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Weaning off of Ultram ER (Tramadol)

Rhonda IndyRRhonda Indy Posts: 28
edited 06/11/2012 - 8:19 AM in Chronic Pain
I've been taking Ultram ER 200 in with Topamax 50mg for about a year now for chronic neuropathy legs and feet after a disectomy L5-S1 in 2003. It's becoming ineffective now and based on my most current MRI, the neurosurgeon (not the one who did my first surgery) says he doesn't really see anything to operate on. He's referring me to a different pain management doctor (my previous doc stopped practicing. Now, how can someone really evaluate how bad someone's pain really is unless they are not taking anything? I was wondering if anyone in this forum has been through the experience of weaning (withdrawling) from tramadol of any kind. I'm an RN and have cared for many a patient going through DT's and withdrawl from cocaine etc. and it's not a pretty sight. I would imagine if there is going to be nausea, sweats, anxiety, etc, I'll be getting some medical leave. I'd appreciate any input from anyone who may have experienced this and would like to share.

Many thanks,



  • That sounds so scary to me. Withdrawl is one of my biggest fears. Your not just stopping the meds all together right? I think that if you wean yourself off the med properly, you shouldn't have any withdrawl... at least I hope that would be the case.

    Good Luck
  • Hi Rhonda,
    To my knowledge the best way to evaluate someones pain is not to be on anything. Then you have the true scale of it.
    I guess I am not really sure what you mean by that. Its the only way I am taking the question.
    Mabye you mean something different.

    As for withdrawal of ultram I never had a issue.
    Iv been on it since 04.
    Iv gone on and off with no withdrawal effects.
    Most likely the reason it being non-narcotic.
    I certainly am not saying that is not the case with everyone. As I know some have gone through them.
    Best bet with the ER ones is to ween off of them, and not stop cold turkey. But of course this would be done through your Dr. He would just cut your dosage down till your off.

    Good luck hun!!
  • I'm going to run all those questions by the doctor when I get in to see her. I definitely need guidance with this one. I had been on Cymbalta before and went off of it before starting Lyrica. I felt like my head was "swimming." (like my eyes couldn't catch up with my body)
    It was very weird.

    I am so sick of taking antidepressants, anticonvulsants, NSAIDS, synthetic opiates, and having needles stuck in my back. I think of the money I've literally flushed down the toilet because I begin to build up a tolerance to the drugs and have to switch treatments.

    It gets pretty frustrating.

  • My doc just put me on this combo for L5-S1 pain (re-herniation, trying to put off surgery or at minimum to manage the pain). One of the reasons she chose Tramadol is because it is a non-narcotic, I had been taking hydrocodone, and this one she felt would be less risk of addiction. As with any med, you should definitely taper off. Then again, I quit smoking cigarettes six years ago, so I feel like nothing can be as challenging as that was...

    Did the Topamax and Tramadol work for you when you started? I'm still "tapering on" so the jury's still out, would love to hear your insight.
  • I was a meth addict in the early 80's. If you gave me a choice between withdrawal and chronic pain I would pick withdrawal every time.

    Withdrawal is temporary misery. Treat it like a bad case of the flu with the knowledge its going to get better. Also... Stay busy and keep your mind distracted.

    Good Luck
  • I dont think Tramadol withdrawal should be a big deal. It is technically non-narcotic and more of an antidepressant I think. I can't say from experience unfortunately, but I'd guess that you can expect some mild depression and anxiety for a week or two at worst.
  • Well,

    The fact that this combination isn't working for me anymore is why I went back to the doctor. You didn't mention if you were taking the Ultram ER or the plain tramadol.

    This combination seemed to be effective for almost a year, then nothing.

    I'm scheduled to get a couple of epidurals soon.

    I hope this works for you!

  • Hi Rhonda,

    I have used tramadol off and on for the last 2 years and didn't have any symptoms when I had to go off. I guess it was because the tramadol never took all my pain away, but it does take the edge off it.

    Tramadol is not an antidepressant, it is used strictly for pain. (Mild to moderate pain, I think it says in the patient info.) The drs write it a lot because it is not a narcotic, therefore not supposed to be addictive. When I didn't have the tramadol, I took tylenol and ibuprofen, and the tylenol PM at night.

    Good luck, and please let us know how it goes. Hugs, Marti
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    an opiate based (though atypical) narcotic medication effecting the u opiod receptor in the brain. It does carry the risk of physical and psychological dependence. Weaning is the way to go ...... cold turkey is not advised.

    Good Luck,

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • Rhonda,
    The preferred mode of accepting some patients onto residential PM sessions was to have to be consuming as little medication as possible, be that right or wrong. However ineffectual taking specific medication is for a long time it is more effect than taking none. Some of this is routine and we increase volumes over time, and loose proportional capability and function as a direct consequence.

    99.9% are not addicted and supervised withdrawn to a more functional level may be more pertinent, for me that initial request for increased reduction seem a bit cruel and uncaring, the consultant pharmacist explained his reasoning and we viewed his mode with some reasonable trepidation.

    I thing the key was not to perform at a constant excess which then necessitated more medication as a consequence, he did not say that initially and but haps with some purpose for our acceptance. Constant evaluation of medication type and cover should be evaluated and it can take considerable experience to get that balance anywhere near correct for our constantly fluctuating level.

