I have a spinal problem in my L4/L5 vertebrae that doctors have finally figured out is curable (with medication), and I have another 5 more months of treatment to go in this regard. It's unclear what will happen with my associated pain which started off extremely severe (15 on a 0-9 scale), the assumption is that it'll go down as the problem is treated and eventually cured. For my pain, I was given opiate pills over a period of 3 months until I reached a dose of 130mg of oxymorphone (taken orally, i.e., Opana).
At this point, my pain was being managed well except for tolerance which I was building up rather quickly (I can honestly say that pills are easily overused by me). So when I proposed going up on the opiate dosage again, my doctor said at this point I'm on a very high dose and I should be thinking about going down rather than up especially as the underlying problem causing the pain was being treated and I should think about my career, that he's seen many people lose their lives to opiates, etc. (I sometimes think this doctor is a bit difficult but his frankness was probably a good thing.) He let me go with the same 130mg/day dose and told me next month he'd reduce it by 10mg.
This concerned (scared) me a lot and for a variety of reasons I decided to go down on my dosage and use conventional meds as well as opiates to manage the pain as I tapered down. Also due to extreme nausea caused by the interaction of opiates and because my pain management doctor (and another one, I ended up having a second opinion from my spinal problem doctor) thought it was good idea to taper down using fentanyl patches.
I started off with the 50mcg/hr patch, which was pretty equivalent to the 130mg/day of oxymorphone and I was very happy and pain free. The patches don't produce any euphoria or anything noticeable after the first few days and I really felt strong with them on and knew I wouldn't overuse them (which BTW is an awesome feeling). I then reached steady state on this dose (5 patches) and went to down 25mcg/hr. Each patch is changed every 72 hours and steady state is reached after two patch changes and after removal of the last patch the drug stays in your skin reservoirs with a half life of ~20hrs. When I dropped my dose, initially there was light pain in the first few days followed by intense acute WD symptoms for a few hours on the 6th day (my first ever, I thought the sniffles were bad but this was horrible psychologically). I went back to my pain management doctor and we decided that was too high a drop. He asked me if I wanted to stay on 50mcg/hr and I said no (I regret this) and we decided to go down 12.5mcg/hr increments to 37.5mcg/hr and that worked with some jury rigging: I had to use extra patches the first day or two but I stabilised to steady state quite readily without much problem at all---I'm extremely happy about this aspect. All this has occurred over a total of 4 months.
The problem is pain. The pain level now is noticeable and annoying (though at the time of writing, I am experimenting with taking my Celebrex twice a day no matter what, instead of as needed, which seems to have made a huge difference but I don't know if it'll stick). So I'm thinking if I should go back up to the 50mcg/hr patch or stay here at the 37.5mcg/hr patch. I could tough it out but the pain causes my walk to be off causing a curving of my spine which had gone away at the higher opiate doses (i.e., my spine started to straighten out) but now is coming back as I walk with some pain sometimes. Also of course, having one 50mcg/hr set of patches (and cutting them) it turns out is cheaper than buying two sets of 25mcg/hr and 12.5mcg/hr patches.
Regarding cutting the patches, in case people are wondering, these are the drug-in-adhesive patches (not the gel ones which can't be cut) and of course I will cut with mathematical precision (i.e., with a ruler and blade).
So my options I feel now are: (1) go back up to the 50mcg/hr patch and use it as is and taper back down in a few months, (2) stay on the 37.5mcg/hr patches for a while and taper down to 25mcg/hr slowly (for example, if the Celebrex therapy holds and as my brain adjusts to the lower opiate state), or (3) get the 50mcg/hr and cut it down to remove 25% and taper that down very slowly (say 10% a month).
I'm really torn about what to do. I figured opiate addicts would have some advice for me here, especially about the doctor's warnings, etc. In terms of addiction, it seems I should go with option (2) or (3), with (2) being the path of least temptation. (If I did (3), I probably would save the cut pieces for later recreational use to be honest but the plan would be to do it rarely so addiction doesn't develop but you know what they say, the best laid plans of mice and men and all that.) (1) would be okay (and I believe I would follow it in a disciplined manner if I chose this option) but I would have to taper off later and this would be the most spine saving.
