opioid holiday questions

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cogito
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Date Joined Oct 2010
Total Posts : 926
   Posted 12/18/2011 11:11 AM (GMT -6)   
Hi all,

I'm planning on taking a break from my BT medications... and maybe from my Ultram ER as well.

I'm now finding that 15mg of hydrocodone or 7.5mg of oxycodone barely touch the pain and don't last long. Just a year ago, they would be effective for 5-7hrs. Now, they are inadequate and have a noticeable effect for only a few hours.

So, rather than upping the dose, I'd rather try to repotentiate my receptors. I did some google searching on this, but didn't find much that was helpful. What I am wondering about is:
a) what would be the minimum "holiday" I should take (2 weeks?)?
b) since tramadol only mildly bonds with the opioid receptors, can I continue to use my Ultram ER or will it make a significant difference if I stop that as well?

I see my PM next week, but I thought I would get some input from members here as well.

I'm actually on something of a trial run right now. On Friday, I gathered up all my opioid meds (as I keep some in my briefcase, travel bag, etc.), put them all in my lockbox and gave my wife the key until the 23rd. However, I am still using my Ultram ER.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

tmjpain
Veteran Member


Date Joined Oct 2008
Total Posts : 2024
   Posted 12/18/2011 11:15 AM (GMT -6)   
Hi Cogito,
I don't know the answers to your questions, but i wanted to wish you much luck in finding the right combo of meds for you. Let us know how you make out at the dr. appt.

Suzane

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 12/18/2011 2:28 PM (GMT -6)   
Noting your other health issues I really think you should discuss this with your doctor. Going cold turkey off your pain meds could be dangerous with your tachycardia.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.
Moderator Depression Forum.

flower123
Veteran Member


Date Joined Apr 2009
Total Posts : 856
   Posted 12/18/2011 2:56 PM (GMT -6)   
Yes, agree with Jim about talking to your doctor. Do you think maybe you need to try a different long-acting medication? Maybe you could tell your doctor that you medication is not covering your pain, because that's really what is going on. So instead of taking a holiday, maybe getting a dose increase/med change would be the way to go. Just a suggestion.

The reason I say this is because I think that it takes much longer than a month or so to reset your receptors. You will probably get more relief for a couple of weeks, but soon thereafter I think you'll be in the same position that you're in now. I have read (don't remember where) that it can take a year to reset, and even then you wouldn't go back to being like someone who never took any pain medication.

I hope that you get some much needed relief from your pain soon.

Hugs,

Flower

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 12/18/2011 4:56 PM (GMT -6)   
Thanks for the concern. I'm not worried about my heart issues as I don't use BT meds every day -- usually about 20-23 days per month lately, and have gone 5 or so days without during the past 6 months.

I do think I need a more powerful long-acting med, but here are some issues:
1) Ultram I think has been helping my mood (though less so than 1+ yrs ago).
2) It is one-a-day.
3) I tried Kadian and it knocked me out.

One option is to add something like 10mg Opana ER over the Ultram ER, another is to switch to it (or oxycontin) - -maybe to rotate for 3-6 months.

But I also need to restore the efficacy of my BT meds and am hoping that a drug holiday will do something. I haven't found any good data on the topic, but anecdotally, I read about 2-3 week holidays. My recollection is that there are 2 mechanisms for tolerance, one has to do with the down-regulation of the receptors, the other with reduction in receptor sites. If memory serves, the former can be restored much more swiftly than the latter. But I'll have to find the sites again where I saw this.

I'm now probably about 60hrs from my last BT dose and I've not experienced any withdrawal. I'm in a fair amount of pain, but nothing greater than what I would typically experience in the afternoon w/o any BT medication that day. I've just been spending my time lying down, icing, and sitting in my recliner playing the Xbox I bought for the family (I am very bad at it).
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

NiNi53
Veteran Member


Date Joined Mar 2011
Total Posts : 816
   Posted 12/18/2011 6:29 PM (GMT -6)   
Hi, I also agree with Jim and the rest that said talk to your doctor first please,  I dont know if you have figured withdrawal into the equation, but it is very serious and should not be done unless under a doctors care.
 
Good Luck and Take care,
Kathy
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 12/18/2011 8:34 PM (GMT -6)   
I appreciate the concern, but whatever withdrawal I might have gone through, would have passed by now.

I guess what I'm now wondering is if a 2 week holiday will make a difference, or whether I'm putting myself through more pain without benefit. I'll probably not take anything again tomorrow as my cleaning lady is here and she's so chatty I can't get any work done. But my goal is to complete the next chapter of my book by the end of the month. I'll delay it if a 2 week holiday will be effective, but if not, I should get back to writing.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/18/2011 8:51 PM (GMT -6)   
I agree to with Jim's advice above. I admire what you are attempting to do, but there is no way I would do what you are doing without the express consent of my doctor. Good luck to you though, regardless.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81, 6/11 5.8
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

sore42long
Regular Member


Date Joined Apr 2011
Total Posts : 235
   Posted 12/18/2011 10:03 PM (GMT -6)   
I am amazed ,I am getting off meds slowly and Iam having a real hard time!! It amazes me you can do this and not feel withdrawl?Good luck and I would tell your DR.your plan ,please keep posting about your progress,I'm having aheck of a time weaning off? take care

sos007
Veteran Member


Date Joined Nov 2011
Total Posts : 615
   Posted 12/18/2011 10:33 PM (GMT -6)   
Cogito...I am with the others I think you should discuss with your doc. I would talk about taking long term meds..I do not find BT meds do much for me..never have.

