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opiod rollercoster pain vs constant pain

This is probally a repeat but I was not able to find something like this.
I was taking 10/500 Hydrocodone 2-3 times a day for 3 years. Due to DEA I have been reduced every month and now take Tramadol. Well after awhile I got used to the constant pain of 5-6 that the tramadol kept it at. However I could not sleep nor eat due to the nasuea of the tramadol.
My doctor gave me the hydrocodone again to take at night for spasm and dull ache pain ( severe Scatica). Well the hydrocodone gets rid of the pain or at least gets rid of it so I can walk without a cane and sit for more than 1 minute.

When it wears off it seems the pain is 10 times worst than it was before but I know that it is still a 5-6 I just had a little rest from it. My ortho doc refered to this as rebound pain and many people experiencing this will increase there dosage or think it is not working. I am learning that the pain is permanent, my foot wil always burn, there will always be a rock in the back of my leg and I will always have trouble walking, and may not work again.

It's hard to say what is better a constant 5-6 that wears you down slowly or the rollercoaster of using opiods from no pain to very bad pain. Right now it looks like splitting the two.


  • I'm not sure what you mean when you say the DEA is responsible for the Dr. changing you from Norco to Tramadol. They are a federal agency and there isn't any law/regulation saying that a Dr. can't prescribe those medications.

    The only recent change overall was the new FDA recommendation that manufacturers have to stop making any short acting pills that contain more than 325mg of acetaminophen. There are still many lots/batches of the 500 or above pills that are in warehouses and pharmacies so it will take some time to phase out.

    The big thing is that each state has their own laws/regulations in regards to opiate prescribing. And I don't know of any state that prohibits Norco and forces a Dr. to change you from this to Tramadol.

    So if your Dr. is telling you this it is false. You can research on your own the state laws in which you live.

    Now, there is also going to be in the next few years where regulations are changing on who can prescribe opiates. If it is a non PM Dr., they will have to go through additional training and certification to understand pain management and medications.

    For most patients, if someone has been on short acting medication for longer than 3-6 months, they are moved to a long acting medication. But your Dr. when from one short acting med to another (I assume unless it is Tramadol ER )

    Are you taking anything for your nerve pain? An opiate does not work for this type of pain. Same thing with muscle pain...that is what muscle relaxers are for. An opiate is just meant to "dull" the pain a bit.

    Nerve pain meds are Lyrica, Neurontin, and Cymbalta.
    Muscle relaxers are Flexeril, Robaxin, Skelaxin, Soma, or Baclofen.

    Also, what else do you do to help lower your pain levels? No one should rely soley on medication to do this. Especially solely on an opiate.

    And even though Tramadol is not an opiate in the true sense of the word, it has opiate like tendencies and hits similar receptors in the brain.

    There is always a possibility of rebound pain....especially if you are only taking an opiate and expecting it to do all the work of reducing your pain levels.

    A good PM will develop a comphrensive pain reduction program to include:

    Aqua therapy
    Physical therapy
    Injections (Lidocaine and/or steroids)
    Oral steroids
    TENS unit
    SCS unit
    Not smoking
    Eating well and maintaining a healthy weight

    And then the other medications I listed like a nerve pain med, muscle relaxer, antidepressant, and possibly a sleep med.

    It's not about trying any of those modalities once and expecting it to take all the pain away and then stopping it if it doesn't..

    It's like a big puzzle and every modality can take a tiny bit of the pain away to add up to a 5 or so on the pain scale which is what most Drs. shoot for with chronic pain.

  • All docs here are scared there licenses will be pulled so they are either no longer prescribing opiods or cutting the dosages down so they don't get flaged ( ex prescribing 180 60mg oxycotins). my story is a very long one and on this site in more than one place. Quite frankly it sounds like a soap opera in the twilight zone. Oh Amitriptyline for nerve pain and lidoderm patchs ( at $10.00 a piece). I have a case "nurse" through my insurance company trying to get me into a reputable PM clinic that is not a licensed drug dealer( which my last one was). I have done everything except aqua therapy. Oh BTW a 6 for me is clenching my teeth a 5 is clenching my teeth every 10-15 minutes.
  • I was just trying to say that there isn't any regulation or law that prevents a Dr. from prescribing the dosages which you listed. 2-3 Norco per day and making patients go to Tramadol.

