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AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:38 AM in Chronic Pain
My pm doctor is suggesting and has been suggesting for a couple of visits now that I go off my pain meds for a time period and then go back on them. Her theory is that for some people, narcotics can actually make your pain worse, if you have been on pain pills for a long time, your pain medications can be attributing to your pain instead of helping it. So her solution is to take a break from pain meds. I am not sure how long she is talking about taking a break from, I did not ask her, I think she is talking 30 days. It would be 30 days of pure hell I can tell you that because I have significant pain from DDD, arthritis, migraines, etc. We went through the entire stages of verifying what I do have, she ran her own tests, some really not necessary, and some were good. I don't understand this hyperalgesia stuff and what I do know about it all the literature I have read says its is poorly understood. From Wikipedia it says: If an individual is taking opioids for a chronic non-cancer pain condition, and cannot achieve effective pain relief despite increases in dose, they may be experiencing opioid-induced hyperalgesia. In this case, they may benefit from complete withdrawal from opioid therapy.
But for me I have been on the same strength for quite some time now, I have not gone up in strength, and in fact went down, I am on Avinza 45mg, I WAS on 60 mg and felt that was TOO STRONG and asked to go down to the 45mg. I also take 15 mg of Roxicodone for breakthrough pain as needed up to 2 a day. So I take 45 mg of Avinza a day and 2 Roxicodone's a day if needed (15mg). I fail to understand how I would fall into this category of Hyperalgesia, if I have not go up in strength in medication, it is not making any sense to me at all. I am not really willing to through the pain and torture of being of pain medication because this doctor thinks it will help me, I think she is wrong, what are some of the opinions of you guys??


  • All I know is that she BETTER be weaning you off the meds, and not expecting you to quit cold-turkey. That would be horrible!

    As for your other questions, afraid I'm not qualified to answer. I'm sure someone out there may be?

    Good luck, hon.
  • I would imagine she would wean me off slowly, but I am more worried about the pain that would surely follow for weeks until I went back on the pain meds. I find this would be a needless, futile exercise of cruelty and frustration. I am thinking that next time she brings this up I am going to be very honest with her and tell her I am against this and dont think its necessary and why.

  • You could let her know you are worried about the pain you will be in and that you fail to see the logic behind it all.

    Got time for a little short story?

    Way back years ago, when I first started taking my meds.... My monthly appointment had to be rescheduled - my doctor's request - she had some sort of family emergency. It was rescheduled for 2 weeks later. I never thought about what to do about my refills. Well, when my medication ran out, I called the office; since my doctor was the only one there at the time (she has since employed 3 more PMs and each has their own NP and there is one Psych), they told me I had to wait until she returned to the office. YIKES! I went 2 weeks without my meds. The WD I endured was awful (I had only been on the meds for 3 months I think; not long but long enough for my body to become "dependant")

    When I saw her finally, I came unglued and went off on her like I don't know what. She looked puzzled, and told me I could have had my meds refilled if the nurse had only called her for verification. We guessed that since it was a family emergency the nurse did not want to disturb her. Needless to say, that nurse is no longer there. BUT, I did notice that being off the meds for 2 weeks, when I re-started them they worked alot better at reducing my pain. Mind you, it was short-lived, but I got a great deal more pain relief the first couple weeks back on the meds than I have since.

    For me, I think it would work. But not for long. I mean, tolerance is tolerance. Is a month (more or less) worth the trouble in the long run? That's the question.

    I hope you can both come to a mutual agreement. Back then, I told my doc that I was paying her for "pain management" and that I felt my pain was not being managed adequately.

    We're doing much better these days, my doctor and I. We communicate. She asks me what I want to try, but only after she tells me what she is thinking of trying.

    Good luck Tinks!
  • tinker - I could not image being without pain meds. I kind of get the drift of her idea - but I would be more inclined to ask her for a different "family" of drugs to try rather then nothing at all for X amount of days.

    I also agree with jeaux - it MAY work but at what cost to you and for how long before this happens again :??

    Please let us know how this all works out :)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Lori,i wouldnt want to go off my pain medicines at all,i take vicadin es and morphine er,surgery is not a option for me.....Could you talk to your primary doctor about it and see what he or she says? i get my pain meds from my Primary doctor....
  • I agree with what you guys are saying, and its the same train of the thoughts I am having as well. When I had surgery back in December of 2007 my surgeon STRONGLY recommended I go off of all pain meds at least 4 weeks and more like 6 weeks prior to surgery so I could receive optimal pain management after major surgery. It agreed with him and wanted to be able to control my pain and not need major massive dosage of drugs to do it. I did manage to get off of all narcotics for 6 weeks. It was not easy at all. I was in some very serious pain. But the pain relief post op was probably much better.
    My PM docs theory is the narcotics are MAKING my pain worse. She says hyperalgesia could be happening to me and making my pain worse. My understanding of this phenomenon is you get your pain meds uppped in dosage and upped again and then your body is resisant to them and develop hyperalgesia. Some doctors don't even recognize this as a true legit condition, my pm doctor admitted this to me today. But I have not even had an increase in dosage. I don't believe I have hyperalgesia, I dont think the pain medication is making my pain worse, I have chronic pain, it has nothing to do with the medication I take. I don't really want to stop taking my meds, go through any kind of withdrawl, horrible pain, just to prove to her I don't have hyperalgesia. She said to me that she likes her pain patients to do this once every few years, for heaven sakes why???
    Could be time to look for a new pm doctor.

