increased Tramadol dose made me feel better than I had felt in years. In fact, I felt so much better I booked a trip to Disney World for my family this coming May, something I never would have done with my prior pain levels. Well, unfortunately the boosted pain relief was short lived. I guess even though I was only taking 30 Tramadols a month before, I had been doing it for so long (6 yrs) that my body had already built up a lot of tolerance to it. After a few months of taking 120 pills a month (4 per day), the pain levels have since crept back up again. Now I have a prepaid trip to Disney ahead of me and I just don't know how I'm going to be able to walk around those parks all day with my current pain levels. My kids would be heart broken if I canceled this trip. What I'd like to do is ask my doctor for some stronger pain medication that I can take for just that one week while I'm on vacation. The problem is my doctor is very anti-narcotic. A couple of years ago, when my disc first slipped he did give me 30 Vicodens (his idea, not mine). They really helped me sleep through the severe pain so when I went back to him a month later I asked if he could refill the script. Well he seemed very annoyed that I asked him for more Vicodens. He proceeded to lecture me about the dangers of dependence. His whole demeanor to me had changed. On the first visit (when the Vicoden was his idea), he was very sympathetic about my pain. However a month later when I went back and asked for more medication, he started questioning me in a way that suggested he was skeptical whether my pain was as bad as I was telling him. I felt very humiliated, like I was being treated like a drug addict or something. So I decided I'll never ask for any narcotic pain medication ever again.

That was over a year ago. Now I'm not sure whether it's wise for me to ask for stronger pain medication again in order to get through this trip, or if I should just cancel the whole vacation. I guess my main question to you all is this, can narcotic dependence develop in as little as a week of regular use? I've never taken anything stronger than Tramaol for more than a couple of days so I'm not sure about that. If it can happen that quickly maybe I shouldn't even bother asking my doctor for additional meds for the trip, since it would just reinforce any fears he may have that I'm some type of drug seeker. On the other hand, I hate to disappoint my kids who have had their heart set on this trip. Any advice here would be appreciated. Thanks.

Steve

 
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Old 03-09-2009, 08:21 AM   #2
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Re: Concern about how quickly dependence can develop

I'm sorry to hear about your issue Steve...It is an all too familiar story, however. What you've described in terms of tolerance is very normal. I had a very similar experience about six months ago (with different meds), and the improvement has slowly worn off.

To answer your question, no your tolerance won't skyrocket in just one week. But if he gives you a fairly big up tick, you would notice a difference after the week was over and you returned to the previous med levels.

I would go in and talk to him and tell him exactly what you've said here...That you felt so great after the increase that you booked that trip and now you just don't know if you can make it. I'd tell him that as a CP patient, you miss out on so much of life and I'd plead with him to support you for this one trip....So that your kids can experience something other kids can. Just speculation on my part, but chances are that if you don't take this trip, you won't ever.

I'd ask for some sort of breakthrough med (in addition to your regular med) to use while on the trip due to the increased demand(s) on you. I wouldn't request a specific med, but rather use the term "break through med" or "something for flare ups." Tell him you will be prudent with the med and only take what you need throughout the trip. Once the trip is over, you'll return to your previous levels. I would imagine that he'll offer some advice once you open up the topic.

I think you may find him to be more receptive than you think. Docs don't routinely throw meds at patients unless they ask, or show a definite need for them...So, if you've been passive at your appts, then that's why he hasn't increased you. Many in PM are afraid to tell their Docs exactly how much pain they are in.

Lastly, if you take the trip, please make sure you safeguard your meds...Losing some or all of them would make for a near disaster.

Best of luck to you.

Regards,

Ex

Last edited by Executor; 03-09-2009 at 08:23 AM.

 
Old 03-09-2009, 08:46 AM   #3
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Re: Concern about how quickly dependence can develop

Steve-

I feel for you...I really do! Living in chronic pain really does stink. It sucks all of the energy from your body....literally. I have been dealing with this for a couple years and my biggest fear was dependence. It stopped me from medicating myself properly and I have missed out on soooo much over the past 2 years.

