November 12, 2009 - 3:49pm
I went to a physiatrist for a 3rd opinion in September and he suggested two routes for me: either stay on my current regimen and deal with the side effects or go to rapid detox and learn to live with the pain (he said, essentially I'll be in pain either way). I told my pain counselor about it and she theorized I might have opiod induced pain at this point. I've been on oxycontin for 18 months and my pain still isn't under control. I should mention that I entered pain mgmt after my second cervical fusion surgery did not relieve my pain. My first such surgery had been 100% successful 5 years prior. My neurosurgeon ordered MRI, xrays, and a mylegram. All showed perfect! Healing. A second opinion orthopod at an unrelated hospital system agreed. Perfect! No reason for such pain. Pm was the right call. But my pm wouldnt speculate as to cause or diagnosis. After a year, I went to the third opinion dr. He actually suggested fibro along with his suggestions and I've since been diagnosed with fibro by a fabulous rheumatologist. My pain counselor has latched onto the detox and opiod induced pain idea. We're talking about it Tuesday. (she wanted to wait until after my recent wedding to go into it).
Has anyone tried rapid detox? It involves being put under for several days - point being you aren't suffering w/d. It's happening, but you're out of it.
How about out- patient 10 day detox with iv amino acids etc daily?
Does this seem a little extreme? It does to me. The only opiods I'm on are oxycontin 20 mg every 8 hrs and 0 to 2 oxycodone 7.5/325 daily prn.
If I did it could I still take my lyrica, cymbalta, abilify, tizanidine, etc, if needed? My rheumy prescribed flector patches which are awesome for me. I don't want to give these up.
Any thoughts appreciated.
Mrs P
November 12, 2009 - 5:06pm
#2
Str8up, Flector patches are
Str8up, Flector patches are patches (obviously!) with diclofenac (Voltaren) in them. Miss P, I'm glad they work for you. I've never gotten much relief from them. I actually get more (but not alot) of relief from Lidoderm patches. they don't seem to really help my neck or back pain, but if I wear them under my wrist splint and elbow pad, esp at night, they help some.
November 12, 2009 - 5:10pm
#3
My thoughts exactly. Does
My thoughts exactly. Does this dr that told you to go through rapid detox own the center that will be doing the detox or have some financial gain from the detox? I think you need to try going up on the OC or try another med that will help the pain. Just because the drs can't find a reason for your pain doesn't mean you don't have it. I still hurt even though I'm on FTD but it would not make sense to get off meds because I still have pain. I would find a new Physiatrist because I don't think he/she has your best interest! Some people just don't understand pain or that it can be well managed with appropriate pain meds. I would not try the detox. You may find the OC helped a little and you can't deal with the pain without the pain meds. Take care, htmom
November 12, 2009 - 6:02pm
#4
That rapid detox is really
That rapid detox is really expensive from what I've read...and there are a limited number of facilities providing the service. Your oxycodone dose is pretty low (40-55mg per day). I've been tapering off for months and I'm only down to 90mgs per day from 150. My pain is basically as well controlled at 90mgs as 150mgs. I've taken slow drops and alot of back and forths but slowly but surely eliminating the meds from my body. I won't lie and say its easy but its not as difficult as some people think. The one great perk is that there is no longer any need for ...how do I say...digestive assistance?
At 55mgs per day you could taper off in a matter of a few months...the rapid detox seems more fitting for a person recovering from 10 years daily excessive heroin use.
Best
November 13, 2009 - 1:26pm
#5
Tough Course
I have been through detox twice (drug holiday). Once from OC and once from Duragesic (fentanyl patches). The first time I had a bad reaction to the OC and my doc pushed me into something I now regret. The second time I had the bad luck to receive defective Duragesic patches for a couple of months which no one knew at the time. Due to the way my pain mgt doc told me to handle problem patches I grew a fentanyl blood level that was toxic. After the horrific detox (still have trouble talking about it), after about two weeks I got a call from my pharmacist asking if I had certain lot numbers of Duragesic patches. Sure enough for three months I'd been using them. I can't even explain how angry and betrayed I felt.