  • hyperalgesia. I can tell you that I have full confidence in my PM doc and he thinks that it is a bunch of hooey. Non existent. Have you considered getting a second opinion? I would really think twice about a doc that suggested taking a chronic pain patient off of their meds for 30 days and expecting them to gtit their teeth and bear it.
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,732
    Your P.M. Dr. Wants you to go off of meds for a while so that after 30 days or so the meds will work better. But then you'll go back on them. And supposedly they will work better. But then after a while you'll be right back where you are now.
    All of that suffering for what? For the Dr. to prove or disprove a theory at your expence! Or so the meds will work better for a short time and eventually you will be right back where you were in the first place! Where is the logic?
    Good luck, Jim :/ :jawdrop:
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • Thanks for helping me think through this, appreciate it. I am not going to go off the meds if its in my power to do so even if it means finding a new pm doctor. I know that like you doctor said, J.J. Grey, alot of docs thinks its alot of baloney. Anywho, thanks again,

  • You are correct that hyperalgesia is only a "theory" and many docs don't believe that it is actually a true condition. If your doc is really adamant on "testing" this theory with you, then one thing to consider is using pain medications that target different pain receptors. So in essence you could take a "holiday" from opiates without suffering needlessly. Since the PM doc has so much available to help treat you, it should be possible to titrate one drug in while titrating the other one down, all the while keeping a therapeutic level of medication in your system.

  • just another story of a dr who doesn't want narcotics. he is the take 2 aspirin and see me in the morning dr. the idea that narcotics make pain worse is fanned by the infamous dr drew on celebrity rehab. this is his reasoning. acutally it is only an excuse to get you off narcotics and i bet once off he will never put you on them agian. get rid of this quack and get a real pain dr who knows the benefits of pain meds and who is not afraid to use them. i hate drs like this. they are an embarrassment to the professions and should lose their liscense. unfortunately the world is filled with these quacks. these drs should be drummed out of their profession. i know you are asking, what do you really feel?
    get a new one asap
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • IF you do have hyperalgesia and to this torture method to find out for sure.

    What happens next?

    Do you go without pain meds the rest of your life? =;

    If she gives you a hard time about not choosing this, ask her that question.

    Please let us know how things go :)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • It seems to me that if you haven't had any increase in the amount or strength of your medications, how can your doctor suggest hyperalgesia? It's clearly stated that it occurs when the amount of medications is increased so much that it induces hyperalgesia.

    You're a lot like me - I've only had one increase in the strength of one of my medications in the past year. That's my choice not to get anything stronger because if I can just keep the nasty little edge of my pain off without taking anything stronger, that's good for me. I don't want anything stronger if I can help it.

    Good luck to you and yes, let us know how it goes.
  • Thanks everyone for your help and suggestions. I am lucky to have a forum to go to so I can get ideas and support. I dont see a diagnosis of hyperalgesia for me, based on I have not had ANY increase of pain medications. I have in fact had a documeted decreased of pain medication from this very PM doctor. I asked to go from 60 mg of Avinza to 45 mg of Avinza. I take 45mg of Avinza every 24 hours and I take 2 15 mgs of Roxicodone's a day, sometimes though I only need one a day. PLUS, I had a break of all pain medication in Dec. of 2007 right before spine surgery. I do think if this PM doctor continues to push this hyperalgesia diagnosis and going off pain pills in the Spring (that what she said this week) I will find a new doctor. I don't believe what she is saying nor do I want to be in pain because she thinks I have this and is doing it on a whim, afterall she is not the one that will be wracked with pain, I will be.
    One other question, is it unreasonable or dumb, or anything else to think that my pain may always need or at least long term need some form of pain medication? I guess what I am saying is this PM doctor makes it sound like long term pain pills for me is just silly and for most people is not good. Now I am very aware of long term narcotics use and the outcome and all the information on that. However, I also know that living with chronic pain everyday without good pain control can mean the differnce between quality of life and no quality of life. Have most of you been on pain pills a long period of time, and or expect to be on them a while? I have been on mine since before surgery Dec of 07 and after surgery. I don't know how long I will need them now since my fusion was a failed one and now I have RA plus I have a level above the fusion that is bulging now.
    Thanks for all your help and support, it means alot.
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