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Change in medications causing withdrawals

Hi, I am new to this forum. I am a 59 year old woman who has had 4 lower back surgeries in the last 10 years, the last was a double fusion on L4/5-L5/S1. I have also developed fibromyalgia, which I was told was caused by my many surgeries, and myofascial pain syndrome. For the last 3 years, following my last surgery, I have been prescribed the Fentanyl patch 25 mcg and Norco 10/325 taken every 5 hours. About 3 weeks ago, I stopped my patch by weaning to 12 mcg for a few days, and then it fell off early, so I just never replaced it. After the first full day without wearing a patch, I started withdrawals that won't go away. What I mean to say is that while wearing the patch, I could go many, many hours without taking a Norco, certainly all through the night, and now I cannot go more than 4 hours without withdrawal symptoms from the Norco. I see my PM doctor next week, but I just wondered if anyone knows what this means and how long it will last. My fear is that I will never be able to sleep through the night again. I wake up with the withdrawal symptom that won't go away until I take the Norco at exactly 4 hours. Of course, this means that I ran out of the Norco early, and my PM doctor was okay with that and is seeing me early, but will this mean I have to go up to 6 a day indefinitely? It doesn't make sense to me. Any suggestions? Thank you!


  • dilaurodilauro ConnecticutPosts: 9,839
    but rather , pain since you dont have the patch. As you stated, with the patch, you didnt need your breakthrough medication that often. Now that the patch is off, you are needed those pills sooner.

    That makes sense, because your body isn't getting the pain medication from the patch anymore.
    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
  • Dilauro, thank you for your comment, but I believe it's withdrawals. I am feeling the pain...that is true....but I'm familiar with the feeling of withdrawals. I have actually gone off of my medications before through rehab to see if I could live without pain medication, and both times, I went back on the medication because the pain was too much to handle. I just had to try, you know? So going off of the patch was also my idea because #1, they give me hot flashes NOT related to being a woman where I am overheated and sweat if I do anything other than sit! And #2, our health insurance will be changing this summer and those patches are very expensive! But now I am considering going back on them if I will have this break-thru withdrawal feeling! I just don't know if it's temporary, which I can handle. But why go through all of this (again) if I'm just going to go back on them!
  • You didn't say how long you were on the fentanyl, but it can take about 12 hours or more before you start to feel the onset of withdrawal symptoms and even though you stepped down to 12 mcg.....you may still notice the missing fentanyl.....
    After you talk to your doctor, he may suggest that you continue to take the norco every 4 hours for a few days, but then stretch it back out to 6 hours after the worst of the withdrawal symptoms are over- usually around day 3-4 depending on the medication....the issue is that you stopped your baseline amount of opiate in your system so having some withdrawal is not at all unexpected.....it is normal for what you are doing. Norco, can help but you only want to do that for as short a time period as possible, otherwise, all you are doing is replacing the fentanyl amount you were using with norco instead......does that makes sense?
  • I have to ask why you just didn't wait til your next appt. with PM Dr. and ask him to switch you to another Long Acting Pain Med that your insurance will cover this Summer? There are a few that might work better than the patches and be covered by insurance that won't cause these side effects... I currently take Opana ER 15 mg. every 12 hours along with Oxycdodone 15 mg. 3 times daily... I have tried every other Long Acting Med on the planet except Oxycontin... I was on Methadone, 120 mg. daily for about 8 years then when I switched to a new PM Doc he tried Morphine, Percocet, and finally on what I am taking now... It may take a few combinations until the right one is the RIGHT ONE.... You already know by experience that quitting the meds on your own is painful and causes a lot of stress... so maybe doing it that way isn't the best thing for you... Talk to your Dr. and see what he says... Good Luck My Friend..
  • I'm not sure if I read your post right but you are saying that now you are no longer using fentanyl patches and are finding yourself more dependant on Norco to avoid withdrawal?

