Question: opioids and fatigue

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cogito
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Date Joined Oct 2010
Total Posts : 785
   Posted 9/30/2012 3:43 PM (GMT -6)   
Hi all,

I started taking opioids about 7 years ago, and until about 2 years ago, they tended to pep me up -- especially hydrocodone.

However, hydrocodone no longer does that and oxycodone seems to make me even more drowsy.

From a few searches, I've seen that this is a fairly common phenomenon. For some people opioids, seem to give them more energy, but then that goes away and leads to drowsiness instead.

What I'm wondering is for those who have lived through this pattern, whether the drowsiness eventually abates. Even with my relatively mild opioid regimen, I'm finding myself struggling to stay focused and have been too sleepy to work much of the time.

My sleep has been fine -- about 8hrs per night. I exercise moderately, etc.. But from late morning through early evening, it has become an ongoing struggle to get work done.

So, can I expect that this will eventually pass?
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds:300mg Ultram ER daily, 2x 10mg Oxycontin daily, Oxycodone 5-10mg or Hydrocodone 10-15mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 9/30/2012 3:56 PM (GMT -6)   
I can't be of much help as I've never gotten an energy boost and I've never been fatigued with them.

The only time I read about major fatigue with opiods is when someone takes too much but that is certainly not your case...

Fatigue can be caused by so many other issues...lack of deep sleep...even if you are clocking 8 hours..you may be snoring or have the beginnings of sleep apnea, stress, lack of exercise, pain, lack of a healthy diet, not enough water each day...

The times you mention are certainly common for people to have a dip in their energy levels..

What do you eat in a typical day? How about any caffeine? How much water do you drink?

When do you exericse? You sit behind the computer most days for work is that correct?

If this persists...I would speak to your Dr. about it. I just can't imagine since you haven't made any huge changes to your dosing of meds that all of a sudden they would be the cause of fatigue for you.

If I have a day where I have a little dip in energy...I will add an iced green tea as it's a small amount of caffeine to give a steady boost. As well as I will have a snack of a protein and a complex carb. I will also get up and go for a walk or do some stretching.
SB (Snowbunny) and the pup that snores (my yellow lab:))

3, two-level, cervical fusions over the past 11 years. The last one was anterior and posterior with lots of fun titanium!
Still have active herniations along with knee problems and another Morton's neuroma in left foot.
I try to find joy in each day even with chronic pain:)

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 9/30/2012 4:35 PM (GMT -6)   
i can only speak for the hydocodone, from being on it steady for over 2 plus years. for the first 3 months or so, it would make me drowsy, but once i became "opiad tolerent", i can't attribute any drowsiness or fatigue directly to the med. there are times i wish it had that effect. i take a total of (6) 10/500 loratabs a day, and I am allowed up to (8).

i think the answer here would vary a lot person to person, weight, metabolism, etc, and whatever other drugs a person is consuming.

david
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 4974
   Posted 9/30/2012 4:37 PM (GMT -6)   
….for me I think the so called energy boost, is from the relief we get from the pain med, but as the med wears off then there is a physical letdown, especially if a patients has been on the med for a long period of time. This is where the ER meds are needed, and followed up with a BT if as required during a flair.

If you are on an IR med they you will probably notice this more. I'm not sure I answered your question correctly, but I have heard of the energy boost by more than one patient.

Good question though!

SE wink
Moderator Chronic Pain Forum

Weekly Quote!

Most of us, swimming against the tides of trouble the world knows nothing about, need only a bit of praise or encouragement - and we will make the goal. ~Jerome Fleishman

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 9/30/2012 4:41 PM (GMT -6)   
SE, if I am understanding you correctly, I think I am in agreement. If my pain is under control at a given moment, it does give me an "energy boost" as you put it, and I am usally able to get a few things done. When the pain is flaring up, there are times where I almost feel paralized by it and get nothing done. When I am in that mode, I have learned the fine art of almost freezing in place and not moving a muscle, until the pain ebbs away.

david
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 785
   Posted 9/30/2012 4:42 PM (GMT -6)   
HI SB,

I usually drink one cup of coffee when I wake up, then if needed, another to fight fatigue mid-afternoon.

Exercise times vary, but typically in the afternoon -- sometimes in the early evening.

The shift from energy to fatigue has been gradual over the past couple of years -- and it seems pretty clear that the BT med was the cause in both cases. Typically 30 minutes after the med, one or the other would begin.

It used to be the case that I couldn't take any BT med after 5pm, as it would prevent me from sleeping until around 2am. That no longer is a problem. I can take something at 8pm and sleep fine. But the problem is that my regular BT dose of oxycodone in particular makes me too sleepy during the day. It has been an incremental transition, presumably as some receptors have slowly transitioned -- maybe accelerated due to my starting oxycontin this summer.

