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    Opiate Tolerance
    Onehurtguy posted:
    Hey folks,

    I was reading another post, in an attempt to learn more about a pain medication called Butrans that my PM and I spoke about switching over to.

    I've been on pain meds for about 6 years now, after a car accident left me with three knee surgeries, 60k worth of Titanium implanted in my lower back, and a pinched nerve in my neck. My pain without medication is not controllable, as I work 12-15 hours a day, and have little time for rest.

    Since starting pain meds, I've gone from 5mg Percoset, all the way to 80mg er Oxydontin, plus 30 mg ir OxyContin. Last September, I decided that I couldn't continue taking medication at these levels for ever, and that a certain point, even the high dose I was taking would become ineffective.

    That said, I decided without my PM's knowledge, that I would stop taking the pills in an attempt to clean out my system for a few weeks, then go back to a more manageable does. I did ask my PM MD about viable,options to ween off, like Suboxone, or Subutex, but these were medications that he couldn't prescribe, and I'd have to see a Phsyciatrist to get on an "addiction program". I did not like the sound of that,mas I'm not an addict, and did not want to be labeled as one. It's bad enough picking these medications up after 6 years, the people at the pharmacy already look at you funny. No doubt I am dependent, but I am not an addict. Again, I told myself that this was something I needed to do, and did, I stopped cold turkey for 2.5 weeks. It was pure torture, as I did go through withdrawals, and my pain was unbelievable, it almost made me crazy it hurt so bad, but I was committed to making this work, for both myself, and my Doctor, as even he was running out of options.

    After the "clean out", so to speak, I went back to 20 mg er Oxy, and 10 mg ir for breakthrough pain, and everything was grand. I am extremely proud of myself for being able to walk away from the meds for that long, particularly with the amount of pain I was in....

    Which brings me to my point.... My dose is becoming not enough to keep the pain away, and as I read in another post, instead of going up on the OxyContin and Oxycodone, maybe there is another "type" or opiate that I can switch to for a few months in the same amount, then return to the original stuff....

    I've tried Opana, Nucynta, and some other "new" medication, and they simply had no effect on my pain, I would compare them to an aspirin, compared to the Oxy stuff. Maye they work for someone not opiate tolerant, but not for me..

    I don't abuse my medication, and try to be as practical and responsible as can be, which is why I'm here posting this. If possible, I'd like to switch up opiates as prescribed by my PM, versus going up to the 80/30 mg combo again, then having to clean it out of my system again a few years from now. I'd much rather do that, then to try another NEW medication, with what would seem to have undesirable side effects for people with a tolerance to opiates like Butrans.

    My PM and I have a great relationship, and he and I work together in managing my pain meds. For that I am truly appreciative of him and his efforts. That said, I know he would be happy for me to present a medication plan instead of just going up on MG levels.

    Thanks in advance for your replies!

    annette030 responded:
    If you and your PM doctor have such a "great relationship" why was getting off of all the pain meds for 2.5 weeks kept secret from him? Think about it.

    Take care, Annette
    Onehurtguy replied to annette030's response:
    Oh no, I may not have been clear. He wanted me to see another doctor, as he cannot prescribe certain medications, and I didn't want to take them, as there is a stigma attached to those medications.

    I went off of my medications through free-will. In fact, I turned the left over medication into him, as I didn't want to overdose being that I had no tellerance for them.

    It's funny you say that, it sounds like you may think I was doing something wrong, when in fact, my only intent was to better myself, which I did...

    You see, this is the problem with taking these medications, everyone assumes that you're doing something wrong because of the negative persona surrounding them. It really is a shame...

    So anyways, back to the point. Does anyone have a regiment of switching medication types that has worked for them?
    ctbeth replied to Onehurtguy's response:
    Hi Onehurtguy,

    Of course, your new MD will see, from your records, that you were prescribed a lot more med and you went through a lot to do what you have done.

    As far as changing from one opiate to another, there is a morphine equivalent to each different med.

    The MD will know this.

    With my MD, and I have read that others do it this way, one is always started on less-than the equivalent, as everyone responds differently to the different meds.

