I… am saving that for a last ditch effort. As many people have stated, “you were ONLY on 50mg 3 times per day? Shit, that’s nothing”.
Not true for me.
But, I will seek help… if I get to the edge of the cliff.
If your doc has tapered you down over a week or three to about 50 mg a day, then cut you off, that’s not bad care. That’s a tapering dose.
I’ll offer my patients a little clonidine at that point, if they’re really jonesing, but there’s nothing life or health-threatening about opioid withdrawal in and of itself.
I hate tramadol. If a patient needs an opioid for chronic pain (a few do), then I personally think one’s better taking long-acting morphine. Less of a buzz, smoother detoxes, fewer problems if doses are missed. Not that I’m big on prescribing morphine either, but it’s better than tramadol for chronic pain.
Wow, this thread is completely insane to me. I’ve been taking 50-100mg tramadol PRN for pain (love the antidepressant effects) for three years. My doctor switched me to oxycodone when I became too pregnant to do the stretches that sometimes help, but I quit taking tramadol on my own the moment I started trying to get pregnant and had no effects at all. I also never experienced any terrible side effects. It makes me more affectionate (and almost insatiably horny sometimes) and occasionally I couldn’t sleep but I always attributed that to “Hey, I’m not in pain and that’s really pleasant. I don’t want to waste it.” Neither of those effects, for me, are bad.
To be fair re: lack of withdrawal symptoms, I only took it very occasionally, same with the Percocet now. A 30 pill bottle could last anywhere from a couple weeks to well over a month. Plus, I’ve quit illegal street drugs (meth is probably the “hardest” one) cold turkey with absolutely no symptoms too so I think I’m just lucky.
Sorry you’re having a hard time. 
I’m curious - why did the doctor put you on Tramadol? Back pain? People think I’m too young to be on pain medicine… but I always hurt and ache all over, from my neck to my shoulders to my head to my lower back. My doc thinks I have a “pain perception” problem :dubious: Regardless, my pain is very real, and doctors don’t take it seriously unless someone is screaming or crying. This may be why I’m headed to a neurologist. I suspect my doctor has had it with my bitching and is moving me to the next specialist.
I hate when doctors sling medication like they’re corner drug pushers, then suddenly get a conscience about it later.
My stepdad is 64. He works 2nd shift maintenance at a hospital. He herniated a disc in his back years ago, which still gives him pain, and he’s had three knee replacement surgeries performed on the same knee, which he can only bend about 30% of a normal range of motion. But his job requires him to be on ladders and walking all over the hospital. Thus, he’s often dealing with pain, and a regular sleep schedule is difficult for him to maintain. So his doctor put him on Oxy and Ambien. Is he too reliant on those medications? Possibly. Do they help him endure life? Undoubtedly.
Now, apparently, his doctor is giving him a hard time about getting more prescriptions. He’s the one who got him hooked to begin with! And honestly, is it really a mortal sin if this older man can get medicated so he can keep trudging off to his job? He’ll be retiring soon anyway, he doesn’t need the gratuitous pain to push him out the door.
I’ve taken 50 mg Tramadol for a couple of years and never noticed anything except reduction in pain.
Back pain, yes. To my knowledge, there isn’t actually anything wrong with my back. The problem is my hips which were somehow messed up during my last pregnancy. The stretch I learned was incredibly helpful* until about 6-7 months into my current pregnancy when my belly became just too big to do it anymore. That’s why I typically can get by with so few pills.
- Lie flat on your back with knees bent and cross legs man-style with the ankle on the knee. Lift and move legs toward chest. I have my husband push slowly until I can really feel it and then hold for like 20 seconds. Alternate legs and repeat. Then I do bicycle kicks for like a minute and sometimes I’ll touch the bottoms of my feet together, move them up to my ass, and spread my legs as far as I can and hold. Helps my back pain tremendously.
