stopping percs

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mtgman
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Date Joined Mar 2005
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   Posted 6/16/2011 2:46 AM (GMT -6)   
so i'm getting a bit ahead of myself as my Crohn's disease is still keeping me in pretty bad pain...
but as my dose is increasing from time to time- currently 10/325 6 times a day I'm beginning to wonder how hard it will
be to stop the percs when they are no longer needed.  I don't THINK i'm dependent on them but that throught is starting to cross my mind as the dose gets higher and higher...what do i have to look forward to?  i'm getting a bit nervous thinking about withdrawal...do they taper the dose down for a while?  how do you stop taking narcotics when you're done after you've been on them for a while?  thanks so much!

flower123
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Date Joined Apr 2009
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   Posted 6/16/2011 3:34 AM (GMT -6)   
If you need to stop taking your medication, your doctor will taper you. Sometimes, doctors don't realize that you have to do a really slow taper, so it's good that you're researching this just in case. I have done the same.

Usually it's good to move down slowly, 10%-15% per week. You'll have minimal discomfort if you take it very, very slowly. That's how you stop taking them...over time, without rushing at all. Then, it really won't be bad.

Hugs,

Flower

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 6/16/2011 6:54 AM (GMT -6)   

 

         Good morning mgtman!

              I have to agree with flower123 here, but wanted to add my own personal thoughts to this.

     One thing I have learned is that sometimes we suffer a sense of guilt (Not saying this is your case)...because of the public's view on pain med's....but I have come to realize that it is quite all right to take them when hurting. There is no need to suffer trying to please a family member or the general public.

      If indeed you find yourself able to reduce you're med's then do so a little at a time. Everyone is different in regards to withdrawals, but if you have a good Dr as flower123 says, then it will be much easier.

     Take care,

  SE


Moderator Chronic Pain Forum

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mtgman
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Date Joined Mar 2005
Total Posts : 1289
   Posted 6/16/2011 10:11 PM (GMT -6)   
thanks guys!  i appreciate it!  i definitely don't feel guilty about the meds.  my main goal is no pain and to be able to get through the day productively.  i do hate the way pharmacies, docs etc. have to lump us all in together though and look at us through the least common denominator lens...that part is annoying, but oh well.  have a great night!

Chutz
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Date Joined Jan 2005
Total Posts : 9090
   Posted 6/17/2011 12:07 AM (GMT -6)   
Hi mtgman!

I do understand your concern about how much pain meds are going through your body. I have had the same concerns.

One thing I want to add is the use of the word 'dependent'. Dependence is when your body is used to getting a certain amount of medication on a regular basis. It depends on it continuing. If you stop the medication you will go into withdrawal which is not a pretty sight. A lot of medications cause dependence...like antidepressants, sleep medications, and even things like insulin. I'm what's considered IDDM... insulin Dependent diabetes myelitis. In other words I'm diabetic and take insulin. If I stopped my body would have serious issues!

I think what you are worried about is addiction! Here's a boring definition for addiction:

The American Society of Addiction Medicine has this definition for Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors. The addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships. Like other chronic diseases, addiction can involve cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

And what I think is a better one:

"Historically, addiction has been defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin and other drugs) which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain.

Addiction can also be viewed as a continued involvement with a substance or activity despite the negative consequences associated with it. Pleasure and enjoyment would have originally been sought; however, over a period of time involvement with the substance or activity is needed to feel normal. Some psychology professionals and many laymen now mean 'addiction' to include abnormal psychological dependency on such things as gambling, food, sex, pornography, computers, internet, work, exercise, idolizing, watching TV or certain types of non-pornographic videos, spiritual obsession, self-injury and shopping."


The rates of addiction for chronic pain patients is less than 1% per a National Arthritis Foundation study. Should we still concern ourselves with it?? You bet! You or I may be that 1%. But excessive worrying over it isn't necessary.