Sorry for the soap opera story. Anyway, I've studied endlessly the subjects of opioid use, opioid induced pain (hyperalgesia) and so on. I personally do not believe in the theory of opioid induced hyperalgesia. Even if it were true I can't see how stopping opioids would address the pain for which one started pain management in the fist place.
These good people have given you great advice. I would try increasing your OC to see if it's just a tolerance thing (already suggested). Opioid rotation is also a good method to try. If you must stop, go the slow route through titrating downward (already suggested). I would consider any form of detox as a last resort. It's been foisted on me twice and I regret both experiences. I can tell you that my first one, from the OC, was a breeze compared to what I went through detoxing from the Duragesic patches. I was taking about 60mg OC daily and was put on the Buprenex protocol. I didn't suffer at all. On day two I was sitting up in bed when my family doc checked on me. He was also amazed at how easily it went. Your mileage may vary, but if you must go the detox route, do it in the hospital using the buprenex method if offered. The only discomfort I experienced was the initial withdrawal feelings that were needed before starting the buprenex. In order to start the buprenex you must be so many hours past your last opioid dose so the buprenex doesn't throw you into even worse withdrawals. If one waits the right amount of time then the buprenex is actually a great relief.
Best of luck :-)
November 14, 2009 - 12:23pm
#6
Thanks y'all.Str8updud, I
Thanks y'all.
Str8updud, I agree. It's not like I'm on a high dose of OC. I don't think choosing to go under anesthesia is a decision to make lightly.
Htmom, I am not seeing this physiatrist anymore. I just went for a 2nd opinion to see if he could diagnose the problem. Perhaps he is involved with the rapid detoz center too - and that would be a way to make me his patient rather than a 2nd opinion. I didn't tell him initially that I just wanted his opinion. Then he asked why I was unhappy with my PM. I said, I'm not, he's still treating me. He just doesn't diagnose; he only treats symptoms." That's when the physiatrist told me to "accept" my (undiagnosed) condition, that I would be in pain the rest of my life, would never work full time again, and should consider rapid detox at a particular facility. This guy was at Emory and he suggested I do the rapid detox at one of the several Emory-affiliated hospitals here. My PM (who I've been with for 2 years) doesn't see a need for detox and my new rheumatologist says he'll get me out of this pain. And he actually prescribed some new things that are helping alot.
Oneir, best wishes for your continued taper. I've found that on days when I don't take any breakthrough oxycodone, I have fewer difgestive issues, too! There's a 15 mg difference between days when I take no BTP and 2 BTP doses. I may try a slow taper just because I do want to get pregnant soon. Also, if I can control it with the lyrica, cymbalta, patches, muscles relaxants, that's fine with me. I just think the rapid detox idea sounds like a racket. I wanted to get all of your impressions, too. It's comforting that we're on the same page!
Blackcow, your experiences sound terrible. I hope you are more in control of your situation now and won't be bullied again into a treatment you don't want. If I do go forward with this wacky idea, I will defintiely look into the Buprenexmethod.
A mom, I have lidoderm patches, too. They really help for the nerve pain I have in my upper arms. I have a lot of pain and inflammation in the upper neck and at that bump between cervical and thoracic spine and the flector works great for that! It's neat that how different things help different people for different types of pain.
thanks so much everybody. Enjoy this Saturday!
MrsP
November 14, 2009 - 2:21pm
#7
rapid detox
I saw a documentary I think on Discovery channel that showed this girl who had a bad drug abuse problem. Before waking her up, they implanted a pellet of naltrexone (sp?) somewhere around her belly which is meant to decrease cravings, or if she took opiates she wouldn't feel "euphoric". Her parents spent thousands because insurance didn't cover the procedure. It was sad that after less than 3 months, the girl was back on the streets buying drugs.
