looking for info on medication holidays

In another thread, medication holiday was mentioned. I would like to hear from those who have done it. What exactly do you do? Can you stop it early and take your meds? Do you wean off, or stop abruptly? I am thinking about doing this as my meds are not working so well and I would liek to see where my baseline pain is like. My PM docs do not want to change or increase meds so I think this may be my only option. I would at least to look into it.

Thanks

 

MerryGirl, Frances does this with her drs supervision, hopefully she will be online soon and can answer your questions. Please do not stop taking you meds abruptly, that can lead to all sorts of problems.

Advice #1: DO NOT do a med holiday without doctor's supervision. That is a bad idea for a lot of reasons from your doctor's no longer trusting you to you finding out you have some kind of underlying condition that causes permanent injury or death.

Also, for comfort reasons, I would suggest asking for meds to manage the withdrawal symptoms. My PM prescribes Catapres patches but I know others have been given multiple meds for each symptom (anti-emetic, anti-anxiety, etc.).

Please, please, please, though, talk to your pain specialist about how to do this safely. Personally, I found out I have an extra heartbeat that 99.9999% of the time is totally benign. about the only exception to that is that if I go through withdrawal at the "normal" rate of speed, my heart has to work way too hard. I get sooo exhausted & it's really bad for my heart in the long run. My PM always makes sure I have a few doses on hand so that if I am really feeling terrible I can tear off the Catapres & after a bit I can take a partial dose of meds. But that can be lethal due to lowering bp too much so really you need to be very careful.

I'm not sure what you're on ... different drugs need to be "holiday-ed" in different ways. I've only been on ultra short-acting meds in the past but now that I'm switching to methadone, my PM said that we would switch to a short-acting med for a month first & then withdraw off of the short-acting med. Sorry I can't be more clear. It's just really a very tricky subject. There are a ton of caveats so really you just need to rely on a trained professional. Just know that the couple of weeks that you are on the drug holiday will TOTALLY SUCK. You will be miserable & in horrible pain & will feel like you have the flu. It is not for the faint of heart (literally or figuratively). For me, it's a good choice b/c it's kept me on a low dose but it's not a fun time.

best wishes,
frances

PS -- personally, I've never gotten my tolerance reset for the short-term. Holidays have kept me from having to increase my dose, but they haven't made what I'm taking work any better immediately afterward. But others have reported that it lowers their tolerance. Just depends. Even if you do get a "boost" it seems to be temporary -- one month, max. So keep that in mind. Have they recommended any other non-pharmacological treatments? That may also be something to look into.

Merrygirl,

I have to agree with straydog. Consult your doctor first (most doctors have no issue, but they can tell you the best way how and if you should tapper down first), especially if you've been taking the medication for an extended time.

With some medications, you can literally just skip a day once or twice a month, if your dosage is moderate and the medication is of a moderate potency. With these medications, you could also do a 4 day holiday weekend. Tapper 25 percent each day until the 4th day in which you don't use any at all. Then day 5 tapper up by 50 percent and day 6 go back to full dosing.  Still consult your doctor or at the least a pharmacist first.

These are just examples and different medications or dosings my require different tappering requirements or require more "holidays" to really have an effect. Its all dependant on your dose, frequency of dose, type of medication, and how long you've been taking it. As White Beard said though, never abruptly stop taking your medication unless your doctor says its safe to just "skip a day" because withdraw can be severe and cause panic attacks, mental confusion, irrational thoughts, cold sweats, nausea, and other flu like symtoms that feel like having a stomach virus and the flu at the same time.

If you tapper *correctly*, your symtoms should be more mild and feel more like a minor seasonal cold and an increase of fiber intake :P

As said above, a holiday also reminds you of the why you are taking them. Sometimes we forget that we are on potent medications and have a decreased pain spectrum, even when we are still feeling pain. If your drug holiday is approved, you should definately feel a differance, although you should try to schedule it when you expect the least pain.

It can definately help reverse some of the additive tolerance that can pile up. Don't expect it to take you back to almost never haven taken the medication, but you should notice your tolerance dropped back a little. The tolerance differance will be more noticable with some medications (example: tapentadol, codeine as they build tolerance slower), and less noticable with others (example: tramadol as it has a longer half life)

MerryGirl considering the meds you are taking , I am glad to hear you will do nothing without your drs advice. I already know how much pain I still have with a pump and I sure don't want to know what the pain would be like without it. I am afraid it would be way more than I could deal with. One thing about CP, we will always have pain no matter what meds we aer on, we will never be pain free unless we are zombied out on the meds. That is hat my PM dr told me.

