Mark,
I like reading your posts. They are full of meat and potatoe's : ) I worked in a methadone clinic part time for about 2 years. Plus I deal with pain and I take pain medication (hydrocodone). I avoid taking it on a regular basis if at all possible and I try to control my pain levels with activity control. I try to stay in a swimming pool and just move my body (the parts that still work).
I have talked to hundreds, maybe thousands of people using pain meds. In general I think that people sort of get the impression that weaning narcotics is a linear event. But, it isn't. If taking fairly large amounts of opiates, you might be able to wean fairly briskly in the begining. So, you can decrease dose by regular amounts and you can do it at regular intervals. But, as you get down to about 50% of the maintance dose (as I recall) you sort of had to slow the taper both in dose and time interval. This is were all sorts of things come into play. Very often coping mechanisms deteriorate, people don't handle stress as well, anxiety rears its head and generalized pain increases. Sometimes people would panic at this point and give up and say "I failed." Typically, even if done slowly you will experience varying discomfort that might last a couple weeks and mess with your sleep (badly). And this will repeat itself everytime you decrease your dose. If weaned to aggressively, people described it like having flue like symptoms x10. I have to add that all this gets complicated when you have had multiple surgeries, unknown pain generators and/or known pain generators that have no treatment. Normal no longer exists and it will never exist.
The problem with pills is that they are usually short acting and they don't achieve the steady state in the body and instead creat a peak and trough situation. This is probably the most difficult way to wean if a person has been taking opiods long term. It actually probably leads to people taking higher and higher doses longterm. The theory behind methadone is that it is long acting and creates a better chance of creating a steady state. But, coming off high doses of methadone is no walk in the park either. How ever a person weans (if they have been on this stuff long term), they need to create a steady state and very slowly decrease the dose letting the physiology of the body change and the psychology of the mind adapt. I suspect you know a lot about this and I might just be preaching. But, I saying it for anyone out there that needs the support. I also really believe that the same should be done with psychotropics but you never or rarely see that happen.
I am aware of extended release pill and patches but I don't have personal experience with them. So, not sure how they would be incorporated into a weaning schedual. Also, there are implanted narcotic pumps and spinal stimulators. I don't have any experience with them but I might eventually.
Another area that is worth appreciating is how the body just naturally rewires itself. It is believed that chronic pain sufferers actually develope a larger pain perseption center in the brain. Sort of like a muscle getting stronger from exercise. People get better at perceiving pain. Then there are people that seem to get a mix of fibromyalgia like symptoms mixed into their pain. Arachnoiditis is a possibility of being mixed in there as well (not fully appreciated with chronic pain suffers) and can be related to spinal injections. I personally don't know how to describe my pain to doctors any more. My body aches and burns. Is this my new normal after 4 back surgeries and 52 years of age and mulitple spinal injections? Is the outcome of multiple injuries and surgeries on the delicate and exquisitely designed machine called the human body? I just know that it hurts a lot and I think its going to be that way from here on out.
Peace, Terry
Just remember that your body isn't a 4 speed transmission that you slam shift when you adjust your medications.
Quote:
Originally Posted by mmglobal
EddieG,
The most I've ever been prescribed was 80mg/day. That was my first oxy prescription and after taking the first pill I called the doctor's office and told them it was way too much. I've had many clients who take much more than that.
Except for that one scrip (and during the 3 weeks following my L4-S1 ADR in 2002), the most I've ever taken was 60mg/day. I always try to reduce my meds when I can... then if I have to go back up, it's that much more effective.
Because of the experience with a client of mine, I'm currently trying to reduce... maybe to zero. I'm down to 2 x 10 = 20mg/day. Oxy does not last 12 hours for me. The 2 a day dosing is very hard because there is not even coverage. I much prefer to be on 3 a day dosing. I get more benefit from being on 3 x 10 instead of 2 x 20, even though it's less overall, the coverage is smoother.
My next step is to leave the oxycontin and replace with oxycodone or hydrocodone.
Call me if you want to discuss. I have some other issues that may be relevant for you too.
Mark
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