I am in pain management for 2 disc herniations (L4-L5 and L5-S1). My injury occurred exactly one year ago (Jan. 21, 2011) and I've been on some variety of opiate since then, and have thankfully evaded surgery which I hear only makes things worse. I had been on hydrocodone 7.5/325 (6-8/day) from my Internist, but I am now in Pain Management and currently on the generic Watson for Percocet 10mg/325 4x per day. I usually take 1.5 pills 3x per day so I'm ingesting 45 mg of oxycodone plus 2 350 mg Somas daily.
My receptors are completely uptaked to this dosage, so its not like I get a recreational buzz or anything. Honestly, it just helps with my pain and discomfort, but I know that I am tolerant (and hence, probably addicted in some way) to oxycodone. Anyway, I just had my second epidural steroid injection, and things seem to be going a quite a bit better with my back. My sciatica is gone (fingers crossed!) and I'm mostly just getting this weak/burning sensation in the middle of the night after my medication dose wears off. I actually wonder if it is something that I've once seen referred to as "reflex pain" which happens in response to using opiates for a lengthy period of time, i.e. at least one year.
I'd like to taper off of these drugs. So, four questions.
1) Given that I've been on some variety of opiate for a year now, and I know how painful cold turkey is, would a slow or a fast taper off of my Percocet be best? I have a feeling that slow would work better for me, but perhaps that is the devil of addiction speaking from the back of my mind.
2) Has anyone had withdrawals from Soma? I've been told by my regular physician that it is addictive, but he seems to think that everything is.
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4) Lastly, and this may be so specific there are no answers out there.
Would it be out of line to ask my doctor if after the success of the injection that I could go back on the Percs if I once again found myself in a moderate-severe pain situation.
I'd just like to know that if things move into the 'acute' phase (or even a moderate to severe chronic pain situation) again that I have the option of going back to what has worked for so long, at least until another steroid injection works (which I won't be able to have for another 6 mo- 1 year).
Sorry if this has been overly long. Lots of questions. Can't wait to hear a response from some of you.
I am in pain management for 2 disc herniations (L4-L5 and L5-S1). My injury occurred exactly one year ago (Jan. 21, 2011) and I've been on some variety of opiate since then, and have thankfully evaded surgery which I hear only makes things worse.
That's probably a bit too sweeping. I imagine it *can* make things worse, but certainly in my case it improved my situation. It didn't completely fix things, but they definitely got better. Worth maybe at least keeping surgery on the table as an *option*?
Quote:
Originally Posted by jerems76
...so I'm ingesting 45 mg of oxycodone plus 2 350 mg Somas daily.
So, you're much higher than I am. My average is 10mg of hydrocodone and that's it. From which I'd say again, keep surgery open as an option. Your back sounds much worse than mine and mine is, according to my surgeon, busted up.
Quote:
Originally Posted by jerems76
My receptors are completely uptaked to this dosage, so its not like I get a recreational buzz or anything. Honestly, it just helps with my pain and discomfort, but I know that I am tolerant (and hence, probably addicted in some way) to oxycodone.
Tiny quibble (and it sounds like you know your stuff, so please excuse). I think what you're really saying is that you are tolerant and hence probably *dependent*. Dependency is a component of addiction, but the latter is a far broader and deeper thing.
(Physical) dependence is a normal, manageable, to-be-expected side effect of certain medications. Even non-pain-stuff like certain blood pressure meds, or some steroids, create physical dependence. And withdrawal is an inevitable (by definition) aspect of the tail end of treatment using those meds.
Question is, does mere *tolerance* (which by your description you do have some degree of) imply dependence? Well, if I had to guess, I reckon that if you've sustained the doses you have for the time you have then yes, you p-r-o-b-a-b-l-y have developed some level of physical dependence, and so you should only pull back from them after asking your doc's advice about how to do it. And if you are dependent to some extent, and you do stop, it may not be as rough a ride as you think. And it *may* not be any kind of a ride at all.[/QUOTE]
Quote:
Originally Posted by jerems76
Would it be out of line to ask my doctor if after the success of the injection that I could go back on the Percs if I once again found myself in a moderate-severe pain situation.
My approach is no holds barred questioning with my doc. I "keep everything in the light" as it were, and ask anything I want. I also have an attitude of "if his advice is X, I'm going to do X" (bearing in mind that I will have nipped his ear for half an hour first if I don't understand X). The point being that he knows if he tells me to stop taking opioid meds, I'll stop taking opioid meds and not make a fuss. I'm interested in the best clinical advice I can get, and if that means eating stewed bananas, I'll have a go.
An important aspect of that is, the more willing I am to take his advice if he said opioids were not appropriate, I reckon the more likely he is to feel OK about prescribing them when they are appropriate.
The Following User Says Thank You to chronological For This Useful Post: jerems76 (01-28-2012)
I agree with the first reply that for the disc herniations, if that's all it is, keep surgery as an option. Sure, some people may have poor results, or minimal results, but that is a procedure that the medical community has down pretty well. If that's the only issue I had, I'd have done surgery years ago for whatever's its worth.