Have a good weekend.

Hi Merrygirl. Thanks for posting this. It's interesting and you've gotten great responses. Has your doctor ever talked to you about a medication holiday? Do you know if your doc does this with other patients?

If you don't mind me asking, what does your doctor say when you tell him about your increased pain? Why does he not want to move your dose up? I know that doctors don't usually want patients to have frequent medication increases, but if you've been on the same dose for a long time then I think that it's expected that you will eventually need an increase.

Have you recently told your doctor that your pain is higher?

Hugs,

Flower

There are meds like Catapres that can manage the runny nose & such. But you will be in pain. I have been on Actiq or Fentora when I went through withdrawals. The good news is that fentanyl is ultra-short acting so the withdrawal symptoms usually start to improve dramatically after Day 3 (by that time much of the medicine is out of your system).
The research is conflicting at this time about medication increases. For many years results seemed to indicate that the vast majority of chronic pain patients could have steady relief from the same dose of medication for decades if tolerance was managed. In recent years, there seem to be some studies that suggest it may be only about 50% of pain patients who would get steady relief (people with cancer and other rapidly progressing conditions were excluded. Obviously if you have a rapidly progressing condition, you will need more pain meds to manage the extra pain). Some doctors & researchers still believe that it is 90+% of patients who can stay on a stable dose while others believe it may be even less than 50% who are able to do so.
Personally, I will say that although my condition got slightly worse I still get the same relief from the same dose of medication that I was on 7 years ago. And many of my PM's patients say they feel the same way. But in fairness, we have also added in more adjunct treatments -- traction, farther along in PT & a brace on occasion. I still have my tough periods and on occasion we will up the dose for a couple of weeks (maybe once a year) & then I will go back down to the lower dose.

good luck with your decision!
frances

MerryGirl after reading the above I believe you have answered your own question as to why the drs re not willing to increase your medications and I personally think your drs are wrong. You are not receiving proper care for your pain or for you as a CP patient. I would be doing some searching for a new PM dr, seriously. It is not uncommon to run into PM drs like them that have their limits of what they will rx to a patient regardless and thats wrong. You re entitled to quality life, and if you are having trouble getting out of bed some mornings, the answer you are too young for that is the wrong answer. I see lots of red flags with this group and I would not hesitate one bit to start looking for another dr. I can see you in the same boat 5 years from now and getting the same answers from these people. I do agree with you on the weight issue, I know when my husband had surgery, he was in the recovery room and in horrible pain, his nurse commented for his size(he is a large man) the dr had him on a very low dose of pain meds. She called the dr and got the dr to give an increase to get him more comfortable. So, yes there is something to that theory.

I just hate seeing anyone get rotten care, dealing with CP is bad enough and rotten drs on top of it all sure does not help.

MerryGirl my PM dr see's patients with pain pumps only. She has been wonderful to me as a PM dr and I do not believe I could ever get any better care. My prior PM dr that handled my pump would not increase the meds in my pump the last 2 yrs I was his patient. He claimed I was at my maximum dose and that I was on the strongest pain medication that was available. I had no quality life at all, was able to do very little activity wise. When he quit PM he referred his pump patients to this dr and she was shocked at the condition I was in, along with 44 other patients. Her words still ring in my ears that not only was I under treated as a CP patient my pain was was grossly under treated. By this time I cannot stand straight and I walk bent over with a cane. I still cannot stand straight and I still walk with a cane and probably always will. And no I was not at the maximum dose in my pump, in fact the dosage he had me at is where they start pump patients out at originally in the beginning!!! You do not have to settle for poor medical care.

My dr says the point of good pain mgt is to reduce a persons pain and to get them back up able to move around and do normal things in our daily living. We will always have a certain degree of pain but it should be at a level we can tolerate. I am able to do so much more now than whn I was with the other dr.. I am still getting increases in my pump, even though they are tiny amounts, but I am so much more active and as long as I am being active she will not have a problem increasing my meds either.

