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Dependence? Or tolerance?


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Old 08-27-2012, 02:09 AM   #1
waters04
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Dependence? Or tolerance?

I've been taking Norco 5mg for a couple of months. Every 4-6 hours, or 3x/day as directed. I dont always take the pain medicine 3x/day, but lately I have been because I've been in a lot of pain. Now I notice if I skip my evening dose I wake up anxious, nervous, and in pain. Could this anxiety be from pain? I get very afraid it will get very bad. I try to take it before the pain gets too bad.

I'm finding the 5mg do help, but not as much as they used to. Now lately I've been needing that 3rd dose. Is this tolerance? Or am I becoming used to the pain meds?

I don't think I'm addicted because I don't abuse them, and I try to take as little as possible.

I honestly have no idea what is going on? Any insights or advice? The meds used to wipe me out for a couple of hours but I'm glad they're not doing that anymore. I just wake up anxious and worried about the pain coming back, at least I think that's what the anxiety is from. I'm scared my meds aren't working as well as they used to and I'll be couch bound again.

Can someone please send some insight? Is it possible I've grown a tolerance in 3 months?

 
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Old 08-27-2012, 10:17 AM   #2
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Re: Dependence? Or tolerance?

For the record, it's very possible you've grown a tolerance in 3 months. I suspect it can happen sooner than that in reality. Most likely, that's exactly what you're experiencing. Relax, you're not on a super high level of meds and hopefully things will level off soon for you. Good Luck!

 
Old 08-27-2012, 03:56 PM   #3
waters04
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Re: Dependence? Or tolerance?

Thanks. I really though I was going crazy here. Almost time for my refill, it ought to be interesting to see how that goes after the last debacle.

 
Old 08-27-2012, 09:42 PM   #4
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Re: Dependence? Or tolerance?

I think its possible that you have taken them enough to both have a physical dependency and a tolerance. If you are taking them daily, yes when you skip a dose (your levels drop) you will get withdrawal. It is possible for some folks to need a higher dose after only a period of weeks or months, especially those who are younger. Have they not been relieving as much of your pain, or have they not been lasting as long? Seems odd you say you find yourself needing that third dose, unless you were able to space out two doses long enough to last you the day otherwise.

I think you are waking up in withdrawal. Even if you took them three times a day every day you could get that. I'd discuss this with your doctor. What you are describing is normal though (unfortunately). You may be able to get onto a long acting med (if that is appropriate) and stabilize at a dose for awhile. Sometimes folks need to make a few increases then they are fine for awhile, or sometimes their bodies just build rapid tolerance. A good PM doc will know how best to work with it. Best wishes.
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Old 08-31-2012, 07:54 AM   #5
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Re: Dependence? Or tolerance?

Just to add to what tortoise girl said, Although tolerance can be somewhat expected, their are other methods to manage pain and tolerance aside from simpluy increasing the dose. There are adjunct meds and therapies that can help control how fast you become tolerant and that willprovide additional relief so that you dont have to increase the pain med everytime it no longer seems to work like it did before. As far as being tolerant or just getting used to it, that's the same thing.

If it's been 8 to 12 hours since your prior dose you have nothing left in your system when you wake up so feeling shaky once you have become physically dependent goes with the teritory. Its the nature of opiates and why most PM docs dont simply rely on opiates alone.

I would also like to say that that tolerance is something that can be controlled for many people and please dont expect an increase every 3 months. I dont know anything about your condition or what causes your pain so I can't really suggest anything else. The dose your on sounds more like your GP is manageing your pain rather than an actual PM doc. GP's get about 3 hours in total of education when it comes to pain meds and treating acute pain like from an injury. Chronic pain is an entirely different animal than acute pain and something your GP isn't trained or qualified to treat.

Addiction is very diferent than tolerance though. Addiction has a huge psych component involved and people that are addicted will take meds beyond the point of improving quality of life, it's quite the opposite, someone addicted will chase the feeling a med provides despite al the negative effects and consequences it may have like loss of family and friends, isolation, crimininal issues, etc etc. Addicts doc shop and simply cant comply with how the med is intended to be taken regardless of the dose provided to the point of whatever is given it's never enough.

