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    Old 09-26-2014, 10:50 PM   #1
    karlee1010
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    "New Narcotics"

    I just had my monthly PM appt. today. My PM Dr. told me I will no longer be able to get Tramadol because NOW, Tramadol, Soma, and (not Valium, but something newer and similar, sorry cannot remember name) are classified as narcotics. Even though I'm still getting the same amount of the Fentanyl patch and Oxycodone, the same amount, my mind keeps telling me I'll be withdrawing some since my normal monthly medications have been decreased. In the past, anytime I've suddenly stopped Tramadol, I've had horrible withdrawals. But, back then I also wasn't taking any other narcotics like I am now. So, logically I know that I'm just remembering my terrible past experiences of withdrawal from Tramadol, but, THIS time should be different. The part that will be hard to adjust to though, are the times I have the patch on and it's not quite enough pain relief. I'd take a Tramadol with it first off, hoping that will be enough BEFORE I have to add the Oxycodone to it. And now, when the patch isn't enough pain relief, I'll have to go straight to the Oxycodones. There was suffiecient times when that Tramadol was enough too, since I used almost all of the prescription each month. Because of that, obviously something will be different and I need to start this month out differently somehow. Since today is the first day of this change, I'm open for any suggestions/ideas. This may sound pretty petty, but, knowing myself, I need to start this month out the right way. When I don't start out right, usually by 2 or 3 weeks into this month, I'll feel panicky that I won't have enough for enough pain relief the rest of the month. Most of this worrying probably just comes from the fact that I know I had less meds to start with since I've had these 120 Tramadols for 2 years now. I KNOW I can make this work right, but some of you just have the best ideas from your experience I wanted to start out right and put this out there on my Day 1 of this change. Thank you so much for any suggestions someone takes the time to put out there. Very much appreciated!

     
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    Old 09-27-2014, 11:23 AM   #2
    tortoisegirl
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    Re: "New Narcotics"

    Sorry you are dealing with this. I looked it up and it appears that as of August 18 this year, Tramadol is a Schedule IV controlled substance (for comparison, your other meds are Schedule II). I do not think you will go into any significant amount of withdrawal, as the amount of the narcotic in the patch is so many times greater than in the Tramadol.

    The brain is very powerful though, so if you believe you will have withdrawal, you very well may have symptoms. Try to stay positive and believe that the Fentanyl (and any Oxycodone you take) is plenty.

    Did you bring up the withdrawal concern with your doctor? So was your doctor saying that because Tramadol is now considered a narcotic, they couldn't prescribe it for you as you are already on a long & short acting narcotic? Might there be something else non-narcotic to add into the mix that could be helpful, like a NSAID or muscle relaxer?

    I agree its good to use the least amount of narcotics as possible, so having two types of breakthrough meds is a good idea for some folks. Or, having an adjustable dose of breakthrough meds, such as taking either 1 or 2 pill. I get different types and intensities of my pain so I have 3 different meds I can take for breakthrough, and only 1 is a narcotic. It took many years to figure out this worked best though, and what works best for someone can often change over time.

    I'm surprised Tramadol even did anything for you considering you're on Fentanyl patches & Oxycodone, although it does have quite a different mechanism of action than other opiates.

    I'd just try to go one day at a time. Perhaps split your Oxycodone into the amount you can take each week or each day and not run out early, and not let yourself take more than that. If the amount of Oxycodone is not sufficient to maintain the pain control you've had, let your doctor know this so they can make any necessary adjustments to your meds.

    If you are getting frequent breakthrough pain above a reasonable pain relief level (such as 50%), then your doctor should consider making a change to reduce your need for breakthrough meds. This could include upping and/or changing your long acting med, and/or adding a non-narcotic adjunct med (such as Cymbalta, Lyrica, or whatever is applicable for your type of pain). Best wishes.
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    constant headache since 2006

     
    Old 09-27-2014, 08:37 PM   #3
    gmak
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    Re: "New Narcotics"

    Hi karlee, I am sorry that you are facing yet another change in your pain mgmt treatment because you have been through quite a few in last year or so but hopefully it will be a minor change & you will do well! You mentioned soma & another med do you have to go through stopping these two as well or were you just reporting all that the pm dr told you? I agree with you that with taking a long acting & short acting pain medicine for bt that this will probably be enough to control pain but i can certainly understand having apprehension about not having the tramadol because i would be too! Especially if i was used to having two bt meds & if i had any symptoms of uncontrolled pain or withdrawal i would let the dr know so that he could make adjustments. I am hoping with you for the best!