All the best, Amy
Chronic Pain(nerve), fibro, mild depression and a few others

Boxerlover
Regular Member


Date Joined Dec 2006
Total Posts : 275
   Posted 12/19/2011 6:55 PM (GMT -6)   
Everything I have read on taking a "holiday" is that it really does not make much of a difference. Especially with just a few weeks, your tolerance would be right back after a few days. Even when taking months off, your tolerance will come back albeit not as quickly with being off for months. Your meds would seem to work better for a few weeks if that and then you would be right back.
 
Now everyone is different so it would not be the same results for everyone and if this is something you really want to do then I am in agreement to speak with your doc. But if you are wondering is it really worth it, from what I have read no, it just does not seem to last long enough. But again, just my opinion!!

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 12/20/2011 3:49 PM (GMT -6)   
Thanks for the feedback.

I'm now 100+ hrs in, but I relented. I didn't have any withdrawal symptoms upfront, but last night, I started to have diarrhea and stomach cramps and it got worse today. After my 5th trip to the bathroom, my wife encouraged me (didn't take much) to take something. So, I had her bring me 1/2 a BT dose (5mg of hydrocodone). That was about 1hr ago and my stomach has calmed down. Normally the 5mg doesn't provide any pain relief (I don't think it did even 5 years ago), nor has it this time.

I'm going to keep on going, though as Boxerlover noted, it may be all for naught. This week and next I can sacrifice to the experiment, as enough holiday stuff is going on I won't be able to get much done anyhow. So, I can lay in bed, play xbox, and not worry about not getting work done.

If anyone knows of any studies on opioid holidays or receptor regulation change-rates, please let me know.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

stingray
Regular Member


Date Joined Oct 2009
Total Posts : 175
   Posted 12/20/2011 8:03 PM (GMT -6)   
Hi Cogito
I admire your effort to get off the pain meds and of course agree with the others that you and your doc should be on the same page with your efforts. I haven't seen any studies I can pass along but can tell you about my own experiences. I take Oxycontin and oxycodone. The normal dosing for these is to use the Oxycontin for long term relief and the oxycodone for break through pain, however in my case the Oxycontin does not work very well at all. I'm not sure if it's because I don't absorb it well. So I have to rely on mostly break through meds for my main pain relief. I have tried switching to just Oxycontin and despite that it's the same does I go through withdrawals and feel awful. I stuck it out for 10 days hoping that once I went back to the break through meds they would work better. They did work better. but the effect was very short lived. Only about 3 to 4 days and I was back where I started. I think someone mention something to that effect . Goes to show how different we all are. I am surprised that you can go for so long without meds and have no withdrawal symptoms. In any case I just hope you don't get any nasty surprises along the way. By that I mean a reaction you hadn't counted on. Best of luck and Merry Christmas.
Stingray

BuccPride
Regular Member


Date Joined Dec 2011
Total Posts : 27
   Posted 12/21/2011 3:22 AM (GMT -6)   
I will continue the broken record and say you need to speak with your physician. I will say that if you are still taking Ultram, that is the main reason you aren't experiencing any withdrawals. Since Ultram is an opioid it is binding the receptors in the brain and works much like what methadone does for people trying to get off opiates. If you have stopped this than I don't see how you aren't experiencing any withdrawal symptoms. Quitting cold turkey is basically committing suicide on a molecular level. You most likely won't die but your body is going to be damaged in some way. The amount of time to decrease your tolerance wouldn't be a matter of weeks but years. Your brain naturally produces a chemical called orphanin FQ. This chemical is close to the molecular make up of morphine and fills the opioid receptors much like morphine. It's one of our brains natural pain killers. When a chronic pain patient begins an opiate regimen, over time, our brains begin producing more orphanin FQ which in turn decreases the effects of the opiate medication. The only way to truly decrease the tolerance in our brains is to chemically decrease the orphanin FQ. This goes without saying, but if this were possible physicians would already be implementing it to avoid having to write increasing amounts of opiates. It's becoming harder and harder for them to do so in no small part due to abusers and in turn increasing the DEA strangle hold. This is bad new for us who need but may not be getting proper care. I've been in college for 7 years, but none of them in medical school. So I don't know everything a doctor would know, but I do know how to research. I research every aspect of my illnesses or injuries (part of the reason I joined this site) to be able to ask every question I possibly can to my doctor. Because I know he went through more years of college than I, but for medical studies. He has the knowledge and experience to answer what I can't.

Basically the only person who can tell you about what is best for you is your doctor. So everyone here is really giving you the only advice you need.

Sam

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 12/21/2011 11:22 AM (GMT -6)   
If this holiday turns out to be a bust, then I suppose I'll have to supplement or rotate out of my Ultram ER.