    The example you now give in the last post is 3, 60mg Oxycontin a day or every 8 hours. That is still not an unusual amount for an opiate tolerant patient and there isn't any law by the DEA that prevents this prescription.

    Only the Drs. that are not PM ones as I mentioned are starting to refer patients out to actual PM Drs as the laws are changing over the next few years.

    But to say that "every" Dr. is moving all their patients to Tramadol and not prescribing anything more than this is absolutely false. There is not a state out there that has this law. If you have information about this, as in an actual government website for your state that shows this exact law, please post it.

    I'm not trying to be agrumentative...I just try to deal in facts and as I said, if your Dr. told you that you have to move from Norco to Tramadol because of the DEA they are not telling you the truth.

    If your last PM was a "licensed drug dealer" in the negative sense...well then obviously they would be running from the DEA...

    But there are good, reputable PM Drs. out there that are helping their patients and prescribe appropriate amounts of opiates when needed along with using all the other modalities I mentioned.

    And yes, we all have a bit different view of the pain scale but a 5 just means that you still have pain all day, but it is manageable. I get to the 7's where I grit my teeth once in awhile....but then I have breakthrough medication for this. I am also on a long acting opiate for my other medication. I have a muscle relaxer when needed as well.

    And Elavil is an old school antidepressant in the tricyclic classification. It may have a possibility of helping some nerve pain but if it's not working for you then there are actual non off label nerve pain meds that are much more effective as I mentioned. Lyrica, Neurontin, or Cymbalta. I hated Elavil when a Dr. put me on this in my early 20's for headaches...but we are all different. If it is working for you in relieving your nerve pain than that is great.

    And you wrote you "did" everything.....which means past tense....As I mentioned...a good PM will have you doing the modalities that I mentioned every day/week/month...

    Exercising is daily. Yoga/stretching is daily. PT is a few times per week. (done at home).

    Injections are every few months. Eating healthy and maintaining a good weight is permanent.

    Are you on a muscle relaxer as well to help?

    You came on here asking for suggestions or thoughts...I am offering:) Many people will go up to 3 hours to find a good PM if you have already been to every single Dr. in your area. Once you get established with one, you can see them every 3 months.

    As I said...a Dr. is only "scared" about their license if they are doing something wrong. Good PM Drs. are not fearful of doing their job.

    I wish you luck..
  • Thanks to politician's in KY, even good doctors have to fear for their licenses. They can now be fined or lose their license if they 1. under prescribe, 2 over prescribe, 3. don't have everyone on NSAID's, 4. don't make patients wait a week afte seeing the doctor to go back and pick up the prescription...I could go on and on.

    Bottom line, the fact that some bad apple doc's and pill mills are now creating a situation where legit patients have to suffer. My doc said that I may have to go back to NSAID's. I reminded him that I have a cardiac history and cannot take NSAID's. I'm waiting to see what happen's when I go in next month.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Yeah I heard about Kentucky, they went off the deep end bad. MD seems to be going the same way.

    DEA has a sting going on, I thought it was past tense but I found out it it still going on. They hit my GP about a month ago, came in as a new paitent complaining of severe pain from some accident, he sent them to the local lab for blood tests and told them to come back the next day. He passed. If he had prescribed ANY opiod his license would have been suspended pending further investigation. I really don't know where the state rules come into play as what is going on here is federal and had nothing to do with the state. Also and I qoute " I don't prescribe opiods becuase I don't want the DEA poking around, they are worse than the IRS and I worked to hard to loose it becuase of some government person looking for a problem"
    That same sentiment has been told to me by every single doctor. Vist dea.gov and read the policy and prescribing guidlines please. Every doctor is putting there carears and possible freedom at risk every time they prescibe an opiod. You are guily until proven inocent as the DEA is judge, jury, and executioner.
    FYI: The doc switched me at my request as I had to get an emergency script out of state and they would only prescribe tramadol.
    It has nothing to do with LAWS it has to do with the a-holes abusing it and the government trying to keep kids from dropping dead, we are just stuck in the cross fire.
  • LovetrotravelLLovetrotravel Posts: 296
    edited 08/17/2012 - 4:50 AM
    I keep trying to say that there are plenty of legitmate Pain Management Drs. in every state that are still practicing...still prescribing...and have no issues with prescribing opiates.

