Seriously addicted to tramadol?

[calluna]

I've just had a rather disquieting appointment with my GP. I went to see him this morning because I was almost out of nortriptyline, and we also had a review of the whole pain situation.

He tells me that I am 'seriously addicted to tramadol', as I've been taking it now for 16 months. He said that at some point I'm going to have to wean myself off it, and that that will be very difficult because I will very likely get pain as part of the withdrawal symptoms, so it will be very difficult for me to ever know if the neuropathy has healed. He said also that the only alternative med that he could think of to replace the tramadol was morphine patches and he was reluctant to prescribe that as he wasn't a pain specialist. He was also very reluctant to give me any additional pain meds to add to the tramadol - in the end he did give me a pack of co-codamol (codeine/paracetamol 15/500) as a one off.

Up til now my usual meds have been 300mg of the slow release tramadol, plus 20mg of nortriptyline at night. If I get a flare, I increase the tramadol to 400mg, and add in co-codamol 15/500 as needed.

I'm having a bit of a flare at the moment - at least I thought I was. Maybe it is just that I've become addicted to the tramadol and my body wants more??

And how will I ever know if the neuropathy has healed? I do still have hopes of this, they told me 1 - 2 years for the nerve to heal, if it was going to, it is 16 months now.

I think I have to get off the tramadol, and I have no idea how to do this, the very idea is scary.

I am really worried, and I would very much appreciate hearing anyone else's thoughts or experiences.

[HerMajesty]

Have you missed any doses and had withdrawl experiences to back up this assertion that you are physically addicted? I am on tramadol and my pain PA who DOES have experience with it said as it is a synthetic with some narcotic-like properties vs. an actual narcotic, withdrawl is highly variable - he said he had had patients that took tons of it for years with no withdrawl, and others who had to wean off after only a couple month's use. So if you plan to get off it, I would suggest just cutting back slowly and seeing if these dire predictions come to pass.
If you DO get withdrawls, the LAST thing you would want is to replace it with a narc, whihc is pretty much gauranteed to cause tolerance (reduced effectiveness over time) and physical dependence. I would suggest you do consult with a pain specialist, to ask about a med which would control any breakthrough neuropathic pain without addiction risk. If you have been on tramadol forever I don't understand the harm in putting off the weaning til you get pain clinic advice. Why is your Doc such an alarmist about this? Are you taking more than is safe on a daily basis?

[calluna]

Thankyou so much for replying, I guess I am a bit upset about this. Being told I am seriously addicted - well, quite an emotive choice of words.

I have missed just one dose since the Pain Clinic put me on the slow release stuff in March - I take 150mg at 12 hour intervals. In April I had some surgery and they told me not to take my usual pain meds that morning, it was 4 hours past the usual time before they took me down for surgery and I was in severe pain by then. I did not have any additional symptoms, just that the pain was back in full force.

I took one dose late, that was in September when I had some more surgery, they initially told me not to take my usual pain meds, as before, but this time as I was in severe pain again they told me to take it, this was 5 hours after the usual time. Again, no additional symptoms.

But I don't know how to distinguish between pain which is from withdrawal and pain which is from the neuropathy.

I've never taken more than the recommended maximum daily dose which is 400mg. If I have a flare which I cannot manage by other means, then I increase from 150 to 200mg slow release. And then add in co-codamol if I need to. I try not to take the co-codamol because it is very constipating, and that means more pain later.

I have just had an appointment at the Pain Clinic on Monday this week, it was for acupuncture. The previous time I saw the GP (different doctor), he was talking about changing from tramadol to some sort of patch, he didn't say what. He said that the changeover might be a bit difficult but that it would probably provide better pain relief in the long run and that I should discuss it next time I was at the Clinic, whether it was ok for this to be done by the GP. So on Monday I asked at the Clinic about this, the nurse consultant said that yes it would be fine, and that I would be possibly getting tolerant of the tramadol by now anyway. Today I was expecting the GP to discuss more about the patches whatever they are, and maybe start me on them. I am not back at the Pain Clinic again until the end of December.

One problem with the GP is that every time I go there, I seem to see a different doctor. This is the first time they haven't been entirely supportive. I don't know why the GP was so focussed on me being addicted. I have just looked up tramadol withdrawal online and it looks most unpleasant. But I suppose that if I am addicted then I really have no choice but to start reducing the dosage.

However it is reassuring to hear that your pain PA (what is a PA?) says that withdrawal can be so variable, maybe I will be one of the lucky ones.

I think I will try Gabapentin again. Maybe the side effects won't be so bad this time.

