Chronic Pain and Opiod Addiction

[Magrat]

There are lots of "pain pills," so not sure which ones you mean. I was prescribed morphine extended release pills, and the physical part of withdrawal included four days of vomiting and diarrhea, and restless legs a couple evenings, plus anxiety attacks. I didn't get the insomnia that some people talk about. It wasn't a big deal in the sense of seizures or life-threatening symptoms, but I couldn't leave the house or eat much of anything.


PAWS was the easiest for me, but maybe because I didn't actually crave the drug, and didn't associate it with a better mood. I wasn't in pain so didn't need it, and I thought about asking for a short term mood-elevating drug like an anti-depressant, but the PAWS wasn't constant and I didn't want to risk withdrawal from something else, so I just got through it. Lasted a few months as I recall, improving over time.

I definitely experienced seriously physical and mental withdrawal from tramadol. I took 300mg every day for several years. Even weaning off of it, I was vomiting, shaking, cold sweats, and my goodness I would have done just about anything for more.

Like heroin? Probably not. But it was pretty bad. Worse than quitting smoking for sure.

Different medications (for pain or not) can cause different withdrawals. When I had to miss a week of cymbalta I thought I was going to die. Read the symptoms of withdrawal! I've seen people having DTS that hurt less than cymbalta withdrawal.

Eta I still crave tramadol. And I was taking it as prescribed, for legit pain.

 

[Fudbucker]

There are lots of "pain pills," so not sure which ones you mean. I was prescribed morphine extended release pills, and the physical part of withdrawal included four days of vomiting and diarrhea, and restless legs a couple evenings, plus anxiety attacks. I didn't get the insomnia that some people talk about. It wasn't a big deal in the sense of seizures or life-threatening symptoms, but I couldn't leave the house or eat much of anything.


PAWS was the easiest for me, but maybe because I didn't actually crave the drug, and didn't associate it with a better mood. I wasn't in pain so didn't need it, and I thought about asking for a short term mood-elevating drug like an anti-depressant, but the PAWS wasn't constant and I didn't want to risk withdrawal from something else, so I just got through it. Lasted a few months as I recall, improving over time.

The usual: norco, oxy, vicodin. Sounds like you were taking some serious stuff.

 

[deadrose]

Tramadol interacts with the serotonin system. I figured that out fairly soon after it came on the market, as that was not long after my post-viral syndrome hit. The first time I was given it for pain, it worked wonderfully, and the second time. The third time I felt like my head was going to explode from the pressure and my heart was racing. The only thing that had changed was that I'd started taking SSRIs again. So I started researching online and found out yes, that was the problem. I was giving myself mild serotonin syndrome every time I took Tramadol.

Same problem for the triptan-class drugs for migraines. The problem is that most doctors & nurses don't have time to learn the mechanisms of new drugs, so even still I run into a lot of them who don't know that's a bad interaction. Which means that when I show up in pain and turn down Tramadol or sumatriptan or whatever, they assume it's because I'm drug-seeking for the Good Stuff. No, I just don't like serotonin syndrome, and I'm on a high dose SNRI.

So that might be why you still crave the Tramadol.

 

[Magrat]

Tramadol interacts with the serotonin system. I figured that out fairly soon after it came on the market, as that was not long after my post-viral syndrome hit. The first time I was given it for pain, it worked wonderfully, and the second time. The third time I felt like my head was going to explode from the pressure and my heart was racing. The only thing that had changed was that I'd started taking SSRIs again. So I started researching online and found out yes, that was the problem. I was giving myself mild serotonin syndrome every time I took Tramadol.

Same problem for the triptan-class drugs for migraines. The problem is that most doctors & nurses don't have time to learn the mechanisms of new drugs, so even still I run into a lot of them who don't know that's a bad interaction. Which means that when I show up in pain and turn down Tramadol or sumatriptan or whatever, they assume it's because I'm drug-seeking for the Good Stuff. No, I just don't like serotonin syndrome, and I'm on a high dose SNRI.

So that might be why you still crave the Tramadol.

Probably.

I know cymbalta is an antidepressant, but I didn't have any kind of interaction between that and tramadol?

Eta it is an ssnri. I don't know enough about all this to know if that should interact or ???

 

[deadrose]

You might just not have been taking enough to trigger a reaction. I take Effexor, at a level higher than the current recommendations, and you *really* don't want to experience withdrawal from that - feeling like your brain gets an electric shock every time you move your eyes? Not fun, and it apparently doesn't go away for a very long time.

But hey, I'm alive and here typing, and without the Effexor the chances are very good I wouldn't be. I prefer it to the alternative

 

[Magrat]

You might just not have been taking enough to trigger a reaction. I take Effexor, at a level higher than the current recommendations, and you *really* don't want to experience withdrawal from that - feeling like your brain gets an electric shock every time you move your eyes? Not fun, and it apparently doesn't go away for a very long time.

But hey, I'm alive and here typing, and without the Effexor the chances are very good I wouldn't be. I prefer it to the alternative

I def had that withdrawal from cymbalta! The brain shocks, vomiting, shaking, ...I thought I was going to die.

