June 21, 2009 - 7:09am
I just wanted to hear about any experiences that anyone has had with withdrawing or tapering off pain meds after an extended period of chronic pain treatment. I know most of us here are undergoing chronic pain treatment with opioid medication, but if there is anyone out there that has gotten their pain resolved and gotten off the meds or possibly had to get off the meds, I would like to hear about your experiences. I have been in chronic pain treatment for about a year and a half and after a recent surgery have no need for the meds anymore. As soon as the pain is gone from the surgery my doctor is going to taper me down so I can get off the opiates.
For about a year up until the surgery I was on 10/325 Percocets, 1 every 4 hours, and 30mg morphine ER, 1 every 8 hours. I would like to hear about anyone who has had any experience in tapering off the meds, or get any and all advice about what I should expect of my doctor through this deal. He told me before I had the surgery that he would taper me down at a rate of about 20% reduction in dose every week or two. If I started to feel any withdrawl symptoms he would put me back to the previous dose, stabilize me for a few weeks, then start going down again.
I would like to know if this is standard procedure and if I should expect to be getting my scripts one to two weeks at a time and having to go in for an appointment every week or two. This is not a big deal for me as I have no co-pay for visits and the clinic is 5 minutes away from my home. I have a 1 dollar co-pay on each script but that is not a big deal either. Is this the way it will go or would I get a month worth of medicine with instructions to take so much a day for a week then so much a day for the next 7 days and so on and so forth.
I am slightly concerned about this since my normal PCP, the doc that has been treating me for the past year and a half, was a 3rd year resident and his residency ended last month so he referred me to a new doctor that I have not seen before. This new doctor is a 1st year resident and being a "fresh, new" doctor is the reason I am asking about what is the standard for a doctor assisted withdrawl off my oxycodone and morphine.
Thank you in advance for anyone who can give me some insight or advice or share their experiences with me!
Thanks,
xTrigeminalNeuralgiaSufferer
June 21, 2009 - 10:37am
#2
onier:
Thanks for the comments.
My doc had said before I went in for the surgery that he would probably drop the morphine er off completely first for the first two weeks, "cuz you're not taking that much of it, then we would start with the oxycodone"
Since I got out of the hospital I've been getting the 5mg oxycodone imm tabs from my surgeon since my PCP isn't available, until I can get in to see the new doc. I think that 2 of the 5mg imm tabs are more effective then a 10mg percocet, I'm going to ask the new doc to continue the imm tabs until the post op pain is low enuf and then he might as well taper me down with those since multiple of 5s would be easier to reduce percentage wise.
It seems to me to make more sense to leave the longer lasting ones for the end because with withdrawl from the opiates its more about the percentage of change then the actual amount. Like going from 40mg/day to 30mg/day is a difference of 10mg but only 25% and not as bad as going from 10mg/day to 5mg/day a 5mg difference but half as much opiates. That is what I have read anyways.
Thank you for your kind comment, my pain was excruciating before, now it is like it was never there to begin with. That's the thing with Trigeminal Neuralgia if you can stop what is causing the problem, the pain goes away completely. My surgeon did an excellent job, he is one of the top doctors in the country. I had it done at the University of Wisconsin Hospital in Madison Wisconsin by Dr. Robert Dempsey, the head of the neurosurgery department and the head professor of neurosurgery there. My father had the same problem but he only had the trigeminal nerve affected while I had both the trigeminal and the glossopharyngeal nerve. My father had the same surgeon and that is why I requested my doctor to refer me to him as well.
I wish the best to your health as well.
June 21, 2009 - 8:54pm
#3
Cool.The only reason I
Cool.
The only reason I thought the ER would go first is because it would be easier to move up and down as needed with the 5mg oxycodone. With the morphine ER you would need different strength doses. Plus my understanding is that ER opioids have a greater withdrawl effect since the drug is almost always in your receptor sites. Your doctor will know better. I've only been on pain meds about 9 months and havn't had the chance to get off them yet. After my first surgery I came to my doc and said "I want off! I feel better!" He said thats great but just wait! He reccomended I stay on and I'm glad that he did. Apparently the injections they gave me during the surgery were still active in my body, making me think I was ready to come off.
Not to make you worry about your own situation being similar, we had very different surgeries. Mine is known to make things worse pain wise before it gets better. Oh well. I'm still alive. Some day I'll be able to get off these meds and get my life back, some day soon I hope. We'll se and I'll keep you all posted for sure.
