I do have to say one sobering thing about tramadol: do NOT let yourself go into a cold-turkey withdrawal! “Hell-on-Earth” doesn’t do it justice. And it lasts! And lasts. And lasts. Thankfully, its only ever happened to me one time in all the years I’ve been taking it.
Hold up…
I have had to use 2% diclofenec (topical) for a bad Achilles tendon injury last month, along with 400 mg ibuprofen orally.
Did similar earlier in the year for wrist issues.
Off them now.
You mean to say, I could have had a heart attack or stroke…
I could barely walk :eek:
I think you’re referring to gettin too much serotonin
Serotonin syndrome
I’m talking about the withdrawal effects, getting too little serotonin
SSRI discontinuation syndrome
I unknowingly foisted the difficulty it on myself over and over thinking that if I could take fewer meds on certain days I should. I was hearing that I should ONLY take them when NEEDED.
I didn’t understand the value of consistent dosing.
Also, it’s hard to get (or give) an answer for what constitutes “needed”.
As I mentioned before, each of the options have downsides (and multiple moving parts).
I’d love to find a qualified professional who would help me sort this.
If had more faith in my current Dr, I wouldn’t be here looking for info.
I’m unsure of how to determine how present a physician is and how holistically they view their patients w/o going and trying them out.
But, I don’t want to look like I’m Dr shopping when there’re controlled substances involved.
So, here I am asking questions.
The bit about finding a physiatrist (not pronounced how I guessed) seems helpful and hopeful.
A wonderful and knowledgeable receptionist(?) volunteered to help me with the pronunciation and finding physiatrists in my area. [Google seems to think physiatrist could be a misspelling for psychiatrist. ]
The facility she worked at has become in-patient only, but she’s worked there “forever” and knows people and places in the biz.
If only someone would discover a med which has the pain blocking powers of opiates, and the withdrawals of aspirin.
The withdrawal effect of tramadol is much more severe than simple SSRI withdrawal.
Well, yeah for some value of “could have”. Idk what the odds of it all are.
Though I think that long-term use of NSAIDs is more problematic than short term use.
That’s kinda the thing i’m asking about here.
It’s easy to discover a list of side effects.
But what’s harder is evaluating the chances of various thing happening against one another and then balancing the potential harms against the potential benefits.
That’s my experience / understanding as well.
[never did a withdrawal from a plain SSRI]
It’s just that the opioid symptoms (e.g. aches, pooping, sneezing, flu-like symptoms) are something I deal with much better than the weird paranoia and mourning (SSRI symptoms).
Especially since I was unaware that the psychological symptoms were the result of reducing my dosage.
I’d just find myself unexplainably mourning, angry, and suspicious for weeks on end until my brain and dosages found an equilibrium again.
I just had no real idea that this was an effect and that it was effecting me that much.
Tramadol also lowers your seizure threshold, something to think about if you are sensitive to that sort of thing.
afaIk, the only seizure risk I experience is when I am going through Tramadol withdrawal.
The fact that tramadol has a withdrawal syndrome (and a mixed one, of both opioid and SSRI withdrawal) makes it more problematic for chronic use, for the typical user.
But the ultimate risk/benefit analysis really is up to the prescriber in conjunction with the informed consent of the patient.
I have a few select folks I maintain on tramadol rather than NSAIDs due to their circumstances. NSAIDs with their very real bleeding/cardiac/renal damage risk make them unadvisable for even occasional use for some folks.
Amen, brother.
I totally hear you.
One of the best kinds of consent is informed consent.
I totally feel for you. I have suffered chronic back pain and it was horrible (and I only had one disc affected!). My primary advice is to go see a pain management specialist.
What finally gave me relief was a microsurgery wherein they inserted steroids into the casing of the nerves alongside the disc and attached vertebrae.
This was about 12 years ago; at that time they would only do it three times per year. I’d be fine up until about the last two weeks and then be taking NSAIDs all day, and opiates at night just to get by. I also used an inversion table every morning and evening, bought a cheap memory foam mattress, and started wearing super shock absorbing shoes like crocs and nurse’s clogs.
If you can’t do the microsurgery option, then I advise taking the smallest doses possible, and attacking the pain with more than one medicine. Take opioids as little as possible, but have some on hand for the really bad nights. If it feels good to take one, then don’t take another one.
The rest of the time use a mix of NSAIDs and tylenol, with lower doses of each.
I am not a doctor; this is just what worked for me. Every body and every brain are different than every other one, so YMMV.
I am a chronic pain patient…originally treated for radiculopathy due to a ruptured disk, and now recovering from spinal surgery (foramenotomy)…and tramadol barely takes the edge off the excruciating pain.
I am certainly not taking a dose high enough to get high.
I think I need to start with a new GP.
This GP sent me to a pain specialist,
But the whole thing was weird.
In addition to being weird, each visit involved a mandatory $300 drug screen my insurance won’t cover. [ To my budget, $300 is a pretty good amount of money ]
And if that weren’t enough, they really weren’t able to give counsel as far as how I make the determination about how much is “needed” in the as needed business.
I’m sure there are some other ones out there who’re better able to suit my needs.
They also offered to give injections at the nerve roots if I had a flare up. However, it take about 8 weeks to get an appointment with them. That didn’t seems responsive enough.
The whole office seemed to be mostly a pill-pushing place.
[ Not saying it was. I only declined the stronger drugs on that visit and haven’t been back since. I’ve never been to a different pain management clinic either. So my opinion about the place is not the most well-informed.