Hey no joke, don’t wait that long. You may fall off the edge before stepping back. Don’t wait until you’re too miserable to even care.
Take advantage of the presence of mind you have right now and get in touch with another doctor, so they can evaluate your situation from another perspective!
If the OP is telling the truth, and the doctor did not taper the dose but abruptly stopped the meds, I would file a complaint.
Have you tried Darvocet? That seems to give me the “buzzed&warm all over” feeling some describe on Tramadol (bad bad drug) without the bad withdrawal potential.
Combining Tramadol with SSRI can cause seizures, as Im sure you know:
“Combining tramadol with an MAO (monoamine oxidase inhibitor) inhibitor or SSRI (selective serotonin reuptake inhibitors) can lead to seizures or other serious side effects.”
http://arthritis.about.com/od/ultram/a/tramadol.htm
Tapering would def be the way to go to avoid seizures.
Probably not the best advice I’ve seen given today.
- requires prescription, and may not even be available in the US any more. Googling quickly brings us to a site which informs us:
Darvocet-N (propoxyphene napsylate and acetaminophen) is a Schedule IV narcotic under the U.S. Controlled Substances Act. Darvocet-N (propoxyphene napsylate and acetaminophen) can produce drug dependence of the morphine type, and therefore, has the potential for being abused.
Well, of COURSE it requires Rx but its a step-down drug from Tramadol! Just trying to suggest ways to cope with the withdrawals which is what the thread is about, no?
Meds containing propoxyphene have been off the market for years. Darvocet was an absolute shit pain killer anyway but, IIRC, the company pulled it due to ease of overdose and potentially fatal side effects even at recommended dosages.
Propoxyphene (darvon, darvocet, etc.) is no longer available in the US, and I’d not consider it a step down from tramadol anyway. If one is physically dependent on tramadol, just taper tramadol, don’t substitute another opioid.
Wowsers.
I would suggest this is a sign - a great big blinking Times Square on 12/31 sign - that you need to find a new doctor.
Now, I’m not saying that “stop the Tramadol” is the wrong decision. But making you go cold turkey, and tossing off a flippant “go to the rehab clinic” is amazingly callous doctoring. I’m stunned that you got that reaction from her, versus a discussion of weaning off the stuff or alternate approaches to managing your health issues.
I have never taken the stuff. But as an RLS patient, I know people who have tried it (narcotics are effective for RLS so many people are offered this “non-narcotic” as an alternative), and the scuttlebutt is that yeah, it’s not as addictive as the true opiates - but it IS more addictive than early publicity said it would be.
Here’s hoping you get past the hump quickly.
I second the Mercotans advice on trying to get some clonodine. A lot of withdrawal symptoms can be alleviated by lowering your blood pressure and clonodine will do that. It works by simply expanding your blood vessels IIRC. Helps you feel more calm and you might even catch some sleep.
Good luck and hang in there.
I stand corrected then. Its been a while since Ive seen anyone use it.
As I posted earlier, I take tramadol, 50 mg, three times a day with acetaminophen for the pain associated with ankylosing spondilitis. I have noticed no “buzz”, euphoria or dependency.
I believed it was much better than taking a narcotic. Although the container is often labeled “no refills”, the pharmacist FAXes my physician and it is refilled.
Is it truly as bad as described in the above posts?
As others have stated, it does get better. Unfortunately, due to it’s multiple mechanisms of action, half-life, and the half-life of one particular major metabolite, withdrawal from long term tramadol therapy sometimes results in a longer lasting acute withdrawal effect combining features of opioid and antidepressant withdrawal. I would echo the recommendations of several other posters and encourage you to seek help from another physician, even if the only thing said physician will do for you is supportive medication like clonidine.
I’m a little confused. In your first post you stated that you were on day 2 of severe withdrawals you didn’t know would happen, yet here you asked her what to do about withdrawals which you knew might occur because you’ve stopped before. It is possible I’m misreading here, of course, but the two statements don’t seem to mesh.
