Opioids Therapeutic use of opiates for pain after cold turkey withdrawal from use

[Rybee]

Hi all, I need some accurate advice as I've read so many different answers and I'm not really sure what to believe and I need to know where I stand.

Will try and keep it short but if you need me to expand, ask away..!

I have had a herniated spinal disc, and 2 compression fractures of the vertebral facet in the spine for ~4 years. The disc pops out every now and then but has been fine for 12 months. 1 compression fracture of the vertebral facet has healed, the other is still fractured.

Under the supervision of my algiatrist I rotate opiates every 6 months and I'm currently rotated to 100mg MS Contin and I also get a 600mg bottle of Oral Morphine to use for break through pain every month. Before Morphine I was rotating from Oxycodone to Fentanyl to Tapentadol at roughly equipotent doses. But as my back has healed, and my pain lowered, I started weening off of my 2 year opiate use down from ~110mg Morphine to just 20mg Morphine during the last 3 months. I was starting to withdraw at a dose of 20mg down from 25mg but chose to go cold turkey and just get it over and done with last Saturday. This week has been literal hell and having nothing banging on my opiate receptors has hit me way harder than I thought it would. I've had all the typical withdrawal symptoms but have been allowed a few days off work to see the worst of it through.

Right now I'm getting horrific fatigue/lethargy in the day coupled with acute insomnia at night. The stomach pains/diarrhea has just about stopped and I'm now just left with feeling quite emotional and 'hollow' in the head. I'm also suffering from pretty severe 'brain zaps' (had them horribly with SNRI/SSRI withdrawals but didn't even known you could get them from opiate withdrawal) and a bit of Diazepam really helped with that, so I'm taking just 5mg every 6 hours which has been a blessing. So I think in a few days I'll feel better, and in a week, I'll feel good, 2 weeks I'll be back to normal... *he says* !

So my question is what's the deal with using opiates if my fractures/herniation flares up? I literally have no clue about this... After withdrawals are done, am I going to go straight back into withdrawals after, say, 1 weeks use of 50mg Morphine per day or not? I can feel my sciatic nerve starting to shoot a little bit and I know that at some point, I'm going to have to take some opiates to help the pain.

I feel like I've done so well to have the will-power to resist any and all opiates whilst in withdrawals, I'm scared it's all going to go to waste if I take them for legitimate pain a few weeks down the line I'll be a the start again? I've no idea how quick my brain can adapt to having it's opiate receptors hugged and thus how quick withdrawals can happen?

I know it's so, so subjective, but any help would be really appreciated. I don't want to reach for that liquid goodness if it's going to undo all my hard work, but i do have to weight that up with genuine moderate-severe pain.

My best idea so far is that I could ask to rotate back round to Tapentadol so that I can achieve a good level of pain relief, but without the heavy opiate presence?

Any help appreciated - love ya'll

 

[PriestTheyCalledHim]

Sorry to hear you are in a lot of pain. Have you told your doctor what you wrote here, or asked him or her questions about opiate based medications?

If you are worried about addiction and relapse, get someone who you can trust to dole out your medication to you in the prescribed amount, when you need it. This is what people I know who have issues with addiction, or addictive personalities do. Good luck.

 

[Rybee]

Sorry to hear you are in a lot of pain. Have you told your doctor what you wrote here, or asked him or her questions about opiate based medications?

If you are worried about addiction and relapse, get someone who you can trust to dole out your medication to you in the prescribed amount, when you need it. This is what people I know who have issues with addiction, or addictive personalities do. Good luck.

Thanks... Yeah when it all started aged 19 I wasn't taken seriously by any doctor, just seen as a young kid at university/college trying to score some pills to get high. When the MRI scan showed a herniated disc and 2x compression fractures aged 22, the response changed immediately - thank goodness. It's been tough, but there are people out there with worse conditions so I'm thankful for that I guess.