Now for the esi's and tapering off of meds. I'm sure some people are able to discontinue use of their opiates after having the injections, but the injections are only a temporary measure, so in my opinion I think you may be able to get off for a month or maybe even 3, but you will reach a point where the pain comes back and you need more shots and more meds. I say this as someone who pretty religiously gets facet injections every 3 months.
I've myself tried tapering after receiving pretty good results from injections, but for me since I have more issues then just the discs, even lowering my dose didn't work for long.
At the end of the day, you need to do what's right for you. If you can find an avenue to discontinue use of pain meds then you probably should. I think I can speak for most long term pain management patients by saying that we would all love to get off of these meds if we could. At first the meds are nice, you get relief, maybe sleep better, get some life back in you, but I think most of us come to a point where we realize that as awesome as the relief is we are reliant upon doctors and pills to help us get out of bed in the morning, and that while better then having the crazy pain we had that drove us here, it would be far better to not deal with any of it.
The Following User Says Thank You to DucStar For This Useful Post: jerems76 (01-28-2012)
Thanks everyone. I'm now down to 30 mg a day from 45 mg and doing pretty well. 27.5 tomorrow and 25 by Feb. 2, my next PM appointment. Had a couple sweaty/chilly days with some nausea and anxiety, but I suspect tapering involves dealing with a few withdrawal symptoms at a time. Going to try the Thomas recipe for when I jump off, if I can get a little Clonadine and Valium from my doc.
My original post probably looks disconnected. The reason for this is that it has been screened due to some of its content. I'll just say that in some states there are a plethora of options for pain management, and leave it there. (I hope that is acceptably vague, moderator). I don't know if anything goes in private messages or not, but if it does, I have a bit more to discuss. Shoot me a message if you are willing to help.
Thanks for all of the comments. Still a bit skittish about the surgery. Even if I have to get 2-3 injections per year, I'm ok with that especially since the doctor seems to know exactly where to put the steroids in my spine now (after failing the first time around). I will probably be on meds again someday after this round of tapering off, and there's no judgment coming from me as I've been on them daily for over a year now. I'm just thinking why not use this opportunity to take a 'med-vacation' so that my tolerance isn't quite as high when I need them again (and as a sign of good faith to my PM doctor that I'm not simply desirous of meds and that I'm really desirous of pain reduction/management). Also, I want to know exactly what my pain level is without medication, and I'd like to actually feel it come back after the steroid injection wears off. I have a 1.5 week supply along with some muscle relaxers set back so I can treat any acute pain while waiting to get into the doctor. For some reason it makes me feel stronger to have the meds around even though I'm not using them unless needed. When I quit smoking when I was younger I always left an unopened pack of cigs around to test myself and never had a problem. Same idea.
"Tiny quibble (and it sounds like you know your stuff, so please excuse). I think what you're really saying is that you are tolerant and hence probably *dependent*. Dependency is a component of addiction, but the latter is a far broader and deeper thing."
I agree completely. Dependency is what I meant to say. I'm not doctor shopping for more meds, etc. And my choic to go off the meds after the successful injection is completely self-motivated. My doctor hasn't even suggested it yet. These things do not suggest 'addiction' at all, but completely admit 'dependency'.
I, like all of us, just don't like being in pain (and how hard it makes to raise my little one who is now 11 months), and the meds did great serving their purpose ,and I'm sure they will again....if needed.
If you're still getting pain after you're withdrawn from the oxy, it might be worth trying tramadol +/- acetaminophen.
Tramadol in a dose of 100mg +/- acetaminophen 1000mg can be taken upto 4 times a day, it is a potent analgesic but it has a very low potential for dependance, it isnt a controlled drug and most doctors are comfortable prescribing it.
Even if you didnt need it every day, it would be nice to have somthing to fall back on ond ays when you were in pain and simple stuff like advil or tylenol didnt cut it
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The desire to take medicines is what seperates man from the lower animals - William Ostler
I'm going off. Tramadol doesn't help me detox because it will keep my opiate receptors 'fat and happy'. 20 mg tomorrow. Jump date 2/9/12. My mom's on Tramadol so I'm quite familiar with it. I will deal with this without any replacements, i.e. Tramadol, subs, etc. Wish me luck!
I am having tremendous 'rebound pain' or 'Analgesia/Pain syndrome' in my lower back. I can almost guarantee that its not from the injury, but is happening because my brain's pain center is confused and trying to get back higher dosages of oxy. I'll be going to something that I can't talk about because of forum rules that is legal in only certain states, including my state of Colorado, and California for instance. Please don't name it as you will get an infraction like I did. It is what was censored out of my original post.
I go in for my ESI follow up tomorrow. Can't wait to see the look on my PM doc's face when I tell him that I've already been tapering and am stepping off next week and that I want no more muscle relaxers or narcotics. Sure hope he is willing to prescribe Clonadine, and Valium or Klonopin (probably the latter as I've been told the former is a bit harder on your neurotransmitters on the whole).
Thanks for your comment. Sorry that I did not respond sooner. I've been getting emails when people respond to my posts, but for some reason did not get one when you posted.
