Stopping pain meds

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opnwhl4
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   Posted 7/6/2009 2:28 PM (GMT -7)   
PaLady - I took your advice and decided to post here about stopping these dang pain meds. I have been on hydrocodone 10-650 since my lung surgery in Dec. '07 due to what was thought to be nerve issues following the surgery. I had the Nissen redo May 18th and was in the hospital for 3 weeks due to complications. Since I wasn't allowed to eat or drink I was using a PCA with morphine the whole 3 weeks. When I was discharged they sent me home with Fentanyl patches for 2 weeks along with 10mg of Oxycodone every 6 hours until 2 weeks ago. I am currently still using hydrocodone 5-325's , but I want to stop using them and when I tried to just stop I was unbearably miserable. I know I should ask my doctor to help me taper off, but I am not sure which one to talk to. Should I talk to the surgeon who did my lung surgery and had prescribed the meds for over a year and a half or the one who did the last surgery? The last time I saw the first surgeon was about May 1st.

Take care,
Bill

Mrs. Dani
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Date Joined Jun 2009
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   Posted 7/6/2009 4:29 PM (GMT -7)   
     Hey Bill :-)
 
    *huggs*
 
     I say call both. Present your delima to both. (might even want your primary care in on it too) Tell them both to communicate with each other. Place it in their hand to discuss amongst each other and tell them to call you when they come up with a plan that meets your goals. Then you can decide if their ideas are worth a try.  I think you are well within your rights to ask for such a plan. In your case thou... would be important to have your primary care aware and on board with your plann :-)
 
     *huggs*
       dani
TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


Tirzah
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Date Joined Jul 2008
Total Posts : 2284
   Posted 7/6/2009 6:00 PM (GMT -7)   
I think the best place to start would be with the physician who last prescribed those meds to you. If he is not willing/able to work with you, then try the old surgeon or your PCP. If needed, you might even want to consider getting a Pain Management Specialist involved. Often, the PM's will know a lot more about downward titration schedules and meds to manage the withdrawal symptoms.

You have been on the meds for a long time & really need some expert help. It may be that the pain is too great to go without pain meds, but if it is not the pain keeping you on the meds, then you probably just need someone who knows how to manage dependence on pain meds effectively.

It can be done, but it is not easy. Try to take it one step at a time & be sure to drink plenty of water. The first few days are the worst, then it starts to slowly get better. You might ask your doc about non-narcotic options for treating withdrawal. My PM puts me on a "drug holiday" every year & he prescribes Catapres patches. They are on-label for high-blood pressure, but do wonders for a lot of the withdrawal sx -- runny nose, watery eyes, nausea, hot flashes/chills, goosebumps, etc. -- pretty much everything except that creepy crawly feeling in my legs. Maybe something you & your doc can consider to help you through the worst of it. :)

feel better,
frances
Moderator -- Depression Forum


opnwhl4
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Total Posts : 4961
   Posted 7/6/2009 6:13 PM (GMT -7)   
Dani and Frances, Thanks for the thoughts and ideas.
I believe the last surgery helped with the rib pain I was dealing with for so long. My old surgeon thought it would help once my stomach was in the correct position and the pressure was removed from my diaphragm. So far that has been the case and the reason I am wanting to stop the meds.
Take care,
Bill

Tirzah
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Date Joined Jul 2008
Total Posts : 2284
   Posted 7/6/2009 6:59 PM (GMT -7)   
Bill,
I'm so glad you are feeling better. It sounds like a great idea to try to see if you can do without the pain meds (or at least with less of them :). Just take it slow so you aren't so miserable. It won't help anything if you go too quickly -- your pain will increase & the withdrawal will be miserable. Then you will give up & end up begging your doc to go back to your old dose (well, that's what happens with me, anyways :).

Keep us posted on how you're doing & feel free to post any time you could use some extra support.

peace,
frances
Moderator -- Depression Forum


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 7/6/2009 9:25 PM (GMT -7)   
Hi, Bill,
Glad you posted over here. (BTW everyone Bill has been a great help to me with this Barrett's esophagus issue over on the GERD forum).

Frances has given you some good advice. I would start with whoever prescribed the medication, but I have found sometimes surgeons aren't so great at helping with pain meds. You might get lucky and have one who knows how to help you through withdrawal. If not, I'd contact your other doctors, and ask for a consult with a pain management specialist.

With Pain Management docs, it's important to find out if they work with medications or just do the high tech procedures like epidurals and nerve blocks and such. A lot of them are going that route. Another possibility if you're really having a tough time is an Addictionologist, if you have someone local. That's a doc with a specialist in addictions (obviously!) and they may really know how to help you taper. But as has been mentioned if you have too much pain it may be you're not ready to wean off. You also may need some other medication to help with the pain as you're withdrawing from the hydro.