I used to be addicted to Ativan/Lorazepam (used to have severe GAD but it just got so out of control) and I did just that... re: 'rationing'. I fessed up to my Psych and he was fine about it, he knew I had bad anxiety problems and we agreed that my brother would keep hold of them and when I was feeling anxious, I'd just go to his room (we lived together) tell him how I was feeling in order to try and release some tension, try some breathing techniques and if it didn't help, he'd then agree to give me one. It was actually a great little way of managing it. I just used to take one the first site of anxiety. The amount of times that talking honestly and just breathing deeply meant I could go without the Lorazepam that I'd have otherwise taken, was quite amazing. It gave me so much confidence and self belief that I didn't have to rely on pills all the time.

Re: painkillers, Yes I have spoken to him, but I've only been part-truthful to him. I'm in the UK and found our NHS to be awful for pain management so I see a pain consultant at a local private hospital. I think he's brilliant and has really allowed me to claw back some quality of life in the last 18 months. My NHS GP/Physician/Doctor reccommended for me to go see him and said he's excellent and is a leading pain consultant in his field (he's actually an anaesthetist by trade) and that he heads up the regional government health panel for advice to general practitioners on chronic pain management.

The only thing is, as he's held in such high regard, he doesn't come cheap. I pay £200 for a 20 minute consultation, which I guess works out as just over $300 for a 20 minute consultation. So in the nicest way, I do try to avoid seeing him, unless I really have to. For me, £200/$300 is a lot of my disposable income every month, so if I can get help from BL or my own GP/Physician/Doctor before paying to see him, that'd really help me.

He did create a detailed taper plan for me, which I started to follow but quickly started 'undercutting' so as to get off of opiates 3 months sooner. Not the best idea, I know...

Obviously I will pay to see him if I have to, but I just thought that there must be someone on BL who could maybe answer that for me!

 

[olypen]

Everyone's body is going to be different, so no one can give you a 100% correct answer that will definitely be your experience. The only way you are going to know, is for you to go through it a couple of times.

Good general advice, what i have learned from my personal experiences if that i'd really try hard to not take any opiates for at least a month. I am usually starting to feel normal about a month after a good run. It takes me like 6 weeks before i actually start to wake up in a good mood and realize i haven't even thought about getting high or feeling tired, sick or shitty.

3 days seems to be the gold standards as to when you might have some withdrawal symptoms again after you've had a habit before. Some people might be able to use 4 or 5 days with little or no WD symptoms and you might have some after only 2 days. Almost certainly you will have some sort of WD after using a week straight, but it probably wont as bad as if you had another 2 or 3 month run at it.

If it were me, i know that i would just always feel like shit if i were on a 2 or 3 weeks off, a week on, type schedule. I'd never fully get over the WD and i would always be experiencing some sort of symptoms. I'd rather just be on a full run and use every day than that type of routine.

Countless times i have used once or twice after only a few days in WD and if i keep it to only 1 slip up it doesnt 'reset' WD completely it just prolongs it.

You're young and sound like you're going to have a lifetime to figure out how you respond to on and off opiate use with your pain problems. Good luck

 

[Rybee]

Thanks for taking the time to reply olypen, insightful post.

 

[Erikmen]

Maybe you just have to take it as prescribed by the doctor. Some people manage to do that just like we would have done it with any antibiotic for example.

From my experience, as long as you do it strictly as the doctor says, the withdraws are going to be minimal.

The problem with some of us is that we (for some unknown reasons) feel so attacked to that extraordinary warmth and euphoric feelings it gives us, and at the end we end up linking and adding an acute psychological problem to an already existing physical one.

Strange fact is that my mother- when in real pain - managed to take her pain medication just as prescribed and stopped.
When I thought she was gonna feel those bad symptoms, all she felt was a little indisposition and blamed it on the medical side effects of the drugs she was taking.
Not even once she considered to increase her dosage or take it differently from prescribed.

I´ll never be able to explain to a naive 'normal' person how I have let my life ruined for decades just to feel those magic feelings I have felt I earned the right to feel as I was in pain due to a bad surgery I once had.