    It really is unfortunate that you didn't tell your MD that you were discontinuing your meds. There are some meds that can be taken temporarily to ease the withdrawal symptoms.

    Not that it matters now, but it could have been less horrible.

    My opinion is that your MD should make the recommendation about which med would have the best potential to help your condition.

    I am not saying this in judgement, but it does seem odd that your MD would want you to suggest a pain med.

    It is the MD's job to assess your pathology and symptomology, know the meds, and make recommendations as to the best "fit".

    Since you're seeing a pain management specialist, he/ she really should know the actions and adverse effects of all the meds that would have potential to help you.

    I have never heard of an MD who prefers his patient to pick his opiate.
    ctbeth replied to Onehurtguy's response:
    Many of us take, or have taken, Methadone for pain management. There is NO stigma here.

    I was taking it for a long time and the side effect of sweating was making my life unmanageable. My MD switched me from Methadone to MS Contin.

    Thankfully, the awful sweating is far less, but the Methadone helped my pain better-than the MS.

    Yes, it is a shame that Methadone has so much stigma attached to its use.

    I think I have a wonderful situation in that my PM practice has its own pharmacy for controlled substances. We get then filled right at the office before leaving. Since all are patients of the practice and all meds are controlled, there is no stigma attached.

    Pharmacists should know that Methadone dispensed to heroin addicts is in a liquid form and the clients get it from a Methadone dispensary, not as a month's supply from a pain management MD.

    Please consider what helps your pain and ignore anyone who doesn't know with what you're living. People who do not live with chronic pain really cannot fully understand what our day-to-day life is like.

    Best wishes,

    Onehurtguy replied to ctbeth's response:
    Thanks for your reply.

    I did not want to take the recommended Subutex or Suboxone, as I've read the they can be even worse than my original medications with respect to getting off of them. Beyond that, I didn't like the stigma attached to them as a "treatment for addiction". I am dependent, not addicted, huge difference to me.

    Now as far as "telling my doctor" what to and not to prescribe would never happen. My wish was to not come to him with "I need to go up" in mg of my medications, I'd like to say "maybe we can try switching them" instead.

    You guys are right, I should leave it to him, my question to all of you, as opiate users is, what kinds work for you, if in fact this is something you've been successful with so that I can "suggest" what may work, and so he doesn't suggest things that don't, like Opana, Nucynta, etc.

    Thanks again for your non-judgmental reply!

    Onehurtguy replied to ctbeth's response:
    Thank you CTB, it's nice not to be judged.

    The Methadone comment was written as sarcasm, though I honestly did not know how methadone is dispensed. That little bit of unknown knowledge is what leads people to judgment most times. I had no idea it was used for pain management, I've only heard of its use for the management of addiction in heroine addicts via the t.v. which only shows my ignorance.

    Again, I meant no offense, I was simply trying to make a point to another about passing judgment, as that same judgment was passed to me.

    I'm not a sneaky addict trying to find new drugs to replace something, I'm looking for options that I might suggest to my PM in lieu of increasing the amount of medication that I take. Simple as that. If Morphine is the same as OxyContin, maybe I can suggest that instead of asking for more OxyContin, switching from one to another will help my body from needing higher amounts of the Oxy. Maybe it's my inability to articulate all of this that is creating confusion.

    Thanks again.
    ctbeth replied to Onehurtguy's response:
    Hi R,

    My pain med history is long. I was also injured in a car accident in 2007/ You can click on my name or little pic to read my brief history.

    When I began with pain management, I was prescribed Oxycontin. It worked really well for a while. I quickly became tolerant to the original dose and had it increased.

    After the second increase, my MD recommended Duragesic( fentanyl) patches. I did very well with them for a while.

    During one summer, I had so much difficulty getting them to stick. I lost three patches in a one-month time. It became more bother to me constantly worrying about losing patches.

    I asked if I could be switched to a po med and began of the Methadone. As I wrote, the pain relief was great, but the side effects were making me miserable. I was sweating so much that I became housebound. I couldn't go anywhere.

    I was switched to morphine contin and decided to have the spinal cord stimulator about the same time.