[HerMajesty]

I don't you should change a thing until discussing with a pain clinic Doc - I am having a lot of trouble understanding why if you are not building tolerance (if it still works for you as well as ever,without the need to take more and more, you are not building tolerance), you "are seriously addicted and should stop taking it". Sounds like you found a med that works well and does what is supposed to at a reasonable dose. Don't screw it all up with one GP comment! 2nd and 3rd opinion please!
A PA is a Physician's Assistant; they can practice in many ways same as Doc's but under the "supervison" of a Doc meaning they get their charts reviewed and signed off and the Doc is liable for the PA's work on his own license. The payoff is less schooling which to me is fine because as my husband said after Paramedic school, most of being a good practitioner is un-learning the crap they teach in school and adjusting to real world practice. I love my PA! Only downside is, he has to refer me out to another Doc for some complex procedures, but the PA is definitely my case manager and a huge blessing.

[calluna]

Sounds like your PA has much the same function as the nurse consultant or nurse practitioner here - I see the nurse practitioner a lot at the GP surgery, and the nurse consultant at the Pain Clinic, and they are both wonderful! I have had a lot of support and help from both of them.

I am sure you are right, and I should not let one GP comment throw me. I too am rather at a loss to understand why he started talking about me being addicted - surely if I am in pain, that is what pain meds are for? I thought - indeed, still think - that I had found a drug combination that worked for me, with minimum side effects. And as you say, it is still working for me as well as it ever did, and I am not needing more and more to have the same effect. It has never made it go away completely, it has only ever taken the edge off. And it is still doing that.

I will stick with it and talk to the nurse consultant at the Pain Clinic in December. I really don't want to go back on gabapentin, I felt like a total zombie on that stuff, I was so glad to come off it.

Thankyou for being so helpful, I do appreciate it.

[Amanda]

Calluna

I have to agree totally with HerMajesty, that if your meds are helping you with the pain and that you are taking the required dose without needing more; and that missed doses are not giving you withdrawal symptoms then it doesnt appear that you are seriously addicted to those medications.
I do believe that if you have a medication that helps then when you stop taking it and the pain rises it is a clear sign that the meds are still working for you.
I would go and have a proper consultation with a pain specialist as they are better than a gp at knowing which combinations of medication can help you without too many interractions or side effects.
Some gp's are perhaps over cautious about long term use of pain medications, maybe as you seem to see a different one that this day you got one who is supersensitive, is it not possible to make an appointment with a different gp and stick to that one rather than get many differing opinions?
I have been taking Tylex (co-Codamol) and other meds now for 9 years, and they still work for me as they did in the beginning.....i have not noticed any difference in side effects in all this time, they still make me woozy and dizzy but they do help with me pain just as much now as they did in the beginning.
I have not taken them some days and while my pain has increased I have never noticed any other changes and nor have i had to increase the doseage to get a better effect.
It is not right that one misplaced comment can cause such upset especially when you visit a doctor for help not criticism. Hang in there please.

[GraceUnderFire]

I have to agree with HerMajesty too. No building a tolerance, needing more to get the same relief - then what is the problem? Sorry short, lots of pain today

[calluna]

Thankyou Grace and Amanda - I will hang in there. I know that I am lucky to have found a combination that works for me, after all.

[elizabeth.w]

I agree with everything posted. Do not change your meds without the advice and assistance of an expert pain managament doctor and do not let drs or PAs who are not experienced with patients with chronic pain scare you about physical dependence. People like us with chronic intolerable pain need pain medication and pain management doctors are the best professionals to help us with the complex issues that go with having to take these medications. Even if you were to become phsyically dependent (I am fairly certain I am phsyically dependant on one of my medications) an experienced pain mamagement doctor would know how to help you with this. I go through this a lot with my therapist who constantly tells me she worries about me becoming "addicted" to pain meds - but I explain to her I am in intolerable pain and my pain management doctor feels my medications are appropraite for my levels of pain.

Good luck and do not worry! Worry increases our pain. Just wait to speak with the pain management doctor.

Elizabeth

[pianogal]

hi,
fyi, if you do get off tramadol, it can have serious serious withdrawal.
I was only taking one or two pills a day and not increasing pills at all, but the withdrawal was terrible even though I did a slow taper. I had trouble breathing, trouble walking from bathroom to bedroom, out of breath, thought I was having heart attacks, blood pressure doing weird things... and all of it stopped as soon as I took one tramadol again.

I went to ER cause I thought I could be dying.

The breathlessness was so painful.

So, do it slowly if you get off it... very very very slowly. If you have weird symptoms like mine, it's withdrawal. I was having withdrawals on quarters and halfs of pills... so keep breaking them up smaller and smaller.

I had similar torture getting off neurontin and vicodin. Neurontin, if gotten off quickly, can cause seizures... it has to be the slowest of tapers. even over months preferable.

Good luck.

By the way, after being off pain meds, the pain is about equal almost. the meds put constipation on the nerve, creating more pain... so once constipation is gone, pain goes down.