I've offered way more than you asked for but hopefully someone who reads it will find some helpful information.
Chutz
Moderator on the Fibromyalgia and Chronic Pain forums
~*~*~*~*~*~*~
Daily Donnybrook: Fibromyalgia, Insulin Dependent Diabetes. Ulcerative Colitis, Rare form of Dermatitis, Collapsed Disk, Osteoarthritis (especially in right hand and neck) and a couple of other adjunct agitations.
~~~~~
Use the talents you possess, for the woods would be very silent if no birds sang except the best.

mtgman
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Date Joined Mar 2005
Total Posts : 1289
   Posted 6/17/2011 4:22 PM (GMT -6)   
thanks Chutz! i think i'm more worried about dependance rather than addiction...i know it is getting to the point where it could become an issue- i've gone from 5/325 4 times a day to 10/325 6 times a day...i guess it's just taking more meds to quash the pain- either bc the pain is less managable or my body is becoming accustomed to the meds...either way pain sucks and i'm glad i have the meds...just don't want the "solution" to become the problem...
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 6/17/2011 5:44 PM (GMT -6)   
Hi Mtgmn...I really wouldn't worry about your body becoming dependent on the medicine...a good Dr. will always tirate someone down if/when you would need to go off the medicine so you wouldn't have any negative side effects...

This only applies to someone who is abusing their medication and would take too much and then run out...and then keep having the actual 'highs' and then the lows (withdrawals)...

One of the ways to keep your tolerance low if you are on a narcotic long term is to always be using other modalities to help with your pain...for me...I use exercise daily, PT, acupuncture, yoga/stretching, injections when needed, aqua therapy, muscle pain medicine, sleep medicine, eating all Organic, not smoking, etc...So whatever else you can do to help with the Chron's..

As well as making sure that not just your Dr. is part of your team...but your Pharmacist...I have used the same one for 10 years...and I always chat with them...ask about their family....and they are in a big box store...the good part is that not only do I know them...but they know me so if there was ever a mix up with something...they would call me and know what I'm on the medicine for...

And if the Dr. decides to keep you on an opiate long term...since you are taking up to 6 a day of 'short acting' medicine....it may be time to move you to a long acting med...So..since you are taking 60mg a day of Oxycodone...you could take an Oxycontin 10mg and a 20mg in the AM....then repeat 12 hours later...(don't think they have a 30mg pill)....

So this would be the exact same medication and dosing as you take now....but it would be released more smoothly throughout 24hours...instead of the ups/downs with the Percocet that hits the most at 45minutes in...then goes down from there...so you are chasing the pain more...as well as you could add either Acetaminophen or even an Ibuprofen if needed but not having it every dose...I actually like the ability to choose..

It all boils down to making sure you have a good Dr. that is working with you...(don't know who is prescribing the Percocets)...and if you need to stay on them...then so be it....or if going down or off them...they will taper you properly...no sense worrying about something that isn't even happening!..LOL..

And hope that you can also add the Humira or Cimzia!!!

Post Edited (Snowbunny21) : 6/17/2011 5:48:24 PM (GMT-6)


mtgman
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Date Joined Mar 2005
Total Posts : 1289
   Posted 6/17/2011 7:20 PM (GMT -6)   
thanks snowbunny- i like your strategy. the percs are being prescribed by a pain doc. we've talked about other options if/when the percs become even less effective. the extended release are no good for me though bc my body passes everything so fast due to the crohn's- i'd end up wasting a lot of the meds. tricky sit. we've discussed a patch but there are some negatives there as well. that's what i love about this site thogh...i can always count on someone having been there or done that! have a great weekend!
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 6/17/2011 7:29 PM (GMT -6)   
Ahh...that makes sense with the Crohn's and the long acting...duh...my brain was not working with that..lol...I am glad to hear you are seeing a PM for the medicine as they are very knowledgeable with their Anesthesiology background..and working with you on different one's if you need...and yes...if you have to go to the patch...there are many of us that can give you some advice on our experiences as well to discuss with him...

But one step at a time..right:) It sounds like you are in good hands..

Hope you are able to have a good weekend and doing something that makes you smile and release some endorphins!!
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

spinal soldier
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Date Joined Dec 2009
Total Posts : 687
   Posted 6/17/2011 7:33 PM (GMT -6)   
very few realize what snowbunny suggests, that you can not gain true pain management or "pain control" (having 1 or more pain free hour/s every day) unless you come at it from multiple directions. if you are having pain still, and you do have a chronic pain syndrome why discontinue pain medicine, or opioid pain medicine. i personally do not react well to Percocet (i have taken the 10/325,7.5/325,7.5/500,10/650, and the first medicine i was given about 10 years ago was Tylox 5/500 and quickly to 5/325 oxycodone/APAP. since then the only oxycodone med that is really effective at pain relief is Roxicodone 30-60mg. if i ever got caught short or grew a tolerance to oxycodone the lower level in my blood made me have half withdrawals and nervousness. other opioid analgesics like morphine, hydromorphone, hydrocodone, oxymorphone, methadone, or fentanyl have caused me to have those feelings. some respond great to oxycodone for long term use but i have heard of others having the adverse effect i described. so why not try a different opioid an see what you think, you have chronic pain. with Chrohn's you have to take in mind some opiates cause more smooth bowel muscle relaxation than others, Morphine sulfate is maybe the worst reported, Methadone/Methadose can be bad, hydrocodone or oxycodone have that rep. also. hydromorphone "Dilaudid", oxymorphone "Opana", tapentadol "Nucynta", or fentanyl "Duragesic/Actiq" are not as bad as the morphine/opium/codiene group. i am running to eat now i will be back

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 6/17/2011 7:58 PM (GMT -6)   
SS..I wish I could have a pain free hour each day!! LOL...but mostly as you said..it is about Pain Management...