 

[crescent]

This article seems relevant:

The Untold Story of America’s Opioid Addiction

There’s no question that opioids are effective at managing certain types of pain. But American medicine has become far too reliant on the potentially dangerous drugs for the wrong reasons. About 15 years ago, hospital watchdog groups grew concerned that physicians were not taking pain management seriously enough. The solution to this perceived epidemic of pain in the early 2000s was opioids. These strong painkillers became the drug of choice as ibuprofen (the active ingredient in Advil, Motrin, and similar products) had fallen out of favor thanks to overblown concerns about the risks of internal bleeding.

Around the same time, pharmaceutical companies noticed a now infamous study from 1986 suggesting that opioids were less addictive than previously thought. The author of that paper has since publicly recanted its conclusions, calling the sample size of 38 individuals too small. But pharmaceutical companies used this small, now roundly debunked study to convince professional medical organizations, and eventually hospital regulators, that it was safe to give opioids to more patients. Since the early 1990s, the annual number of opioid prescriptions has tripled. Opioid overdose deaths have quadrupled. Today, Americans consume 80 percent of the world’s (legal) opioids, despite accounting for less than 5 percent of the world population.

(Bolding added)

 

[malbec]

The butrans patch I wear (buprenorphine) blocks the pain receptor in your brain, so you're still in pain, your brain just doesn't know it. Better for long term use.

Chat with your GP and sell him on prescribing you a minimum 100 mg daily of Fentanyl .Bupe is fine for some conditions , but not if you need the top help
I take 200 mg and it is OK . I still swear . But not as much .

 

[skeptichaggis]

The paranoia over opioids is ridiculous. I just had surgery to remove part of my right lung due to cancer, and they only sent me home with just enough hydrocodone to last me a week (and at a dosage that barely took the edge off the pain, not nearly enough to let me actually SLEEP at night).

My sister (39) is a carer in a old folks home and a pain in her leg turned out to be arthritis. Its not the worse kind but she can't lift heavy patients etc anymore. The doctor said, clearly, that its there for life but they won't give her a repeat prescription for dihydracodine in case she gets addicted. She gets two weeks pain free then four weeks in pain. She finally went to a different doctor who was baffled, she pointed out that a lifetime painful condition must lead to some level of addiction and gave her the repeat prescription.

On the other hand I have never been in trouble with the police, I don't drink, smoke, steal etc and never have. Aside from epilepsy I am fit and healthy. I study at open uni and work everyday part time. I spend all my money on history books, with a little science thrown in. And anime DVDs of course.

In short you would not have a clue that I,I'm 37 this month, have been on methadone since I was 18. No one knows, my sister but that's it. I don't know any other drug addicts or dealers period. My friends have no idea, they would not believe it if someone told them. Once every three months I go to my docters then the chemists.

I started off taking morphine tablets(I have never seen heroin never mind taken it) and got addicted.
It is a danger. But its 2016,and in a first world nation no one should be in severe pain.

 

[Hlafordlaes]

FWIW my AS is in partial remission tonight, which has me giddy. It's like, you mean normal people get this, only better, all the time? I know, we all adjust to where we are at and complain from there, that's how it works. Anyway, laughed till I cried on a post a moment ago. Takes the sting outta being occupied.

 

[Pup]

In short you would not have a clue that I,I'm 37 this month, have been on methadone since I was 18. No one knows, my sister but that's it. I don't know any other drug addicts or dealers period. My friends have no idea, they would not believe it if someone told them. Once every three months I go to my docters then the chemists.

I started off taking morphine tablets(I have never seen heroin never mind taken it) and got addicted.
It is a danger. But its 2016,and in a first world nation no one should be in severe pain.

First, congrats on getting along so well.

I'm curious how you're using the term "addicted." If addicted means "can't suddenly stop taking or I have withdrawals" wouldn't that apply to both the methadone and morphine? Or was there something different about the morphine?

 

[Magrat]

Skeptic haggis I am proud of you for getting help!

Can you explain what methadone is please? I know addicts take it to get off the drugs but does it make you high?

 

[Giordano]

Suboxone is a legal mix of buprenorphine and naloxone designed to help people kick illegal opioids (buprenorphine is a partial agonist of the same receptors as morphine/heroin to prevent a physical withdrawal but seems to not produce a high, whereas the naloxone is supposed to prevent the patient getting high from any illegal opioids if these are taken during the treatment). Suboxone requires long term maintenance doses (mixed with psychological assistance) to continue to prevent withdrawal, but it is harder to abuse than methadone and seems to be very effective for many former illegal narcotics addicts. People can live quite normal lives on suboxone, with the exception that the patient has to be certain to see their doctor periodically and get their prescription renewed. Many people on suboxone work up to an appropriate living and psychological moment to go off it and all opioids. I understand the pharms have/are developing an implant to reduce the need for a daily dose.

