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

I don't knwo what razzle meant but I would question the intellegence of your doctors. Recommending an unsupervised CT withdrawl from narcotics is illogical. It is also more difficult for you than neccessary. Though I agree with you about not wanting rehab on your records. It isn't fair but dealing with the repruccussions of having rehab on your record regardless of the reason is just to difficult and long lasting.

 o3Mach,

    Bravo! I think. I have just had the same thing happen to me. I was in a bad car accident in 1994, was struggling with it, set an appt. to see another doc to get 2nd opinion, was hit again on the way to the doc. Doc referred me to a pain mgmt. doc who put me on a pain patch in mid 2002. I have been having major problems, first thought it was menopause, did all to fix that problem, 2 years later still having tightness in neck and shoulders and never ending headache. I myself concluded that it was a "rebound" effect. My body had finally tired of having the darn thing on my body slowly poisoning me. I didn't stop cold turkey though, I cut the dose in half and bit later in half again. I feel so much better. Part of my pain problem was fixed last year when I had surgery, then I wokred really hard in physical therapy to make the rest get a bit better. I don't know if I can keep going and step off of it completely, but even if I stay at 1/4 the dose, it's better than I was before. 

    I commend you, too many people choose to go in deeper when they hit a post. I think your doctors advised you correctly. I have since read that pain mgmt. meds shorten your life by about 10 yrs., you can not be covered for any long-term healthcare, and you will notice, that your mental clarity will return. It is amazing how clear my head is now. I had no idea I had drifted so far away to begin with.

    Don't get me wrong, I believe pain should be treated, but then, if you can, work to make it better. I personally found the doctors didn't help much in this area. I found a sports doc that referred to me an excellent P.T. that used a new method. Since my problem was scar tissue healing over nerves and leaving the muscles in spasm, I needed someone to take the scar tissue away. Surgeons said they would not touch it that it was too close to the lung. Then I found my Physical Therapist who used a new system to deal with scar tissue. They worked on the scar tissue, slowly I was able to start doing exercises to use a whole set of muscles I hadn't been using and they had atrophyed.

   Didn't mean to get into all that, Good for you. IF you have problems, consider that it might be easier to step down, then off. I have come to learn that if you take another drug to get off the first drug, you will become addicted to the second drug. When dealing with addiction (which what happens to us when we treat pain, not like addicts, but we do become addicted) we can move from one to the other. The way I'm doing it, I'm not taking anyhting else.

    GOOD LUCK! times two, three, four whatever you need. You go for it!

I really just cannot buy the idea that chronic pain patients do not feel the euphoria of the pain medicine they are taking. I just think that some people interpret the sensations as good and therefore euphoric or, as more people who are truly trying to achieve functionality and relief would do, look at the sensations as a side effect and therefore bad. It also causes a slurry of other side effects which both recreational and medical users experience. What really makes it difficult for me to believe is that the same receptor that opioids bind to in order to cause analgesia, the mu receptor, also mediates euphoria, and you cannot create a molecule (so far) which binds to the mu and only activates the analgesia but does not deliver euphoria. The two are intrinsicly intertwined, though you can create molecules with less abuse potential, they also tend to have less analgesic potential. The mu receptor also mediates respiratory depression, nausea, and itching, all of which are experienced by both recreational drug users getting high and CP patients in true pain trying to relieve it. I, for one, think that the reason many pain patients do not feel any euphoria from their medications is that the doses (when a non-tolerant patient starts on opioids) are much smaller than doses taken by even non-tolerant recreational opioid users, and also they do not interpret what they feel as euphoric. Just as some drug users do not like opioids but prefer instead benzos or stimulants. Why? Because not everyone interprets the same stimuli in the same way (I see black you see navy blue kind of idea). Along these lines I think that the majority of chronic pain patients, as this is a non-drug using community mostly, may not notice the euphoria or interpret it as good. But if someone is in real pain, is non-tolerant, and is suddenly slammed with morphine in the hospital after breaking a leg, they most definitely will report the experience as being euphoric, despite the presence of real pain (and I have had multiple people tell me this happened to them when it happened, all the way from age 11 or so). Thus the idea of the drug JUST helping the pain, seems, in my mind, to be a gross oversimplification of a much more complicated dynamic at work.