    Last edited by gmak; 09-27-2014 at 08:57 PM.

     
    Old 09-28-2014, 10:21 AM   #4
    karlee1010
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    Re: "New Narcotics"

    Hi ladies: 2 of my favorite answerers. Thank you both. The mind IS a very tricky and strong part of my back pain for sure! I'm very grateful you mentioned that, Kate. I do realize that most of any withdrawal I have will probably be coming from my worrying about the terrible withdrawals I've had in the past from stopping Tramadol just like I am now. Still though, it is real to me. After reading both of your posts, it just crossed my mind to make a daily journal of this, starting from Day 1 to my next appt. Gmak, I do not have to get off the Soma's or anything else. The law is that I'm only allowed 1 long acting and 1 short acting narcotic. Makes perfect sense to me too. Yes, I did mention it to my Dr. She didn't directly answer my question, because I told her since I've been on these same doses for awhile now, I already feel there's a difference in my tolerance now. I told her that before I even started seeing her (it's only been 3 times) my Dr. for the past 2 years had suggested upping my Fentanyl almost anytime I mentioned to him any other type of new pain I was having. So, I now am already used to a pretty strong amount of Fentanyl when she first started seeing me. I never ever thought of: "What will I do, say 10 years down the road from now???" THAT is something I really wish now I'd have considered. Oh well, it is what it is. I can only help someone else maybe consider this one. For me, yes Gmak. Take 1 day at a time. I'm going to seperate those Oxycodone into 4 weekly parts. And Journal. Take one day at a time and Journal a little every night on my emotional, mental and physical pain each day. For me I KNOW that if i'm an emotional mess, I have ALOT more physical pain. If I'm more stable emotionally, I tolerate alot my physical pain than usual. For that reason I pray alot. Some may disagree, but for me, I DO believe in God. When I pray to him for "the power beyond what is normal" that is in Phillipians, I am way better off. This works for me, but only when I ask for it. Other people have different ways that work best for them. Healthboards is wonderful because we ALL can share what works for us and we can read each others ideas and suggestions and try each one until we find something that works for each of us individually. Ok. I need to go start a Journal now, and get started on the things I just committed myself to here. Just saying it here doesn't work for me (I have tried that one. haha) I have to actually do what I said I'd do here for my commitment to be a success. That's something I've learned from my past........

     
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    Old 09-28-2014, 11:25 AM   #5
    gmak
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    Thumbs down Re: "New Narcotics"

    Yes Karlee I can totally relate to the problem of increased tolerance & fentanyl patches because I had a pm dr that told me no when I wanted to change from a short acting pain med, Norco, to a long acting pain med & his reasoning was because I was only 45 & he had to manage my pain for upcoming decades & I didn't understand what he meant I just thought he was mean so changed drs & this team of drs gave me fentanyl patches & it's was & is still effective in relieving most of my pain but I wish I wouldn't have made such a huge leap because now I cannot be increased because my insurance will not cover more than 15 patches a month even if two different strengths. So far I'm ok but unsure about what will be done in the future especially when changes are implemented like the one you mentioned above. God helps me too & has all along the way! I truly hope that your pain stays tolerable & controlled.

     
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    Old 09-28-2014, 03:16 PM   #6
    tuloud54
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    Re: "New Narcotics"

    In 2007,my pain drugs were 5mg Darvocet 4 times daily. These worked fine for a year.Vicoden 5mgs/4 times daily worked for 6 months.Moved to Vicoden 7.5 which worked for another 6 months. Fentanyl patch of 50 mcgs had stayed constant since 2008. Vicoden was later upped to Percocet 5mg,4xdaily.Now the year is 2011 and I am getting scared and shocked at the tolerances and what do I do in 5 years! Pain pump installed in Nov 2012 because I wanted consistant pain relief and also wanted to live a long time. Research daily will hopefully solve some of these tolerance issues but being 58 years young,I did not feel I had time to wait for them to work it all out. The pump was my way of grabbing the reins left of my life.Not one regret so far. Just pray for all that suffer to realize that some relief is better than no relief! Maybe I could have taken my pills a little longer before upping my dosage but my pain did not care! Wish you well and stay strong. God Speed! Tom

    Last edited by tuloud54; 09-28-2014 at 03:19 PM.

     
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