November 14, 2009 - 5:54pm
#8
She was back on the street
She was back on the street because they never addressed her addiction! Sure they got her off of the drugs physically but she is still going to have those psychological cravings. The money they spent on her detox would have been better spent on Suboxone treatment. That thing they implanted in her wax something that released Naloxone, which is the second half of Suboxone; Buprenorphine being the first half. Kicking opiates simply is not enough, the most important thing to do is take control of the cravings! If you don't have the cravings you don't have the problem in the first place.
November 14, 2009 - 6:16pm
#9
Miss Priss
I hope you get your pain under control. I have also been dx with fibro, and my doc tells me at every visit that it causes opiod induced hyperalegisa. So, if I stop the opiates, I'll feel the pain even worse.
I do have a general question... when you stop taking opiates, or benzos, a person is in pain/ more pain than they were when taking the meds, right? It doesn't last forever, but it's there. Withdrawal makes us feel bad in different ways. To me, I think I would construe the extra pain as hyperalgesia, but I don't know if it really exists beyond the immediate period after stopping.
Miss Priss, do you mind if I ask, why are you taking Cymbalta and Lyrica together?
Sorry I can't answer about rapid detox, but my personal opinion is I think I'd rather do a slow titration down. You can monitor your progress. I would be worried about waking up in horrible pain with rapid detox. Good Luck.
November 14, 2009 - 6:38pm
#10
Opiod induced hyperalgesia
My pain counselor explained it this way: while you're taking opiods, if you have opiod induced hyperalgesia, the opiods make you more senstiive to pain. 36 hours or so after he opioids are out of your body, your pain is decreased because the portion of your pain caused by the opiods is gone. She said there's no way other than going off the opiods to know whether you have opiod induced hyperalgesia. Detox seems like a really expensive way to do that little experiment.
I take cymbalta and lyrica as well as abilify because I have depression as well as pain.
For what it's worth, no one has suggested that I am addicted or have any abuse issues.
November 14, 2009 - 6:59pm
#11
Forgive me if
I gave you the wrong idea. Personally, I don't know if I'd go for an experiment like that. I was curious about taking the cymbalta and lyrica together... and the abilify is a shot in the arm for them to work better. I just saw my pain doc, and he thought I was taking them together, and was surprised. When I took cymbalta, it put me into a deep depression. It really snuck up on me. I had to stop it. Doc put me on trazadone. My pain doc, at my appt. the other day asked me if I was taking it because I was depressed, or because I'm an American. This guy has a sense of humor. But that's another thread.
I hope things work out, no matter which way you decide to go.
November 14, 2009 - 7:50pm
#12
believe the Dr. who told You opiates makes Your body
more sensitive to pain , needs to take a nap before practicing medicine, if You re in pain there s a phyiscal reason, after your 1st surgery the medication worked until You healed, after the second surgery they also worked, Your tolerance has builted an You need a increase or changed to shake Your system up, after surgeries there s no gaurntee that the surgeon did nt sever nerve endings that can take years to deal with, My Father had this happen to Him after throat surgery.
if opiates caused me to be more senitive to pain I would not to be able to get out of bed not unless, I took my meds at least 2 hours before getting up, an I been a chronic pain suffer for going on 16 yrs, if I was a bookie I lay 10 to 1 odds that Your fibro is getting worse thus the increase in pain.
WOODSTOCK, NO DR., NO BOOKIE EITHER
November 14, 2009 - 10:53pm
#13
Right on Woodstock. I agree.
Right on Woodstock. I agree. And it's too bad you're not a bookie because you're right! This time, at least : ) I think part of the problem is 4-sided: (1) I look younger than I am and that makes Drs not want to "over" prescribe, (2) in the beginning and for awhile (until may 09, or so) I expressed concerns about being on too much medicine (3) my Drs know I want to "start a family" & I'm already 34 and (4) I haven't been assertive enough about how my pain affects my life. I'm an attorney about 15-20 hours a week, down from 60-80. My rheumetologist is treating me like an adult (and I'm presenting myself as one, being adequately clear, I think.) he wants to get me pain free but he's not my pain mgmt dr.
