Opioids Did my pain consultant poison me?

[Damoc]

I have just read that terribly sad thread about Tyler who it is believed passed away from Serotonin Syndrome. I had never even heard of this before let alone had it mentioned to me by one of my many doctors. I'll just reverse a bit to start if it's ok;

in July I saw my pain consultant, who was in right state, someone's notes had been lost and nurses were running everywhere. He seemed really flustered and in a rush.

i explained my pain still wasn't under control and it was (is) ruining my and my families lives.

i was taking; Lyrica 600mg a day, Morphine Sulphate 60mg a day, Oramorph, Ibuprofen Up to 1200mg a day, Sertraline 100mg a day and Omeprazole 20mg a day.

He looked at my notes and said "what shall we do with you?". I said I'd heard there were time release patches that can be more effective?". He said "yes, let's try that". Next thing I know is I have a prescription for 25mcg Fentanyl patch once every three days and he was looking to shake my hand.

i got it made out in the hospital pharmacy and she said "you've had this before right?" And was shocked when I said no. (I later got a missed call from pharmacy to try and talk to me about using then but the chemist was closed for the weekend when u rang back.. Hospital one..)

So on went the patch and boom... Instant weird ill feeling followed by hot sweats, cold sweats, temperatures, diarrhoea, heavy sweating, shivering, strong frontal lobe throbbing, headache and smell and taste gone.. Just strong chemical smell and taste. i went to bed on Friday and came downstairs on Monday.

i stupidly thought it was just settling in probs with moving from morphine to fentanyl, so I put up with two weeks of hell to allow for three patches and the week it takes me to get an appointment with my GP.

My GP says I have had a bad reaction and I should go back to morphine so I taper back to that with a Oramorph and WOW.. I have never appreciated being in pain and constipated as much as then. All my 'new' symptoms vanished.

My question did I have a bad reaction or is;

600mg Lyrica Pregabalin
100mg Zoloft Sertraline
25mcg fentanyl patch

and the other stuff ibuprofen and Omeprazole.

something that could have cause this Serotonin Syndrome?

I'm particularly interested because even though all my acute symptoms went away overnight after the meds were changed back, I have found less acute versions coming back recently. The frontal lobe thing and smell taste has been with me again today and my toilets have changed since, I don't have diarrhoea but I feel I want to go when I don't.

Am I being paranoid or?


My thoughts and prayers for Tyler's friends and family.

 

[kleinerkiffer]

Well,there are a few studies claiming that SSRIs like sertraline and fentanyl can result in serotonin syndrome

CONCLUSION: Healthcare professionals should be aware of the possible development of serotonin syndrome as a complication of initiation of fentanyl and other phenylpiperidine opioids in patients treated with SSRIs. (http://www.ncbi.nlm.nih.gov/pubmed/17381671)

and in germany the company producing fentanyl even warned all doctors that fenanyl + SSRI can result in SS (https://www.deutsche-apotheker-zeitung.de/news/artikel/2013/03/12/serotonin-syndrom-unter-fentanyl) so yes, SS could be possible, but it could've been an adverse reaction or too much fentanyl for your tolerance too, so I wouldn't say that he poisoned you.

 

[Damoc]

Thanks for the replies guys. Shocking how this all seems like a new thing.

I did approach my pain medication specialist nurse about the change to fentanyl, and she just said she was surprised he started me on the 25's.

Ill see if the problems persist or get worse then and go back to my GP I guess.

 

[keeping]

yeah like priest said, if you think your dr. is over-prescribing/'poisoning' you, go for a second opinion. its your life mate.

 

[Ksa]

Yes you experienced Serotonin Syndrome. How do I know from your side effects:

- Rapid onset of symptoms (escalation in less than an hour);
- Strong chemical smell and taste, smell and taste gone, this is the Litmus test for SS;
- Hot sweats, cold sweats, temperatures, diarrhoea, heavy sweating, shivering, strong frontal lobe throbbing, headache are all symptoms of SS;
- You mentioned symptoms lasted 2 weeks;

Were you masturbating/having sex and did you try to achieve ejaculation when symptoms were triggered or was it just the patch?

 

[Damoc]

Yes you experienced Serotonin Syndrome. How do I know from your side effects:

- Rapid onset of symptoms (escalation in less than an hour);
- Strong chemical smell and taste, smell and taste gone, this is the Litmus test for SS;
- Hot sweats, cold sweats, temperatures, diarrhoea, heavy sweating, shivering, strong frontal lobe throbbing, headache are all symptoms of SS;
- You mentioned symptoms lasted 2 weeks;

Were you masturbating/having sex and did you try to achieve ejaculation when symptoms were triggered or was it just the patch?

urm yeah, I did have very increased libido throughout and had like proper sex for the first time in ages and suffered massive pain for it for three days after (as my main issue is spinal related). My wife was very surprised, is that related to it?

If it was could it leave me with permanent issues in future?

 

[SS373dOH]

Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy. -Paracelsus

 

[Ksa]

urm yeah, I did have very increased libido throughout and had like proper sex for the first time in ages and suffered massive pain for it for three days after (as my main issue is spinal related). My wife was very surprised, is that related to it?

If it was could it leave me with permanent issues in future?

Ok so it couldn't have been anything else but a mild SS. Remember next time, sex and especially ejaculation greatly increases serotonin, so combining that to lots of serotonin medication can lead to serotonin syndrome. The damage is not permanent it takes about a year to fix completely.

Also note that SS may have worsened your spinal cord injury. In order to enjoy sex, you have to use the spinal cord to communicate nerve signal from the dorsal nerves of your penis all the way to up your brain. If you send too much signal through these nerves, while they are stiffen out by a combination of adrenaline and serotonin, and you enter serotonin syndrome, the myelin on the nerves can break apart (only if mechanically stirred or bent) so its important when you notice serotonin symptoms to lay down and do fuckall. The spinal cord is protected because the amount of bending that can occur is very limited. The penis however can twist in all directions.

The nerves are wired so that the myelin starts breaking down at the source of the signal, so the dorsal nerves of the penis break down first, followed by the nerves going along the urethra right above the asshole, ultimately but very rarely the spinal cord can lose myelin. Symptoms of lost myelin due to SS is a tingling sensation feels like tiny sharp needles are poking one or several areas of the penis and below the penis AND the needle like sensations extend to one side of the face and the back of the skull. So just feeling tingling is not enough, the tingling has to communicate to other unrelated areas for you to say "I lost myelin".

 

[xbandit07x]

Yeah do research, do not listen to the forum when they say always/ listen to your doctor.

 

[Damoc]

Thanks for all the great answers. I'm very glad to hear it should all sort itself out, even if it takes 12 months.

The 'myelin' concern is new to me. I'll bear it in mind but the sharp pins in those areas aren't something I've felt so far.

I actually took took my concerns to my clinical psychologist at the pain clinic in the first week, and he said I should stick with it and see if I could get through the symptoms. I really should have followed my gut on this one it seems!