[Marty SLC]

It's been a long time since I've posted.

Background information:
I have tried with no luck Cymbalta, Gabapinten and other forms of anti-depressants.

I’m taking:
Lyrica (150mg twice daily) with some relief.
Tramadol (100mg as needed) pretty good relief.

Here's the issue. At times I take tramadol every day for like a week before I notice it’s not as effective and I need to increase its dosage. At about a week of daily use I also feel like I start to become dependent. I then have to go off it for maybe week so it's as effective, also so I don’t become dependent on it.

If anyone has had success with other forms of pain medications that could be rotated on a weekly basis with Tramadol I would appreciate the input.

Thanks!

[Marty SLC]

Has anyone had any luck with Tapentadol?

[Dr. Smith]

Hi Marty,

While medication rotation is sometimes used by doctors and chronic pain patients to help attenuate medication tolerance; I don't know that it will avert dependence. Rotation often avoids symptoms of withdrawal by—in effect—swapping one dependence for another, e.g. heroin & methadone.

Physical Dependence
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Tolerance
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

Definitions Related to the Use of Opioids for the Treatment of Pain: Consensus Statement

Doc

[Breia Lee]

I know what you mean about not wanting to overuse Tramadol, even though it works. I am the same way.

I used Cymbalta for my PN and while it worked, it was not worth the side effects. I took Topamax (generic topirimate) along with it because I could only handle 30 mg of Cymbalta. When I discontinued the Cymbalta, I stayed on the Topamax and discovered that it worked almost as well for the PN all by itself.

I tried Lyrica once and it gave me the worst headache. I researched medications and came up with topamax because it was weight neutral and there were reports that it would work. It did, with very few side effects (dry hair and finger tingling, but YMMV).

[Marty SLC]

Originally Posted by Dr. Smith

Hi Marty,

While medication rotation is sometimes used by doctors and chronic pain patients to help attenuate medication tolerance; I don't know that it will avert dependence. Rotation often avoids symptoms of withdrawal by—in effect—swapping one dependence for another, e.g. heroin & methadone.



Doc

Never thought of that way but it makes sense. I must think things through carefully. Thanks

[Marty SLC]

Originally Posted by Breia Lee

I know what you mean about not wanting to overuse Tramadol, even though it works. I am the same way.

I used Cymbalta for my PN and while it worked, it was not worth the side effects. I took Topamax (generic topirimate) along with it because I could only handle 30 mg of Cymbalta. When I discontinued the Cymbalta, I stayed on the Topamax and discovered that it worked almost as well for the PN all by itself.

I tried Lyrica once and it gave me the worst headache. I researched medications and came up with topamax because it was weight neutral and there were reports that it would work. It did, with very few side effects (dry hair and finger tingling, but YMMV).

I have never tried topamax. For you does it work for your burning, pain or both? Lyrica keeps the burning under control, it the nasty pain in my feet and legs i need relief from.

[zorro1]

Im taking Trama 400mg per day with 300mg Lyrica.

let me say I could halve the Tramadol and put up with a little burning to avoid dependence. The thing is Tramadol works for me at 400 with zero burning and Im not worried about dependence because the PN is with me for life .

Regarding dependence yep there I times I don't need my full dose but I take it anyway just to feel a bit dumb n happy but its no different to Booze really.

[Dr. Smith]

Originally Posted by zorro1

The thing is Tramadol works for me at 400 with zero burning and Im not worried about dependence because the PN is with me for life .

I don't know how things are in other parts of the world, but here patients also need to be concerned/worry about tolerance. Even though opioids have no theoretical upper dosage limit, doctors are becoming leary of prescribing ever-higher doses as tolerance rears its ugly head. Rotation works for some—unfortunately not for everyone.

Doc

[zorro1]

Originally Posted by Dr. Smith

I don't know how things are in other parts of the world, but here patients also need to be concerned/worry about tolerance. Even though opioids have no theoretical upper dosage limit, doctors are becoming leary of prescribing ever-higher doses as tolerance rears its ugly head. Rotation works for some—unfortunately not for everyone.

Doc

Hey doc, 400mg is the upper limit both in Australia and wider Asia and I believe its the case in the USA as well

[Marty SLC]

Originally Posted by zorro1

Hey doc, 400mg is the upper limit both in Australia and wider Asia and I believe its the case in the USA as well

400mg a dose?
How many doses per day?