    The DEA only goes after Drs. that have raised red flags with their prescribing. It's hard to believe that you have visited every single Dr. in your state and have them tell you this...

    I don't mind people sharing stories about personal experiences but it's a bit of yelling "fire" to scare newbies that read this site.

    Pain Management has been changing over the years but it is not going away. As I stated and not sure if you read in my post, that yes, if a Dr. is NOT an actual Board Certified Pain Management Dr....then they are not caring to go through the extra certification and training needed to continue to prescribe opiates.....

    Even Florida....which has one of the highest rates of abuse and pill mills....still has pleny of legitimate Drs. who are helping chronic pain patients and are on opiates.

    The key is doing urine tests....which are no big deal...Our state started requiring them yearly two years ago...NOT the DEA.....

    And yes, we sign pain contracts as well and as I've mentioned in many threads....There are 41 states so far that are part of the Prescription Monitoring Program. So anywhere you try to fill an opiate, it tracks you by your name and helps prevent those who are Dr. shopping.

    This will be my last post on this particular thread as I truly am not wanting to argue to the death here...LOL...I just hate to see when people use blanket statements....

    The DEA is not shutting every single Dr. down. Only the pill mills....

    I am not doubting that your Dr. said to you that they don't want the "trouble" of dealing with opiate prescriptions......That is their choice...There are GPs, PCPs, Internists, and Rheumys that will have to get extra certification to continue prescribing....some are choosing not to...but others are.

    But that is completely different than what you said in your first post about the DEA "forcing" your Dr. to stop prescribing Norco at 2-3 a day and make you go to Tramadol. That was a decision that your Dr. made on their own.

    That is completely different than saying ALL Drs. are cutting people off and not prescribing...that simply is not true.

  • I am fromCanada, so I get most of my information from the news. Washington State has passed a law that anyone prescribed 120 mg's of moriphne, or equivalent in another form of a narcotic, has to either have their treatment reviewed by a PM or treated by a PM, and I believe that the consequences for a Dr for over prescribing are quite severe (sorry I can't remember exactly what was stated, I will try to find the articles I read and post again). A lot of Doctors are not treating patients that require narcotics anymore, and telling them to find a PM doctor. The problem is that there is not enough PM's to treat the patients, so a lot of people are now going without.

    Other states are now concidering adopting this legislation because the number of people on narcotics has reduced, however my understanding from these news reports is that there are not near enough PM's to treat all of the patients that are in some form of chronic pain.

    Again, my source for this is news outlets in the states, I am in canada and we tend to follow what the US does when it comes to medication, so I have been trying to follow this issue.

    If the DEA, or the state is cracking down, I can see how Dr's would be afraid to prescribe. The have been multiple cases in the news of Dr's on trial, some found guilty some not. I have a hard time believing that a doctor would knowingly perscibe a patient too much narcotics. OxyContin guidelines were there was no limit on the amount that can be prescribed if a patient is used to taking it(sorry, I know there is a better term, I can't think of it right now).

    Again, I am an observer from another country, but this is what I have read in the news.
  • EMS GuyEEMS Guy Posts: 920
    edited 08/18/2012 - 2:33 AM
    Part of the problem is the DEA - they need to perform a "bottom up" review of their regulations and decide on the proper form of enforcement so that states don't have to supercede federal law.

    My problem with the new legislation in my state (KY) is that they have crafted a law that is darn near ridiculous. For example, one portion of the law says each exam room within a PM office must have operational sinks utilizing gooseneck faucets and paddle on/off handles. Explain how that is going to stop people from diverting medications?