    That seems like a likely outcome of going off the patch IMO. Before you did, you were using Norco just to top up the fentanyl, to treat break through etc. Now it is your sole opioid medication and if you miss a dose, you will feel it.

    Call your PM and discuss this and what you should do about it. In future, don't make medication changes without prior permission from the doctor who prescribed the medication. If you feel unable to keep to your treatment plan, call your PM.
  • IMO, Fent withdrawal was the worst, and I've been on every pain med except methadone. When I was on the patch, I would need it changed every two days instead of three, but then found withdrawal starting at 45 hours, then 42, until I finally switched to something else. Many people found the Thomas recipe (just google it) to be helpful. I certainly loaded up on my vitamins and needed Xanax and more oxycodone while switching. It doesn't last forever. As Sandi asked, how long were you on the patch? My withdrawal was short because I was only on it for 2 months the first time and 1 month the second. Great relief, but not worth the withdrawals. I also used sleep medication during that time period, and I hate taking pills! Good luck. Pray for comfort and hope for all of us.
    DDD, L3-S1 almost gone. Waiting to hear about 3 disc fusion. Sciatica and arthritis. Life is like a box of chocolates...
  • I think it's also important for folks to realize that withdrawal symptoms can start at various times depending on the individuals metabolism and body chemistry.

    My father in law was an alcoholic and would typically start DT's after a couple days without a drink (he was in the hospital various times for heart attacks/stroke and would DT in there). However, on his deathbed he went into DT's just 6 hours after his last drink (as sad as it may be).

    The one constant I think everyone can agree to is that withdrawal's suck big time! My wife says I'm anal regarding my medications. I've tried explaining it but she doesn't seem to get the big picture. I'm sure the day will come where I'll forget my meds at home while were traveling and she will get to witness the fun which is withdrawal!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • anisa69aanisa69 Posts: 55
    edited 03/30/2014 - 8:04 AM
    I agree with you Keith I take my meds on time everyday and my husband says why do you take it like that. 6 am I get up to go bathroom and then I take my synthroid. I wake up at 8 am take my MS Cotin. I usually eat something and make breakfast for him. I give him his meds and I also take my gabapentin and Vit D. I get dressed and go to the hospital for my two hour treatment of the hyperbaric chamber. I usaully take my dilaudid before I go in because my back starts to hurt usually about and hour in. Then at 8 pm I take my Morphine again. At 10 I take my Ambein, dilaudid, and my gabapentin and I go to sleep. I try to explain to my husband that withdrawal is a killer.
    Female 44 survivor of thyroid cancer...just had two surgeries for breast cancer and chronic back pain. Live in upstate ny. On 8mg dilaudid 6 a day and 60mg morphine sulf er 2x day
  • Anisa, why aren't you using Exalgo instead of dilaudid 8mg? One dose in the morning lasts all day and night long.

    When I couldn't afford Exalgo (insurance lapse), I was trying to manage with plain hydromorphone round the clock, but my body was demanding it every 2-3 hours. I had trouble managing. I've since rotated back to oxycontin and don't have that racing tolerance thing going on anymore.

