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med tolerance build-up

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Posted 11/21/2012 4:44 PM (GMT 0)
I posted this in another thread, but realized there's probably a lot of people that could speak to this issue who might not see it in the other one. Hope you don't mind me reposting it as a new thread:

Is there a tolerance issue with chronic pain meds? For example, in the beginning, one 50mg tramadol in the morning and one 50mg at night was working perfectly to get rid of my pain through the day and through the night. But after awhile, it started to seem like its effectiveness was wearing off. My doctor said to start taking 100mg in the morning and 100mg at night and I thought: "uh oh! I see where this is going. Flash forward a year from now and I'll be taking 600mg a day!" Is that the reality we're in? The meds only last for so long at certain levels and then inevitably have to get bumped up? I don't know why, but the idea of having to take stronger and stronger doses kind of bums me out.

Post Edited (ookla76) : 11/21/2012 9:47:32 AM (GMT-7)

Posted 11/21/2012 5:05 PM (GMT 0)
Hi there...Haven't had a chance to welcome you to HW yet:)

Tolerance to any medication, not just pain meds, is to be expected...

The way to keep it from happening too fast is to make sure you use all the other modalities to help with your chronic pain.

There is everything from daily exercise, physical therapy, ice, heat, massage, acupuncture, TENS unit, injections, nerve ablation, aqua therapy, steroids, eating healthy, not smoking, counseling, cognitive behavioral therapy, getting proper sleep, maintaining a healthy weight, etc..

As well as using other medications that pinpoint certain types of pain like muscle relaxers and/or nerve pain medications. Even certain antidepressants help with pain.

Opiates should only be a small part of someone's pain management and most Drs. think getting to a level 5 or so on the pain scale using every single modality is good for chronic pain patients as we are never going to be pain free.

If someone only reaches for an opiate to help with their pain...their tolerance will develop very quickly...

Another thing that my PM believes in is rotating medications instead of having to go up in dosages. So for me, I have been on the same dosages for 3 years now and doing well.

I would be leery about a Dr. who jumps to doubling your pain meds instead of moving up in slower increments (by 50mg) or wanting to add another modality if possible.

Just my thoughts:)
Posted 11/21/2012 5:50 PM (GMT 0)
Thank you for the welcome. That's kind of why I think I don't really belong here. My pain isn't exactly "unbearable" - it's very frustrating and distracting and uncomfortable and makes me misreable, but I can still walk and stuff. The constant throbbing in my legs just drives me crazy. I can't find a comfortable position to sit in. I have to sit cross legged to keep from moving my legs all over the place, but then my knees start to hurt from being in that position so long. I don't know where to place that on a pain scale, though. I mean, I have trouble falling asleep cause my legs are throbbing and thrashing around trying to get comfortable (which never happens)... but then I read on here about someone that could die in her sleep every night?! Really puts me in my place... especially since all I need is one 50mg tramadol and my pain is like a 2? While you all are trying everything under the sun just to get to 5. Yeah. I think I'm not supposed to be here.
Posted 11/21/2012 5:57 PM (GMT 0)
LOL...There isn't any qualification or pain level to be here:) You are perfectly welcome and we are all a great big family...

Everyone's pain is relative and it's not about comparing yours to mine or to anyone elses. So please don't think that you don't belong here. It's wonderful that you get to a 2 with your Tramadol...the pain scale is just a way for most Drs. and patients to be able to verbalize their levels. If you are doing well with that medication then maybe just adding some other modalities like IcyHot or a massage/acupuncture could be beneficial as well.

From what you write..it also sounds like maybe a muscle relaxer would be helpful...Obviously I'm not a medical professional...but from the word "throbbing"...that is usually associated with muscle pain..

I am on Flexeril and it works very well for me. There is also Robaxin, Skelaxin, Baclofen or Zanaflex. So, this may be something to discuss with your Dr. to see if it might help.
Posted 11/21/2012 6:09 PM (GMT 0)
I don't take the tramadol anymore. I'm in a bit of a spin here. Ever since I started taking medication for my pain, my libido dyed his hair, bleached his fingerprints, and fled the country. It wasn't a big deal to me, but then my wife not-so-subtley pointed out that it was a problem to her. And the search for a medicine that gets rid of my pain, while not erasing the interest of sheet dancing, has not been going well. My doctor prescribed cymbalta... an anti-depressant! That's like the number one libido-killing type of med! But yeah, some sort of muscle med might be better. But I was hoping for one magic pill that gets rid of the leg pain and the nerve pain (which really comes and goes and, in the grand scheme of things, I couldn't care less about now, I just want the leg pain to go away and my libido to move back in) without the pesky bedroom side effect... cause even though I feel like I sound like a junkie, I really don't want to be taking a lot of pills. I want to take as little as possible.
Posted 11/21/2012 7:27 PM (GMT 0)
I think a few others suggested some things on your other thread about the libido part..It could be due to testosterone issues...

