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Is it REAL pain or withdrawal pain?

If back and joint pain, and muscle aches and pain, are all symptoms of withdrawal from Oxycontin, how would one know whether pain is due to their underlying condition or to needing to take more meds?

I'm one of those stubborn individuals who often doesn't take my Oxy dose on the prescribed schedule, always hoping the pain won't come back and I won't need to continue meds. I was very overdue for my dose last night and started having what I'll call "body anxiety" symptoms, where I just couldn't sit still, even though I was in great pain. While researching withdrawal symptoms today, I noted that the exact pain I'm being treated for is also a withdrawal symptom. So, I ask again: how would one know whether pain is due to their underlying condition or to needing to take more meds?


  • Trainer,
    If you are supposed to be taking Oxycontin, which is the long acting version of the medication oxycodone, then not taking it in the prescribed intervals will bring on a form of mini withdrawl after a period of time. It will not be immediate as in you didn't take it within a few minutes of your regular dosing time, however within a few hours, you will notice increased pain levels, some muscle aches and pains, maybe some minor sweating or flushing, and as more time passes, the symptoms will worsen.
    Increased pain may be from not taking the meds in the allocated time frame, but also from the falling blood plasma levels of the medication in your system.
    It really depends on how long of a time frame we are talking about here...
  • That's a loaded question, If symptoms are just aches and pain with back and joints might not need oxy to begin with,

    Might be beter off geting off the oxy and go on some anti inflammation medication if you think your symptoms are from withdrawals not spine related, At some point we all try to stop our meds just to see what pain we do have without meds and to see if it can be tolerated with no meds or very low dose of meds,

    Talk to your doctor if you need help geting off the oxy and detox your system to reset the clock as this helps posibly change to diferent meds or no meds if you are lucky, Once body is clock is reset low dose of meds help a lot more,

    Good luck,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • trainer1158ttrainer1158 Posts: 4
    edited 02/04/2013 - 8:18 AM
    Symptoms are way more than aches and pains. After a laminectomy 12/11 and two cervical fusions 8/12, I'm worse than before the procedures. In addition to constant stabbing pain from herniated disk in upper left buttock, I have unremitting pain throughout my neck, shoulders, chest, upper arms, back, and rib cage. Without Oxycontin (20mg 3x/day) and Oxycodone (5mg 4x/day), the pain is intolerable. It's like my body is "buzzing" with pain. I'm a personal trainer, so without meds, I wouldn't be able to work at all. Unfortunately, I can't continue bending and lifting weight all the time, so my 16-year career is ending this month and I'll be taking a desk job. My whole life is changing. Very sad.

    I like and respect my pain doc, who explained that when you operate on the back or neck, everything else along the spine is affected. I have other herniated disks, but no one's touching me unless/until I have severe neurological symptoms, as was the case for my neck.

    Alexhurting, if "At some point we all try to stop our meds just to see what pain we do have without meds and to see if it can be tolerated with no meds or very low dose of meds," how can we know if it's PAIN pain or withdrawal pain unless we all start over again?

  • I have both lowered my total daily meds and stopped them to get an idea of what my pain levels
    Would be with lower doses and with no meds. I have given both options at least a month before
    making a decision. Doing it that way gives my body time to adjust and start making its own endorphinw
    as well...that's the only way that I know of.
  • Sandi...so what were the results?
  • alexhurtingaalexhurting Posts: 1,991
    edited 02/05/2013 - 6:03 PM
    Only way I know how is slowly lowering the dose each day, It's not easy but once levels of meds are down at very low dose and kept at a low dose, withdraw will pass and body will adjust, Of course it can be frustrating as pain always wants us to go for the meds even when we realise it no longer helps much,

    Then as we increase it a litle now it helps again, I been playing this game for 20 years so my body don't get so use to the meds at high dose where when it stops working I have no direction to go if my body got use to the medication,

    It sucks to have to do this but I rather do it this way then drop dead by mistake, Long term medication is a concern to me so this is how I learned to deal with it , It's my body and if I took every medication in the 20 years dr,s pushed my way Iprobably would be dead already,

    Pain is bad enough and nothing worse then geting over medicated and pain is still out of control , Been there done that,

    Good luck,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • sandisandi Posts: 6,343
    edited 02/06/2013 - 1:42 PM
    So far Trainer,
    It's going well for me. I've been on many forms of opiates since my first back surgery and even before that, for Reflex Sympathetic Dystrophy in my right arm, shoulder, and hand....I have found that for me, I feel better on lesser dosages. I am the first to admit that there were times when the lower doses didn't work as well as I would have liked at the time- in the immediate post op periods, high flare times, things like overdoing it when I know that I shouldn't have but for me, I have found that I like to periodically try to reduce my meds to see where I am at......for the first time in 7 years, I am taking a moderate dose of fentanyl, and still have my breakthrough meds, my muscle relaxers, and so far, the pain levels are holding...I am considering trying another reduction - maybe another 25 mcg down on the fentanyl and dropping one or two of my breakthrough doses to see how I manage- but the weather is still too cold right now and that causes my pain to go up so I may wait until the weather is a bit warmer.....
    The hardest part is sticking with it, while you are going down in doses, and giving yourself the time and the permission to tolerate the pain levels so that you can see how you are really doing after a few weeks. But you can do it, if you make your mind up to.
  • dilaurodilauro ConnecticutPosts: 9,842
    The important messages you have been given here by both Sandi and Alex

    1 - Oxycontin is a long slow acting pain medication, generally taken with breakthrough medication. You should NEVER alter the dosage that was prescribed to you. IF you plan on making any changes, contact your doctor first for their approval.

