[jakatak]

Hello everybody. Well, my PN hasn't changed much in the past 7 years or so. It still is relegated to my toes. It still befuddles me as to the cause. I did much standing the other night at a very cold parade. My feet burned all evening as did my lower back pain. I've tried to connect sweets to possible diabetic stuff...nope. I'm not diabetic.
I've been on tramadol and lyrica for quite some time...I think they work. The times that I haven't dosed, I have paid the price. I do know that I am not addicted to tramadol. Although, not technically an opiate, it has all the side-effects of opiate withdrawal. This has happened when I have been forced to cut back by my new GP. She says there isn't any definitive proof that tramadol does anything for PN. Well, after so many years of 2 tabs of 50mg 3 times a day, she's cut me back to 4 a day. NOT FUN! I am not taking as much...I suspect that may be a good thing in the long run for my system, but the downside, at least in my mind, is that I do feel more pain. Am I crazy? Should I get off of it and just stay with the lyrica? I see her today. I don't know what to do. She will not let me go back to 6 a day....I do know that.

[Dr. Smith]

Originally Posted by jakatak

Hello everybody. Well, my PN hasn't changed much in the past 7 years or so. It still is relegated to my toes. It still befuddles me as to the cause. I did much standing the other night at a very cold parade. My feet burned all evening as did my lower back pain. I've tried to connect sweets to possible diabetic stuff...nope. I'm not diabetic.
I've been on tramadol and lyrica for quite some time...I think they work. The times that I haven't dosed, I have paid the price. I do know that I am not addicted to tramadol. Although, not technically an opiate, it has all the side-effects of opiate withdrawal. This has happened when I have been forced to cut back by my new GP. She says there isn't any definitive proof that tramadol does anything for PN. Well, after so many years of 2 tabs of 50mg 3 times a day, she's cut me back to 4 a day. NOT FUN! I am not taking as much...I suspect that may be a good thing in the long run for my system, but the downside, at least in my mind, is that I do feel more pain. Am I crazy? Should I get off of it and just stay with the lyrica? I see her today. I don't know what to do. She will not let me go back to 6 a day....I do know that.

It's not clear to me if the tramadol was prescribed for your neuropathy or lower back pain, or what kind of pain (neuropathic from PN or nociceptive pain from some other cause) you're feeling more of. You may have more than just PN going on, which may require something other than Lyrica.

You may not be addicted to tramadol, but probably are dependent on it, which is what's causing the withdrawal symptoms. The good news is that those symptoms should be temporary. But, if after getting past that point you're still in significant pain, that needs to be addressed.

Google: talk doctor pain

Let us know how the appointment goes.

Doc

[jakatak]

Originally Posted by Dr. Smith

It's not clear to me if the tramadol was prescribed for your neuropathy or lower back pain, or what kind of pain (neuropathic from PN or nociceptive pain from some other cause) you're feeling more of. You may have more than just PN going on, which may require something other than Lyrica.

You may not be addicted to tramadol, but probably are dependent on it, which is what's causing the withdrawal symptoms. The good news is that those symptoms should be temporary. But, if after getting past that point you're still in significant pain, that needs to be addressed.

Google: talk doctor pain

Let us know how the appointment goes.

Doc

Actually, the tramadol is for my feet. I do have a very typical L4,5, T1 degenerative arthritis. I get occasional zaps in my legs, feet, if I overdo it. I just don't understand the chemistry of tramadol having an effect on a nerve type pain. It doesn't make sense...but it works. I don't have nerve pain that runs from my spine to my feet (typical of sciatica). My ongoing, burning feet are non-radiating. It has stayed in my toes for 7 years.

[mrsD]

Seems to me you have a diagnosis of MGUS?

Didn't your doctors tell you to avoid cold? Which thickens the blood and impairs your circulation?

Tramadol only works for central pain. It cannot help with your thickened blood or improve circulation. Other things may help with that.

I'd find ways to keep warm, esp the feet, so extremes of temperature are avoided. Also stay hydrated well. When was your last checkup with bloodwork for that?

[nide44]

................Should I get off of it and just stay with the lyrica? I see her today. I don't know what to do. She will not let me go back to 6 a day....I do know that.


I have been on Tramadol too. Originally (and still get Rx's for) 400/day= 2 '50's 4xday, and now have cut back to 300= 2 '50's 3x day.
This has been for over 12 years. When I miss a dose, I get w/d sx, so I know I'm dependent. I KNOW that it reduces the foot pain and would be in a mess of trouble without it. If it were me, I'd demand to stay on your regular dose.......... or get another doc (a neurologist-not a GP) who will agree with you & Rx it.

[Dr. Smith]

Originally Posted by jakatak

I just don't understand the chemistry of tramadol having an effect on a nerve type pain. It doesn't make sense...but it works.

I don't either, but I hear similar things quite often. There are several possibilities, but they'd all be speculation. I would think that the fact that it works for you would be enough for your doctor (or someone) to investigate further, or at least suspect something more.

I think I'd still read some of the links I suggested, and focus on talking about the pain and the effect it has on your day-to-day life. Rather than assuming it's just PN, ask about a cause/reason, and proceed from there.

Doc

[DanP]

Sounds reasonable to me.

[hopeful]

I am also on Tramadol. I am suppose to take 100mg 3 times a day but I don't always take that. I usually take it twice a day. I have gone to once a day at times and don't seem to have any symptoms when I do that. I also KNOW that it works for the pain.
You need to talk to your doctor to see if she has any suggestions what to replace the tramadol with if she does not want to have you take it. I hope you make out ok!

[Dr. Smith]

Originally Posted by jakatak

I just don't understand the chemistry of tramadol having an effect on a nerve type pain. It doesn't make sense...but it works.

Since I have heard things similar to this before (opioids helping PN/neuropathic pain), and at least 3 times during the past week here on NT, I did a little poking around.

I googled: peripheral neuropathy treatment opioid. The question of opioid pain medications for PN seems to be somewhat nebulous. Many sites list "painkillers" as treatment options without specifying what types, so that may be open to interpretation. Some links cite studies that support opioid therapy for neuropathic pain, others argue both ways, and some dance around it with statements like:

Orally, opiate derivatives were found to be more effective [for chronic neuropathic pain] than cannabis for most people.
http://en.wikipedia.org/wiki/Peripheral_neuropathy

without coming out and saying that opioids are an effective treatment.

It may be that the doctors are as confused as the rest of us. Science has been known to change its positions before, and maybe there's more that needs to be learned about pain and its treatment.

In the meantime, for those patients whose doctors are changing/cutting their pain meds to their detriment, I would hope it couldn't hurt to search out and glean some of the studies/articles supporting what they already know to be true, and discuss them with their doctors. If the evidence is not persuassive, they may at least get some better answers.

Doc

[glenntaj]

--in which people report, and some in which some papers are cited, that seem to indicate that while non the first line of medications recommended to combat neurological pain (that line includes the anti-epileptics and anti-depressants, which have specific neurotransmitter mechanisms), opiods, and opiod analgoues such as Tramadol, are effective in SOME people in controlling neuropathic pain.

Like may other meds, they work for some (often in combination with anti-epileptics and/or anti-depressants) and not for others.