I've mentioned this to my PM a few times, but I've just been dealing with it rather than looking for yet another med change. It does, though, get frustrating as now both pain and BT meds seem to impair my work. Formerly, the latter would both deal with the pain and allow me to remain on task.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds:300mg Ultram ER daily, 2x 10mg Oxycontin daily, Oxycodone 5-10mg or Hydrocodone 10-15mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 4974
   Posted 9/30/2012 4:45 PM (GMT -6)   
…yes! you read me correctly David. Usually my meds hit within 35min or so, and it is at that time that I have to take advantage of the pain relief. about 3hrs later…the pain is well back on its way downward,...…and I feel drained. I hate that feeling! shakehead

SE
Moderator Chronic Pain Forum

Weekly Quote!

Most of us, swimming against the tides of trouble the world knows nothing about, need only a bit of praise or encouragement - and we will make the goal. ~Jerome Fleishman

Snowbunny21
Veteran Member


Date Joined Jan 2010
Total Posts : 3557
   Posted 9/30/2012 4:54 PM (GMT -6)   
One other natural thing to do...

How about working out in the morning or right before lunch? Is this possible?

Reading through your signature though....and I apologize for asking this again....but I guess I don't understand why your Dr. has you on two long acting meds and two short acting ones..

Maybe this is something that is causing the issue as most of us don't do this and after being on meds for awhile we don't get a huge boost of energy or fatigue from them.

Of course I agree with others in that when our pain is relieved that we feel better...but my meds and days are so consistent that I never feel a big swing either way.

So...do you take the Ultram ER every day?

If you alternate the Ultram and Oxycontin...you are swinging widely on strengths as Oxycontin is a lot stronger than Ultram...

And then switching from Oxycodone to Hydrococone for your BT med....same thing...you are really swinging your body/receptors greatly with this.

As mentioned...I don't know of hardly anyone but you that is on these 4 types of meds simultaneously.
SB (Snowbunny) and the pup that snores (my yellow lab:))

3, two-level, cervical fusions over the past 11 years. The last one was anterior and posterior with lots of fun titanium!
Still have active herniations along with knee problems and another Morton's neuroma in left foot.
I try to find joy in each day even with chronic pain:)

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 9/30/2012 6:20 PM (GMT -6)   
The Loratabs with me are very consistent, it takes a full hour to kick in, I know this in advance, and when I can, I plan activities knowing that. I don't have the advantage of caffine in my life, perhaps I should consider it. I haven't drank coffee, tea, or caffine sodas for over 25 years, was always an irratant on my stomach even way back then.

My last pain med pass is either 8 or 9 pm at night. I never take anything else for pain during the night, but sometimes if I wake up in pain, I wonder. Going to disucss this with my oncologist/pm on my next visit.

i have been dealing with chronic fatigue since 2000, after I did my first radiation treatments for the cancers i fought before my prostate cancer came on the scene. my radiation oncologist said at the time, that i would be lucky to get back to the 75% mark, and he was right. When I underwent even more radiation in 2009 for the prostate cancer, it made the chronic fatigue even worse. if i could quantify, i would say at most, i have 40-50% the energy level i had back at year 2000. i just have to keep making adjustments in my life and QOL to compensate for the loss.
Plus I was 48 back then, and I am 60 now. Even natural age causes dimmishing energy levels, as much as i hate to admit it

david
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3223
   Posted 9/30/2012 7:09 PM (GMT -6)   
cogito I used to take Vicodin and Vicoprofen which has Hydrocodone in it, and Hydrocodone had that affect on me, if I took it at night I would be wide awake most of the night! Instead of making me drowsy it would make me wide awake. It also kind of gave me a dopey feeling that I did not like. Oxycodone does not do that to me, it doesn't make me drowsy but it doesn't keep me awake either, and it doesn't give me the "dopey" feeling either, it just relieves my pain.  Anyway allot of these medications would act like a stimulant to me, oxycodone is one of the few that doesn't. I know allot of people talk about Benadryl as making them sleepy, and it does not have that affect on me either. It is interesting how different people react so differently to the different medications.
 
White Beard

Snowbunny21
Veteran Member


Date Joined Jan 2010
Total Posts : 3557
   Posted 9/30/2012 7:25 PM (GMT -6)   
WB...I am the same about Benadryl...it makes me wound up and wide awake!! LOL..
SB (Snowbunny) and the pup that snores (my yellow lab:))

3, two-level, cervical fusions over the past 11 years. The last one was anterior and posterior with lots of fun titanium!
Still have active herniations along with knee problems and another Morton's neuroma in left foot.
I try to find joy in each day even with chronic pain:)