Keep posting here and we'll support you through this!

PaLady

opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4961
   Posted 7/7/2009 10:02 AM (GMT -7)   
Hi all-
I sent an email to my surgeon today. This is the easiest way to communicate with him since he is always on the go. I am just waiting for his recommendations on this.
Thanks for all the help. I appreciate it greatly.

Take care,
Bill

Hello~Kitty
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Date Joined Jun 2005
Total Posts : 610
   Posted 7/7/2009 10:38 AM (GMT -7)   
Hello, like Palady said, an addiction doctor doesnt just deal with people with 'addictions' but also dependence and can help you taper as that is what they specialize in. I see one for dependence, and he knows I'm not an addict but he is helping me taper off of all pain meds. I was worried that he may not see me since I never abused my meds, but he said he's got like 6 patients on suboxone (including me) that arnt addicts but just need to be slowly tapered off of meds as aour doctors that got us on pain meds where not able to help us. I just think I should throw that out their since you dont have to be addict to see an addiction doctor, just have to be dependant on pain meds and willing to taper off.

-hellokitty

Chronic Pain Moderator

Dx-Gallstones at age 14 that caused Fibromyalgia in 1998. Chronic Pancreatitis at age 15 from Pancreatic Divisum. Fell down cement basement stairs on my bottom in 2001. Got severe migraines after the epidural from my 2nd childbirth in 2002. Was rear-ended by a lady doing 55mph in 2004 then 2 months later rolled my car down a hill and did even more damage to my back. Depression caused by having chronic pain. Asthma from allergies.

meds- Suboxone for pain, Cymbalta for pain and depression, Lyrica for pain and migraines, Imitrex for migraines, Ibprofen for migraines, Ventolin Albuterol inhaler for asthma. Phenergan for nausea, Seroquel for sleep.

"I know God will not give me anything I can't handle. I just wish that He didn't trust me so much."         -Mother Teresa


opnwhl4
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Date Joined Dec 2008
Total Posts : 4961
   Posted 7/7/2009 1:28 PM (GMT -7)   
Hellokitty-
Thank you. Sometimes the titles doctors have are deceiving. I am still waiting to hear back from my surgeon. He has several different residents with him every month. Last month he had an anesthesiologist with him. Actually she is the one who prescribed the last meds. Unfortunately she has rotated to a different department this month. I probably should have forseen this and asked her about it when I had my followup last month. She was there to because she wrote my discharge orders. If he doesn't want to help I am sure my old surgeon will. HE actually sent my to a pain doctor here last year. Unfortunately he wasn't willing to help. He actually told me that I was making it up and sent a letter to my surgeon saying he didn't believe I was having any pain. So my surgeon decided to deal with it himself since that was the only pain management doctor in the area. He is the one who referred me to go see the doctors in Chicago about my stomach issues since the GIs here couldn't figure anything out.

Take care,
Bill

SpaceButler
Regular Member


Date Joined Jun 2009
Total Posts : 23
   Posted 7/7/2009 6:10 PM (GMT -7)   
Bill,

I don't believe I've had the chance to make your acquaintance. I'm very sorry for your trials and tribulations, but applaud you heartily for stopping the opiate-based pain medications.

First of all, talk to both your doctors. They will be able to give you good advice from their respective perspectives. I would feel that the surgery doctor that prescribed the actual medication has some responsibility to give you advice at this point, no?

Second of all, the road of withdrawal is different for everyone - sometimes it is bumpy and long - sometime short and relatively well maintained - sometimes you feel like you drop off a cliff and land flat on your face. I've had several friends go through withdrawals, and it's never been pretty.

The most extreme way to do it is to either "quit cold turkey" or to take an opioid antagonist, like Naltrexone. This will almost immediately kick all the opioids out of your opioid receptors, allowing for an intense 12-18 hours where you vomit, urinate, and make bowel movements uncontrollobly. This is usually only used in an emergency room or hospital setting.

The best way, I've heard, is to ween yourself off and start doing it as soon as possible. One of your doctors may recommend an addiction specialist or psychiatrist/psychologist. They would most likely ween you off and have you take Suboxone (a combination of a synthetic opioid and Naltrexone). I had one friend that has been off his opiate medications for 4 months, but still takes a Suboxone every now and then, as needed. Although the first option is much more intense, many report the entire experience lasting quite a short amount of time compared to this second method, which can take months or years, depending on the depth of your addiction.

Once again, I'm sorry for your misfortune, but glad you're taking the step to get off those opiates. I also sincerely hope that any pain you feel can be at least modulated by NSAIDs or the like.