But my gut said the place felt a bit janky ]
I don’t know how to go about finding a really good Dr.
And because scheduled substances are involved, I don’t feel free to just start trying Drs willy-nilly.
The steroids were in some sort of long lasting, time-release somethings?
Do you know the name of the surgery?
I don’t think I have heard of this one.
I did use an inversion table. I found it helpful.
In the past, when I had a flare up and was only leave bed on crutches to use the restroom, I’d try to always make it to the table to hang.
That would give me some temporary relief while I was hanging and for a bit afterward.
The surgeon who installed my new hip advised against hanging from my legs like on the inversion table though.
This is a super drag as I found the table helpful.
Though the new hip has resulted in a great reduction of pain.
I broke my hip years ago in different fall. Saw a Dr for that as well. Dr said that if walked away, then the hip wasn’t broken. I walked on it for about 8 years.
An Xray of my lower back which happened to include my hip initiated the whole hip replacement process. In the Xray you could see where the tip of the protruding bit of the femur had been knocked off and then grew back a little lower sticking a little further out in the wrong place.
[ I guess the Dr decided that my complaints of hip pain were the result of nerve issues in my lower back? idk exactly]
I agree with the idea of taking the opioids at the slowest effective rate.
It just took me to till just recently to figure out that it’s about the rate rather not the total amount.
I had previously thought that it was a good thing for me to be able to skip doses.
However, the steadiness of the dosing regimen is important for dealing with the side effects.
So, rather than “only take them when needed”, the better advice is to set the dosage rate as low as possible. And keep that rate rock steady.
of course.
After my initial MRI, I saw one neurosurgeon who said on paper I looked like a good candidate for surgery. But he was only offering spinal fusion surgery.
He said the fusion would eliminate the nerve pain in my legs, but that my back would continue to hurt.
He also said that even though the MRI indicated that I was a candidate for surgery. clinically(?) I was not a good candidate as I still had feeling and mobility in my toes.
No one offered me foraminotomy.
[The healthcare marketplace is super fucked up.
There’a a real problem with infomation flow that upsets the market’s attempts to function like a market.]
Though I have seen some experimental surgeries which looked interesting where they 3-d printed a new back (anterior) half of the spine. This helped with the central canal stenosis as well as the radiculopathy from the growths on exterior bits of the spinal bones.
And a surgery where the used experimental cushions between the spinal processes to keep them apart.
I agree. But it does take the edge off.
It’s enough to make the difference between being able to cook dinner in the evening after work and needing a day ahead of time for prep to cook dinner because I have to take too many breaks to get the meal done by meal time
Imho, the lack of a big buzz is a ginormous selling point for tramadol.
Pain is distracting enough.
Tramadol does make me feel a bit weird, but not nearly to the same degree as something like hydrocodone or oxycodone. the weirdness of tramadol seems qualitatively different than the weirdness of other pain pills.
My big gripe about tramadol is just what happens when your dosing regimen varies too widely.
It sounds like you don’t need a “pain management” clinic per se… well, you need a way to deal with the constant pain, but as you say, it sounds like the one you went to is more about dealing with controlling access to narcotics and treating it medically, versus from a functional standpoint. I’d definitely look for a place that is willing to work with you on both aspects.
I’ve never used tramadol. I remember when it was relatively new and shiny, it was touted as a much safer alternative to narcotics. Then they began to realize that dependency was a real thing with it. I had no idea there was a link to problems with serotonin or norepinephrine until this thread (anyone know offhand if regular narcotics have the same issue?).
I did use diclofenac for a few months for knee pain. The main problem I had from it was it made me sprain my ankle (ya see, all of a sudden I could walk fast again… and I rolled my foot and went down like a sack of potatoes :D). As it happened, the doc gave me a version called Arthrotec, which was a combination of diclofenac and misprostol. That was to protect the stomach from the diclofenac-induced irritation. The misoprostol had the unwelcome side effect of giving me Farts From Hell, but I had no stomach upset.
Long-term: honestly, from things I’ve read, narcotics are very safe… well, except for the whole addiction/dependence/overdose thing. I still wouldn’t LOVE to be on them if there were an alternative - but from what I understand, the cox-2 and NSAID class are likelier to cause nasty systemic issues. On the other hand, missing a couple of doses of the diclofenac will leave you in pain, but missing a couple doses of the tramadol would make you pray for death.
Are you on any kind of SSRI or other antidepressant that would interact with the tramadol?
Is there an inflammatory component of your pain? (I would think the diclofenac would deal better with that).
Personally, I have found that NSAIDs help me more with bone pain than narcotics: when I had wrist surgery last year, the first 48 hours, during which I had Percocet (I think), really, really sucked. When I saw the surgeon, and he said it was OK to take ibuprofen - well, things still sucked, but less so.
So: my less-than-perfectly-educated opinion: If this is intended to be a daily medication - one that you take every day as a maintenance med - I’d lean toward the tramadol (assuming it does an adequate job with your particular flavor of pain). You’d need to be vigilant about making sure you haven’t run out of it etc. It’s easier to fill than most true narcotics (schedule IV versus schedule III or II), so you don’t need a new prescription every 30 days or whatever (every 6 months, I think, and they can be refillable).
Have you looked into alternate ways to help with the pain, such as icing, TENS, etc? (you mentioned an inversion table but not whether you tried other options). Do you have access to a swimming pool - ideally an indoor one?