Going off narcotic pain meds...... Wish me luck!!!!

you should never do it cold turkey

You will probably actually want something that will knock you out, and the doctor probably gave it to you for that reason. The reason is because it can be exceedingly difficult to sleep during withdrawals, even minor ones, so having a dose of valium that "floors you" might be just what you need. Not to mention, as apparently the doctor told you, people are generally very anxious and uncomfortable during w/d so it will also help that. But probably the best thing is it will help you sleep, also you might want to ask your doctor about clonidine. It is a non-narcotic med originally for controlling blood pressure I believe, but is now commonly used to help people detoxing because it is very sedating and helps anxiety (it is actually prescribed for this off-label). Just be careful not to become dependent on those benzos!

By the way, what your doctor is talking about happening to you, from what I could tell, is opioid induced hyperalgesia. Did he say anything about that. It is basically where you become more sensitive to pain because the opioid you are taking causes your brain to upregulate its opioid receptors, meaning it creates more. This is also probably the mechanism by which tolerance develops, at least that is what is commonly believed today. You body also stops producing endorphins (its natural opioids) because of all this your body is unable to cope with pain on its own properly any more for some people. This is bad enough for some people that even though they are replacing their endorphins with whatever opioid they are taking and filling those receptors, they have become so sensitive to pain that the meds dont keep up and do as much as they should, but they definitely are helping some. I imagine he came to this conclusion because you were taking meds and had to increase your dose frequently or felt like your pain was getting worse or both. The good thing is your receptors will return to normal after you stop the med and your body will start making endorphins again. The bad news is that this takes a while and in the mean time, as you may be finding out now as we speak, the pain can be much worse than it was before you started the meds. I am certainly no expert, so do not take everything I say literally especially if your doctor said something else, but I have down a fair bit of research (of medical texts, research studies, as well as online information), read lots of first hand accounts, and also had lots of conversations with doctors (mine and the doctor in my family). I hope this information was useful for you and helps you understand the condition that your doctor is concerned about a little more. You can read about it on your own if you'd like, look up opioid induced hyperalgesia.

I hope things are going alright for you and that the lyrica helps, it has been quite a good med for me and some people I know (though I have migraines/chronic daily headache).
Circa

Post Edited (Circa1988) : 1/18/2008 4:32:35 PM (GMT-7)

I commend you for taking a bold step in coming off the meds but as has already been said just be safe. I know you didn't choose Rehab but You know, it just doesn't sit well with me.

Rehabs are normally for people who are dealing with addiction and not just dependency. Dependency by it's self as you know is not the same as addiction but if one decides to go to rehab when all they have been doing is following the doctor's orders for treatment of chronic pain could come back to haunt you later on. If and when you need to start pain medications again and you must see a new physician who does not know you, if they find out you went to rehab they may think you are an addict. I have seen this happen many times. Federal law also states that it is illegal for a physician to provide narcotics (Opioids) if you suffer from addiction. There are of course ways around this and doctors who can treat addiction but for the most part it could cause some unneeded difficulties.

Now I'm not a physician but I have done quite a bit of research on what is known as Opioid Hyperalgesia. There are studies that say it exists but there are also studies which say that it does not. Some of these studies were based on bad science and faulty data. Now, I won't go into the results here but my opinion is that not enough is known to actually say one way or the other as to whether or not this condition is occurring. There are however physicians who feel that it does exist but a lot of them are basing their beliefs on these faulty studies. To blindly accept a study without question is unacceptable.

Just some food for thought.

Anyways, I wish you luck with the detox and hopefully you get through it fairly quickly and your pain levels stay low.

Post Edited (quahog) : 1/18/2008 9:11:13 PM (GMT-7)

drink lots and lots of water and green tea.  those pills  will being doing everything they can to you to get you to take them. just keep knowing it will go away, good luck.

Actually, federal law is a bit murky in this area. The law does state that it is illegal for a physician to provide ANY narcotic medication to someone who is suffering from addiction. But as you pointed out they can obtain special waivers but there is quite a bit of red tape involved.

Here's an excerpt from the web page pain and the law.

Under federal law it is illegal to prescribe or dispense controlled substances to addicts for detoxification treatment or for maintenance treatment. Some physicians and pharmacists, erring on the side of caution, have denied patients access to legitimate pain therapy, out of concern that they might otherwise be duped into a violation of federal law by a convincing drug addict.

http://www.painandthelaw.org/mayday/brushwood_090102.php

I stand by my original statement.

