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  • Dizziness from and Access to Tramadol

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    Old 06-05-2005, 03:26 AM   #1
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    Dizziness from and Access to Tramadol

    I go to a pain doc and he prescribes Tramadol, it does not help entirely,
    just takes the edge off sometimes, but I can't find a doctor who will
    prescribe anything stronger. I have herniated disks in my neck, repetitive strain injury, muscle spasms, sciatica, and nerve atropy of my right arm.
    One neurologist even dropped me from her care after giving me Tramadol for a year, saying she didn't know anything about pain management and I should go to a pain clinic! I think she dumped me because of the addiction warnings
    that came out about Tramadol/Ultram. She told me in the past she was afraid of lawsuits from prescribing narcotics.

    I am in severe chronic pain, and have a very poor qualtiy of life
    due to the fact that I cannot get stronger meds. My insurance company rep told me that they have had several complaints from their customers who live in my state for the same reason, and she said there is so much drug abuse here that the doctors are afraid to prescribe pain meds. I have been thinking about being treated out of state or patronizing the on-line pharmacies.

    Anyway, the last time I went to my pain doc I told him I felt dizzy sometimes when I move my head down. He told me to go to my primary doctor and get an MRI and have my blood pressure checked because it could be dropping with the Tramadol. I told him I just had my blood pressure checked a week before and it is normal. I went to a physiatrist instead, because I haven't had a physical exam on my musculo-skelatal system in three years because the pain doc writes prescriptions only (my former physiatrist dumped me also, and referred me to a pain clinic) When I told him about the dizziness, he referred me to a neurologist.

    I don't understand why the doctors are concerned about the dizziness because it says right on my prescription bottle that dizziness is a side effect from Tramadol, and I told them so. Why aren't they familiar with the side effects from the drugs they prescribe? I think it is very incompetent of them and I have been through this with other drugs that I have refused to take because of side effects that the docs didn't know anything about until I brought it up! It's scary. I don't want to be dragged through unecessary testing, but it seems like the pain doc or the physiatrist don't want to treat me unless I am examined for dizziness.

    Any comments regarding either issue would be greatly appreciated.

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    Old 06-05-2005, 07:49 AM   #2
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    Re: Dizziness from and Access to Tramadol

    Hey JaCal, If you hve been taking ultram for a year and you have recently developed dizziness it's hard to atribute dizziness as a side effect of a med that hasn't bothered you in the last year. Side effects like dizzynees, drowsiness, itching and nausea deminsih over time and rarely pop up after a year of use unless your excededing the recomended dosge.So it does make snes to pursue the dizziness and not dismiss it as a side effect to a drug you are well acomadated too. Let the docs diagnose you, what may seem logical to you may not seem logical to someone that understands the mechanism of action and effects of these meds better than you. I wouldn't recomend anyone self DX or self medicate via the internet.

    As far as having no quality of life, you need to be able to explain what that means, No quality of life is as vague as my pain is a 6. What does that mean. You need to be able to describe how the pain has effected you in a way your doc can relate too.Or simply move on to look for other treatment options. What else have you done as far as pain mnagement if all your PM doc does is write scripts for Ultram and you haven't seen your physiatrist in 3 years. Have you had ESI's, Nerve blocks, Botox, trigger point injections, tried TENS, TINS, ACupuncture, Chiropractic, PT, learned any relaxation techniques like Yoga, bio-feedback, self hypnosis, or guided imagry? What about adjunct meds like antisizure meds and antidepressants.

    If ytou hav e done all these things creat a documant that describes what procedures or meds you r tried, who, where and what was done or prescribe and the effectiveness . S when yu do find anew doc he has a concise list of everything you have already tried and can look elsewhwere if those methods didn't help at all.

    AS far as the internet, It's a bad idea, 100 pills will cost you about 300 bucks, at best that's 3 pills a day, 6 pills a day will cost you 600 and 9 will cost you 900. You would have to be working 3 diffeent internet sources at a time which can be construed as doc shopping. Internet "quacks" all prescribing the same meds for the same problem is doc shopping. The DEA wants to reclassify all hydrocodone products as a schedule 2 meds to prevent internet doc shopping, once that happens your back to square one, but dependent on hydro.

    The reason why they want to reclassify Hydro is because of the internet. Your insurance says abuse is why decent PM is hard to find, It doesn't make sense to use the same methods the ones that have made it hard on you to find PM use. If you can't beat them join them?

    If you have the money to do that than you have the money to go outside your network of docs or go outside your area to find relief. A thousand a month for vicodin will fly you to the best PM doc in the country every month? You would actualy be seen by a PM doc, treated with more than the meds you can find on the net and possibly find something that helps.

    What have you tried as far as PM? You might be surprised by the options you do have.
    Good luck, Dave

    Last edited by Shoreline; 06-05-2005 at 07:59 AM.

    Old 06-10-2005, 06:58 AM   #3
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    Re: Dizziness from and Access to Tramadol

    I wanted to thank you for your detailed reply, I am having trouble accessing this site for some technical reason, that's why I didn't respond sooner.

    I did try many of the modalities you mentioned, to no avail. I didn't have any injections or nerve blocks/burning. but I tried acupuncture. I understand
    trigger point injections and nerve blocks are only temporary and that's why I didn't try them. Many people I spoke to say those modalities didn't help them

    I went to a neurologist last week and he told me I have vertigo, which could be caused by not moving my neck around because of the pain, so when I do move it I get unbalanced. He gave me exercises to move my neck, similar to the range of motion evercises. I didn't take any Ultram for five days before I saw him to make sure the medication wasn't causing the dizziness.

