Dear Mrs. D,

Greetings!

It has been awhile since I was on the boards, but have been going through a recent flair of my Lyme SFN pain and had a question.

What are your thoughts regarding the use of Tramadol (Ultram ER) for my small fiber neuropathic pain, rather than my traditional fall-backs of Lyrica or Cymbalta?

Many thanks!

David

Tramadol is thought by some doctors to work on nerve pain better than opiates. It is often used in fibromyalgia patients.

It works on the mu pain receptor like the opiates, and has some actions with serotonin. Because of the serotonin actions it is not to be used with SSRIs.

There is a listed "major" interaction between Cymbalta and Tramadol:
Drug Interaction Report - Drugs.com

Tramadol has to be activated by the liver to its pain relieving compound. Some people lack this enzyme,and so for them Tramadol doesn't work well. It is also slow to relieve pain because of this delay of activation.

Tramadol does have side effects. Nausea, dizziness are the most common. And for some it is habituating.

You won't know it if works for you, unless you try it. I would suggest a short trial of the immediate release. If you have side effects they will be short lived. If it works for you, you can then try the ER version.

Thank you for your outstanding answer, as always, and I hope that you are feeling better

Mrs. D, is oxycodone metabolized the same as tramadol? I tried tramadol and itched everywhere and it didn't touch my pain, but small doses of oxcodone do help when I am in a flare.


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The tramadol didn't help my SFN pain but it sure did make me grouchy

Per the adult kids.

Debi from Georgia

There can be an emotional component to Tramadol... the first time I took it, I had mild hallucinations... just jumbled thinking.
I didn't sleep at all that night, and recall our late kitty Tippy sleeping right on me the whole time. When I rolled over, or got up for the bathroom she's jump right back on when I returned!
She never did that before at home, but sometimes on vacation, for some reason. Cats I have learned have some psychic traits, and this is one time, it reinforced by feelings about them.

The itching has to do with the serotonin actions. Opiates also can cause itching. Codeine is also activated in the liver, so it is slow to act. Oxycodone and buprenorphine are sometimes used for treatment resistant depressions too. They seem to affect serotonin in the brain for some people. There are a couple of threads on NT at our bipolar forum and Depression forum discussing this.

Each person has his/her own unique serotonin levels-- some high already and others lower. The high serotonin types don't like SSRI antidepressants and often react to some opiates.

There is a general observation about the itching. Those who itch with natural opiates, like codeine and morphine, don't usually complain about the synthetic ones, like oxycodone. And the reverse also happens with other patients. Patients often call this an "allergy", but it is not really most of the time. It is a serotonin effect, and metabolic.

That is interesting. Here's the other odd thing. They have me Vicodin after a c section once and it was the most disgusting feeling ever. I was hallucinating, felt panicked, couldn't sleep, and vomited. Then after another c section they gave me morphine in the drip ( with out even telling me) when o was in the recovery room. With in 15 minutes I felt like I was losing my mind, vomiting, shaking like crazy, then the strange tramadol reaction, but oxycodone no problem and helps for pain. So strange, but interesting.


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I had the same effect with Morphine after my gallbladder surgery. I knew I was hallucinating; but was seeing bugs on the ceiling above me. Also, did very little to help with the pain.

After this experience, I informed my doctors, as well as the hospital where my doctors work out of about hallucinating with the morphine. It has been put on my record that I am allergic to Morphine. I have had a few surgeries since and have had good results with an IV using Fentanyl.


Gerry

I have had the same reactions with Percocet and other pain meds. When I had a tooth implant I didn't even get the prescription filled. However, oxycodone was wonderful after my back surgery, not just with pain but also my mood and sleep. I can understand how so many people are addicted to it. My only caution is withdrawal, which I immediately had when I tried to stop. (I was only taking 1 pill at night.) I am tapering off slowly and it still isn't great. I gathered that you are only taking it occasionally for pain so I don't think you'll have that problem.

I don't think I'll have that problem. I use it because it's the only pain killer that works. It's been 2 years since I have the prescription and I've been taking in average 1/2 of a 5 mg pill about 3 x a week. There have been a few times that I had to take a whole one. I think I must be very lucky in that I don't get addicted and I guess because I'm careful with it, I don't get rebound pain when it wears off. It seems to quiet the flare and I rarely have to repeat the dose in the same day. When I went on vacation I took it more often so that I wouldn't ruin the kids time. There were certain things I couldn't do, but it helped a lot. I really don't know what I'd do with out it living with this terrible disease. I don't know why it is a last resort for doctors. I am able to avoid a slew of daily meds and take a few rescue meds as needed and most days I don't have to have anything in my system. I have chronic pain everyday of my life and I could justify taking it everyday, but I manage it with natural methods unless I can't... I am thankful that I have a doctor who trusts me as an adult to know what is the best for me.


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