    Anyway, just curious, or if you were unaware, you should know that there's an ER /LA hydromorphone available now.
  • sandisandi Posts: 6,343
    edited 03/30/2014 - 2:54 PM
    She is using MS Contin as her long acting, and the dilaudid for breakthrough pain......
  • LC84LLC84 Posts: 599
    edited 04/01/2014 - 3:43 AM
    This was a few months ago but I've been taking Percocet 7.5/325 mg and was on it for about 6 months continuously then stopped it for a week, ( Sandi- this was one of those situations where my doc was out of town and the O/C doc didn't refill it. I should have raised the question then, but didn't even think about it). Anyway, thankfully I had absolutely no withdrawals, I was just in a lot more pain :( This medication is also much milder than what many of you are on, so that may play a part, along with not being on it as long.
    Progressive DDD
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 101
    edited 04/01/2014 - 4:46 AM
    I guess I am out of the loop as to what the definition of withdrawal actually means. I always understood it to mean getting the sweats, hallucinations and uncontrollable shaking and flu-like symptoms. I've never heard it described as having just pain.
    What if your body is telling you that you actually are in pain. That something somewhere is causing this pain and you actually just need the fentanyl to calm the severe pain? How can you tell the difference between true withdrawal and true pain?
  • Are we talking about IR pain meds not lasting long enough or is it withdrawals? I didn't think that withdrawals from Fentanyl could last over 3 weeks. I think Sandi said 3-4 days. Can you really start to feel it 3-4 hours after taking an IR, isn't that just the med starting to wear off & feeling the pain a bit more?
    Osteoarthritis & DDD.
  • Withdrawal is the sudden cessation of a medication , after being on it for an extended time frame.......
    The symptoms of withdrawal include :
    Diarrehea, headache, nausea, vomiting in some cases, flu like symptoms, muscle aches and pains, chills, sweats, loss of appetite, insomnia and muscle cramps.
    Symptoms of withdrawal will set in at different times , depending on the half life of the medication , duration of time that you have been on it, With medications such as fentanyl and methadone, symptoms may not appear for 18-36 hours or more ( more with these two drugs) due to the delivery mechanism of the fentanyl and the extended long half life of methadone.....
    With other opiates, the extended release versions of most of the medications- usually will set in about 15 hours after your last dose, and worsen over the next two days..and then begin to improve toward the end of the third or early fourth day.
    With the immediate release or short acting versions, withdrawal symptoms may start to appear around 6-8 hours after your last dose, or a bit longer....again, the symptoms will worsen over the next two days, as your body eliminates what was left of the opiates in your system and toward the end of day three or early on day four, you will notice improvement..
    Opiate withdrawal is not dangerous unless you have other medical conditions such as heart issues or blood pressure issues , and there are medications such as clonodine that can be given to reduce withdrawal symptoms when necessary.
    There are several over the counter medications that can ease withdrawal symptoms, including immodium, benedryl, topical creams and rubs can ease muscle aches and pains. Even something like nyquil can help with the sleeplessness.

    The difference between withdrawal and the use of medications slowly receeding in the amount of pain relief is simply that..over time, tolerance issues occur, where , especially in the use of immediate release medications, they don't seem to last quite as long as they once did when you first started on them......withdrawal symptoms will not occur unless there is a period of time between your last dose of several hours, or you suddenly stop taking the medication....
    A proper tapering plan, one you work out with your doctor can avoid any or most withdrawal symptoms if you wish to stop using the opiates. A small reduction in dosing occurs , over a few days, and continues until you are at the lowest possible dose, then you stop.....no withdrawal symptoms.
    A word of caution for those who are taking benzodiazepene's.......never stop taking them suddenly on your own. Benzodiazepene medications must be tapered off, or you can have a seizure and other problems.
  • Sandi, that was probably the best definition/explanation I've seen on this website! "LeeLee", part of the "pain" refers to body aches, but also the pain for which you were taking the medication to control.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • dilaurodilauro ConnecticutPosts: 9,839
    that about Sandi.
    She does do a great job in pulling together informative threads/posts.

    Sandi along with the rest of team( tamtam, liz, jellyhall) makes it so easy for me to be the System Moderator.
    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
  • Keith and Ron...........now, I'm blushing.........
  • Sandi- you have a way of responding in the most informative ways.
    Progressive DDD
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • I've had lots of years unfortunately to learn, and experience this stuff and I try to make things clear and simple so that it is not so complicated.
    Terms can be confusing, protocals can be confusing, understanding prescription bottle directions can be confusing, so I try to clarify things so people can avoid the pitfalls of dealing with doctors, pain management and treatment options.....there is tons of information out there, but trying to find what applies, what doesn't, the terminology can be enough to make anyone's head swim.....I try to clear the sharks out of the water a bit to make the shoreline a bit easier to reach.....
    Sandi -( who has swimming on her mind in case anyone can't tell ....LOL)
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