If the meds allow you to go from couch bound to relatively functional then you need to do everything in your power to take advantage of that relief and prevent being couchbound again. Meaning excercising, weight losss, getting out of the house even if just to volenteer somewhere. Their is nothing worse for your overall physical health and mental health aside from addiction than being homebound and sedentary.

If the doc is doing his part and providing pain relief so that you can function, you should also be doing your part to improve your situation, wether it's excercise, weight loss, finding something to do so that your not simply sitting on the couch with nothing to distract you from your pain. Distraction is one of the best PM methods you can find.

Your doc and meds can only do so much, their is no such thing as a happy pill, it's something you have to find on your own and very tough to do if being couchbound is an exceptable way to live in your mind. People need to interact with other people and feel their life had some sort of meaning asside from waiting for the next pill. If your having trouble motivating yourself to get out of the house even with the pain meds and relief they provide, you might want to seek some help from a professional. I dont think most docs would consider avoiding anything and everything that might cause an increase in pain as a success story when it comes to the use of pain meds. Good luck, Dave

Last edited by Shoreline; 08-31-2012 at 08:00 AM.

 
Old 08-31-2012, 10:49 PM   #6
waters04
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Re: Dependence? Or tolerance?

Quote:
Originally Posted by tortoisegirl View Post
I think its possible that you have taken them enough to both have a physical dependency and a tolerance. If you are taking them daily, yes when you skip a dose (your levels drop) you will get withdrawal. It is possible for some folks to need a higher dose after only a period of weeks or months, especially those who are younger. Have they not been relieving as much of your pain, or have they not been lasting as long? Seems odd you say you find yourself needing that third dose, unless you were able to space out two doses long enough to last you the day otherwise.

I think you are waking up in withdrawal. Even if you took them three times a day every day you could get that. I'd discuss this with your doctor. What you are describing is normal though (unfortunately). You may be able to get onto a long acting med (if that is appropriate) and stabilize at a dose for awhile. Sometimes folks need to make a few increases then they are fine for awhile, or sometimes their bodies just build rapid tolerance. A good PM doc will know how best to work with it. Best wishes.
Thanks. I'm allowed 3tabs/day every 4-6 hours. I sometimes supplement this with heat packs, sitting in the whirlpool at the gym to relax my muscles and a few times a week I attend a water exercise class. It seems to be easier on my body than lets say kick-boxing. The meds appear to work ok for me, so I don't need a dose increase, but it's the morning that's the trouble. I take my last pill as late as possible, but I still get pain in the morning since I'm not taking any during the night. I was actually going to ask the dr if I could try an TENS unit as I've heard it suggested quite a few times. I'm not trying to take the meds unless absolutely necessary.

Shoreline, I am trying to do what I can. I don't veg out on the couch all the time. That was before I had meds, and for stomach reasons I can't take any extra medicine except tylenol, which I don't want to do since the norco has tylenol in it. I've been trying to exercise, and I've been thinking about a TENS unit or some massage therapy--very very light massage therapy--as it can sometimes aggravate the fibro. And the fibro meds are out of the question due to my bipolar disorder. I don't expect them to reduce my pain to nothing, but they bring it down from 8 or so to more like a 4-5, which is something I can live with. I have also used a lot of hot packs and warm baths to help. So I'm not expecting to get 100% pain relief from the pills.

Are there any vitamins/supplements to help with pain? I would also be willing to try some of those if I get them cleared through my psychiatrist. And my rheumy is managing the meds now, not a PM dr. I'm quite afraid of going to one after I read all the horror stories on here. But is that something I should be looking into?

 
Old 09-01-2012, 01:39 PM   #7
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Re: Dependence? Or tolerance?

i am not trying to be the "ant at the picnic" if this is going to be an on going issue, you will grow tolerant to the 10 mg norcos, thats what I started on vicodin, then norco, then 5 mg oxys, then 15 mg oxys 3 times a day, i dig disc disease and is never going away, surgery is not an option for me due to an immune system issue or I WOULD HAVE THE SURGERY NEXT WEEK!, but you do become tolerant and need more and stronger medication and your body does become dependent. I remember when I experienced what you did the first time, I pray you someday can stop taking pain medicine and hope you never have to use as much as I do now. 160 mg of opana er a day PLUS 2 100 MCG FENTANYL PATCHES every 3 days. If I decided (cannot live with the pain though) to stop, I would have to be admitted to a detox hospital.

 
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