    When I say I have a poor quality of life, I mean I cannot partake in many activities I used to enjoy like swimming, bowling, tennis, bike riding, long walks, dancing etc. due to my injury. In addition, I can't sit, stand, or lay down without being in constant pain.

    You make a good point about patronizing on-line pharmacies, both expense
    and abuse wise. You are correct, I can't afford those prices as the dosages you mentioned, but I was thinking about taking one tablet of Lortab in the morning, and supplementing with Ultram for the rest of the day to get
    better relief.

    My problem is that my MRI (shows double disk herniation at C5-C7) doesn't look that bad, according to the doctors,
    and they say narcotics aren't warranted. In other words, the MRI doesn't correleate with the chronic pain I have. They might just be using that has
    an excuse not to prescribe, because anyone famaliar with repetitive strain injury knows that soft tissue damage is a serious injury that does not show
    up on MRI's. MY EMG's are all negative for nerve damage, even though I have pins and needle numbness down both arms and hands.

    I was thinking about switiching pain docs because mine is a long drive away from my home so I went to a physiatrist/pain doc close by. On my first visit last week he told me that repetitive strain injury is a chronic condition so I thought he understood the disability I have. On the second visit, I told him that if I used him as my pain doc he would need to advocate for me, and it might be necessary for him to send letters to Social Security to continue my benefits if they happen to reopen my case (a S.S. judge already ruled that my disability is permanent) or the courts to excuse me from jury duty. Guess what his reply was? He said, "I don't see much evidence of disability."
    If he ever wrote a report with that diagnosis, I would not get social security checks any longer, and I would not be able to work either due to the muscle atropy of my right arm.

    His comments told me he is does not understand my injury, and did not give me a proper exam of my right hand, arm, and wrist to determine how useless
    and injured my right arm really is.

    I hope you better understand the complexities of an injured worker's plight, and the use of on-line pharmacies would be a last resort for me to find better relief for my pain, since I can't get it through our medical system, at least in my state (I am also considering going out of state).

    Thanks again for your response.

    Last edited by jacal5; 06-10-2005 at 07:02 AM.

    Old 06-10-2005, 10:10 AM   #4
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    Re: Dizziness from and Access to Tramadol

    Hey Jacal, My initial injury was comp, so I understand the sytem well. It comes down to do what they say or they cut you off. I've been there and done that. Things become advesarial, you end up needing a lawayer... I understand, and thanks for explaining, it makes a differnce, and you said the obvious, How can he be treating you and not undertsand the complexity of the problem.

    Getting away from the comp system, and paying for an IME myself, Independent medical eval, gave me the evedince and the suggested treatment I needed to at least be taken seriously, IT was the best $275 I ever spent. Someone drove me 5 hours each way to get to Duke, but I knew what was wrong by the tme I was heading home.

    As far as comunicating your problems to the doc, you have to make him understand the way you did me.

    I'll see an NP every now and then at my PM clinic and they have no idea why they are treating me or writing the scripts for what I take, But the docs know what is wrong, they know the options I have and I have no problem with any doc, now that I'm outside of comp.

    If I had known someday I couldn't afford to take the meds prescribed I never would have settled for what I did, but the insurance co. can certainly wait longer than you.

    You need for that doc or any doc to know why you are there. Other than your back pain is an 8 and you hurt all the time. They hear it all the time. Sorry, folks are noticing I'm blunt. I promise to have a huge staff around me some day to tell me "you can't say that in public" LOL

    If you have to wait for that doc on your next apt buck naked sitting on the table he will remeber you, He will see the atrophy. Sit a plate and a cup and saucer at arms length on your bad side. "preferrribly filled with something like amonia or ink, Just kidding, But soda or milk will do. Show hm how you pick up that plate, something everyone else takes for granted. Show him your range of motion when your buck naked and explain what you average day is like and what you would be willing to accept as far as Pain management, but you know there are limits.

    With the level of disability you describe, I doubt it will get much better, correct? You have to do something that seperates you from every other patient, either through conversation or action. My docs know me by name and would say hey if we passed on the street. It sounds like your doc wouldn't recognize you. Make your self recognized,Give him something to remeber. If not this doc, the next one. Of course there is better pain management out there, but a comp doc giving you meds would be admitting you have a problem.

    That's where the IME comes in, All the stuff circled in red wax pencil were hard to hide when I showed my workmans comp docs. The report really just varrified problems theywere trying to dismiss or deminish. If you have a problem with you back, comp is going to balk about treating your vertigo. There position is that it's not job injury related.

    You also may need a Myelogram /CT to pick up something the other tests didn't. If a dsicogram can be done at those levels that test may show something. You never know with a test where you laying flat and no pressure or movement is being observed, Myelos (sp?) look at movement.

    Good luck, the system can't be more degrading, when your charater is questioned by every doc, so once you reach a certain level of being degraded, sitting there naked on the table is easy if it proves your point. If a nurse comes in, tell them you will get dressed when the doc has examined you. Think of a way to demonstarte to this doc, one that makes him rember who you are. I can't gaurenetee it will change him but if he ignores it get a lwayer and get an IME and get your next docs attn.

    Good luck, Dave

    Last edited by Shoreline; 06-10-2005 at 10:18 AM.

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