At 4 months, am I better off with keeping my dosage down as much as possible in the interests of becoming opiate free (and monitor my spine closely and only switch if REALLY needed, i.e., if my spine curves really badly as before---right now it's just a little but I'm worried about the trend)? Or should I say to hell with it and be completely pain free at the 50mcg/hr dose and taper later when I am really cured?
Thoughts, please?
At this point, my pain was being managed well except for tolerance which I was building up rather quickly (I can honestly say that pills are easily overused by me). So when I proposed going up on the opiate dosage again, my doctor said at this point I'm on a very high dose and I should be thinking about going down rather than up especially as the underlying problem causing the pain was being treated and I should think about my career, that he's seen many people lose their lives to opiates, etc. (I sometimes think this doctor is a bit difficult but his frankness was probably a good thing.) He let me go with the same 130mg/day dose and told me next month he'd reduce it by 10mg.
This concerned (scared) me a lot and for a variety of reasons I decided to go down on my dosage and use conventional meds as well as opiates to manage the pain as I tapered down. Also due to extreme nausea caused by the interaction of opiates and because my pain management doctor (and another one, I ended up having a second opinion from my spinal problem doctor) thought it was good idea to taper down using fentanyl patches.
I started off with the 50mcg/hr patch, which was pretty equivalent to the 130mg/day of oxymorphone and I was very happy and pain free. The patches don't produce any euphoria or anything noticeable after the first few days and I really felt strong with them on and knew I wouldn't overuse them (which BTW is an awesome feeling). I then reached steady state on this dose (5 patches) and went to down 25mcg/hr. Each patch is changed every 72 hours and steady state is reached after two patch changes and after removal of the last patch the drug stays in your skin reservoirs with a half life of ~20hrs. When I dropped my dose, initially there was light pain in the first few days followed by intense acute WD symptoms for a few hours on the 6th day (my first ever, I thought the sniffles were bad but this was horrible psychologically). I went back to my pain management doctor and we decided that was too high a drop. He asked me if I wanted to stay on 50mcg/hr and I said no (I regret this) and we decided to go down 12.5mcg/hr increments to 37.5mcg/hr and that worked with some jury rigging: I had to use extra patches the first day or two but I stabilised to steady state quite readily without much problem at all---I'm extremely happy about this aspect. All this has occurred over a total of 4 months.
The problem is pain. The pain level now is noticeable and annoying (though at the time of writing, I am experimenting with taking my Celebrex twice a day no matter what, instead of as needed, which seems to have made a huge difference but I don't know if it'll stick). So I'm thinking if I should go back up to the 50mcg/hr patch or stay here at the 37.5mcg/hr patch. I could tough it out but the pain causes my walk to be off causing a curving of my spine which had gone away at the higher opiate doses (i.e., my spine started to straighten out) but now is coming back as I walk with some pain sometimes. Also of course, having one 50mcg/hr set of patches (and cutting them) it turns out is cheaper than buying two sets of 25mcg/hr and 12.5mcg/hr patches.
Regarding cutting the patches, in case people are wondering, these are the drug-in-adhesive patches (not the gel ones which can't be cut) and of course I will cut with mathematical precision (i.e., with a ruler and blade).
So my options I feel now are: (1) go back up to the 50mcg/hr patch and use it as is and taper back down in a few months, (2) stay on the 37.5mcg/hr patches for a while and taper down to 25mcg/hr slowly (for example, if the Celebrex therapy holds and as my brain adjusts to the lower opiate state), or (3) get the 50mcg/hr and cut it down to remove 25% and taper that down very slowly (say 10% a month).
I'm really torn about what to do. I figured opiate addicts would have some advice for me here, especially about the doctor's warnings, etc. In terms of addiction, it seems I should go with option (2) or (3), with (2) being the path of least temptation. (If I did (3), I probably would save the cut pieces for later recreational use to be honest but the plan would be to do it rarely so addiction doesn't develop but you know what they say, the best laid plans of mice and men and all that.) (1) would be okay (and I believe I would follow it in a disciplined manner if I chose this option) but I would have to taper off later and this would be the most spine saving.
At 4 months, am I better off with keeping my dosage down as much as possible in the interests of becoming opiate free (and monitor my spine closely and only switch if REALLY needed, i.e., if my spine curves really badly as before---right now it's just a little but I'm worried about the trend)? Or should I say to hell with it and be completely pain free at the 50mcg/hr dose and taper later when I am really cured?
Thoughts, please?
