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spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 8/12/2010 9:13 AM (GMT -7)   
hello, first of all i would like to say to you regulars on the chronic pain site are doing a very adrimal thing by giving people with life-long pain moral and emotional support. in many cases im sure this is the only outlet where we can find people that can relate. i have been seeing opioid tolerance brougt up alot lately. has anyone been offered any anti-tolerance or tolerance lowering methods. i have seen studies about meds that antagonize th NMDA receptors like: methadone, dextrometoraphan, levorphanol, and alzheimer meds like namenda. my friend i posted about the pain pump issue was given namenda cocurrantly to opioids to bring down tolerance but it gave him temporary severe dimensia; so that one is still up in the air. but has anyone heard of this tatic from PM docors or dings this now. some may be promising?
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008

current Rx: MScontin 30mgs 2x, dilaudid 8mgs 4x p.r.n., soma 3x, Arthotec 75mgs\200mcgs 2x, neurontin 300mg HS, vistaril 25mg 3x prn, wellbutrin 150mg 2x(ADHD),Adderall 20mgs 2x(ADHD)

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 8/12/2010 11:10 AM (GMT -7)   
Hi Spinal Soldier we have a couple on here their PM dr has them take a drug holiday once a year for I believe a week. I am sure Frances if she see's this will tell you how hers is done. I do not recall any of our members being placed on the medications you have listed above. Generally speaking the drs will put the patient on a different pain medication and thats it. It is kind of like with any medication if a person is on it long enough there is a very good chance of it becoming ineffective. I have had this happen many times with my BP medication and we just put me on something different. Is your dr wanting to try you on any of the above meds or what? What happened to your friend does not sound too good to me. Sorry I am not of much help.

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 8/12/2010 12:19 PM (GMT -7)   

 

   Hello Spinal Soldier! Good question!

      This subject has interested me for quite some time, and I actually did a little reserch on it about a year ago. While I do believe that my tolerance is rather high for most pain meds, I err on the side of caution when using this term for several reasons.

Straydog is right, in that many Dr's  (PCD) simply find a pain med that works and then that is it. I have to agree, that if one needs long term care in pain management, they should be seen by a PM (perferably). We see many cases, where a PM will change meds several times for a patient. I think this is done to keep a person from building up a tollerance up so quickly to anyone med.

There are some rather unorthodox methods being touted at various places on the web in reference to reseting the receptors for tolerance control. But I would be careful in putting any faith in them. A GOOD PM should be able to answer your questions regarding this subject.

      I do have a friend here on the forum that went through a series of treatments, using (Ketamine) to reset the receptors for her. Also one has to be careful not to pick back up from where they left off when going on a med Holiday. (IMO)

     I have provided you one of the websites here for you to look at, and hope it is not against the rules for doing so. If is is, a Moderator can edit the reply.

 
   Good luck with your reserch!
 
     SE


"Respect your fellow human being, treat them fairly, disagree with them honestly, enjoy their friendship, explore your thoughts about one another candidly, work together for a common goal and help one another achieve it."

Post Edited (Screaming Eagle) : 8/12/2010 1:34:04 PM (GMT-6)


Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2283
   Posted 8/12/2010 5:10 PM (GMT -7)   
Hi!
Like Susie said, my PM & I agree on a drug holiday at least once a year (sometimes I get sick & end up on an unscheduled "holiday").

FIRST & FOREMOST: Please, please, please do NOT do anything without first consulting your PM. You may have an underlying health condition that could result in serious illness and/or death if not managed properly. Almost everyone can go on drug holidays, but some people need to be on a slower titration schedule to prevent dangerous health events.

For me -- and I have a very minor heart condition, so it may well be different for you-- when I am feeling better (i.e., in pain, but not as much as usual) then I work on slowly decreasing the number of doses I take per day (I'm on the lowest dose, so if you're on a higher dose, you would cut down the dose first, then the # of doses/day). I do this by setting specific times when I take my meds -- regardless of how much pain I'm in. Once I'm down to 1-2 doses/day, I apply a Catapres patch (off-label use of a bp med). The next day I stop all narc pain meds. We increase my doses of Lyrica, which makes me sleepy but makes the pain more bearable. I try to stay off the pain meds for at least 7 days. When I can, I stay off for 14 days, but I rarely make it that long. Then we slowly see how much medicine I need after the reset. Usually I need the same amount as before, but I've been on the same dose for nearly 7 years so something must be working (and physically I've gotten only a tiny bit worse -- if you have a rapidly worsening condition drug holidays won't work so don't put yourself through the misery).