Strictly speaking, while it does have very mild uptake inhibition of dopamine, this study found a much greater (~2 orders of magnitude) selectivity for uptake inhibition of noradrenaline over dopamine and this uptake inhibition likely directly contributes to it’s painkilling properties via spinal descending noradrenergic pathways.
I wouldn’t say it’s one of the most addictive, given its non-scheduled status in most US states, though at least in my state, it does show up on the state prescription monitoring program similar to scheduled medications. I would say that some physicians, pharmacists, and patients seem to under-appreciate the very real risks of dependence associated with this drug, at least in my anecdotal experience, but disagree that it is anywhere near “most addictive legal substances out there”.
Given the picture you are presenting here, I don’t think it unusual that your doctor is referring you to a specialist. I’m assuming the doctor who stopped prescribing the tramadol is a general or family practice physician. If so, she may simply feel like she is reaching the limits of what she knows to do to help your situation, which isn’t all that unusual (IME) when dealing with comorbid pain, depression, and anxiety in a patient.
This response is not all that unusual, in my experience (both as a patient and as a professional), since most providers don’t want to interfere with another provider and their treatment choices unless a patient is being specifically referred to them for that purpose, or in the case of an emergency.
Also, given your description of how you are responding to your antidepressants and anti-anxiety meds, have you informed your psychiatrist that they leave you feeling like a zombie?
If RedBloom is looking to get off the pain meds altogether, yes, providers trained to deal with addiction and dependence would be a good choice due to their familiarity with the risks of withdrawal and evidenced based procedures for minimizing the more severe aspects of withdrawal. However, if RedBloom is more interested in pain relief, then the referral to a neurologist or a pain care specialist might be the better choice in the long run.
Assuming you aren’t either a rapid metabolizer or slow metabolizer, 150mg of tramadol daily is considered to be approximately the equivalent of 15mg of morphine daily. I would actually be a little bit shocked if after 6 years of use there weren’t signs of withdrawal.
One study, linked here, found some degree of dependence at a daily dose of 200mg (50mg four times daily) for up to 4 weeks. Granted, the study in question demonstrated dependence via challenge with an increasing dose of naloxone, an opioid blocker (separated by 48 hour intervals) while participants were kept on a regular scheduled tramadol dose, versus stopping the tramadol altogether and observing for withdrawal.
Oh, if only I could unleash you upon some of the providers in my area.
While I don’t doubt that there are some healthcare practitioners who too quickly write off a patient’s complaints of pain, many of us have been trained under the philosophy that if a patient says they are in pain, treat them as if they really are in pain. If you say you are in pain, I’m going to treat you as if your pain is real (well, within the limits of my scope of practice, as I’m a pharmacist, not a physician/PA/NP). However, the treatment of chronic pain, particularly non-cancer pain, can be challenging, even to those who really know their stuff. Sometimes, in my experience, the solution the patient often wants (increased frequency/dose of their current pain medications) can actually end up making things worse, directly or indirectly, while the option(s) the practitioner feels has the best chance of helping the patient might require time to start working or may actually make the patient feel worse for a short period of time.
Oh joy–combination opiates and benzodiazepine(-like) drugs in elderly patients. :smack:
Please don’t misunderstand, there are times when they are appropriate together, as may or may not be the case with your stepfather. The combination, particularly in elderly patients, can however pose significant risks beyond even simple dependence/addiction, so the general rule of thumb is to limit the use to the lowest effective dose for the shortest possible duration.
Day 4. COMPLETE AND UTTER RESTLESS BODY SYNDROME that is making me feel like I am completely and utterly losing my mind. Pacing, walking, no sleeping, ANGRY AS HELL, still chilled and aching to the bone, pounding heart…
I can see why people stay addicted. I really can. And this is Tramadol, for fuck’s sake. No amount of Ativan and Advil will help this. I hope my doctor burns in hell.