Logan
Web development, programming, camping, chess, go, painting


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 7/7/2009 10:21 PM (GMT -7)   
Logan,
Maybe I'm wrong, but it sounds like your view of opiates is not very positive. Many of us take them, and need them to have some sort of life. Also, some are safer than NSAIDS for long term chronic pain. So if Bill continued to have pain, a low dose of an opiod might actually be safer for him. But that's all up to Bill and his doctors, of course. I just know long term use of NSAIDS is hard on the GI tract.

At any rate, Bill, I hope you get some good medical advice on a withdrawal schedule and maybe some help easing any symptoms you have.

Let us know how it goes!

PaLady

Tirzah
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Date Joined Jul 2008
Total Posts : 2284
   Posted 7/7/2009 10:50 PM (GMT -7)   
I agree with PA. I thought that Naltraxone was only used either for an emergency like respiratory distress or for addicts. I would definitely get a second (and maybe third) opinion before listening to a Pain Specialist or surgeon who suggested that a patient who was taking a responsible amount of narcotic meds exactly as prescribed be given Naltraxone. It comes with its own set of risks (from what I saw a friend go through) & I can't imagine going through that for a less serious situation.

Bill,
If you do end up seeing an addictionologist, please be sure to ask ahead of time whether they handle patients who do not have an addiction problem. Some addiction specialists only treat addicts. They will not allow others into their practice unless they agree to be treated the same as the addicts. I have talked to people at my PM's office who went that route with their prior PM's & some really benefited from it, while others said they were refused access to meds when in severe pain, were belittled for wanting pain meds, etc. There are some people, apparently even within the field of addiction medicine, who do not differentiate between addiction & dependence. There are some really great practitioners out there who understand the needs of CP patients getting off/cutting down on narc meds. I'm not trying to discourage you, just suggesting that you find out ahead of time how they view that & whether they have worked with non-addicts in the past. :)

take care,
frances
Moderator -- Depression Forum


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 7/7/2009 11:47 PM (GMT -7)   
Frances,
That's a good point about the Addictionologist. Hopefully Bill will be able to get withdrawal help from one of his current doctors.

PaLady

opnwhl4
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Date Joined Dec 2008
Total Posts : 4961
   Posted 7/8/2009 5:39 AM (GMT -7)   
PaLady and Frances, Thanks for the great information. I returned to work last night and unfortunately the rib nerve pain has returned full force. I was afraid it would when I lifted the heavier parts at work. Very disheartening. I think I am going to call my other doctor and see what he thinks.

Take care,
Bill

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 7/8/2009 10:01 AM (GMT -7)   
Bill,
From your description of your work on the GERD forum (you all wouldn't believe what he lifts!!) I'm not surprised about the pain. I just hope you didn't injure yourself - internal sutures, things like that. You went through a lot with 3 weeks in the hospital. And maybe to do that type of work you will need some ongoing pain management - more than ibuprofen. Just as long as it's not something that makes you groggy.

Good luck!

PaLady

SpaceButler
Regular Member


Date Joined Jun 2009
Total Posts : 23
   Posted 7/8/2009 12:52 PM (GMT -7)   
PAlady,

I have a pretty neutral view of opiates most times, and I definitely didn't mean to suggest anything in general terms (it wasn't about you or anyone else's use, just Bill's). I always try to consider a concept or situation from every possible perspective. I was just trying to lend some support to Bill specifically, as he stated he wanted to stop using the opiate-based medications. One of the worst things about opiates, though, is the low LD-50 that most of them have compared to many other pain medications. I had a friend die from an overdose of opiate medication.
Web development, programming, camping, chess, go, painting


opnwhl4
Forum Moderator


Date Joined Dec 2008
Total Posts : 4961
   Posted 7/10/2009 2:51 PM (GMT -7)   
PaLady -
I was worried about the suture issue, but I only had a slight twinge in my stomach area. It was the second time lifting them parts that got my rib acting up again. I did call my doctor about it. Unfortunately he was over booked this week and gone part of next week. I have an appointment for next Friday and sounds like he wants to do another nerve block. Until then I am going to have to continue the pains meds or not work. I have been off way too much this year already, so I have to get back to work to pay some bills. At least with the meds it's an ache and not the burning/stabbing pain without them.

Take care,
Bill

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 7/10/2009 3:35 PM (GMT -7)   
Bill,
Many people here who are still working wouldn't be doing so without the medication. That's what it's for. As long as it doesn't make you groggy or something else that would endanger you with the type of work you do.

Better to take the medication and have your body relax a bit.

Take care!

PaLady
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