Questions: Tramadol Tapering and Pain Management

[Miss_Amy_2009]

I was prescribed Tramadol 50mg/2X -day almost 5 years ago for back/neck pain.

After the first year, my dose was raised by my doctor to 50mg/4X-day...I reduced that back down to 2X day.

I'm currently tapering 100mg/day with 50mg pills...and have gotten down to ONE 50mg pill...

My question: Can someone tell me which is better to do???

Right now my current tapering dose is:

12.5mg/5xday = 62.5mg/daily down to 12.5mg/4xday=50mg

Sooo...I have a 50mg pill to deal with now...and I'm wondering if I should take 12.5/4X a day OR 25.mg/2X day or 50mg/1X day.....

The pharmacist said that one pill only lasts about 6 hours....so I'm concerned about the w/d's on all three of those methods...I guess I'm looking for the lesser way of suffering, of the three.

Can someone tell me which method to use? or another that is better?

Also, at what mg is it safe to take at the last dose and exactly how should I do this? I've heard that I should taper at 10% or 1/8th at a time....but I've been tapering by as much as 25%....but have since slowed that down due to the withdrawals...

Again, I'm taking 12.5/4X day now...is it safe to try to go down to NOTHING at all? or keep tapering? (i.e. one of the methods mentioned above)

One more thing...

Once I am Tramadol FREE.....How do you suggest that I deal with my chronic pain?
I've been prescribed Skelaxin 100mg/4x (as needed) and I haven't taken more than 50mg (breaking one in half) at a time...and not daily....I'm wondering if taking one here and there will help with my weaning process and there after. I refuse to take them daily because I'm not trying to trade one addiction for another..

Any suggestions would be appreciated....If more info is needed, please let me know....

Thanks,

-A

[Miss_Amy_2009]

Good morning.  

Red: I haven't directly contacted Worried yet...but I will...especially if today doesn't go well. So far so good though...we'll see....

Tuck: I've been in pain management for years...I guess it would be good for you guys to know what my diagnosis is: ...Myofascial Pain Syndrome (MPS)

It sounds like a lot of the people on this site have bone related pain...mine is a muscular-skeletal issue...I was in a car accident and due to the impact, my muscles don't relax like they should anymore...which causes the constant discomfort...

I've had trigger point injections, facet block, physical therapy (cranial sacral and myofascial release, TENS units, traction, ultrasound (penetrating heat therapy), chropractor adjustments, wet heat therapy and muscle strengthening...


Day 8

Down to 12.5/4X day = 50mg for two days now...


Whatever I'm feeling before the next dose is due...drives me nuts..I feel the hold it has on me and I HATE IT...especially in the morning...because I feel like I'm ALMOST there and then in the morning, I can't think of anything but getting that 12.5 mg in my body before ANYTHING ELSE! Is this what they call HABIT forming?  

I'm confused about how this drug really works....I've heard that it effects the brain....but I'm convinced that it IS addictive....low doses in comparison to other..or not..I think it's addictive either way...I do not believe that I'm struggling more than most of the people on here..but I AM struggling..for whatever reason..Otherwise, I really don't think I would be in this forum. I wasn't even the type of person to participate in forums...until now.

If it's all in my head..then what is waking me up at 3am when I'm not awake to think about it? Why was I sweating the first 3 nights? Why am I feeling other aches in my body? have my legs kicked? Why am I sneezing all the time now? Why did my immune system feel weak?, The anxiety/worry is the worst part to me...I'm thankful that I can sleep...and things ARE getting better...The discomfort is there...especially in the morning..

I have to continue with some type of pain management...so I'm going to strengthen the muscles that have deteriorated and pay for my own massages (had a prescription but my insurance won't cover it). I'll get trigger point injections and take an anti-inflammatory...and Skelaxin (was told it wasn't addictive by Doc..but pharmacist said all muscle relaxers are addictive - I believe the latter)...so I will take them carefully and NOT daily..just to loosen me up enough to bare with it... I hope I'll be able to manage it somehow...

I want you guys to know that I don't even like saying "pain" when I refer to my condition because it's more like a tightness that is extremely uncomfortable and never goes away...I am fortunate to be able to do most things that I like to do..However, I am limited (probably through conditioning of being "careful" not to over do it) because of a fear of pulling muscles...which happens quite frequently in my back and neck since the muscles are so tight...(imagine pulling a neck muscle 3X in a month..feeling like you have whiplash....each taking a week to start feeling better and then it happens again..and again...same with the back....)...

I have always told my doctor that it's not really a PAIN...(the type I imagine you all to have)....it's an extreme ache and tightness...and dealing with it day after day wears on a person...just the same as it would if it was pain....who wouldn't get depressed?
I spend a LOT of my time in bed...for someone in their mid (now late) 30's that used to be very social and outgoing...is now a couch potato that goes to bed, directly after work.....Not sure if I"m depressed about feeling this way day after day, or if I'm depressed because I can't spend time with my loved ones because I'm going to bed while people are eating dinner together....