When people on here talk about how they changed to oxycodone and they were 'all jazzed up' or that 'I felt weird' or more commonly, 'I did housework all day.' This is one of the properties of oxycodone that drug-users seek so much, THAT IS THE EUPHORIA! It is not some magical place of bliss, drug addicts become addicted to exactly those kinds of feelings. Or when people on morphine or dilaudid or methadone say that they were doing something but they had trouble staying awake and that they were nodding off, that is what drug users seek. In fact an opioid high is called 'nodding' because you nod in and out of sleep during it, just like I am sure many patients here did when they were starting their meds. The difference is that most of you probably did not enjoy it because you were trying to gain back your life, and 'nodding' is not exactly conducive to that. That is what I think the major reason is that most chronic pain patients dont become addicts, because they interept the 'high' as a bad thing, whereas addicts crave it. (BTW I have read MANY MANY stories like those above about the patients, here and on some other chronic pain sites, and also I have seen with my own eyes my friend who was in terrible pain with cancer do this exact thing, and she was very very 'high' and it was apparent, but she did not enjoy it particularly, except for the pain relief.) I hope people understand, I am not saying that chronic pain patients take their meds to get high. I am merely saying it is a bit rash to suggest that being in more pain somehow eliminates one of the primary effects of a drug. I am just trying to say that people, for the most part feel the same effects from the drugs they take, despite the reason, but interpret those effects in vastly different ways. I hope you guys understand.

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

Post Edited (Circa1988) : 2/3/2008 6:35:25 AM (GMT-7)

I have read much here about pain and the use of different medications. Fortunately through my issues of the past 15 years, I have never used anything stronger than hydrocodone. Through the years, it was possible to simply work through the pain and block it out. I think everyone who knows anything would agree that blocking pain out can be done for a period of time. 15 years after my first surgery, I have a much tougher time blocking out that pain. Frankly, I think it is a combination of the pain becoming much worse and the fact that I am just mentally tired of being in pain. By the way, I have worked in law enforcement for 26 years and have put my fair share of people in jail for illegal use or abuse of narcotic pain medication as well as many controlled substances. O.K., feeling euphoric or a little foggy is probably not the greatest thing for anyone, but it beats the hell out of aching and hurting so bad that staying focused on a work project or anything else is impossible. My definition for addiction is this. Addictions are created through choice or need. Someone using narcotic pain medications who began their use from social use with friends needs the psychiatric assistance. Those of us who experienced actual injuries resulting in surgeries to repair structural issues or those of us who have unfortunatley developed diseases causing severe pain are a little different. I'm not sure about you guys, but I could not give a crap about people and there opinions about the use of opiates causing additional pain. Hell, I'll take them. I have not been normal for 15 years. I can not sit around trying to fool myself into thinking that it is important to be like everyone else. I can not act like there is nothing wrong with me anymore. I just want to feel well enough to do things with the people I care about.

My history: 1993 Disc herniation w/ laminectomy L5/S1 - failed in PT

                1993 Anterior/posterior fusion L5/S1 - failed would not fuse

                1994 Failed fusion - Posterior Fusion redo -

                2004 Disc herniation w/ laminectomy L4/L5 - failed

                2007 Failed laminectomy - Posterior Fusion

Pain: Consistently at a 7 and often reaches a 9.

 

I know you have probably said but what is your diax. Have you ever been checked for Chiari  or Syringomyelia ?

http://www.chiarione.org/symptoms.html

Like I said, I I am not accusing anyone of 'getting high' from their meds or anything like that, I just suspect that many people experience euphoria from opioids and do not recognize it because the feelings produced by these drugs are pretty subtle, or that they feel it and write it off as a negative side-effect. So when they are asked if they have felt good or euphoric from their meds, they dont think they really have, because those feelings were negative to them (being as they would impair their functioning). That is one interpretation. Also tolerance to the euphoric effects builds quickly, and so people who have taken pain medications, even just for a short period of time at any dose are probably somewhat tolerant to opioid euphoria. By that I mean if they are on a low dose of oxycodone, hydrocodone, or whatever, but they had been on an even lower dose of codiene or tramadol for while before, they are not likely to feel much from the new drugs, even though they are stronger because it is still a low dose and some tolerance built while on the weaker meds will inhibit the euphoria (the tolerance will make it so the dose of the new med is too low to feel euphoric for some).

