pain meds

After my surgery in Jan 07 my doc put me on fentenyl patches (sp) for the pain.  I discovered that it helped with my back pain considerably.  So since then I have been on them.  The problem is now I think the withdrawls from the drugs might be worse than the pain.  I change the meds every third day and my life revolves around that cycle.  First day after changing I don't sleep and the next day I am hyper and want to do everything.  2nd day kind of slows down but sleep is good.  third day lay around the house  with the blah blahs!  Just waiting for it to be time to change the meds.  I have a doc appt next mon and I want offf of these meds. My question has anyone taken this med and how difficult was it to stop?  I have tried a couple of times to just stop taking the fentenyl but after hours of trying to sleep and being unable to stop squirming and fidgeting I give up and put a patch on. thanks  JIm d

I and few other guys around here know EXACTLY where you're coming from. The pain from three herniated discs in my lower back was so bad that was on hydrocodone (vicodin) 24 hours a day. Of course my body built up tolerance so I kept taking more and more, and physical dependency and some component of psychological addiction all followed as well.... I had to struggle under the care of a pain management specialist to find the right treatment plan. We tried a few different things before we figured out what worked. With each try, he gave me a plan to taper or wean myself off the narcotics so the withdrawals were much easier compared to going cold turkey. What worked in the end for ME was MS Contin which is an extended release oral morphine - much different in terms of intensity from IV morphine which was a good thing for me. All it did was take care of the pain and that was it. No euphoria, which at first is a bummer, but that is what makes it so much less addictive. Eventually as the weight fell off so did the pain, and now I don't have to take anything at all for pain - so when people asked me what did I do to cure my back pain I say I had surgery, then I explain it wasn't a spinal fusion that cured me, it was RNY - I love my RNY!

Jim, Fentenyl ranks up there with morphine in terms of addictive potential.  I hope you are seeing a pain specialist.  Norcotics and synthetic narcotics aren't great choices for long-term pain relief due to rapid habituation (and consequent dependence).  Have you tried a "medication holiday" - a period off all pain meds that will allow you to get a baseline read on your pain (especially with your weight loss)?  Working with a pain specialist you might find better alternatives to narcotic pain control.  When I have taken morphine or morphine synthetics I find that they peak in terms of effective pain relief in about five days.  After that codiene, tylenol or ibuprofin work about as well (of course, check with your bariatrician, too.

I have worked with a number of people addicted to fentenyl as an addictions specialist.  You might be in a pattern of addiction/cross-addiction and it is possible you'll feel a whole lot better if you explore some alternatives.

Good luck,

CB

He's absolutely right, the sooner you can get away from the narcotic options the better, and the best way to do it is under the care of a pain management specialist. Also, I remembered there is a drug that can be prescribed now that is supposed to help tremendously with withdrawals. I can't remember the name though, but your doc would know - it basically works by binding to the opiate receptors so I am told....the non-narcotic options we tried were: Ultram (tramadol) Neurontin Baclofen These worked but the neurontin caused an annoying side effect of tingling in my arms, when we took the neurontin out of the equation though, the pain relief wasn't adequate Methadone- Great pain relief, awful side effects - nightmares and waking up not being able to tell the difference between dreaming and reality - three nights of this and he took me right off it.. MS Contin - worked fine, few side effects, not as addictivie because it wasn't so much up and down - just steady control - but still a narcotic and still a bit addictivie Lyrica - This was the last thing I was given and it worked well and is NOT a narcotic,  but my pain has subsided so much that now I take nothing at all!

The drug used for opiate withdrawal is buprenorphine.  It's available to be prescribed in two forms: Subutex and Suboxone.  Both tablets contain buprenorphine (either 2mg or 8mg, depending on your degree of dependence), and both are administered sublingually (let the tablet dissolve under the tongue); Suboxone also contains naloxone, an opiate antagonist, which prevents the drug from being abused when it's dissolved and injected.  (Naloxone isn't well-absorbed orally or sublingually, so it has a minimal effect on buprenorphine administered sublingually.) Buprenorphine is called an mu-opiate partial agonist, which means that it binds to mu-opiate receptors (and doesn't like to leave them), but when it binds, it causes many of the same effects that a pure mu-opiate agonist like fentanyl does, but not to the same extent.  This means that it blocks the effects of other mu-opiates, but continues to stave off withdrawal symptoms, and because it binds so tightly to mu-opiate receptors, it has a very long duration of action. When buprenorphine is used to assist withdrawal, you get switched to buprenorphine, and then the buprenorphine dose is tapered down over a period of time (decided by you and your doctor.) Only medical personnel who are Federally certified to use buprenorphine for opiate withdrawal and maintenance can prescribe it, but I'd expect that any pain management facility would either have such personnel, or know the people in your area who are so certified. You can also search for a local doctor on the manufacturer's website: http://www.suboxone.com This is also a great place to find out more about the use of buprenorphine for opiate dependence. The one advantage of withdrawal using buprenorphine under the supervision of a pain management or addiction specialist is that buprenorphine is actually a very potent, long-acting analgesic, so you shouldn't find yourself suffering too much from pain while you're on Subutex or Suboxone. Tramadol (Ultram) is a very weak synthetic codeine analog with some additional antidepressant-like actions.  It's "non narcotic" from the point of view of the DEA (it's not a scheduled drug), but to a pharmacologist, much of its pain-relieving effects come from its effects at mu-opiate receptors, just like every other opiate.  That said, it's several orders of magnitude less potent and less powerful than fentanyl, and would only be helpful once you were totally off the harder stuff. /Steve