Increase in pain, need a med to rotate with Tramadol.
 

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!

Tapentadol?
 

Has anyone had any luck with Tapentadol?

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

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).

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

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.

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.

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 :)

400mg a dose?
How many doses per day?

Main thing is I don't want to become dependent. If I ever had to stop them cold turkey it could be a painful experience. I know a week or two is my limit because after being on them for two weeks due to a big event in my life that needed my full attention, the passing of my father. Then stopping once I didn't need to stand and things the withdrawals were not pleasant at all. I can't even imagine how bad it could be if I had been on them for a long time at large amounts.

I need to find something else to get me through the hard painful times from events out of my control.

Marty as I mentioned above its 400mg per day. It depend if its slow release 2 x 200mg or 8x50mg either way the max prescribed is 400mg/day

Just to be clear the maximum dosage is 100mg at a time unless its slow release where its 200mg at a time

I found long term use at 400mg/day is the sweet spot for me

Hello, I am new to the boards. I have been on Nucynta ER 200mg 2xs a day since early Feb for SFPN.

It helps. It does not completely take the pain away for me. It took 3 weeks for it kick in and during that time I was calling my dr telling them the crap don't work and he kept telling me wait it out, all the sudden I had energy and my the burning and tingling dropped down quite a bit and I was like wow, I was even in a great mood.

Right now I think I need a dose adjustment because the burning and humming are coming back. I was on 3600mg of Gabapentin with the nucynta and still having pain so they just switched me to Lyrica 150mg 3xs a day. Whoa they are worried about the opiates being abused, heck I get more zonked on Lyrica than I ever had on opiates.

But long story short it helps enough that I have no desire to go off of it and try something different. I am just using it in combo with other meds and when the combo works it's great.

Welcome Ouchiefeet. :Wave-Hello:

The topamax (50mg-but you can go higher-that's all I needed) took away most of the tingling and all of the pain and pressure in my feet. They felt like normal again for the most part. I stopped taking the topamax when I discovered that the dextromethorphan (120 mg) I was taking for my back pain worked just as well on my neuropathy.

Do you feel that Nucynta ER has a high degree of a risk for dependancy?

Sometimes it helps to understand the process of tolerance better.

With pain receptors in the brain, it has recently been found that the glia cells around the neurons which actually support the neurons, somehow stimulate the mu receptors (pain receptors) to increase in numbers when they are all filled with drug.

So what happens is the pain returns because those new extra receptors are empty until YOU increase your dose, or change drugs etc. Then in the end, if you decide to stop the drug, then you are left with all those extra new receptors and the perception of pain is HIGHER than when you started out. It becomes a never ending spiral.

Now, studies do not yet explain what happens next, as this is quite new information. The new receptors may atrophy away with time, or not. Given the high rate of relapse in addicts from rehab, I suspect not, or it may be a long time necessary and many people just cannot stand this long period and then they start using again. (studies for non-addicts are not as numerous as for addicts-- so I am not implying that opiate pain relief for PNers is addictive, the studies are just not there yet for chronic painers).

Sorry—I was talking about opioids in general—not just tramadol. ;)

Doc

Honestly no, it is nothing like traditional pain pills, I feel nothing from it other than the relief I got after it got in my system.

It really does help calm the burning and humming so much as I said in my other post I would hate to think about going off of it for fear the pain would come back. So I am dependant on it for the pain relief but if it stopped working I wouldn't hesitate to kick it to the curb to try something else and I wouldn't feel I needed it after it was gone. (I don't think anyways)

Like I said takes about 3 weeks to work and in that 3 weeks before it works you will swear it is the worst drug it doesn't work blah blah then all the sudden you will notice that you aren't walking on the sides of your feet to keep from touching the pads and your mood is good. I told the NP I hadn't been in this good a mood in years.

Marty, I don't know of any prescription pain medications used regularly that don't produce dependence eventually. Even the antiseizure meds (gabapentin, pregabalin, topiramate) and the SSRI/SNRI antidepressants do that. Rotation may help retard tolerance, but dependence will still be there.

It may be a choice of the least of many evils. I realize you're in SLC, but have you been following the CBD thread?

Doc

No I have not been following it.

I am pretty new to this Neuropathy thing, mine got really bad in July of last year and it took til October for them to diagnose and then another few months in pain management to get some relief to the point I wasn't in a ball in my bed sobbing to my husband.