When I took Cymbalta...I never had any issues with libido and I'm a female who is someone who wouldn't give up "romance" (being vague as this is a family site:))

Cymbalta is used for nerve pain and being a SNRI type of medication...it usually doesn't have the same effects like tricyclic or SSRI meds...So it's not in the same class as many of the antidepressants.

I actually had a lot of extra energy when on Cymbalta and had to take it in the evening as when I first started it by taking in the am...I could not get to sleep at night!

Obviously all medications are different for each person so it's all trial and error...

May I ask if you are at a good weight for your height, do you eat healthy and not smoke? These are all other things along with having chronic pain that can affect one's libido...

I think others mentioned possible counseling as well. Finding someone to talk with for a bit about living with chronic pain has been helpful for many of us on here.

If you are still having the same issues and are off the Tramadol...then it seems that this wasn't the culprit so I wouldn't sacrifice pain relief if that medication was working well for you to lower you pain levels..But if your pain levels are doing well without it...then certainly leaving it out is best as there is no need to take a med that isn't helping you...
Posted 11/21/2012 7:40 PM (GMT 0)
I don't smoke or drink or do any recreational drugs. I'm about 5'7" and around 135 lbs. The first two weeks of cymbalta, I was on the edge of throwing up at any minute and could barely stay awake. Then had the blow up with the wife over the lack of "romance" - she had gone out of town for two days and thought I should (and would) be all over her the night she got back. When I was contentedly watching tv in bed next to her (instead of doing things to her), I guess she reached her boiling point. So I stopped the cymbalta and have switched back to neurontin to see what happens. The first time I was taking it, I was taking it with the tramadol - I stopped it thinking that was the one causing the side effect, but then I was having it when just on the tramadol, so then I thought maybe it was the tramadol causing it instead. Any medicine I've had if I enter "does x cause decreased libido" into google, I get tons of results of other people complaining about the same thing, even though the Drs claim it's lower than 1%. So I don't know if I'm just unlucky enough to always be in that 1% and suffer that side effect no matter what I take. Or maybe there's some other issue. My next appointment is on December 5. If my lbido doesn't return after a few days of just being on neurontin, then I'll ask the Dr for a testosterone level blood test.
Posted 11/21/2012 7:46 PM (GMT 0)
It may take a bit longer (a month or more) to get your body used to things again as you have been going on/off medication abruptly that shouldn't be cold turkey'd....So this alone could be one of the big issues causing your hormones to be off balance...

I would go ahead and get the testosterone test either way as it's always good to get a base line at your age.

And it could be something totally unrelated like thyroid issues as this can be common..
Posted 11/21/2012 7:59 PM (GMT 0)
a month! :(

do you think i should have tried cymbalta for a month? i was already on tramadol and neurontin for a long time, so maybe just cross them off the list instead of going back and forth between them? or do you think i should have given tramadol alone for a month and neurontin alone for a month a try?
Posted 11/21/2012 8:07 PM (GMT 0)
I'm just giving a possible time frame that it may take to get your system back on track...

I really can't say much to your other questions...As it's really something to discuss with your Dr...

As I mentioned earlier..most all meds have some sort of side effect to them and they usually go away within a few weeks to a month. That is why many Drs. will have their patients stay on a medication for that long to work out the kinks and get a good feel for if it is working well for them. Same thing with increasing any dosages with meds like Neurontin...they will start very low and tirate up as needed.

Only you can decide with your Dr. what you want to be taking and if it is helping you or not...
Posted 11/21/2012 8:24 PM (GMT 0)
Thank you for all your replies, I greatly appreciate it. My wife and I are going on a cruise for a belated honeymoon. If we're still married when we get back, I'll stop jumping around my meds or adjusting my own dosage. And I'll follow whatever the Dr says after our next appointment. I was supposed to be on the cymbalta for a month, but I stopped after two weeks cause of the marital fight and the unwanted side effect others were claiming to have (so it seemed like a waste of my time to even try it). Next time I'll follow the Drs orders.
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