Matt-man&little-boy
Veteran Member


Date Joined Jul 2012
Total Posts : 788
   Posted 9/30/2012 7:44 PM (GMT -6)   
Hi cogito, I am judt curious when the last time you had a blood test was, being a gradual decline of energy, perhaps it could be declining testosterone levels in your body. My twin brother and I are both 28, but he has had half my energy for years, and finally found out that he doesn't produce enough testosterone. The doctor called it male menopause, and said that me and him age almost half again as fast as normal folks if we don't keep up on our vitamin supplements, this is because of having a gastric bypass surgery. I'm basically saying that I wonder if your meds could just be compounding a different problem.
Matt
dx: just had L3-4 XLIF and ILIF, gotta see what happens. Disc bulge in T12-L1, ddd through rest of lumbar region. Gastric Bypass 2003, bleeding ulcer in pouch 2005, full small bowel obstruction 2011. Left shoulder has Bursitis, tendonitus, separated bicep muscle (I was told all the muscles look like string cheese lol, or a frayed rope), and arthritis of the Glenoid and humeral head.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 785
   Posted 9/30/2012 7:47 PM (GMT -6)   
WB -- likewise, I found that hydrocodone would have more of a stimulant effect, and oxycodone has pretty much always been a bit sedating.

SB -- I realize that 2 ERs and 2 IRs is uncommon. The double ER is basically due to the max dose of Ultram not being strong enough, but finding anything above the 10mg Oxycontin to be too sedating as well as impairing my memory and concentration. As for the 2 IRs, that's because of the sedating issue as well. During the day, I'll take hydrocodone as it doesn't impair my concentration, but also doesn't help as much as the oxycodone. So, hydrocodone IR during the day, and oxycodone IR for evening needs. I've actually been using the hydrocodone/oxycodone IR this way for about 3 years.


Eventually, I'd like to stop the Ultram and switch to Cymbalta. I think that the former's benefit at this point is primarily in its SRA effect. However, I can't afford the time it will take to make the transition until my book and a few other projects are out of the way (3.5 months left per my contract, then 2 more promised research papers after that -- one in late Jan, the other in April).

Off topic -- tomorrow I'm going in for a myofascial release massage. I've not had one before and am hoping that it will offer me some relief.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds:300mg Ultram ER daily, 2x 10mg Oxycontin daily, Oxycodone 5-10mg or Hydrocodone 10-15mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 9/30/2012 9:57 PM (GMT -6)   
matt,

you bring up a good and important point concerning testosterene levels in men. in my world of prostate cancer, one's "T" level is very important to know, as it is a fact that hight testostrone levels fuel or feed prostate cancer.

for many men with advanced prostate cancer, they are put on hormone therapy to lower the "T" level to as close to zero as possible, with the thought of slowing down the growth of the cancer. It can't cure the cancer but it can buy time.

However, for those men on hormone therapy with low "T" levels, one of the most common side effects is fatigue and even chronic fatigue syndrome. So your thinking on that point may very well be the case for your brother.

hope you are still doing better yourself

david

It's an easy blood test to have, and it never hurts to for a man to know his "t" level, even at a younger age, if nothing else, to serve as a base line for the future perhaps he should have his tested by his GP if he has one.
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3190
   Posted 9/30/2012 11:43 PM (GMT -6)   
Hi Cogito...

I think I've mentioned before that I had the same effects are you - the hydrocodone was more stimulating.... and more tired on the oxy.

For me, the drowsiness w/ the oxy has resolved. But I think for some people, opiods can cause fatigue that doesn't go away. As others said, too, I would think getting some blood work would be a good idea.

Hope your massage goes well tomorrow. Let us know.

--Tina
Moderator - Chronic Pain Forum

My faith and family sustain me even on my worst days... as well as my wonderful friends here at HW.

Health/Pain Issues - too many to list; feel free to ask

Snowbunny21
Veteran Member


Date Joined Jan 2010
Total Posts : 3557
   Posted 10/1/2012 9:20 AM (GMT -6)   
Ahh...the testosterone levels could very well be the culprit..

I totally blanked on that one..I went through this with my now ex hubby. He was in his early 40's when we married and started having some fatigue issues as well as just the "blahs" as he described it. Just wasn't as excited about things.

He was found to have low levels and he only used a supplement for awhile but started eating better, exercising more, and actually went on an antidepressant for a year.

Anyway...getting a blood test would be good to check this as well as possible thyroid issues which can cause fatigue if you truly think it has nothing to do with your meds.

Just know that with your massage today...you WILL be sore the next few days...A Myofascial release massage is different from your regular "spa" massage. I have gotten them many times...

And most important is to HYDRATE, hydrate, hydrate...from the moment you leave the place. As well as avoid salt the next few days.

Post Edited (Snowbunny21) : 10/1/2012 8:46:24 AM (GMT-6)


cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 785
   Posted 10/1/2012 9:42 AM (GMT -6)   
Testosterone could have something to do with the fatigue -- I also don't have much of a libido, but it isn't completely absent either.

However, since fatigue onset correlated with my use of oxycodone, I'm quite confident that it also is playing a role.

Thanks for the notes about the Myofasical massage -- I'll be heading there in about 1hr.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds:300mg Ultram ER daily, 2x 10mg Oxycontin daily, Oxycodone 5-10mg or Hydrocodone 10-15mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray
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