Anways...I've always been grateful to be ABLE to walk..and to function in daily living.....but I've somehow started using the word "pain" to get my point across because I look so normal to people that they don't understand what's really going on with me, when I tell them I can't or don't feel up to doing something....I figure that the diagnosis has the word "pain" in it and it's just easier to say that than explain how my muscles are all screwed up...

I want you all to know that I REALLY REALLY REALLY appreciate your feedback...IT"S COMFORTING to just KNOW that there are other people like me out there after being told by some doctors that "it's all in my head"...until I got an MRI done by a specialist..Please know that I'm not here to compare my level of pain/discomfort..I know that so many of you have much more severe conditions to deal with....I'm here to vent and find a way to live without medication....

Thank you so much for listening...

~A

[Tuckamore]

Red you know me well in such a short time. (smile too)

Miss Amy there are other physicians out there that will help you if your current one will not. I have read your post on the Substance Abuse Forum too. I gather you feel you are addicted to this drug rather than dependant upon it for pain relief.

You mentioned that you were concerned how you would live with the chronic pain. I am concerned for you too. Are you in a state that has PM Clinics? If so I encourage you to make an appointment with one. They may be able to offer you some alternate ideas, treatments and or medications.

Best of luck and hang in there, Tuck

[Red931]

Did you make contact with Worried? She was on for awhile about an hour ago.

[Miss_Amy_2009]

Hello again...Well, the doctor that I have now is not the doctor that Rx'd the Tram....but I will talk to him again if I struggle with this any more than I have already...I think I'm ready to let go...I'm either going to drop another dose soon....I'm almost there...Thanks for your suggestions Red and Tuck....your responses give me direction....which brings me comfort..more than u know... :)

[Red931]

I knew you were going to say that.  (smile)

[Tuckamore]

Hi Miss Amy,

I think that Red gave you great advice, especially when he said he would be in his doctors face. You need to consult with him again.

I am not comfortable telling any one how to taper off medications. This is a question that can only be answered safely by your physician. Withdrawal symptoms can be grueling and some times dangerous.

Good luck to you.
Tuck

[Miss_Amy_2009]

Will do! I appreciate your help. Thanks Red! :)

[Red931]

I read your post in the other forum and it is not worded as you did this one. That post gives the impression that you are doing well on a structured plan. That is why worried878 posted back to you that you were doing well and stick to your plan.

She is very knowledgeable in this area, you should pose your concerns to her as you did here and being as you have a goal I'm sure she will be glad to help you.

Send her a quick note or a message.

[Miss_Amy_2009]

Hi Red/MollyRae and thank you both for responding. I've already posted on the Substance abuse forum...That was actually where I started posting before anywhere else....but I'm not getting much feedback, if any at all....

I read Worried's profile, as she actually replied to my post in the other forum..She was encouraging and supportive but I haven't had much of a response from anyone in regards to any of my questions. :( Hence, my post on this forum...

To answer your question..my doctor said to "start by cutting the second pill in half"...then something like "and go from there"....I basically took that as "reduce by halves until gone" but it's not that easy..even if I stay at a dose for days....as I have found...and from what I've read here and elsewhere, it's too much of a decrease...Other than that, I have no direction....and I'm just kind of winging it...

Thank you for your suggestions/feedback...It's very comforting to be here and I'm so glad that I found this forum...This site in general is helpfully to me on so many levels and it's people like you that make it a helpful, comfortable and encouraging place.

Thank you ALL for being such CARING people...

[Mollyrae]

I agree with Red in everything he is saying. You should post this in the Substance Abuse forum and talk with Worried. She can help you the best. The folks in that form know a lot about the w/d process. Good luck.
Mollyrae

[Red931]

worried878 is an RN over in the addiction forum also. She may also be able to help you. She has helped members with tapering plans before.

They are both better qualified than Nick and myself and I am sure either one of them will give you somemore information that you are looking for.

[Red931]

Let me see if I understand at this point. Your doctor wants you to get down to 75mg. a day and then go Cold Turkey?

I wouldn't do that, but that is me. Tuckamore is the RN member in our forum. Maybe she can give you some better advice.

Me....I would be back in my doctor's face. That is what you pay him for.

[Miss_Amy_2009]

Thanks for responding...However, my doctor already knows that I want to quit taking it and I've already have consulted with him about tapering...He told me to go from 50mg/2x day to taking 3 halves a day...that's it...no tapering schedule..and no other suggestions.. :(

[nick30]

Red is absolutely correct. I was going to post earlier but it was too complicated. This is "Dr only" stuff. You are doing well though. Best of luck Amy.

[Red931]

You are asking alot of questions that you should really discuss with your doctor. You have already had a pretty successful taper on your own but you should continue with the supervision of your doctor as Tramadol (Ultram) withdrawls can result in siezures.

There is a nurse here that may have some advice for you as well as two other nurses over in the Addiction Forum. They all offer very good advice but I am pretty sure they are all going to tell you that you should consult your doctor on your decision to stop this medication and what the next step for you should be for controling your pain.

Best of Luck to You.