    2 - For the most part, I think one can distinguish between withdrawal and chronic pain. I like to refer to withdrawal pain as pain similar to like when you have the flu, or when you fell off a bike and how you felt the next day, etc But everyone is different. IF you are not sure, contact your doctor first so that they can help you out.

    3 - Never attempt cold turkey. You could really create problems. Again IF you want to give this a try, contact your doctor first to get their approval.

    Now, hopefully you also get my message: IF -> CONTACT -> DOCTOR 1ST -> FOR APPROVAL
    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
  • Interestingly, I would describe my medicated pain as you described withdrawal pain: similar to pain w/the flu and feeling like I went 10 rounds yesterday (as opposed to falling off a bike). From my neck to my hips, and throughout my chest, arms and abs, it ranges from severe aching on meds to unbelievable body pain everywhere w/o meds. Different for everyone, I guess.

    I have no interest in changing my meds just to see how it goes. Since I'll be retiring from personal training and starting a desk job in two weeks, I need to do my best to keep the pain manageable. I am worried about my ability to stay alert at work all day, as by my second dose of the day, I'm quite drowsy and often need to lay down for an hour.
  • djw2112ddjw2112 Posts: 9
    edited 02/12/2013 - 4:50 PM
    Well, when a pain patient goes through withdrawal, the pains are WAY worse than one that does the stuff for kicks. You've got to think, to feel the max potential of a withdrawal you've got to go a minimum of 48 hours (withdrawal normally starts after 8-12 hours pass) after your meds wear off. Anyway, as a chronic pain patient that does have legitimate medical need for your medication, when you go into withdrawal, you not only feel your withdrawal pain: that pain you always deal with certainly isn't going anywhere, so it gets compounded.
    I am not a medical professional, and everything that I say should be taken with a grain of salt. No diagnoses or truely medical opinions can be drawn with out a physical, face-to-face doctor visit.
  • One thing that most, not all, of us who have tried to just quit suffer from is diarrhea. Every time I have just up and quit, I get this wicked symptom and have to take some hydro to stop it. Not even Amodium helps. I have heard several people say the same thing about sudden withdrawl.
  • It's even more problematic when coming off cold turkey as opposed to tapering off (weaning). The reason for this, is that there are µ(mu)-receptors (opioid/painkiller receptors) in the myenteric plexus your large intestine, and when you take an opioid analgesic that activates these sites, it decreases the tone of the longitudinal smooth muscles but increases the tone of circular smooth muscles of the intestinal wall. This keeps substances from moving as quickly through your large intestine and allows for more of the water and nutrients to be absorbed from said substances. This is the cause for the constipation resultant from taking painkillers.

    The opposite is also true. Once you run out of these medications, the change is not only undone, but your body is used to having SOME activation of these receptors, so the tone of longitudinal smooth muscles then increases, while the tone of the circular smooth muscles decrease, which then turns your GI tract into a water slide, in one way of illustrating it.

    Loperamide (Imodium), unknown to many, is actually a VERY POTENT opioid itself. Just without other substances, that will be left unsaid, manipulating the drug in some form, cause it to cross back over the Blood Brain Barrier (BBB) almost as soon as it penetrates it. This is why Imodium was originally considered to be made a C-V (Schedule V) substance, but the lack of non-prescription drugs for diarrhea kept them from not only scheduling it, but from making it a prescription drug all together.

    That being said, if one took enough Loperamide (Imodium), it would then address most of the GI problems from withdrawal and fully take care of the diarrhea. Caution must be exercised in not taking too much of this medication though as it can cause fecal impactions/blockages at higher doses. Recommended dose of the medication is to take 2-4mg after first loose stool and to follow up with 2mg after each subsequent loose stool. NOT TO BE CONSTRUED AS MEDICAL ADVICE - ONLY AN ANECDOTAL REPORT: In my experience (and the amount might vary dependent on tolerance), taking 6-8mg (10-12mg at it's worst, but would always start small) each day of withdrawal (waiting on the first instance of diarrhea of course) has always been enough to take care of that particular issue of withdrawal (and because of how long it remains in the blood, this only needs to be dosed once every day or two).


    A little dry and science-y, I know, but at least you now know why this happens during withdrawal AND why they have to print on the box of Imodium that it "may cause drowsiness and dizziness" even when it doesn't to almost all of the population, haha.
    I am not a medical professional, and everything that I say should be taken with a grain of salt. No diagnoses or truely medical opinions can be drawn with out a physical, face-to-face doctor visit.
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