From July 13-Mar 14 I was in so much pain I was like a crazy woman who begged every single doctor I saw to please help me. I never knew until then that your brain can be so consumed pain to the point it was all I thought about was begging for help.. If you knew me you would understand that that is waaay out of character for me. I am generally a very independant suck it up type of person and I was a mad woman. I soaked my feet in ice, plunged my feet in snow piles, kept buckets of ice next to my bed to soak my feet in when I woke up in the middle of the night (if I slept at all) I tried using sunburn gel with lidocaine in it to try and numb the pain. I was literally bathing in sunburn gel lol. During that time they had me on many different meds and kept raising the doses of my gabapentin to max dose of 3600mg.

My pain doctor asked me to try Nucynta ER. After the first week on it I was still begging for help calling them telling them it wasn't working. They told me to wait it out and if it wasn't working by my appointment date we would try something else. Like I said before after about 3 weeks the pain relief was so much better than any of the other treatments I had tried so far. I have been on it since March along with now Lyrica and that combo seems to help enough I can actually function most days to the point I can even go grocery shopping and for small walks where I couldn't before.

You have to understand that with any drug there is a chance of dependency. I know I have to be on these types of drugs for the rest of my life. I know that this neuropathy is never going to get better doctors told me that not long ago, so I needed to decide the risk of the med vs dependency and other side effects and I have chosen to give it a try for the relief it gives that allows me to function at least a little bit.

Your last paragraph is important. Its acceptance. I know there are many who dance around medication never fully committing just in case one day they wake up and the PN is gone and I used to think like that and didn't want to be dependent to much.

There are also a host of other ailments that we get as we get older and these to are masked by pain killing drugs so when we try to stop its hell.

There is a also a psychological factor both with antidepressants and pain killers like tramadol that help us deal with the disease by numbing the senses and telling us sure we are sick but I don't care to much about it, now there is a big dependency right there. I cant see how anyone with serious pain issues can not become dependent.

Good point, and conversely, those more toward the beginning of their PN (and the stages of grief for chronic illness)—who believe it may one day go away/be gone—may be in denial.

Doc

I am at the beginning. I am thankful that between the two medicines I take I get marginal relief. Some days are good and they seem to allow me to make it through my work day with enough energy to get mobile quality family time in. Some days- stretches of days- I have to take more the secondary medication than I might want to.

I have made significant lifestyle changes that leave me at the odd life juncture of- best shape of your life since you were an athlete (20 years ago) while having a chronic condition that is often extremely dibilitating.

These ebbs and flows left me reeling earlier this year. I thankfully had a secular Road to Damascus moment and decided that I had to keep positive. So I do my best to lead with that. Results, as always may, er do vary.


I have lowered the intake of one medicine while increased the other. I no longer wait to see if I can withstand a bad day. I have been caught behind the curve of the pain that way. It takes five minutes of stretching to know which day it will be. I know it may come to a day where it takes five minutes of trying to get out of the bed to consider stretching.


It is a tough decision on how to handle it. Such an individual one too. My wife is in on all of it. I have my kids to consider and they are both young.

Thanks to many of the suggestions here- Salonpas - I have found some OTC stuff that at least helps take some edges off a tad.

It is a matter of degrees at times.

My best to all.

Jon

Withdrawals are awful. I hate taking drugs so I periodically go off painkillers and even though I taper off I get bad withdrawals. I have not had luck from pills in general. My doctor gave me a topical cream I can use multiple times a day that does help ease the pain. But my pain is mostly in my foot and lower leg, if yours is more widespread that may not be a realistic solution.


I know I'm still in denial. I refuse to accept that I will have to be on painkillers for the rest of my life. As someone who works in bio-med and does research on the mechanisms behind regeneration I'm hopeful that one day we will be able to fix PN instead of just managing the symptoms.

This has been my practice now for several years and have done OK at managing my build up tolerance to tamadol. It is vary difficult to do this or rather impossible it seems when I'm busy with life and commitments out of my control. I view pain killers as a way for me to get what I have to do done, like the passing of my father or traveling to see my in laws in Finland. But at this point I have pretty much avoided taking pain med's just to lower my pain when I can get through the day without them. Get through easily? No but none the less possible. The mental game is in my view the most important and without it things start slipping. My weight, my exercise, my food quality and so on. Once this happens the pain increases incrementally. But I have to wonder is my pain increasing only because my healthiness has decreased? It's a combination of health of body and mind. If I can be strong enough to control what I eat, how much sleep I get, my exercise and so on I seem to strong enough to deal with pain better which in turn makes it seem like it's less. Less because mentally I'm stronger and less because I'm controlling my habits better.

Sorry for the rambling.