Hey there. I can't get in a full fledged post right now but I just wanted to comment on one point. Regarding your detox from painkillers, I do think that you should know that, while Tramadol is different than many opioid painkillers, it [b]is[/b] indeed still an opioid painkiller. Maybe people view it as somewhat different because it is a synthetic opioid AND its analgesic (painkilling) effects are not wholly caused by binding to the opioid receptors in the brain (it can modulate the brain's Norepinephrine and Serotonin systems, two very important players in the development of a migraine--though the way that tramadol does this is not totally understood). And you are definitely on the right path regarding the abuse potential for tramadol. From extensive reading and seven more extensive personal experience, I can tell you that while there is some validity to the pharmacutical companies' claims that tramadol does have a lower "dependence liability", nearly anyone who has actually taken the drug or worked with it over an extended period of time will tell you that it can easily become just as addictive as any other opioid.
That being said, I just want to impart one thing I've learned from taking painkillers (on and off) over the many years in which I have experienced literally constant pain. During these years I have been on the vast majority of opioids that are prescribed for human use and at times I've felt that I couldn't live without them, once or twice felt truly addicted, gone through varying levels of psychological and physical dependence and learned some very important lessons about controlling increasing tolerance. I don't want to sound aloof or anything--it's entirely possible that you know more about this than I do, but in case you or other readers don't, I just want to share something that was very difficult for me to learn:
A year or two ago, after two failed nerve stimulator implant surgeries and a sit down with a team of neurologists at the Jefferson Headache Center in which I was told that they had nothing else left to try on me, it was pretty apparent that I was going to be starting with opioid painkillers again after a year or so hiatus that we had hoped would be helpful. I was very eager to get some relief but also very nervous, remembering the problems I'd had in the past, really just having so much pain that I could easily justify taking more and more and stronger and stronger pain medications. Luckily I have a friend who runs a pain management clinic (a friendship forged from innumerable visits starting with a different chronic pain disorder more than ten years ago). I asked him for his advice on the scenario and he said that, even though he didn't feel comfortable giving me a specific recommendation as he was not overseeing my care nor familiar with headache disorders as much as my main neurologist was, that, in his many years of dealing with patients with chronic pain, he had a fairly simple throught to share. And that was this: [b]Painkillers can be wonderful tools in improving your quality of life and lessening your pain, but [i]be sure to have realistic expectations[/i]. They will not get rid of your pain and are unlikely to do more than even just make it a step or two more bearable. If you expect more out of them then you're asking for trouble.[/b]
I realized that in past years that I didn't just look at the painkillers as a bit of a helper but instead looked for them to get rid of my pain--or at least make it much less.
Anyhow, I think you know where I'm going with this and I'm very sorry to have been so longwinded about it--I have trouble focusing sometimes. I hope that at least some of this is helpful to someone. Personally, it's made it so that I've been able to take a fairly high, but steady, dose of oxycontin for over a year without ever needing to increasing my dosage or frequency. Even though my pain still never drops below a 7/10, I can confidently say that I'm much better off.
Best wishes always,
DX: NDPH, Recovered CRPS
RX: Lamictal, Provigil, Clonazepam, Ambien CR, Emsam, Namenda, Oxycontin, Oxycodone
PRN: Haloperidol, Zyprexa, Lodine, Zofran, Skelaxin