Tux, cymbalta helped me with extreme, irrational irritabilty - a su
ptom of depression for me- and my previously daily weepiness. I couldn't tell a difference painwise, though I'm on the "pain dose". At that time, I was also taking huge amounts of gabapentin. That helped with nerve pain but hurt my ability to think clearly or to analyze anything! Ive since learned that gabapentin is mood stabilizer but it didn't have that effect on me. I switched to lyrica, which works even better for nerve pain. But it likewise didn't have a "mood stabilizing" effect on me. That's why I say I take lyrica for pain and cymbalta for depression. Now, I just started abilify (2mg /day- the depression dosage). It's a mood stabilizer that's helping me a lot!
November 14, 2009 - 11:18pm
#14
MissPriss:
do You think that the Cymbalta is working ok, if not a change to Paxil for mood irritability might be the ticket, each has their side effects if not the same, but they may be a cost savings too.
Woodstock
November 15, 2009 - 5:57am
#15
More than glad I have insurance but copays are killing me
I'll ask at my December appt about switching. My copays are $10/$30/$60 & I have too many at the $60 level. Seeing a specialist costs $50 a visit. I've been meaning to sit down and see what my insurance recommends (which is cheaper for me too) instead of various stuff. If paxil would work, I'd be glad to try it. I've never had it before (have tried zoloft, Prozac, wellbutrin, effexor, and one other I can't recall)
mrsP
November 15, 2009 - 7:00am
#16
A few months ago I decided to
A few months ago I decided to take 24-48 hour period off my pain meds to establish my baseline pain levels. Surprisingly, despite the withdrawals I was in basically the same amount of pain. Perhaps the discomfort of the wd's took my attention off the usual pain...I'm not sure if that addresses your question or not, Tux...
I had never heard of opioid induced hyperalgesia before but just spent some time reading about it. Interesting stuff...if I had to guess I would say chronic exposure to opioid pain meds has decreased my general pain tolerance. In some ways the experience of chronic pain has helped me learn ways to deal with pain but it has also made me more sensitive to it in some ways. The vicious Pain Cycle takes over...hurt too much to sleep so you don't get enough rest, when you're tired you're more sensitive to pain and soreness which leads to more trouble sleeping etc. In alot of ways when my pain started it became like an avalanche of suffering; one unpleasant experience leads to another and it snowballs out of control. Thankfully my figurative snowball has been melting out and losing momentum.
November 15, 2009 - 8:42am
#17
Paxil
I think I have heard less complaints about Paxil than any other A/D. I have heard the most complaints about Prozac and Zoloft, but of course it varies per person. Paxil works great for me, but just dont stop it suddenly, of course you know. Years ago I tried it for anxiety and when it wasnt working I just stopped it suddenly, and felt really depressed after. When you taper properly though, its not a problem like with some other medications that have horrible "discontinuation sydrome".
November 15, 2009 - 10:41am
#18
opioid-induced hyperalgesia
MissPriss, I'm glad you seem to have decided against the rapid detox route. I think that is WAY too extreme, and I can't imagine you'd be happy with the outcome... I've heard nothing but horror stories about rapid detox (the only good stories I've seen are those that are "testimonials" on the websites of docs who do these procedures) and that was from people who were doing it simply for addiction issues- with chronic pain, I think the the outcome would probably be even worse. It just makes more sense, to me, to slowly taper down to see how your body reacts to less pain meds. Or to try to maybe change your meds or increase your Oxy dose to see if you get more relief- tolerance can definitely be a factor that sometimes isn't even considered. In the past when my pain has gotten worse, I've tried a bunch of different things only to find out in the end that the simplest explanation- tolerance- was the right one. Keep us posted and don't give up on being pain free! I know how frustrating it is to be young and feel like you're losing your life to pain... but you said you just got married, right? Congrats. :) And you said you still work and plan to start a family.... so you're NOT being defeated by your pain.
BTW, this is my first post here. I've been coming to this site for years, but just decided to join after seeing this topic- I will introduce myself and ask my own question about this topic below.