I would suggest going to a Pain Management Doctor or clinic. They are trained in dealing with chronic pain patients. I was originally given my narcotics by my back surgeon, but he cautioned me against taking too much and the whole addiction thing. Those words hung over me for a LONG time.

My Pain Management doctor is helping me find the right combination of drugs. He is constantly telling me to take more of my pills because he sees the amount of pain I am in. He asks me certain questions each month, and can base how well I am functioning from my answers. I have been sooo afraid of addiction and becoming dependent on the pills, that I limited what I took.

Three months ago I asked to see a Pain Psychologist to help me deal better with my chronic pain and to help me with the adversion I had to taking my pills. He said something to me last month that really stuck..he said surgeons are brilliant, but they really don't understand the whole concept of chronic pain and are not educated properly about narcotics. This is why it is so important for people like us to get to a pain clinic. It is just so sad that so many people live their lives in pain because of the fears associated with pain medications. He had me read such an amazing history of narcotics, but I don't think I can post the link to it here. It really helped me understand what they are all about, dependence, and addictions. Only a very small percent of pain managment patients become addicts. Most do become dependent on the medications and this is where the confusion lies.

Now I really don't know how to answer your question about what you should do. If it were me, I would tell my dr. that my quality of life is not where it was. I would tell him that your body has adjusted to the level of medication you were on and it's not providing enough pain control.

Good luck and I hope you find a good doctor who is willing to work with you in controlling your pain. Have fun at Disney too! I am going this weekend and I know that fear you have about not being able to make it around the park. I am planning on phoning my doctor this week and asking him if I can take an extra dose of my pain meds to make it through.

Good luck again!
10sox

 
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Old 03-09-2009, 08:53 AM   #4
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Re: Concern about how quickly dependence can develop

Steve-

I feel for you...I really do! Living in chronic pain really does stink. It sucks all of the energy from your body....literally. I have been dealing with this for a couple years and my biggest fear was dependence. It stopped me from medicating myself properly and I have missed out on soooo much over the past 2 years.

I would suggest going to a Pain Management Doctor or clinic. They are trained in dealing with chronic pain patients. I was originally given my narcotics by my back surgeon, but he cautioned me against taking too much and the whole addiction thing. Those words hung over me for a LONG time.

My Pain Management doctor is helping me find the right combination of drugs. He is constantly telling me to take more of my pills because he sees the amount of pain I am in. He asks me certain questions each month, and can base how well I am functioning from my answers. I have been sooo afraid of addiction and becoming dependent on the pills, that I limited what I took.

Three months ago I asked to see a Pain Psychologist to help me deal better with my chronic pain and to help me with the adversion I had to taking my pills. He said something to me last month that really stuck..he said surgeons are brilliant, but they really don't understand the whole concept of chronic pain and are not educated properly about narcotics. This is why it is so important for people like us to get to a pain clinic. It is just so sad that so many people live their lives in pain because of the fears associated with pain medications. He had me read such an amazing history of narcotics, but I don't think I can post the link to it here. It really helped me understand what they are all about, dependence, and addictions. Only a very small percent of pain managment patients become addicts. Most do become dependent on the medications and this is where the confusion lies.

Now I really don't know how to answer your question about what you should do. If it were me, I would tell my dr. that my quality of life is not where it was. I would tell him that your body has adjusted to the level of medication you were on and it's not providing enough pain control.

Good luck and I hope you find a good doctor who is willing to work with you in controlling your pain. Have fun at Disney too! I am going this weekend and I know that fear you have about not being able to make it around the park. I am planning on phoning my doctor this week and asking him if I can take an extra dose of my pain meds to make it through.

I also wanted to add that fighting dependence is part of pain management. You don't want to be in pain, but then you don't want to build up strong toleranes to the pills. But I also did not understand this concept very well and my pain doctor and my psychologist have helped me here too. There is a difference between being high all day long from pills and then having adequate pain control to function in daily life. Three months ago, I was barely functioning. I was in bed by 7pm and on the couch all day long. I could barely take my 2 and 4 yr old to the park. I was living this way because of all my fears I named above. I am now on double the amount of medication I was on before, but I am still in pain...but functioning a little better. We are still working on finding a happy medium for me, but I have let go of a lot of my "pill fears". I will no doubt develop a high tolerance for pain medications, but I am NOT going to watch my children grow up from sitting on the couch! NO WAY. I am confident that I have good doctors watching me and help me when needed.