Merry,
You should not be getting scripts from 2 doctors at the same time. That is doctor shopping. If you are looking for a new PM to replace your current one & are open and honest with them about what meds you are on, have them to bring with you to the appointment, and are willing to give your new PM access to your old PM's records, there's nothing wrong with that.
If your PM had given you a valid reason on why you cannot be on a higher dose & you decided that even though it was for a good reason (like safety) you were going to try to see how much medicine you could get another PM to give you & were totally unwilling to try any other non-phamacological treatments that would be a major problem (and a red flag for most docs) but you're just trying to find a competent doctor with a wider range of treatment options.
I imagine that you would be just as happy if there were some non-drug treatment that could get rid of your pain. Tell your new doc that (& be open to trying new things). Any doc who would turn away that kind of a patient is not going to be any better than your current PM (and maybe worse) so don't worry about it. I have to believe there is someone out there who can help you.

My first PM was a moron. Only wrote for Ultram & Neurontin. Unfortunately, I got covered head to toe in itchy hives every time I'd take a dose of Ultram (which for obvious reasons was not very often). He did get me a cervical collar, but that was the extent of his alternative treatments. Basically, he sucked. I went without a PM for a while & was nervous when I started a new one about telling him I couldn't tolerate Ultram & my neurologist had tried me on a bunch of other options that likewise caused allergic reactions. He was really great. Looked through my records & agreed that they guy was not likely to win PM of the Year. He tried a whole bunch of different things. It took years to get my pain well controlled, but we made pretty steady progress all along. I was just in horrible shape when I started with him. My muscles were weak from not moving very much. I couldn't stand & cook meals from scratch so I had basically been living on junk. I was sick, malnourished, weak & it took quite a while to undo all that. But he set me up with aqua therapy & I was on a number of meds for a while (17 at my peak - don't recommend that, it was mostly meds for side effects & then meds for the side effects of those meds) and really struggled. Landed in the hospital for a couple weeks. It was just really rough. But we stuck to the plan, with a few modifications along the way, and sure enough I got steadily better.

Hopefully you will find someone who can do the same. Whether its meds or pain pump or SCS or whatever, a good PM should take more than 5-10 minutes to listen to his/her patients, should set out the plan so you know where you're going & should respond to basic questions about why they are choosing a particular treatment/dosage.

Also, I'm not sure what the scores mean with your doc. With my PM, based on the Mankowski pain scale, he will medicate to get someone down to a 6-7 and then they either need to add another (non-drug) treatment or learn how to deal with the pain (e.g., pain psychologist). As long as you're able to get out of bed, aren't throwing up & aren't dizzy, he feels the negatives of pain meds outweigh the positives. I'm not saying whether that's right or wrong for you, just that it may be something to take into consideration. When I can't get out of bed & can't talk b/c the pain is so severe & keep throwing up every bit of food, that's when he will up me from the 200's to the 400's. In any case, I don't think the way your PM is handling it is right. Just wanted to make sure you realized that there are PM's who won't up meds unless you're physically sick from the pain; I'd hate to see you go from one PM who won't help you to another who might explain things but still won't give you the relief you're seeking.

blessings,
frances

MerryGirl whatever you decide its your choice. But to be handled the way you are is not right. Sometimes just changing medications around will do the trick with some people without even changing the dose. You seem to have a dr that is set in his/her ways and those kind are always trouble. You cannot expect a patient to remain on the same medication because that patient will eventually over time become tolerate to the medication and it will no longer be effective. My PM dr tells me this all of the time. This holds true with other medications as well. I can usually take blood pressure meds about 2 years then have to change because they become ineffective. When a patient stops responding to treatment the drs ar suppose to change the treatment plan not leave us sinking.

I think Frances must have been reading something else or misunderstood somewhere in this post. I saw nothing about you getting meds from two drs. If your drs are not helping you that is reason enough to find other care. Pain mgt is not a one size fits all either. Usually how you are treated by who ever answers their telephones in these drs offices can be an indicator as to how they treat patients. If you have a crab on the phone you sure don't want to go there, lol.

If I came off strong about changing drs, I apologize but I have had bad care before and I hate to see that happen to anyone. Good luck.

Merry,
I'm sorry for the misunderstanding. My point was that you are clearly NOT doctor shopping & I couldn't understand why you were worried about coming across as "doctor shopping". You are just looking for someone who's a competent doctor. There's nothing wrong with that. :)