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Quote From : Darlene46-8 January 29, 2009, 11:21 pm Hi,
I am a pain patient on a very high dose of pain meds - 300 mcg fentanyl, 120 oxycodone, & 480 oxycontin/day. In the fall, I had a horrible experience with the fentanyl patches - I didn't realize taking warm/hot baths would give me huge infusions of fentanyl. To make a long story short, I went through terrible withdrawals -violent shaking, cognitive breakdown, and an elevated heart rate before I found out that the baths were causing my symptoms. Once I stopped taking baths, my body had already become used to a much higher level of fentanyl than I am taking.
I have chronic pain. I don't meet the definitions online of an addict. I don't get high off of the stuff, all I ever do is titrate dosage to pain levels. Through this holiday my meds have always been in arms reach, I just don't reach, having made the decision to holiday.
I've notied what you are talking about. Once you increase dosages, it is hard to go back.
OK, a couple years ago I did a holiday. When I did it, I was on 1000ug (1 mg) fentanyl/hour, as well as 240mg oxycontin per day. The oxy was way harder to get off than the fentanyl, probably because I just took off the patches (12) as I'd worn them out put up with the detox. So that took a week. Then I stabilized for a week on 80 mg of sustained release hydromorphone per day == 160 mg oxycontin until I felt OK at that level, and I did a fast taper.
A month later, I went back on the pain meds. One question a 30 day holiday answers for you is, "How much of this pain is the pain of addiction, or hyperalgesia and how much is pain from the original pathology?" It took me years to get to those dosages (2000-2005). And when I was at them, I got a kidney stone and 13 shots didn't cut the pain at all.
I don't get high on the pain meds accientlally, and when I do, I don't like it. This time, my doc had me on oxy only, about 680 mg a day. The dose I needed to do more than lay abed, was about a gram a day. He was more worried about the DEA than my pain, so I'm changing doctors.
And I decided to do another holiday. If I was not going to get a theraputic dose (I went in and asked him to rotate me to a different drug, he told me I had a month left on my script) I might as well be in full withdrawal. One way or the other I'm going to be in pain. This time I went to my regular MD, who I have been seeing for 15 years and told him what I was doing. He gave me klonipin, promethazine for nausea, and muscle relaxants.
Klonopin makes it a lot easier. You take one or two and within 20 minutes the shakes and stuff stop. My last dose of narcotics was 10AM on the 15th of June.
I've read that with klonopin you take out 1 pill or patch every 4 days as opposed to one every 7 on a typical taper. Heck, I know when I start this process I am going to be in continual screaming pain (7-8) from the day I start my taper until 30 days after my last dose. Twoards the end of the 30 days the pain settles at a 6.5, still intolerable. When I am taking meds, I'm happy if I can control the pain to 2-4. So I want the taper part to be over fast. If I took out one pill every 4 days, it would take me two months to taper. This time I did it in 10 days, but on the 15th I had to function so I took an oxy 80. That was my last dose.
And, yeah, I get the cognitive disfunction as part of the detox. Last time I had bad insomnia, would sleep two hours in three days. This time not so bad but I'm using Lunesta for sleep. It will knock me out for 4 hours. Had one day where the nausea was so bad that the promethazine didn't work.
I'm married, my wife takes care of me. Not sure I could do this by myself. Even when my pain is well controlled, it goes up rapidly on activity.
The doc I'm leaving wanted to put me on suboxone for pain - but he noted that I had to be off the opiates for 48 hours. I read online that suboxone only hits two of the three receptors that opiates hit. And acts like anabuse with alcohol, makes you sick if you have any opiates in your system. So what do you do if you get a kidney stone and are allergic to NSAIDS?
Unlike some of the others here, as I said, I'm not an addict. I don't seek the drugs, I don't crave them. I crave pain relief, and if a topical rub would work I'd use it, but it doesn't. I get foot pain, I go to the podiatrist and I get a shot of cortisone. But that does not work on the other pain. If the pain went away, I'd stop taking the stuff once I reached a point where I could taper.
I've been through a pain program (and they could not taper me, because I had a theraputic dose at the time) and the narcotics are simply not as bad as the pain is. I can trade three-five years at 2-4. for six weeks at 8, it is a good trade. None of the whack modalities in the pain program did anything for me. It was a stupid waste of tiime and money for me. Works for some. I didn't have a diagnosis as to why I hurt. Still don't. But failing a pain program helps you get disability without appeal.
So my last dose was on the 15th, and it is now the 22nd. How do I feel? My mind is still racing. My hands feel like someone is working them over with a blowtorch, and if someone touches me on the hand I want to jump out of my skin and run away.
Every muscle in my body hurts according to its size. That is my usual problem, and it is the pain that is usully suppressed by the narcotics. Three more weeks.
I think last time I waited too long to do a holiday.
So I said all that to say this: I'll bet if you just leave your current patches on for a week (they automatically taper you) and put up with it, then put on one patch, you'll feel better after the process. I can't prescribe but I can bet. A trade: Five days of moderate misery for more effective fentanyl patches, let your brain reset from the bath doses. Make sure you have some neosporin ointment, leaving patches on for a week requires that you treat the area with topical antibiotics once patches are removed.
One thing I noticed this time. Twice during the taper I had to function and a slight dose increase from my previous days dosage got me going, in relatively little pain. I also noticed, both times, that it was easier to remove most of the narcotics than the last of them. My last days dose was 110 mg. Day before was 60 mg.
I don't know that others can do what I can do. All I know is what I can do. Maybe I have a strong will. I quit smoking the same way. At 3.5 packs per day I was physically dependent so I took a weeks leave and just stopped smoking.
By the way, I don't believe in 12 step programs. You are not powerless over the drugs. That kind of crapola just encourages relapse. Sometimes people are addicted in hospitals, but if it is pills, you put them in your own mouth or you put the patches on your own skin, and can choose not to if you can stand the pain. Check the stats, the number of people helped by 12 step programs are the same as the spontaneous cure rate, but the relapses are worse for 12 steppers because they are told and believe that they are powerless over their addictions. 12 step programs are useless.
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