Does it have to be this bad?

[BusyGrl]

I'm weaning off of ms contin in favor of tramadol. I started from 45mg ms contin 3x daily, now down to 15mg 3x daily. Throughout my 10 days of withdrawal, I have had wakefulness and the usual withdrawal buzz, and mostly was bothered at night. Yesterday I started have more severe, typical withdrawal symptoms. I called my pain manager and she said they can't offer me anything else to ease the transition. This was after she said it would be perfectly fine and they would help me get off of ms contin.

They gave me 30 clonodine pills with an "every 6 hours" dosage and I stopped taking them frequently because I was going to run out before the first week. "You can get a refill," she said. (Thanks, I'll pay another copayment to get me through another 10 days.) Also, they don't seem to do much of anything.

I understand that it's not recommended to take benzodiazapine-class drugs like alprazolam, but my psychiatrist gave them to me last fall when I was weaning off of hydrocodone. Is it just this PM, or are others as conservative, erring on the side of letting patients suffer? I can't seem to find a doctor who can manage my pain worth a darn. I am so tired of suffering. This is my second time through the h#ll of withdrawals in 6 months, but at least this time I know what is going on.

Please help. Any recommendations? Does it have to be this painful and difficult? And what if the tramadol isn't enough? Should I seek another pain manager? Or maybe go back to the psychiatrist who was treating me well?

[BusyGrl]

Just a correction to one mistake in my monologue: The MS Contin now causes INSOMNIA, not drowsiness. I wish!

[BusyGrl]

Hi everyone,

I was so happy to log on and see your support. It is just after 1:00am here and I am up after a full hour of sleep because the low dose of MS contin I took 2 hours ago is now acting like a stimulant.I can't sleep when I take it, and I wake when the dose is wearing off. Utter h#ll. Good thing I was layed off this month so I don't have to worry about going to work tomorrow.

I am only taking 50-150 mg of Tramadol a day because the pain of w/d is distracting me from the nerve pain. The PM also OK'ed Neurontin, so I had just started increasing the dose to 200 mg/day when I started having bad body twitches that kept me up all night as well. I think that happens only in combination with the MS contin.

Once I read valerian root is good for w/d symptoms. Last week I was at that horrible begging stage and they gave me 7.5mg of Buspar twice a day, which now also seems to not do much. The next day, I waited for the PM to call me back all day and prescribe something so I could enjoy a short trip with my kids and my mom, and they got back to me at 4:45 and said they couldn't prescribe anything without seeing me first. They are definitely fired, Tuck. I share your perspective. I have an appointment with the local teaching hospital--my next shred of hope--on Thursday. I'm trying to decide whether to keep my last appointment with the PM on Wednesday. Is it advisable to have closure with a pain manager before moving on?

In the meantime, I've been seeing an acupuncturist who I swear was helping with the other things that go with chronic pain (depression, sapped energy). He used to work in a drug dependency clinic and seems confident he can help me, but my testimony is that drugs are way stronger than acupuncture. I had a 1-1/2 hour treatment mid-day today and here I am awake and shivering and shaking. This is after taking 15 mg 2 hours ago. I have been taking a crumb of alprazolam (about 0.12 mg) several nights to take the edge off, but I'm afraid of dying in my sleep. It is also not working any more since the somnolence side effect kicked in.

Thanks for listening, everyone. And I suppose it does help to know that I am not alone, bluespence, but I wish we had a solution for each other. I'm sorry you are so far down the road with MS contin, although it is probably not without a good reason. I thought it would take more and more of the drug, so where does it ever end? I am beginning to think that anesthesiologists are sadists.

Tomorrow I will be down to 15 mg/day and I am afraid. The pain was pretty unbearable when I dropped from 45 to nothing; very much like being cold, wet, and naked with no relief. I know what you mean about the cold, tingling fingers. It sounds like not much until you experience it. Very creepy and unsettling. I keep thinking about the Pink Floyd song Comfortably Numb.

I think I'll go and take a fistful of Valerian now!

[Mollyrae]

Hi BusyGrl:

I agree with the above comments. I want to add that it seems your PMP is new to Pain Management. I cannot believe some of the comments or beliefs that these Doctor carry. She very well should know that breakthrough does exist when taking MS Contin or any long acting narcotic. I would bet that her partners will and do prescribe BT meds for patients.

She does not have your best interest at heart. In regards to the Clonidine, I would recommend the Clonidine Patch. I used that back in 2005 when I had to stop taking the Oxycontin. I didn't;t stop the W/D completely but it did make a difference. The only draw back to the patch is having to watch your blood pressure. It can drop pretty low if your not on the right dose.