Good luck again!
10sox

Last edited by 10sox; 03-09-2009 at 08:59 AM. Reason: forgot something

 
Old 03-09-2009, 09:34 AM   #5
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Re: Concern about how quickly dependence can develop

Steve, I experianced the exact same thing with a doctor. I understand how you feel & it does stick with you. Its degrading.
Honestly you have been given some good advice. I wish I would have went into PM long before I did & people here encouraged me to do so but I held out hope that I would get better. I could have saved myself alot of aggravation. I still have a hard time asking for any changes & probably always will. I have come out in the past & told a doctor I was not an drug seeker & just wanted some quality of life. I had my husband with me & that was a huge help. I was scared to death of all these meds & much of the time stayed in pain out of fear. I would express your concerns about your vacation & seriously think about getting into PM. You have nothing to loose by trying & a good PM will understand your fears.
First things first & thats getting some enjoyment for you & your family. I would not wait till the last minute to see if your doctor will cooperate though & in my experiance it helped me to take someone along, some doctors do better with someone who can verify what your saying. Good luck & I hope it all works out, I am sure we all understand how important family time is. Sammy

 
Old 03-09-2009, 09:47 AM   #6
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Re: Concern about how quickly dependence can develop

Ex,
thanks for the advice. That's a good point about not requesting a specfic med. That was probably my mistake last year. I should have just gone back to my doc and said I still needed something for pain, and then let him make the offer rather than specifically asking for Vicoden. The only reason I mentioned Vicoden by name was because he had already given it to me once and it worked. However, in this climate of hyper vigilance against drug abuse, I guess I need to be very careful about how I ask for pain medication in order to avoid raising red flags. Evidently asking for medications by name is a red flag. This whole thing is like walking on a tightrope, if I'm too passive then my doc is not going to do anything for me, but if I'm too agressive then I risk being labeled a drug seeker. I think I'll follow your advice though and just ask for a one time prescription to deal with any vacation flare ups.

10sox & Sammy,
thanks for the encouragement. In response to your suggestions, I have tried a pain management doctor. He gave me Cymbalta and Lidoderm patches. The patches helped a little bit but they were no magic bullet. The Cymbalta helped more, but unfortunately it caused my blood pressure to spike so I had to stop it. After that, the pain doctor said there was nothing more he could do for me except give me some type of spine injections. I declined the injections due to the fact that ANY type of trauma to my spine causes my fibromyalgia to flare up. I had a horrible experience a few yrs ago following a spinal injection I received during a kidney stone procedure. The fibro flared up horribly for months after that. Even last year I tried Physical therapy where they gave me a TENS unit. It helped the back pain alot but when I put it anywhere near my spine it would cause the body wide fibro pain to flare up. My entire spine is tender and feels like it's been beaten up and down with a baseball bat. I told the Pain doctor that I won't do anything that's invasive to my spine (which my neurologist concurred with) and he (the pain doc) basically said there was nothing else he could do for me then. As far as my own feelings, I'm not afraid of addiction myself. It's my doctor who seems to be paranoid about it. Honestly, narcotics make me so drowsy I'm just not tempted to abuse them. I know they make some people happy and energetic, but not me. I just want to go to sleep when I'm taking them.

I agree with you 10sox about watching my kids grow up from a couch. It would kill me to take this trip away from them, which is why I'm trying to find a way to make this vacation work. thanks again to both of you for your advice.

 
Old 03-09-2009, 10:52 AM   #7
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Re: Concern about how quickly dependence can develop

Steve:
That really stinks about not being able to get injections in your spine. I am going for one in two weeks and cannot wait!! They are the only thing that realy give me any relief. They only last a few weeks, but hey..I'll take anything at this point.

I would really encourage you to try a new Pain Doctor. I know here in Florida there are several in the area. If you have a legitimate reason for pain, then there is no reason why you cannot be treated with narcotic pain pills. It sounds like your old doctor may have run into some trouble and is being very cautious. My pain doctor does routine drug tests and I think that helps weed out any problem patients.

