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Waking up in withdrawals?!

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Posted 6/10/2015 11:07 PM (GMT 0)
Hi everyone,

I have been in pain management for several years. And I have been on some form of long acting pain meds along with break through meds for a few years now. I usually take both either a little while before bed time, or right before, and I always wake up feeling like I'm in withdrawal. I absolutely hate this feeling! I take one of my long acting and one of my short acting as soon as I wake up, but it takes any where from half an hour to an hour before they kick and I feel better. Which really sucks when you need to get up and go to work! Between this and the terrible paiin, I can't move for a while! I can never just wake up and get moving like I used to. Is this normal to feel these withdrawals when you are on these type of meds? Is there anything that can be done to prevent this?!

I hate that I am physically dependent on these meds, and have tried going off of them several times over the years. I tapered down and then stayed off them anywhere from 1-3 weeks. But the pain was just too unbearable! I am working on getting various treatments to reduced the various types of pain, and ultimately hope that one day I can go off them, or at least greatly reduce them. But in the meantime, I would love to find a way to at least reduce how crappy they make me feel, especially in the mornings! Just want to mention that I do take them exactly as directed.
Posted 6/11/2015 1:56 AM (GMT 0)
Taking the breakthrough meds on a regular schedule only serves to drive up tolerance, the baseline amount of meds your body is accustomed to having in your system.
It also leaves you nothing for episodes of severe pain.
You may want to consider reducing that nighttime dose and then eliminating the short acting all together at night.
Posted 6/11/2015 7:06 AM (GMT 0)
I agree with trying to ditch the b/t med at night as it's likely your source of the w/d feeling. Using on a regular bases does exactly as mrsm suggest and drives your need up for that med therefore it's probably not doing much good pain wise only serving to prevent w/d symptoms on the 4-6hr dosing schedule. At night your not awake to take it and the amount in your system drops causing you to wake feeling that way. Better to change the times on your Er Med allowing for better coverage through the night and the slack time to be daytime when your awake and can add the b/t should you need to. Taking it like this allows your Er med to be used up slower by your body as its at rest and metabolism slows then when you awaken and get moving the med will also wake up and start stirring. Your taking them both together is a waste of resources and taking your Er Med too close to bedtime is not the best policy remember the slower metabolism while you sleep and that delays your peak time on the Er med. You want it to be on the rise as you fall asleep covering the night and reaching it's best potential as you begin to awaken to start the day and not knowing what your on and if it's a 8or12 or 24hr med I can't pinpoint a actual timeline.
Posted 6/11/2015 1:53 PM (GMT 0)
My experience has been that there's nothing that prevents morning pain if the medicine doesn't last long enough. I haven't found a long-acting med I tolerate or that works for me, so I sit with my heating pad and coffee every morning for an hour too. I'm on tramadol and hydrocodone.

Tramadol ER doesn't give me anywhere near the relief of the IR, although a lot of people seem to get along with it fine. There's not much use taking a breakthrough pain med at bedtime if you can get to sleep without it.

Maybe your nighttime ER pain med isn't working long enough. You might ask the doctor about trying something different.
Posted 6/11/2015 4:47 PM (GMT 0)
Hi Louise, sorry to read what you are dealing with. When I first started PM many, many years ago & was put on an ER, my dr said not to take the IR's on a schedule with the ER's. He said the IR's were for the bad pain spikes & only to be taken then, otherwise my body would become use to having the extra meds & that would defeat the purpose. Which when you stop & think about it, its true.

None of us ever wanted to be on pain meds but for many it is a way of life. I now have a pain pump implanted & even with those you still have pain & my pump runs 24 hours a day.

Take care.
Posted 6/11/2015 6:52 PM (GMT 0)
You can also time taking the med, just before going to bed, which should give you better when you first wake up coverage.
Posted 6/11/2015 8:14 PM (GMT 0)
Thank you everyone, I will try changing the way I take my b/t meds. Although I don't think I could go without taking them on a daily basis. My ER meds just don't cover my pain enough! But I will really try reducing them though, and maybe not take them before bed.

Just curious though, am I the only one who feels this when I wake up? Do all of you take these type of meds and you don't feel the withdrawals when you wake up???!!
Posted 6/11/2015 8:57 PM (GMT 0)
In answer to the question, when I was taking ER morphine last fall, for the first few days or after an increase, I'd notice a slight fading before the next dose, but not what I'd call withdrawals, just a slight increase in pain. Happened both a.m. and p.m. After that, it felt like a steady amount 24 hours a day.
Posted 6/11/2015 8:57 PM (GMT 0)
I was having morning nausea and vomiting every morning, my doctor thought it was because I was going thru withdrawls cause I was only taking 2 oxy's a day and the last one being around 2pm. So she gave me another one to take before bed, and YaY no more nausea in the morning, well okay I have some every once in awhile but not everyday like before.

So I do think it is from your meds, but sorry I don't know the answer how to stop it cause you said you were already taking one at bedtime and that didn't work for you. Hope you can figure it out.
Posted 6/12/2015 12:24 AM (GMT 0)
I think it is an individual incidence as I don't feel any problems after 24 hours of an ER med.
Posted 6/12/2015 2:40 PM (GMT 0)
Hey MsLouise.Sorry you're having problems.I take MSContin ER and Morphine IR for break-through.

First thing in the morning is usually the worst I feel during the day.I take the IR med as soon as I get up.

I'm not suggesting anyone do this but I usually take more of the IR med during the day then at night.

I try to take my ER med as close to 12 hrs apart as I can.

I don't think I'd call the way I feel in the morning WD's but rather the Morphine dropping to lower levels.

I hope you get to where you're not feeling so bad in the A.M.

Take care and God Bless.

Rick
Posted 6/15/2015 2:00 PM (GMT 0)
MsLouise,
Part of the reason that you think the ER meds don't cover your pain sufficiently is directly related to taking your IR meds too regularly.
The way it is supposed to work is that the extended release medications are supposed to cover most of your every day pain levels. This is your baseline dose and should deliver a constant level of pain management.
Adding taking your IR meds only increases the amount of opiate in your system, when taken regularly, which your body will very quickly become accustomed to having....if you don't take the IR , your body will give off signals that you are in increased pain ,as well as other withdrawal because you aren't giving it what it has become used to having.
If you can manage to reduce the IR medication reliance/dependance and only use them when absolutely necessary, your body will learn to adapt to the ER med dose again, and give you better overall pain management.
The more opiate you put into your body, the more you can create a vicious cycle of ever increasing dose adjustments, and creating mini withdrawal symptoms by relying on/using the IR meds too often.
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