    If I though for one minute that I was going to a "pill mill" for treatment, I would be out of there in two seconds. But, my PM is on the local law enforcement Diversion Task Force and is the head of the KY Doctor's Association. He is Board Certified in PM, anesthesiology and a former Flight Surgeon from the Navy. I was just notified yesterday that he is moving his office across the bridge to Indiana because trying to conform with the new law was tying his hands on how to treat patient's. If you knew how big of a pain in the butt it is to get to Southern Indiana and the time it takes to do so from where I live you would understand my frustration.

    The practice of medicine should be controlled by doctor's with oversight from the government to a point. But the politicians who wrote this law are from districts where diversion is the worst in the state. Instead of throwing the baby out with the bathwater, they need to focus on that area and clean it up. But, because they are politicians and want to keep their jobs as such, they deny a local problem and decry that the issue is statewide. That way, their hometown isn't pinpointed as a problem area.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • MrGrouchin said:
    It's hard to say what is better a constant 5-6 that wears you down slowly or the rollercoaster of using opiods from no pain to very bad pain. Right now it looks like splitting the two.
    I think this was your point; don't know why that one passage about the DEA got jumped on so much.

    I totally understand your quandary or your musing/thoughts. It is a constant weighing of pros versus cons. There are so many reasons not to use opiates, and the rebound pain is just one of them. The potential that at any point the doctor is going to stop prescribing them or give a very small amount due to DEA pressure that they are getting or just perceive they may get is another reason. My doctor said that 99% of the world's consumption of hydrocodone is in America. I don't understand why that is, but I think it does show that it's overprescribed. If the rest of the world gets by without it, then there must be something for us to learn from them. Maybe the DEA should be bugging doctors after all.

    I too have learned to accept that the pain is permanent; my leg and foot may just always burn and my lower back may just always hurt. I'm lucky that Tramadol works for me, and though I keep swearing I'm going to stop using Norco completely, I do have it and do use it for breakthrough pain but I have varying amounts of pain every day (except for a few blessed days/weeks after an injection). I took a 3-hour a day job at a school this week, and had to go to the OT room to lay on a mat and do stretches, but I am still convinced that the job is good for me despite the aggravation of the pain. Like you said, I'm going to hurt anyway.

    On the government policing of pain medicine that others have commented on, I wonder what effect President Obama's healthcare plan ("Obamacare") will have on PM doctors. I did read recently that it nixed a treatment a pain management center was using for patients that involved gathering stem cells from the patient, doing something magical to them and then reinjecting them (or something like that). If the federal government begins passing legislation about what PM clinics are going to be allowed to do and/or prescribe versus not allowed to do/prescribe, I think it will be much more restrictive than the present, i.e., where each state handles its own, regardless of who wins the election in November.
  • dilaurodilauro ConnecticutPosts: 9,874
    Politics is a subject that we do not want to see on our forums. Discussions of this type can only lead to problems.
    So, for now, I am just asking to stop any post that are dealing with politics.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • BlueSkiesBBlueSkies Posts: 59
    edited 08/26/2012 - 8:13 AM
    dilauro said:
    ...[S]top any post that are dealing with politics.

  • Just to jump back to your original post -- I wanted to mention another neuroblocker that worked really well for me (at least for awhile). Desipramine. It's in the same family as Elavil, Lyrcia and Cymbalta - all of which I tried and none worked. For me, it was like a miracle drug. The problem I had with Despiramine is that every 3 or 4 weeks, it was like my body got used to it, and I would have to increase my dose. Eventually, I got to the max dosage and it stopped working. I'm planning to go back on in the next month (have given my body a 9 month respite). Anyhow, just thought I'd mention and maybe you could discuss mention to your PM. It might help with the nerve pain. Good luck.
  • DEA has no control over state laws and cannot over ride them unless federal laws are broken. Your doctor may not believe you need the norco, if he thought you were in pain he would not fear any legal recourse. I was on hydrocodone 10mg and moved to percocet 10mg over a 2 year period and once I went to a long acting oxycontin op, the "rebound pain" was more under control. I am not saying you do not have pain and I have been in the same position. The nerve pain was what brought me to my knees and I wish opiates and nerve meds worked better but they are not enough on their own. Perhaps it is time you seek a surgeons advice, after I took the leap for a fusion on l5-s1(my second surgery) my nerve pain has almost completely gone away.Good luck
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