I really hope you do find a new doctor who is willing to work with you. I just took my pain pills 2 hours ago and I am already on the couch. I cannot imagine what my pain would be like if I didn't have them. My pain is a real condition....just like if I had a heart defect.

I have to go pick up my 4 year old from school. Best of luck to you. Oh...by the way, I moved from Massachusetts a few years ago. I don't know how I lived up North my whole life..with all that snow..ha!!

10sox

 
Old 03-09-2009, 12:07 PM   #8
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Re: Concern about how quickly dependence can develop

One thing I wanted to mention is that tramadol is a very weak pain reliever. You can safely take 400 mgs a day, which is 8 pills per day if there 50 mgs. they also come in a long acting form and 100 mgs so maybe you need an increase to 8 per day, this is not unreasonable at all this is not a strong pain reliever so don't be afraid he will lecture you about an increase of that. That is what he might end up doing is increasing your tramadol so be prepared for that, but I Don't know if it will be enough to control your pain on a trip being on the go with kids. I really think if your living in CP every day than you need to go and see a pain DR. Most GP Dr's don't like to prescribe pain meds and it sounds like you have a real narcotic phobic Dr. I am lucky in that my GP is not that way at all but I choose to see a PM Dr because he helps me so much. All the best. And don't ask for Vicadin if you can help it. Maybe you can say this. Last year when my back went out you gave me something for my pain that worked really well, and could you have that again. he will go through your records and see that it was vicadin. so maybe that would be a better way to approach it. A Lot of Dr's will give you 1 RX for a narcotic thinking its a flare up of pain and will be gone in a week and that is why he didn't want to prescribe it again.

good luck!
SS

 
Old 03-09-2009, 11:18 PM   #9
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Re: Concern about how quickly dependence can develop

There is another option for you - Disney locations have wheelchair and electric scooter rentals at the park. I have my own unit and cannot imagine getting through the park with back problems.

Wheelchair rental fee is $10.00 per day. The Scooter rental fee is $45.00 per day plus a $20.00 refundable security deposit for Theme Parks. Quantities are limited and subject to availability maybe phone ahead.

At tourist locations like Orlando there are also companies who rent for length of your visit. In Orlando there is a company called Orlando Scooter Rental - they deliver to your hotel - you just need to figure out how to get it to where you are going. Hotel shuttle might have disabled passenger service.

Have Fun.

 
Old 03-11-2009, 10:04 AM   #10
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Re: Concern about how quickly dependence can develop

Hey Steve, Let my add my well wishes to the list of great supporters here. If I thought I had to make a trip to Disney, (with or without kids) I would feel panicked. Unfortunetly, living with CP, thats an all too common reaction. I wish you the best on your trip. I am fortunate to have an internist who perscribes my pain meds for me. I see him every month. He has me see a PM doc, once a year to make sure we are on the right track with my care. That has worked well for me. My regular physician is much more available than the pain doc I see. It took awhile for me to get to this point with my care. There are good doctors out there, and you are intitled to good care. Keep looking until you find one that you feel good about. It's an ongoing battle living with CP, and you should not have to do battle with your caregivers as well. Don't forget your sun screen!! Let us know how the trip turns out.
Bullymom

 
Old 03-11-2009, 02:15 PM   #11
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Re: Concern about how quickly dependence can develop

Thank you all for the additional tips and encouragement.

Guess what, I just got back from an appointment with an acupuncturist. It actually worked! Pain levels went from 6 down to a 3. I've always been skeptical of alternative solutions...most things I've tried were a waste of time and money, but this really did work! How long this pain relief will last remains to be seen but so far I'm very encouraged.

Maybe if I continue these treatments over the next couple of months I'll be doing pretty well before I leave for Florida. Also, if my PCP knows that I'm willing to shell out $100 a whack for acupuncture appointments he may realize that I'm truly in pain, not looking for some type of drug high.

I do think I will ask my doc for some stronger meds though, just for the trip. I don't want to spend $4000 and get stuck staying in my hotel room all week. I'll let you all know how it goes. Thanks again.

 
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