Please call around and find yourself a new PMP. I realize that they are not easy to come by but maybe with time you can find a better Doc. I'm sorry for all the non-sense that you're dealing with and I really hope it gets better for you. Please take care and good luck in your search.

Mollyrae

[nick30]

You don't say what other drugs you are taking for your nerve pain. Unfortunately nerve pain can be trickier to deal with than other types of pain becuase narcotics often are only useful in fairly high doses. However there are drugs that are specifically for nerve pain, are you taking anything like Neurontin? Be careful with tramadol, at over 300mg daily it can cause seizues(it did in me). However just because it's weaker than MScontin doesn't mean that it won't work. Apart from fentanyl , tramadol was the only other drug to work for me. I agree with Tuck , find a new dr. find a good one and stay with her/him for the long term. the fact that your dr denies BT pain but instead calls it 'bad days' is laughable, but i'm sorry that it isn't funny for you.
regards,

nick

[Tuckamore]

Hi BusyGrl,

I'm sorry to hear about your withdrawal symptoms. I think you may be decreasing too quickly also.

Yes Tramadol is weaker than MS Contin but it may work for you. We all know that Oxy is stronger than hydro but hydrocodone works better for me that oxycodone. Some ppl react differently than others to the same medications. I applaud you for trying attempting to management your pain without a scheduled narcotic. You are brave. However I have heard nasty things about tramadol withdrawal. I hope that will not be true for you.

My physician prescribed break through medication for me and I am on MS Contin. Just a few posts ago we discussed how different physicians had their own personal beliefs, some seem very strange. Break through pain does exist on MS Contin.

And to respond to your closing question, yes, in my opinion I would find another PMP. It appears that your current PMP doesn't have a lot of empathy for your chronic pain or the challenges that it is presenting for you. If you are familiar with me you know how I feel about physicians. They are service providers. We hire them to perform a service and if they do not meet our expectations they should be fired, just as you would fire a poor preforming employee or an inadequate plumber. It is unbelievable to me that we continue to pay $125.00 for ten minutes of poor service. There was a time I was guilty of that but I refuse to do that any longer. Physicians are not doing us a favor, we hire them. I am blessed with an excellent physician of five years but it took years to find one. No one should settle for less.

We are here for you. Hang in there and please keep us updated on your progress. I will look forward to your next post. Take Care, Tuck  

[bluespence]

I am on Morphine, 100mg 2x's a day and there most definitely is break through pain. I am suffereing right now. I take Roxi, 30mg for breakthrough but I ran out early so I only have the morphine and I swear the only thing it does is keep me from going into w/d. My pain has gotten worse over the past few weeks and I am having throbing in my shoulder and lower back and my fingers are tingling and my arm falls asleep all the time. So maybe we can just find comfort in the fact we are all suffering together. This stinks though I hate being in pain all the time. I am 38 and feel like I am 60. Uggg

Good luck to you!

[BusyGrl]

Interesting that you mention xanax for WD. I asked my PM about taking a tiny bit of alprazolam, just at nighttime so I could sleep, and she said no, just take Tramadol and clonodine right before bed. It totally doesn't work, but I know that alprazolam or xanax would. She is paranoid about respiratory problems, so I suffer.

My PM's response to "break-through pain" is that it doesn't exist (on morphine); you just have some worse days and some better days. She never offered anything to help me with the "worse days."

I knew that Tramadol was going to be less effective; I wanted to see where I am after being on narcotics for a year, starting before surgery last May. I'm afraid I'm going to be disappointed, but I have to try.

I will see if the PM can help wean me more slowly. Thanks for your suggestion.

[nurseaudrea]

Sorry to say but Tramadol is a much weaker drug. If MS Contin does not control your pain you can guarantee the Tramadol won't either. Have you tried taking bread thru pain meds for your pain when the Morphine is not enough? I have had to add Oxycodone IR in between the times I take Morphine. It does not take my pain away, but it does help some. My PM doctor also is very conservative. Anytime I weaned off meds I was given Xanax for a week. It sounds like you are weaning down too fast. Anytime I tapered down I did not have wd's until I stopped taking them or was at a very low dose after tapering slowly. If you reduce your dose more than 10-20% at a time, depending on what it is, you will have more severe wd's. Maybe if you try doing it slower that will help you to where you won't feel it so much. Good luck and God bless.