I have no idea if suboxone helps with pain, but from what I can tell it is a very good approach to dealing with addiction to other, more problematic pain drugs. I suspect it would be publicly considered a "breakthrough" treatment of addiction except many people view the entire addiction problem in a weird way- if you have to take maintenance doses of a drug that allows you to remain free of heroin and yet allows you to stay fully functional, then "you are still addicted." If you have to take maintenance doses of a drug to maintain a safe blood pressure instead, then that is "just a wonderful example of modern medicine!" Taking maintenance drugs to minimize depression or other mental disorders are viewed by the USA public as somewhere in-between, indicating a "moral flaw" but not a downright "moral failure."

 

[Magrat]

Having any mental illness is a failure in you as a person. When I had a psychotic break at age 17, my father said "just stop having delusions, you *********** drama queen".

My transdermal patch is buprenorphine, is that the same thing as what's in suboxine?

 

[skeptichaggis]

First, congrats on getting along so well.

I'm curious how you're using the term "addicted." If addicted means "can't suddenly stop taking or I have withdrawals" wouldn't that apply to both the methadone and morphine? Or was there something different about the morphine?

To answer you(and rougekitten)

As bizzare as it sounds methadone is well known to be far harder to come of than morphine or heroin, however if you stick to your doctors instructions you can take methadone safely for decades-and a single dose(I get 20ml daily)will be ample for 24-72 hours. Heroin/morphine would have to be taken every 7 hours or so.
Methadone is a bit controversial. But again if taken as prescribed you can live a normal life. Would I like to stop, of course, and I hope I can some day. I just know its not going to be today.

Rougekitten- yes methadone does get you high, but at the controlled dose right for you it just makes you feel um "comfortable" I guess, a bit euphoric too. On its own its hard to overdose on it but if mixed....

There is no reason for my addiction, I had a great childhood, a bit out of the ordinary but great. No unhappy things happened to me, close with my family etc. It was just my stupidity that caused my addiction.

Thankfully here in Scotland the medical establishment decides on addiction treatment and not the Scottish version of Nancy Reagan.

 

[Magrat]

Addiction happens. People want to think "it can't happen to me" but of course it can. People have terrible upbringings and never take drugs; people have privileged upbringings and od at 21.

Both of my parents and one of my grandparents battled addiction so I have always been very aware of my propensity for it. I started down the road to a drinking problem a few years ago but decided that's not the life I wanted to live. Alcohol is much easier to stop in the early stages than heroin.

I am certainly addicted to a few of my medications but that's to be expected. Not snorting my cymbalta! Lol

I think the pain medication in my patch is the same that's in methadone. I am familiar with how that makes you feel. Certainly helps a lot of my neurological pain.

 

[Lithrael]

Tramadol interacts with the serotonin system. I figured that out fairly soon after it came on the market, as that was not long after my post-viral syndrome hit. The first time I was given it for pain, it worked wonderfully, and the second time. The third time I felt like my head was going to explode from the pressure and my heart was racing. The only thing that had changed was that I'd started taking SSRIs again. So I started researching online and found out yes, that was the problem. I was giving myself mild serotonin syndrome every time I took Tramadol.

Same problem for the triptan-class drugs for migraines.

Ah, this is good to know, thank you! Triptans are the only thing I've found that work on my migraines (I gather because I seem to get them monthly) and not being able to use the stuff in the future for bad interactions would be Awful. Now I can keep an eye out.

 

[Giordano]

Having any mental illness is a failure in you as a person. When I had a psychotic break at age 17, my father said "just stop having delusions, you *********** drama queen".

My transdermal patch is buprenorphine, is that the same thing as what's in suboxine?

Yes, except suboxone also has naloxone with the idea of preventing abuse by the patient also taking illegal drugs (by the way- there is not much evidence naloxone has a effect in addition to the buprenorphine in this regard). If you have a good doctor prescribing it, it should continue to help and not interfere with your life much. I understand that there is a new implant for it, too, in additional to oral medication.

I just thought of another example of how society is so weird: if you take steroids for a significant length of time you become dependent on them and if you need to stop you need to withdraw over a gradual period of time. Yet somehow this is not considered a moral failing, although it is a physical addiction by all criteria.

 

[wasapi]

For over 20 yrs I have been on some form of opiod treatment. A few months ago I weaned myself off Mscontin, a time released morphine. My goal is to only treat the pain so I can function. I no longer have fantasies of being pain free.

But, yes, the stigma. And yes, the addiction. I am aware that if I gave up my medication, I would suffer serious withdrawals. There is no euphoria. Briefly trying methadone several years ago gave something like that but I found it uncomfortable.

I wish I had an answer. My doctor has offered ketamine treatments, but I guess that's a different topic.

 

[deadrose]

Lithrael, if the triptans do become a problem for you, you might look into Botox for migraines. I think it requires more frequent headaches than what you mentioned, but that can also change (both their criteria or your number of headaches).

I get 2 out of 3 months migraine-free now, the third one they start returning as the injections wear off. I'm getting a new set of injections in 2 days *whew*.