A narcotic is a small piece of the puzzle...and even with that, and other modalities...most PM Dr.s shoot for a 5 on the pain scale...So if people are that and below...that is great:)...I have between a 5-7 depending on activity...but I take a lower amount of medicine than my Dr. wants me to take but I want to keep my tolerance low as well as I am used to this level of pain but like to stay more alert each day...

Some days I will take my higher dosage prescribed...and add a muscle relaxer to help like this weekend...and get to a 4 or 5...

SS...as I just was reminded because of Mtgman's Crohn's...he can't do the extended release medicines....

I think you are on the right track Mtgman:)
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

mtgman
Veteran Member


Date Joined Mar 2005
Total Posts : 1289
   Posted 6/17/2011 10:36 PM (GMT -6)   
thanks guys! i think my docs are pretty good- the main doc i saw at the pain clinic has some family with crohn's so it was awesome not having to describe anything and not having some doc belittle my pain bc they were not comfortable with the condition. the PAs I see there now on a reg basis are great also. i was really nervous last time i went in bc i had run out a bit early due to a few days of really bad pain (plus a kidney stone to boot)...yes i get them too- a symptom of the crohn's- at least i don't need to go to the er for them anymore...i've had about 10 now so i can usually deal with the pain on my own and they've always passed (knock on wood). one of the reasons i tend to stick with a drug is that i get nervous about switching...i'm on so many meds that if i have a combo that doesn't interact etc. i tend to like the status quo instead of risking some unforseen reactions...i was hitting a 10 on the pain scale in my book- way worse than the kidney stone pain which can be BAD...i'm talking gut pain so bad i literally puked and cried and screamed sitting on the can- not exactly how you want your 5 yr old daughter to see dad...now i run between a 4-7 or 8...definitely more managable. i can get through work without puking in the office and get my stuff done. the percs manage the pain well for the most part- i have doubled up at times and when i mentioned that to the docs they were pretty much like- ok...just be careful with the acetomenophen of course...but they said they have people taking 30 mg x 6 times a day-- my doc said what i take would drop him on the ground...it does not even affect me other than mitigating the pain to a certain degree...another reason why i like the percs- i can do anything normally while i have them in my system...
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!

straydog
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Date Joined Feb 2003
Total Posts : 16281
   Posted Yesterday 9:05 AM (GMT -6)   
MTG, I totally know where you are at dealing with CD. My first kidney stone was a few short years ago, I would compare that pain to the complete blockage pain. I saw every color in the rainbow at 2:00am when I passed that thing and nearly passed out I was in so much pain. Yes, it is wonderful that your dr has some first hand knowledge of kind of pain CD can cause a person. Many drs just don't have a clue about that kind of pain.

Have you started Humira yet or not? I hope if you are getting ready to start it soon that it helps. You know when I first started Remicade infusions it really did help me, but as time went on it lost its punch. I went every 4 weeks for my infusion as that schedule worked the best for me. Then I started getting so sick after each infusion and they did some testing and found it had induced Lupus. Humira can do the very same thing so the drs just keep me on Lupus medication.

It is scary when tampering with our meds, not knowing how we will react to a new one. I have Dilaudid in my pain pump, it is a very old drug that is effective on pain and has few side effects like so many of the newer pain meds today. I do not tolerate medications well at all and usually end up having severe reactions or allergic reactions, either way, I normally get shot in the foot, lol.
Moderator Chronic Pain Forum

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted Yesterday 9:32 AM (GMT -6)   
Mtgmn...I have never had a kidney stone...but I used to have large ovarian cysts rupture and those to me were my highest pain levels I have hit even with all my surgeries..so I can empathize with you...

If I can make a suggestion...if you are having a very high pain hour or day...and think you need more medicine...it is best to call the Dr. (or on call one) and ask if you can up your dosage...This will show them that you are not trying to self medicate...which you said you have done and then run out of meds early....you never know if they are noting that on your file which can harm you in the future...and it's something we really can't do as it's very important to follow what the Dr. prescribes..

The other option is what some Dr.s do, and you can speak with yours about this....say a prescription is for 6 a day...so 180 pills to last 30 days....on a good day...if you only take 4 or 5...then you have an extra one or two for a bad day....and then you don't run out by the end of the month...(obviously not saving up a bunch and then taking a really large amount later)

But again...only do that with a Dr.s permission...
 
I would certainly speak with your Dr. about having a plan on what to do when you have a kidney stone as I'm sure he is aware you get these...then you have this in place and don't have to worry..

I just don't want to see you have red flags on your file as you need pain management...

Just trying to help as for me, I've been at this for 10 years with chronic pain....you can never go wrong with talking to the Dr. first...

Hope you have a good weekend!

Post Edited (Snowbunny21) : 6/18/2011 9:36:42 AM (GMT-6)


mtgman
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Date Joined Mar 2005
Total Posts : 1289
   Posted Yesterday 3:18 PM (GMT -6)   
hey straydog- i've been on the humira for approx 3 months now...it's so up and down it's hard to get a read on its effectiveness- i had to bump up the prednisone for a while unfortunately. right now i'm feeling pretty good so i hope it stays that way. i've been doing a lot of travelling for work which is always fun and exciting with crohns...just a ton more anxiety for me to deal with haha.

snowbunny good idea about keeping the doc apprised of what's going on...
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!

mtgman
Veteran Member


Date Joined Mar 2005
Total Posts : 1289
   Posted Today 9:01 AM (GMT -6)   
oh yeah forgot to mention- we also tried 2 celiac plexus blocks- very painful shots that i guess try to block the pain signals in the nerves- they didn't work and it was horrible bc my insurance would not pay for sedation so i had huge needles stuck into my spinal column with just a bit of xanax...ouch.
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!
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