~jennifer
November 15, 2009 - 2:41pm
#19
Welcome Jennifer!
I am so honored that you decided to post first here : ) I am definitely NOT defeated. I will not give up and I finally have a doctor who hasn't given up either. My wedding was tailored to my need to rest as well as to the rest of my preferences. It was try awesome and beauiful and "us". If anyone here is planning a wedding or anticipating a big event, I'd be glad share my stealth tactics! I am now working three days a week 8:30-2, plus an hour or so from home occasionally. Thank you for the encouragement. As for starting a family two doctors now have told me it's ok on my current meds. I know it's controversial and I don't want to start a firestorm but they independently said what's good for the mom is good for the fetus/baby.
MrsP
November 15, 2009 - 6:17pm
#20
MissPriss re: Paxil
I was prescribed Paxil in 1995 and it worked well for me. After about a year, I found out I was pregnant and panicked. My doctor told me to slowly taper off them (it took a couple weeks) I had no problems, however recently I keep seeing this law firm's advertisement on TV. There have been reports of babies born with serious birth defects and/or heart problems and the mothers were taking Paxil while pregnant. There's a lawsuit now pending against the makers of Paxil.
That scares me because heart troubles run in my family already. My PM doctor was the only doctor who detected I have a heart murmur. (I'm 45) Now I'm thinking my son needs to be checked... Sorry I know this is completely off-topic! Theresa
November 15, 2009 - 7:53pm
#21
Thank you Theresa. That's
Thank you Theresa. That's good to know. If I do get pregnant, I want to cut out some meds if I can. (that's why the rapid detox held any appeal at all for me, though I am not doing it!). But depression is a lifelong problem for me. There's a psychiatrist here at emory that specializes in treating pregnant and postpartum women. He's not on my insurance but I might be able to take part in a study. I want to work with someone who is a true expert!
MissP
November 24, 2009 - 6:05pm
#22
Opioid-Induced Hyperalgesia
It's my first time here, too. Now that I have alittle time on my hands (after a spinal fusion) I've been able to do alot of Googling, and this place is the best site for issues that seem to get for interest (and candidates).
Spent the month after surgery with unbelievable pain - I slept with 7-10 pillows so my back wouldn't touch anything - constant overwhelming pain all over the place. I had been on Hydrocodone for a few months, and it was getting to the point of "Hello???? Can you call my prescription in like, yesterday?" I stopped for a day - 3 to 4 days ago, and the difference was ubelievable (for that first day). I vowed never to take another.
I went to a pain doctor, who gave me some Gabapentin, which hasn't helped, along with Zolpidem for sleep. He never did admit to those three words (OIH - Opioid-Induced Hyperalgesia), but I knew. Plus, my ortho had been prescribing them for 5 months because he was so booked for the surgery. It was like trick-or-treating, way before Halloween.
But the pain I havetoday and yesterday! The muscle spasms! The crying over almost nothing! I did some more Googling, and realized that I was going through Hydrocodone withdrawal. Checking my store of candy and some internet sites, I took a Diazepam (I have so many - they just kept throwing this stuff at me), a nap, and what a difference. I'll take one for the next 3-4 days just to get over this, the worst of which I've read should last for 3-4 days.
But OIH definitely exists, and it would have been nice to have an earlier appointment with the pm doctor associated with the orthopedic group.
November 25, 2009 - 4:51pm
#23
OIH is a real phenomenon.
OIH is a real phenomenon. I've experienced it myself.
Only time it was mentioned by a doctor is when I was seeing an opiophobe who told me "morphine was evil," and was the sole cause of my pain.
Of course I know better, but it is a real problem that must be dealt with.
Good luck.
November 25, 2009 - 5:03pm
#24
Seizures
I've seen footage of the procedure where the patient is required to be intubated to maintain airway due to the seizing that commonly takes place.
I wonder how they deal with emesis...
Very costly, and risky. This procedure was develeoped for Hollywood stars with addictions who couldn't afford to "disappear" from the celebrity spotlight for a traditional rehab program.
