Juggling Meds - Can it be Done?

[Jim M2]

I posted this on MGH and got some pretty good feedback. Hopefully I'll get some good feedback here too.

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Is there any way to juggle various PKs to keep effectiveness up and dependency down?

For example take:
1 or 2 vicodin a day for a week, then
1 or 2 tramadol a day for a week, then
Repeat

If this sequence doesn't work is there some scenario that does? I'm trying to find some way to feel better to improve my life.

[Cheryl]

Hey Jim,


I was off most meds very quickly post op and didn't think I'd be needing them again.

I told the doctor at the appt. for my neck yesterday that now I cannot sleep without valium but what I do is every 4 or 5 nights stop taking it for a night or two. Of course I don't sleep and my muscles are much tighter but it tells me I'm not addicted. This was completely of my own doing because I really have never taken much despite the high levels of pain I've had for three years. He gave me no feedback just a blank face.

I'll be curious to hear what others have learned as I haven't needed to worry about this issue yet. I'm thinking I may need a PM doctor now.

Cheryl

[Maria]

Jim,
I really don't care much about physiologic dependency anymore however what I care about are end organ consequences such as damage to liver and kidneys and pain relief.

I think the body can habituate to a certain pattern and the pattern might be able to be changed or lengthened/shortened and the like.

I don't have experience with your particular meds, however I have been taking my own meds a way that works for me even if prescribed a certain way. I don't go over the prescribed dosage, usually under it but rather in a pattern that works best for my pain levels, functioning, sleep and so forth.

I found when I was taking Elavil for neuropathic pain that over time (5 years) I was able to go from taking 20mg to 10mg every day then every 3 days, then once a week, then once every two weeks, then every week to not taking it all ~ severe drowsiness was occuring while at work doing Telephone Triage so had to make this change.

At the end of a near 5 year period of Elavil I latter started on Neurontin and lowered this dose by 600mg/day but cannot get under 1800mg/day w/o quite a bit of repercussion.

Methadone is taken once a day vs. multiple times/day for effectiveness and at lower dose than ordered.

Added Fioricet daily (don't like this because of Tylenol) as it seems to help with cervical muscle spasms and TMJ symptoms as well as Migraine prevention.

Good luck with your trial and hope you find a good way to meet your pain relief needs. Again, I'm more concerned with potential end organ problems related to medication intake than physiologic dependence but that's just because I am pd on Methadone...

[Jim M2]

Cheryl
That pattern seems to work with the valium. I was suspecting some urges on a less frequent use of oxycodone.


Maria,
I had an extremely difficult ordeal giving up cigarettes some 30 years ago. Based on something as mild as nicotene it's hard for me to imagine the difficulty giving up narcotics.

Last summer I was put on Neurontin with an allocation of 15 to 20 oxycodone pills (5mg) per month for break through pain. I have a love-fear relationship with the oxy pills. I always want to take PKs to feel better. I think this is to be expected given the constant chronic pain, however, last month I was suspecting some beyond-pain-relief urges. I asked for tramadol on the next doctor visit. So now I have 40 tramadol pills (50mg) for the next two months. It's not as good as the oxy but they do help and two are as good as an oxy, maybe better (I know tramadol does nothing for some people).

Here's what I'm learning from you about narcotics, namely methadone. There's two major concerns: dependency and organ damage.

Now about dependency. At some point a person in pain says, "I give up, I realize I'll have to deal with dependency at some point in the future, but I am a mess, I need help now."

Then there's organ damage. One must accept it along with the dependency. How long can one go. What can be expected. Does it shorten your life and make one sickly in their later years. Probably very dependent on the individual. I don't expect you to know or answer these questions, but I do wonder about them.

Kathy (Nana4&cntn) on MGH says "I disagree that all short term meds cause the need for increases to accommodate pain. I have been on the same dose of methadone for over 4 years, never needed an increase as I did with vicodin."

Hope everyone is having a low pain day,

[mmglobal]

I spoke to a client today who's a pain management doc. He says that yes, in theory it MAY be possible to do this, but he's not seen it studied. He believes that it's more likely to be successful with the synthetic and non-opiate meds like tramadol, ultracet, etc... Opiates 'rev-up' the neuroceptors so switching between opiates will not have the desired effect... but Jim's original question seemed to be targeted at alternating opiate and non-opiate meds.

While being typically non-committal (as they should be when the conversation gets out into the fringe), the take home message that I got was yes it's possible.

People react so differently to meds, so be careful and run your ideas by your treating physician first... don't make decisions on info you get here. Also, there can be much lost in translation, so take all of this with a grain of salt.

All the best,

Mark

[nopain]

I do is every 4 or 5 nights stop taking it for a night or two. Of course I don't sleep and my muscles are much tighter but it tells me I'm not addicted.

This is not to offend you, but you clearly do not understand how Benzodiazepines work!!!

The half life of Valium (Diazepam) can be as long as 200 hours!!! Stopping for shot periods plays no role in your ability to tell if you are Physically Dependant (Physical Addiction).

The fact that you do in fact "feel" symptoms when you are "off" the drug even for short periods is an indication that you are in fact physically addicted. Psychological addition is a whole new ball game.

You should NEVER play with your dosage.

http://www.benzo.org.uk/ashvtaper.htm -- read up! Valium is an incredibly difficult drug to come off of for many people.

Narcotics are in fact addictive, but work in a different part of the brain. And unlike Benzo's there are actually drugs that can help you come off of them. Not true for Benzo's you just suffer the withdrawal.

American Doctors are VERY uneducated on Benzo's because they do not understand the devastating effects they have on some people.

If your Doctor just looked at you and said nothing, you seriously need to find another Doctor.

You NEVER "Cold Turkey" a Benzo, you always taper or you put yourself at risk of seizures and death!

You would be well served to find another Doctor and start tapering off of the Valium. There are other solutions for sleep.

This is the voice of experience. I had an extremely difficult time coming off.

Due to the effects that benzodiazepines have on the brain they can sometimes produce "dependence" or "addiction" in people if taken regularly every day for more than about 4 to 6 weeks. Dependence or addiction means that you cannot manage without them because if you stop them you get withdrawal symptoms. In the worst cases withdrawal symptoms from the benzodiazepines could include anxiety, tension, panic attacks, poor concentration, difficulty in sleeping, nausea, trembling, palpitations, sweating and pains and stiffness in your face, head and neck. These withdrawal symptoms could occur several days after stopping your benzodiazepine. They may last from one to three weeks but can go on for months. If you have taken them for a long period of time your doctor will need to take you off your benzodiazepine gradually. This will be by reducing your dose slowly over a period of time to reduce the chance of withdrawal effects.