June 22, 2009 - 6:23pm
#4
Yeah
Now that I have read what you said I would have to agree with you. I didn't think about it that way, I was thinking like the addiction clinics want to use methadone or bup because of its longer half-life but I supposed that doesn't make withdrawl easier just staves off relapse longer. I think I would rather be taken off the morphine at an acceptable rate first then with the oxy once I was down to the lowest dose just basically "cut and run". With the shorter acting opiates, and oxycodone is the quicker of them, the "withdrawl" would last the shortest amount of time and them I'm done with it. I am not worried about any mental addiction since I already have a mind set of wanting to get rid of my dependance. Plus I would think I would feel some kind of anxiety towards getting off them and I just want to get off them without having to withdrawl is my only concern. Plus, I don't want to get off them too soon either cuz now 4 weeks after my surgery my headaches are coming back, the ones caused by the surgery not the pain I had before the surgery. Being already dependant on the opiates, I see no need to put myself through any unneccessary pain. I can understand doctors wanting someone who only started taking the opiates from the surgery to get off them asap to avoid dependance or addiction, but for me, that's a year plus long gone. Not that I think I should keep taking em cuz my back aches or my feet hurt or some lame excuse like that. OT, I injured my back lifting a motorcycle a couple years ago, just some torn ligaments nothing permanant, and was on vicodin for a couple months. I came off that stuff and was fine until my TN started to get bad.
June 23, 2009 - 7:04pm
#5
Doctor Appointment
I have a doctor appointment with my new PCP that will be taking me through the rest of my recovery and then taper me off the narcotics. It is at 10:30am my time. I will post tomorrow on how it went.
June 23, 2009 - 9:11pm
#6
Awesome. Good luck. Keep us
Awesome.
Good luck. Keep us posted!
June 23, 2009 - 11:32pm
#7
What happened?
I'm curious...
June 24, 2009 - 1:07pm
#8
Just got back in.
Hey,
Just got back in from my appt. and things went very well I think. We switched back to MS Contin 30mg from the Kadian 20mg. I didn't like the Kadian's plus it was a lower dosage. We are going to keep the morphine for the first month. I got 270 of the 5mg OxyIR's to take 10 a day for 2 weeks and 8 a day for 2 weeks. I like the fact that he gave me a month worth, I hate calling or going in more often plus I have to pay more co-pays as well.
I say "We" because this was all based on what I told the doctor that I would like to do. He just went with what I said which is cool. I prefer a doctor that actually listens to you about pain management especially since hey, I know my body and the pain I feel better then anyone. With the doctors that I had gone through over the 2 years before I got treatment that didn't believe me and just labeled me as a "drug seeker", I almost wish they would be beset by the pain I felt just so they would understand what it is like for me and my fellow chronic pain sufferes. I say "almost wish" because I would not wish the pain I had on anyone.
As far as the pharmacy goes they gave me the standard watson brand morphine ER and for the OxyIR I got the Qualitest ones, they have a "V" on one side and "48|10" on the opposite. I got these once or twice before and I would like to know if anyone else has had these before as I know they are relatively new. BTW, my pharmacy is the Walgreen's giant.
Feedback is always appreciated.
Oh and for anyone who may be curious, your pain is considered chronic if it lasts anymore than like a few weeks, and acute if its short term. Just a little FYI there.
Greg
June 24, 2009 - 3:11pm
#9
It sounds like you have a
It sounds like you have a really nice doctor.. that makes all the difference in the world!
I have weaned myself off of hydrocodone and xannax before.. without the help of a doctor. I had been taking both for about 3 years at the time. Just go slow. Stick to the schedule (that's the most important thing). Practice deep breathing. Eat Healthy Food. Enjoy the Sun. And... try to find something to do to take your mind off the pain (in case it comes back..)
I noticed that if I my pain started up (usually around the time I would be taking another pill... lol) then I would go lay down for 20 minutes and meditate or relax. The pain usually would go away or I would distract myself to the point of not thinking about taking another pill.
Affirmations work really well too... Everything is Fine, I couldn't Be Happier, I am in Wonderful Health.
I wish you all the best!
June 24, 2009 - 5:43pm
#10
trig
I've heard different definitions for chronic pain. Some say 6 months, some say 3 months. Others say if its pain that does not respond to treatment....
June 24, 2009 - 5:55pm
#11
Chronic pain and acute pain definitions
I would have to say, yes, there are many different points of view when it comes to what makes chronic pain, chronic. I would have to say the first definition from Wikipedia is the closest to the way I feel about it, but basically it's up in the air for the pain sufferer or the doctor to determine which is which. 
Definitions of "chronic pain":
- Chronic pain is defined as pain that persists longer than the temporal course of natural healing, associated with a particular type of injury or ...
en.wikipedia.org/wiki/Chronic_pain - Pain that persists or progresses over a long period of time.
www.bonati.com/_dictionary.html - Distinctly different from and more complex than acute pain. Chronic pain has no time limit, often has no apparent cause and serves no apparent biological purpose. ...
www.pbs.org/secondopinion/episodes/chronicpain/medicalglossary/story425.html - Pain that has lasted a long time (more than 3 months).
www.spineuniverse.com/displayarticle.php/article3150.html - ongoing or recurring pain.
www.womenshealthmatters.ca/centres/osteo/glossary/index.html - pain that may exist for months or years, rarely causing changes in heart rate or blood pressure but often causing loss of appetite, sleep ...
www.mywhatever.com/cifwriter/library/66/4620.html - How long pain must occur before it becomes chronic is disputed - six months is a time used for some types of human pain.