    This may assist you in the future by taking less powerful medication more often, he is saying this for your long term health and any change and medication specifically is difficult living the continual existence that we do, time and a good strategy will help and you are wise looking for someone who has been through this specific process for support and guidance.

    I applaud your endeavour to change and incremental changes will help with this transition.

    Take care and good luck, keep us posted.

  • yes, there can be a withdrawal. Very opiate like, with sweats, nausea, anxiety, craving for the drug, i.e. flu like symptoms. This is the most common type IF it occurs. It depends on how long you took tramadol (years vs days) and what dosage. The rare withdrawal is much worse with hallucinations, agitation, and severe anxiey symptoms. My best advice, if you can't get a good MD to help, then decrease your daily dose by 10-25% once a week. 200 mg daily would be 150-175 mg daily for one week, then 125-150 mg daily for one week, etc...to make it easy, as long as you are over 175 mg per day, decrease daily dose by 25 mg once a week, until down to 25 mg daily for one week, then do 25 mg every other day for one week, then 25 mg on Mon/WED/Fri for one week, then Monday and Friday for one week, then 25 mg on Wed for one week then stop. Sounds like a lot but you need time to rebuild the brain chemistry. Trust me.
  • I have dealt with back pain since I was 30 yrs. old and am now 54. If you taper off taking 3 a day than 2 and than 1. Most people who take pain medication for back pain do so because of the fear of pain (because of course we know what is going to happen. Make sure your doctor is smart enough to prescribe another antidepressant so you won't have to go through depression. The fear of pain will be hard enough. I have been through every kind of pain management and now I just deal with it. I had a fusion in lower back and now my upper back is beginning to give me problems. I have such great empathy for you.
  • self removed from this post
  • Hi I am new to this .Just a note that I also was put onto Tramadol,as I have had a chronic back injury for 12yrs and wanted something stronger than panadole forte, I was not getting much relief .I then moved and changed doctors. My new doctor is trained in depression (which I also have due to the injury) told me to get of them straight away as they can cause fits when used with certain other tablets.So I would suggest if you can either get something else or make sure you check with your dr before taking them with anything else
  • I had an accident at work about 4 years ago which injured my neck and back. After taking generic tramadol for a couple of years and constantly having to up my dosage I saw a new doctor who switched me to 300 mg Ultram ER, what a difference! I have been taking it for 2 years now and I can't imagine what I would do without it.
  • Hi Rhonda
    Good luck with all of this. I am a RN also. Sometimes I think it is harder for us because we are expected to know and understand everything. This isn't always the case.
    One time I accidentally messed up my meds and went off Cymbalta for several days. I did not realize it until I began going through withdrawal--terrible vomiting, nausea, headache, etc. I think most of the medication that most of us take will cause some level of withdrawal if it is not tapered down.
    Interesting question about how the new doc will determine just how much pain you are in. I would love to find some definitive test for the docs to find out the level of pain and the pain generator--ending any doubts of what is going on and where it is coming from.
    As a RN, it was difficult to believe that I could mess up my own medication dosage after being responsible for an entire group of patients medication dosages. Even after two years of pain management, I still have not accepted the fact that I will have chronic pain for the rest of my life. Right now I will continue to search for a solution, and look for a way to "fix" this.
    Good luck with your new doc, and keep us posted!!
  • I've been on ultram for several years, starting with only 1 pill 2 times a day and increasing last Sept. to 2 pills 3 times a day as needed. I'm up to as much as 300 mg. a day. I also take 25 mg. of Topamax 2 times a day for my migraines. I was taking it before for my back and was taking 100 mg. a day but all it did was help my head aches after a while. The doctor (ortho) that I was seeing didn't feel that it was doing the job so I was taken off it at 25 mg. a day per 7 days. it took me 5 weeks because the last week was on pill every other day. As for the ultram I'm sure depending on the dose, the withdraw would be something the same as I did with the topamax. I don't depend on just the pills to take care of the pain though nothing takes it all away, I also use a tens machine, hot and cold packs, Lodium patches, voltern gel two back braces. Good luck.
  • Tramadol also affects norepipi and serotonin uptake. Please seek your doctors help in weaning from this medication.
  • Tramadol is a synthetic opioid acting on the Mu opioid receptors, and so as such (contrary to what many of you here have stated) is still very much a narcotic analgesic. The US government also scheduled it as a controlled substance in November 2013. So if you are taking tramadol believing it is not a narcotic, this would be an erroneous assumption.

    Tramadol can, and in most cases after long time use, will produce withdrawal effects similar to that of other opioids. What makes tramadol unique is that it also acts on serotonin and noradrenaline (like antidepressants), so it can also produce a simultaneous withdrawal syndrome (similar to other antidepressants). For that reason, some find tramadol even harder to withdraw from than opiates.

    Doctors seem to like tramadol because there is less abuse potential than with opiates and other opioids, because it produces less of a high. They can also (or at least, used to be able to) prescribe it in unlimited amounts without having to answer to the DEA the same way they have to with opiates.

    Added note: Some people seem concerned about seizures when withdrawing from tramadol. This has been documented, but is highly rare and most people going off tramadol are not going to get seizures.
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