Many facilities are located in unassuming office complexes. This used to be a very "back alley" procedure.
Good luck.
November 27, 2009 - 2:43pm
#25
Weird! I am trying to taper
Weird! I am trying to taper instead. Definitely not doing the rapid detox thing. The first week I stopped taking my 7.5/325 oxycodone with apap (rx bid prn). Then last Sunday I halved my nightime dose of oc. So I went from 20 20 20 to 20 20 10. I didn't bring enough meds for on T'giving trip so today the plan is 10 20 10. It's half an hour before I get to take the 20 dose. I'm having more pain but I'm not throwing up or anything. I have 10 for tomorrow am. Then we plan to be home for tomorrow's second dose. My pain counselor said I won't know about the OIH until I'm off the oc altogether for a couple of days. Widh me luck and take care,
MrsP
November 28, 2009 - 4:48am
#26
Yes, Doctors do suggest
Yes, Doctors do suggest opiate induced pain and put you through a rapid detox, These Doctors are also sometimes refferred to as Defendants. A couple pet scans which are safe and accurate can answer that question. After 5 years with chronic pain my Dr, did the same thing however I went through the 1st 24hrs with no meds or help. My pain went up super fast as well as my blood pressure. with in 30mins of starting withdraw my blood pressure went from 125/84 to 279/132, this changed my doctors thoughts very quickly, 911 called, Pain-stressed Heart Attack was the result. He is being sued. Be careful,, It can happen if u r on a lot of short acting opiates. U can have mini withdrawls between doses. Change to a long acting opiate 1st. Don't let the Dr talk u into it
November 28, 2009 - 7:11am
#27
beavismom lidoderm
whats a lidoderm patch? is it anything like a lidocaine(check my spelling)patch? my pcp is gonna rx me some of those to try.
November 28, 2009 - 7:14am
#28
Hey Saturated, what do you
Hey Saturated, what do you think about how to deal with it? How could you tell it was affecting you?
MrsP
November 28, 2009 - 1:41pm
#29
Yes Lidoderm is a lidocaine
Yes Lidoderm is a lidocaine patch, the only one Im pretty sure since Lidoderm is rather expensive & without generics.
Generic Name: Lidoderm 5%
Strength: 5%, 700mg of Lidocaine - 50mg per gm adhesive
Manufacturer: Endo Pharmaceuticals
Trade Name:
Type: anesthetic
Class: RX
Size (cm): 10 X 14
Comment: Imprint: Lidoderm lidocaine patch 5%
November 28, 2009 - 7:12pm
#30
MsPriss
I thought the best way to deal with it was to increase my opiate consumption, which is what I did. The addition of a medication used to treat nerve pain (lidocaine topical, Neurontin, Lyrica, etc.) is appropriate for many people, either in addition to, or while reducing the today daily dose of opioids.
I'm personally not going to reduce my consumption until I no longer require opioid therapy.
For me, it was an increase in sensitivity of seemingly every nerve in my body. A paper cut would feel like a gunshot wound- figuratively speaking of course, but you get the idea.
I really think you're making the right choice with the taper, just don't rush it, and you'll be fine. 
Rapid detox does seem extreme considering the low dose of OxyContin you're on. Plus, rapid detox involves dangerous anesthetic drugs and is terribly expensive. I think you should just go the "very slow titration" route if anything at all. Drop your dosage of oxy by 5mg or so every 2 weeks, or at a rate that you're comfortable with and one that minimizes withdrawals. Have you ever considered transdermal fentanyl to control your pain?. From what I can tell you sound like the perfect candidate for it. Before I gave up on opiates, because as your physiatrist said "you're going to be in pain either way" (which I think is bunk) I would def. give this a try. Fentanyl is the most potent opiate on the market today and it works wonders. No drug is going to relieve all your pain, but it can certainly be brought down to a level where you can tolerate it. It (fentanyl) has changed my life. I'm sure others can attest to this:-) ...Hope this helps...Ray...Also, what are flector patches? I've never heard of them.