www.link.vet.ed.ac.uk/animalpain/Pages/glossary.htm - Chronic pain is that which lasts a long time (over six months) and is not relieved by standard medical management. ...
www.drugdel.com/glossbot.htm - Chronic pain is a state in which pain persists beyond the usual course of an acute disease or healing of an injury, or that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain over months or years.
www.dhss.mo.gov/PainManagement/Glossary.html - Pain that has lasted for more than three months generally having significant psychological and emotional affects and limiting a person's ability to fully function.
www.garyflegal.com/glossary.htm - A pain state which is persistent and in which the cause of the pain cannot always be removed or is difficult to treat. Chronic Pain may be associated with a long term incurable or intractable medical condition or disease.
www.painclinic.org/aboutpain-introduction.htm - is considered chronic if it last over 6 months. The condition may include weakness, numbness, tingling, or other sensations, along with sleeping difficulties, a lack of energy, and depression. The state of your mind has a lot to do with your perception of pain. ...
www.arthritis-msm-supplements.com/msm_glossary.htm - Describes pain that is long-lasting.
www.lyrica.com/content/main_glossary.jsp - the least common type of back pain. Chronic pain may begin either quickly or slowly; it generally lasts for 3 months or more.
www.pain101.com/GlossaryOfPainTerms.aspx - is pain that has been present for three to six months, depending on who's defining the period. Chronic conditions tend to much harder to treat because the physical and psychological changes causing it have become much more permanent. ...
www.pudendal.info/info/glossary/GlossaryMain.htm
Definitions of "acute pain":
- Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or ...
en.wikipedia.org/wiki/Acute_pain - Acute pain is the normal, predicted physiological response to a noxious chemical, thermal or mechanical stimulus and typically is associated with invasive procedures, trauma and disease. It is generally time-limited.
www.dhss.mo.gov/PainManagement/Glossary.html - Pain that is severe but lasts a relatively short time.
www.nationalpainfoundation.org/MyTreatment/articles/Cancer_PainDefinitions.asp - pain that starts suddenly; may be described as severe or sharp.
www.womenshealthmatters.ca/centres/osteo/glossary/index.html - Pain that is sudden and severe and, typically, short lived.
www.asbestos.com/glossary/a.php - a suddenly occurring sharp or sever pain.
www.doctorsforpain.com/patient/terminology.html - Describes pain that happens suddenly and for a short time.
www.lyrica.com/content/main_glossary.jsp - the most common type of back pain. Acute pain often begins suddenly – after a fall or injury, for example – and lasts for 6 weeks or less.
www.pain101.com/GlossaryOfPainTerms.aspx - is defined as short-term pain or pain with an easily identifiable cause. It is the body's warning of disease or current damage to tissue. Acute pain often presents itself as fast and sharp and is usually followed by aching pain. ...
www.newworldencyclopedia.org/entry/Pain - An adaptive, beneficial response necessary for the preservation of tissue integrity. The Neuroscientist, Vol. 5, No. 5, 1999
www.uphs.upenn.edu/addiction/berman/glossary/ - Acute pain has a crucial function for good health because it is a warning of actual or potential physical harm. In situations of acute pain the pain usually stops before physical healing is complete.
www.painrelief.co.nz/terminology.html - Pain that has lasted a short time (eg, less than 3 weeks) or is severe.
www.spineuniverse.com/displayarticle.php/article3150.html - Pain with a sudden onset, lasting from just a few days to as long as 3 months. If pain lasts for more than 3 months, it is then considered to be “Chronic pain”.
www.healthymedicine.net.au/chiropractic/chiropractic-terminology.htm - Pain that is high in intensity but generally lasts a short time. See also Chronic Pain.
www.touchstonemassagetherapy.com/glossary.htm
June 24, 2009 - 6:02pm
#12
Thanks
Violet:
Thanks for the kind words. I couldn't be happier with the outcome of my surgery and the overall treatment of my last doctor. I only switched doctors because my last one was a 3rd year resident and had graduated this month. My new doctor is a 1st year resident, fresh outta school. I explained everything and he seemed more focused on my quality of life and how I felt about my opinions, I am definitely blessed to have such an understanding doctor. I am liking the resident doctors so far as it seems they are more concerned about how you feel and your quality of life then the money they can make out of you. The resident that I started seeing today only makes 40,000/year and doesn't make any kickbacks or anything that is for sure. He couldnt even write the scripts for my CII medicine, he had to have his "supervisor" if you could call it that, sign the script (they use computer printed paper).
Again, thanks for the kind words and advice, I will keep posting and responding to any comments as my recovery moves forward.
Greg
20% dose reduction every other week is in the normal range for rate of tapering off, from everything I've heard. Maybe 10% every week would be easier on you.
Given that extra appointments and scripts are no big deal for you they will probably write them every other week for the morphine ER. With the percocet you can cut them in half usually so one script would be fine. He/she will probably write you for 5mg percocets. I've heard of some doctors wanting to start tapering off breakthru meds and then ER but I think the other way around makes more sense since you can take portions of IR but not ER tablets...
best to you, glad your pain has subsided