During the holiday period, I drink lots & lots of water -- at least 3 liters/day. I wrap myself up tightly in sheets & blankets and if I have to go out I wear tight fitting clothes. I've found eating helps somewhat so if I really want more pain meds, I have something to eat. Basically, try to stay as warm as possible. If I can walk, I do, but sometimes the pain is too awful so I just rub my legs. Compression stockings are somewhat helpful if I am dumb enough to try going into work -- usually I get very little done, so don't schedule this during a peak time at work. For me, I am on an ultra-short acting med, so the withdrawals are much more intense, but they really only last for about 3 days & then start getting much better. Of course, then the pain starts up something awful.

If I need shots, my PM will see me. If things get really dreadful, we will sometimes try another narcotic pain med. There is research that shows that switching to another med in place of a drug holiday does have some benefit, but a true holiday is ideal. If all else fails, we go back on my normal med early.

Hope that helps. Good luck!

frances

PS -- If you're thinking about the Namenda, I personally would talk to a neurologist about the possible side effects & long term effects of using that drug for an off-label use. Any drug that crosses the blood-brain barrier has a strong possibility of causing severe side effects. Maybe it would be worth it, but it seems like that it would be pretty risky to me.

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 8/12/2010 5:35 PM (GMT -7)   
Frances, That was very educational, and good stuff. You are right on the money, from what I have researched on my own.
I have read that taking water will help this process as well.

I'm slowly coming off of my pain meds as we speak, and I think it will be a tad bit harder than I thought.
But of course, as always, my expectations are much too high, and this is what gets me into trouble mentally.

It was interesting to see you write about the worsening condition and the fact that one may be wasting their time.
This is what I was talking about, in that some may think they are becoming more tolerant to their meds, without realizing
that they may be actually getting worse physically.

If I need corrected here in my thought, feel free to jump in and gently correct me :)

As always, I totally agree that long term pain management should be done with a PM.

SE
"Respect your fellow human being, treat them fairly, disagree with them honestly, enjoy their friendship, explore your thoughts about one another candidly, work together for a common goal and help one another achieve it."

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2283
   Posted 8/12/2010 6:16 PM (GMT -7)   
SE-
Wow! It seems like there would have to be about 100 safer ways to go off of narcs instead of using ketamine. I hope your friend wasn't planning on going back on the narcs after the ketamine treatment. But it probably did work. Ketamine is being studied for treating so many things these days -- pain, mental illness, acute addiction.

Basically, it sucks to go without meds. But that doesn't necessarily mean your condition is actually getting worse. There is a thing called "hyperalgesia" basically it means that your brain stops making as many natural painkillers because you are taking synthetic painkillers. The hyperalgesia actually takes months to correct. But if you can somehow take a lower dose of meds for at least 3-4 months, in many cases the pain from hyperalgesia will lessen.

The only encouragement I can offer is to come to HW as often as you need support, to keep telling yourself that it sucks but that it will start getting better soon & to try to go as quickly as you & your doctor agreed is safe -- kinda like ripping off a bandaid. I've found that dragging it out only makes it worse. But if your health doesn't allow that, then you just have to do what you can do.

If you are used to taking meds at a certain time, buy some smarties or tic-tacs or something that somewhat resembles a pill & take one at the same time you would normally take your meds (there's a psychological advantage to that -- even though it's dumb sometimes it tricks your brain a little bit for a little while). Then make a deal with yourself that you will wait at least 30 minutes for a rapid acting med, or at least 45 minutes for a swallow pill. That only a little longer than it would take for the medication to start working anyways & you'd be surprised how often you can make it longer if you just make an effort.

The Catapres patches really did help me, though. They let me go off the meds faster because they kept my heart from beating too many times, but they had the added advantage of stopping runny nose & goosebumps & other miseries.

good luck!
frances

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 8/12/2010 7:28 PM (GMT -7)   
Frances, the Ketamine treatment for my friend was to reset the receptors for her. Not for coming off the narc's. Sorry if I confused you on this :)

I'm now coming off of my meds, and have seen signs of some small withdraws. Not pleasant, but I think I can do it.
I didn't think I was going to have these, but I guess I was wrong.

SE
"Respect your fellow human being, treat them fairly, disagree with them honestly, enjoy their friendship, explore your thoughts about one another candidly, work together for a common goal and help one another achieve it."

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2283
   Posted 8/12/2010 10:09 PM (GMT -7)   
They get a lot worse once you actually stop the meds altogether.
As long as you have a little bit still in your system the w/d's will be pretty mild.
After stopping you feel like you are ready to crawl out of your skin. And that's on top of the pain.

But, at the end of the day you are keeping your organs happier & preserving the option to increase meds later in life when the pain may truly be beyond unbearable.

stay strong!
frances
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