I also stand by my research that suggest opioid hyperalgesia is a rare condition. As Gramps pointed out the problem is that it is being used by physicians to refuse treatment to patients. It is sad that an obscure research paper, that has not clearly identified identified the "hyperalgesia" theory has been spread all over the media, to further scare the patient population. This happened in a handful of elderly white females. It was not good research. There seems to be a group, in medicine, that is pushing to stop using opiods, without offering any alternative therapy to the patients. This shows a lack of concern about people in chronic intractable pain.

Post Edited (quahog) : 1/19/2008 3:08:41 PM (GMT-7)

I hate to say it, but "opiate induced hyperalgesia" is basically a non-existent condition that docs have made up to create a legitimate seeming excuse for taking you off pain meds.

It's not in your best interest, it's not based on reality, and your doc may not even believe it himself (although many do have themselves convinced -- either way, it's for their sake not yours).....IMHO, I would dump this doc like a bad habit before you get your records showing that you agree with his conclusions and have accepted treatment changes based on them.....

It's not that hyperalgesia NEVER happens, but it's virtually unheard of and doesn't happen NEARLY as much as docs would like to think it does.

Yet another cop-out myth docs use to throw up a smokescreen over their lack of compassion and their massively selfish greed.

The Hippocratic Oath is long since dead.....never forget, YOU are your own "primary care physician." Doctors are secondary at best, and really only exist to carry out the obvious and advise the uneducated. If you learn much of anything about your condition(s) and how to really treat them/manage their pain effectively, you will almost certainly be light-years ahead of 95% of doctors.

Sad isn't it?

Most definitely take this "hyperalgesia" BS with a Mt. Everest sized mountain of salt.

Quahog- I am not trying to start an argument, but the quote you posted states, "Under federal law it is illegal to prescribe or dispense controlled substances to addicts for detoxification treatment or for maintenance treatment." That states right there specifically that it is illegal only for detox and for maintenance (as I said above). What the second part of that quote, "Some physicians and pharmacists, erring on the side of caution, have denied patients access to legitimate pain therapy, out of concern that they might otherwise be duped into a violation of federal law by a convincing drug addict," is saying is that some doctors have denied patients access to pain treatment because they are afraid that the patient will actually be using the drugs as maintenance or detox drugs, thus making it a violation of federal law. Notice that they use the word 'legimate' here in order to show that the treatment actually was legal, but the doctors were afraid of what I said above thus they were 'erring on the side of caution.' It is most certainly perfectly legal for doctors to provide pain medicine to drug addicts as this is something I have talked to my uncle (a surgeon) about a number of times. However that does not mean that it is not MUCH harder for a drug addict to be prescribed opioids for their pain because the doctors are afraid that they will abuse it. For that reason it was wise of you 03Mach to avoid the rehab, suboxone, and the label of 'addict' that often goes with it.

And to everyone out there, opioid induced hyperalgesia DOES exist. It has been noted in herion addicts for a long time (before opioids were used to treat chronic pain often). The issue is whether or not it is such a large problem for people that it increases their pain to a point that the amount of meds that would have to be used would not give any more functional ability to the patient. I do not believe that it is this extreme as often as some doctors like to think, but it DOES occur. It is not an excuse made up by doctors to keep people from taking pain meds. Some doctors might exagerrate the dangers of it and use it to this effect, but it was not 'made up' for this purpose. The main dispute with this problem, as I stated earlier is simply whether or not it is a bad enough side-effect to justify discontinuation of the meds, and of course this varies for everyone.

By the way Gramps I agree that tolerance is a much bigger problem, in fact I do not believe that this is a very serious side effect for most people. As long as doctors inform people of the fact that if they are ever able to discontinue the meds they will most likely be more sensitive to pain than they were before they started the meds, at least for a while. I do agree that some doctors play up the issue of Opioid Induced Hyperalgesia to get a patient off of meds or as a reason not to prescribe them, I just wanted to make it clear that it is a real problem that occurs and can be a major issue for some people.

I hope everyone is having a pain-free day,
Circa

I agree with everything you said. In fact I said most of it myself in my last post. I just wanted to clear up that it is not ILLEGAL for doctors to prescribe opioids to addicts to treat pain. I was not saying anything about there not being tremendous pressures for them not to, obviously there are. I did say that it is much harder for addicts to be prescribed opioids though because doctors are afraid they will abuse them (the root of DEA investigations). I also said that I felt some doctors exaggerate the risk of hyperalgesia and use it to discourage treatment w/ opioids. So really I dont think we disagree that much. Anyway back on topic, dont want to hijack this post.