I see my PM in just over a week and suppose we'll have to discuss that.... assuming he's in the mood to talk that day (I can imagine the last day of the year will be busy for him since so many people try to cram their appointments in before their next year's deductible kicks in).

I do all I can non-med wise (I work from home nearly every day, work in a recliner with well adjusted ergonomics for my monitor and keyboard, use ice just about every day, follow my PT instructions, etc..).

Frustrated!!!
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 12/22/2011 9:47 PM (GMT -6)   
i think it is absolutely crazy to take a holiday. it has been proven as of late that that hurts more than helps. instead do things to reduce tolerance like take D-Phenylalanine or Huperzine.
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: MScontin 100mg q8hrs. , dilaudid 8mg q6hrs. prn, oxymorphone IR 10mg q6 ,vistaril 50mg prn nausea, Lyrica 150mg 2x,Adderall 20mgs 1x A.M. 10mg PM prn, Soma 350 mg 3X, Elavil 25 HS, diazepam 10mg bid prn, Supplements: CO-Q10 100mg, Vitamin D 1000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, ALA

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 12/23/2011 12:05 AM (GMT -6)   
Spinal soldier, do you have any citations for the claim that drug holidays are counterproductive?

Note that I don't use BT meds daily. I've been migrating close to that, but I average roughly 20-23 days per month, and about 1/5th of those days, I'll take BT meds twice in a day. So, my level of withdrawal would be quite a bit less than others on this board.

Today, however, I gave in and took 7.5mg of oxycodone.... aside from the 5mg of hydrocodone to deal with diarrhea from withdrawal, that's my first use since the experiment began. It was, BTW, definitely more effective than that dose has been lately. Maybe it was psychological, and even if not, maybe the tolerance will be right back in a few days. I guess I'll find out.

I see my PM in a week and will talk all this through with him and see what he thinks I should do (next).

Thanks for all the comments.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 12/23/2011 8:56 AM (GMT -6)   
i just typed a reply and erased it somehow. i will condense what i said to this; the best case studies i know of about opioid induced hyperalgesia and tolerance have been conducted by Dr. Forest Tennant. "the cure is not the cause"
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: MScontin 100mg q8hrs. , dilaudid 8mg q6hrs. prn, oxymorphone IR 10mg q6 ,vistaril 50mg prn nausea, Lyrica 150mg 2x,Adderall 20mgs 1x A.M. 10mg PM prn, Soma 350 mg 3X, Elavil 25 HS, diazepam 10mg bid prn, Supplements: CO-Q10 100mg, Vitamin D 1000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, ALA

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 12/23/2011 5:04 PM (GMT -6)   
Spinal Soldier,

I went through Tennant's web site. Though I have some doubts regarding a few claims (such as the "trapped electricity" stuff), the site contains a trove of excellent information and may be worth becoming a "sticky" for this site?

But still, I don't think that drug holidays are counter-productive for someone in my shoes. The story would be different for someone who is taking far more than I am.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Dagger
Veteran Member


Date Joined Apr 2008
Total Posts : 1522
   Posted 12/23/2011 7:27 PM (GMT -6)   
Do not stop the Ultram ER cold turkey. Depending on your dosage and how long you've been taking it, it can take 6 weeks or more to stop it. I followed my doc's directions to taper off yet still had withdrawal for days when I finally stopped. I was taking 100-150mg/day for a few years and a 5 week taper was not slow enough.

You might need to switch to regular tramadol to taper off.

For some people, even just one 50mg/day for a few months will trigger withdrawal when stopped.

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 12/23/2011 11:37 PM (GMT -6)   
i agree with you about the "trapped electricity" and rubbing down with a magnet. i like his emphasis on under treated pain and "cardiac-adrenal-intractable-pain syndrome and his thoughts on minor healing of nerve tissues. one part of his advice to his own patients that i have started that has been very helpful is taking precursor amino-acids like L-tryptophan or 5-HTP, GABA or L-glutamine, L-tyrosine, and D or DL-phenylalanine. i am also curious to try topical homemade opioid or carisoprodol cream that he says patients get drastic improvment from. you have a restful evening.

Lasardo
Regular Member


Date Joined Jan 2011
Total Posts : 373
   Posted 12/24/2011 4:06 AM (GMT -6)   
Cognito,
I agree with everyone to speak with your doctor but aside from that I do feel your "holiday" is counterproductive in that within a week your tolerance will be right back where it was unfortunately. I have tried a holiday also. It was great fora week then...back to square one. The only thing you can do is maybe switch medications for a while. Try something else. This you can discuss with your doctor, of course. Good luck with everything, I admire your ambitious in this endevour. ..Leslie
Crohns dx,Pelvic Floor Tension,Pelvic Adhesive dx,interstitial cystitis,ileostomy,chronic pain,arthritis,fibromyalgia,severe 42 degree scoliosis,degenerative disc dx,neurological impingement,pelvic tilt and complete loss of neck curve. 4th degree tear during childbirth with 13 reconstructive surgeries (including fistulas) resulting in chronic pelvic pain and an ileostomy. Bp and panic attacks.
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