Also you said you never increased in 1.5 years, this makes it very likely that you would feel no euphoria due to tolerance. And you become tolerant to the painkilling effects more slowly than to the euphoric effects and the other side effects generally (except constipation, no tolerance ever gains to opioid caused constipation). Also this illustrates the fact that because tolerance to the euphoria builds so fast, it is gone within a week or two of starting opioids for the most part. Most pain patients will not raise their dose because they need pain relief and thus need a months supply of their meds to live. In turn, these people will not experience euphoria at all after starting their meds because they are on a steady dose, as you were, for long periods of time. If someone raised their dose by a lot in an attempt to get high (which some pain patients do, because they are possibly addicted), in the same way alcoholics drink more, or herion addicts take more, they would experience the euphoria, I am quite sure. This is despite how 'real' their pain is or how chronic it is.

I am open to believing that CP patients have a different effect from opioids than the general public, I just do not like the explanation that 'pain soaks up the high' and the like, because I have seen little chemical evidence to back why this would happen. But dont get me wrong it could, I am just looking at all possibilities and right now the one I posted above seems most likely to me.

Post Edited (Circa1988) : 2/3/2008 4:49:43 PM (GMT-7)

Circa,
I have to disagree on one statement you made: "except constipation, no tolerance ever gains to opioid caused constipation". When I first started taking the oxycodone on a regular basis I was constipated like all heck. I wasn't really aware that it caused this, my sis in law was like "you should take a stool softener or you might get backed up" (maybe a but paraphrased). So I did for a few months off and on. I no longer have any issue with it whatsoever. Not really an important, relevant or even tactful thing.... Just something I noticed.

Like I said it's very plausible that I'm just tolerant to the euphoric effects. I mean sometimes I wish I felt that feeling, but I'm not willing to do anything to pursue it. I just found it odd that I never really felt that warm, fuzzy floating on a warm bed of water feeling that I did prior to the back issues. Are you at all interested in the technical/scientific side of this topic? If so I can see if my sister in-law can point me to the studies that talk about this.

JohnK,
I can see where you are coming from. After 15 years of chronic pain you must be tired!! For me I just feel it's too soonfor me to give up and accept that I can't be a normal pain free person again. I mean heck... I'm not even 30 yet!!

TexasJen,
"doesn't ruin their lives" (partial quote from your reply)
I'm starting to feel like they are somewhat ruining my life. I mean, I'm dependent on them, if I don't take them every 8 hours or so I start feeling the icky crudy stuff. I also feel like everyone looks at me like I'm some sort of crackhead! My mother in-law just recently found out...even saying that "found out", like it's some dirty secret... Anyways she just discovered I was taking them. When I was coming off them, I think my wife was stressing a lot and talked to her about it, and her reaction was something like "Oh no, is he addicted to that stuff, that's not good". She knows I have issues, and I'm sure she realizes (somewhat) the situation, but it just makes me feel like a looser at times.

The little holiday I took off the meds really put things into perspective, and has really hit me hard. I just don't feel right anymore, I felt pretty worthless before, but not like I do now. I just hope things start looking better soon.

The hydrocodone was at least a year before the oxycodone (I can't remember when my last hernia surgery was). I know they say that tolerance is never really lost, but it was a pretty long period between the 2. Different opiate variants effect individuals differently, so maybe I just had a stronger reaction to the hydro.

I hear you about school! I'm taking a bit more than my normal load, and it's getting rough already and it's only 3 weeks in! I'll ask her about the studies, so she can look into it (she's on her next to last rotation so she's busy) just in case you do want it ever. Plus I wouldn't mind seeing what I can understand in it. Maybe my constipation well lack there of has to do with vegetarian diet? I've been a vegi for like 6 years, maybe it just took some time for my system to learn to process the meds? sorry to see I'm not the only one still up.. 2:30 am here....

Yes, tolerance to the relief does occur. It just occurs at a slower rate, and for some a much, much slower rate, so much so that a stable dose can handle their pain for years. It has been observed, as I earlier pointed out, that tolerance to different effects occurs at different speeds. Constipation is a perfect example of this, the tolerance to it grows very slowly compared to the other effects. Some people will not become tolerant to the itchiness, for example, though they ahve become tolerant to the other effects, while others may become tolerant to nausea slower than most of the effects. It seems that tolerance to the individual effects are mostly independent for some reason.

I absolutely cannot stand the steroids. When I told one doc. before "they make me want to kill someone." He kind of laughed and said, "yeah, they can make you edgy, but they really help with the inflammation." I had to explain I was not "egdy" and I was NOT joking, I really wanted to inflict serious bodily harm. The subject of taking them has never come up again.