This was to Quahog not Gramps, by the time I posted it Gramps had made his post inbetween.

Post Edited (Circa1988) : 1/20/2008 4:06:35 AM (GMT-7)

GOOD LUCK TO ALL. AS FOR MY PERSONAL EXPERIENCE HERE GOES; ANTERIOR LUMBAR FUSION L-5 S-1 2002.SEVERE LOWER BACK PAIN&LEG PAIN EVEN AFTER SURGERY. PRESCRIBED EVERY NARCOTIC PILL,PATCH.IN THE END I WAS ON 200MGS OF METHADONE DAILY PLUS K-8 DILAUDID 3XS. AND SOMETIMES THAT WASNT ENOUGH.ANYHOW I SIMPLY GOT TIRED OF CHASSING THAT GORILLA. WENT TO MY PAIN MGT DOC AND TOLD HIM I WANTED HELP. AND THAT MORNING HE GAVE ME 2MGS OF SUBOXONE. WAITED 25 MIN SENT ME HOME WITH PRIscriptION OF 8MG 3X DAILY.LIFE HAS BEEN GREAT.THE HARDEST THING WAS GETTING OFF OF THE METHADONE <PRIOR TO GOING TO DOC I HAD RAN OUT OF METH FOR 2 WEEKS.THE MOST HORRIBLE EXPERIENCE IN MY LIFE. I HAVE A BEAUTIFUL WIFE AND 4- WONDERFUL CHILDREN.AND ALOT OF FAITH IN GOD I TRULY BELIEVE THER WAS WAS AN INTERVENTION FROM ABOVE. I COULD GO ON AND ON JUST BE VERY CAREFUL IT IS VERY EASY TO DEVELOPE A TOLERANCE TO THESE DRUGS  AKA=ADDICTION.

Gramps,
As anyone I know in my personal life will tell you, surgery is the LAST thing I want! At this point they would just be going in there to "poke" around and see what's going on. the 2 neuros I've seen both say I don't need surgery, which is great.... But they also both say I have no real reason for pain! Which I can attest to is absolute BS. I have pain, many days at about 7 on the pain scale. I've had 2 hernia surgeries, been hit by a truck which caused skull fractures, broken shoulder and ear damage and have had countless broken bones. So for them to asume I don't know pain really not only pisses my off but also just plain old hurts my feelings. Most times I've had injuries or surgeries I've been able to get by with some advil, now with my back that just doesn't cut it.

I've heard way to many bad stories about surgery gone wrong and ending up worse than before... I'm going to see a good chiropractor next month, so maybe this will help?? I'm at my wits end. I don't want to be on drugs, my wife wants me off the drugs...... AGHHHHH I'm just so frustrated!!!!!!!!

To top it all off we are now starting to run into financial issues due to the fact that I can't seem to hold a job for very long. Life sucks ***!! I had said to my wife last night; I'm not going to kill myself or anything like that, but if life were to cease I don't think It'd be all that bad. The thing that really hurts is she agreed, and she is always someone who loves life. I'm so sick of bringing her down with my bulls**t.

Sorry for my rant... life is just becoming exceedingly difficult, and I'm not sure how to cope..

Post Edited By Moderator (Chutz) : 1/24/2008 10:19:55 AM (GMT-7)

Chutz,
You would think that someone going into clinical psychology would seek counseling... But I hate going to them! I have actually been thinking about going to see someone. I've been in and out of counseling for all my teen and adult (oohhh I'm an adult ). Now wheres that 30lb abnormal behavior text book so I can throw it at you!!!

Gramps,
I have thought about looking for a good PM team, but I fear they will just put me back on drugs. I really don't want to be medicated unless it's absolutely necessary. I've already had steroidal injections which just hurt like heck and made me sick as a dog for a week each time. What else do PM clinics do? I've heard they do group therapy, and other such voodoo. The funny thing about the whole thing is my PC doc is sure that there is something wrong in there and it can be helped!
I didn't realize that less than 1% of cpp got addicted! I'm not undermining you, but where did you read or hear that? I find it extremely interesting because when I told people that I had an rx for oxy they were all so ooo-aaaa gimme some! And for me it wasn't like that, they relieved my back pain and put me at ease but never really gave me that euphoric feeling. Why this stunned me so much is because when I had taken vicodin for other injuries I got high as heck off of just 5mg and oxy is supposed to be 10x stronger I think!

Its hard for me to believe a DR. telling you to go cold Turkey ??