    The SCS has been a miracle to me. I have written extensively about it on this site. When you click on my name, some recent topics that I've written will show up. There is probably a discussion on spinal cord stim there, if you'd like to read more. I'd be glad to speak with anyone about this modality.

    With the SCS, I was able to reduce my morphine by about 60% over the initial six months.

    Right now, I have tapered down from 210 mg/day to 120 mg/day.

    I am also going to do a drug holiday. For the last 120 mg, I am going to have medical support of a benzo and clonidine.

    I am afraid that I won't be able to take the pain, but I really want to try. I don't see my PM for another few weeks and am waiting to see him for discussion and prescriptions before I abruptly stop the last 120 mg/day.

    Keep in touch, ok,

    ctbeth replied to ctbeth's response:
    P.S. "R",

    I am going out and will not be on line until tomorrow. I am not ignoring you should you post a reply.

    I promise to check this site tomorrow and will be pleased to discuss this more.

    You know, it has been six years for you; that's a long time.

    Have you or your MD considered spinal cord stim?

    Below is a site for the company that makes my unit.

    If you have any questions that I may be able to answer, do ask.

    "Talk" to you tomorrow,

    Onehurtguy replied to ctbeth's response:
    Good luck with your holiday CTB, that is not an easy thing or pleasent thing to accomplish. But if you tell yourself that "I only have the flu", it will make things much easier to deal with mentally speaking.

    My biggest issues were severe diarrhea, which is easily controlled by large doses of Imodium ad, which also will help with the feeling of uneasiness, if taken in the proper quantities. Other than that, was my leg, the pain shooting down was amplified by ten, which I treated with 800mg Ibuprofen. Lastly was my inability to sleep, that was the worst part of this, as after a few days, I would have givin anything for 5 hours of sleep straight. Nothing I tried helped with this, and any medication used for sleep made me tired, but still unable to sleep for more than a few minutes at a time. That part was torture.

    I wish you strength to get past this, but you can do it if you really want to! Again, Imodium ad is your friend, don't forget that! Just don't take it longer than needed (3-4 days).

    Good luck, let me know if you need to talk.

    ctbeth replied to Onehurtguy's response:
    Hi R,

    Thank you for writing and addressing this. I need all the info and support that I can gather.

    My daughter is my primary care giver. I have another friend who helps me when my daughter isn't available. She works full time and is a full time college student. I hate that my injuries interfere with her life, but she says that she is happy and like to help me. Yeah, I know that I am lucky!

    During the "holiday", I've already secured a housekeeper for once a week to take some of the strain off of my daughter.

    I have a few friends who want to help if they can.

    I'll also have Clonidine for the sweats (ugh) and chills and Ativan for the anxiety and restless legs.

    I still have a few weeks until I begin with this last phase. I'll probably be on this site a whole lot during the "holiday".

    Thanks again,

    Jenrick responded:
    Why would you stop the meds cold turkey? You should never do that esp on the dosage you were on. You always need to wean off medications.
    ctbeth replied to Jenrick's response:

    To whom are you addressing your question?
    annette030 replied to Onehurtguy's response:
    Methadone was invented by the Germans during WWII for pain management when they could not get enough morphine. I have worked with methadone as a treatment for heroin addicts back in the early 1970s, but when I was in nursing school it was added to a cocktail for pain for terminal folks. It is fairly commonly used for pain today, at least on the West Coast where I live.

    I started using methadone when I went on Medicare Part D, as it is VERY cheap and I could avoid going through the whole donut hole thing. It is about $25 a month if you don't have insurance, can't get any cheaper than that. I was on a generic of morphine ER before that for many years.

    I never accused you of being a drug addict, I didn't even think of that. I just commented about not even telling a doctor that you have a great relationship with that you were going off of opiates that you had been on for a long time. I thought like Beth that the doctor could have helped you through any withdrawals you ended up going through. There is no need to suffer like that these days.

    Take care, Annette
    annette030 replied to Onehurtguy's response:
    Please see my reply further down this thread.

    I did not assume you were doing anything wrong. I just commented on how you went about it.

    Take care, Annette

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