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Tramadol Cold Turkey
#1
Hi,

There is an old Tramadol tapering thread here (good info on L-Tyrosine) but I'm suddenly in a different situation.

My doctor announced that she's pulling me off tramadol after more than a year at 400mg/day. Since I also have depression/anxiety, I mentioned that I thought I was getting some mood lift from the tramadol. Big mistake. She thought I meant getting high. I explained I was talking about its serotonergic qualities and this was good because one medicine was treating two conditions (pain and mental health). I think she sees tramadol purely in opiate terms, so she didn't think this was good at all and literally tore up my prescription.

Rather shocked by this I asked about tapering, and said I was worried about us not controlling the pain (I mean there is a reason I'm prescribed tramadol!). Her answer was paracetamol. Sad What about withdrawals?, I asked. "You won't have a siezure," she reassured me. So I'm trying to get an appointment with a different doctor, but I'll be waiting a couple of weeks.

Yet again a doctor has got me thoroughly dependent on medicine and then pulled the rug from under me. What I really resent is being pushed into this legal grey area of using IOPs. I could do what she says and have a miserable cold turkey, but I do have a life and job to be getting on with. And I'm far from convinced that after a few rough days I'd be ok - this isn't a simple opiate.

Does anyone here have experience of going cold turkey from tramadol? Or a very rapid taper? What did it feel like? What should I be preparing myself for in terms of nasty symptoms? I'm aware tramadol hits a lot of neuroreceptors, so this could be a bumpy ride if I followed by doctor's advice!

Thanks in advance.
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#2
She literally tore up a prescription?  - sounds like she has anger issues.  And doesn't know what she's doing, patients taking painkillers that alleviate level of pain may have decrease from the low mood that go with high level of pain/not being able to manage with levels of pain.  I don't know, sounds unpleasant at best, unprofessional behaviour.... I'm sorry you went through this - have you got some painkillers to do you for a few days? Or have you ran out?
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#3
Maybe you should warn her with a possible lawsuit for doing this, this is not a good medical practice. She is responsible for the previous RX for you and also for tapering you out of this. It is a nasty WDS . And it takes longer to recover from it since Tram infuence many CNS pathways. My advice is to find as soon as a possible another doctor, explain the problem, and start by lower doses a 50 mg reduction every week until you get to 100 and then very slowly reduce dose . Get a supply from a IOP in case things go very wrong . A useful tip worked for me is starting Cymbalta at lower doses it helps a lot by raising serotonin levels and helps with leg pain and restlessness. If you need further advice PM me I will be happy to help.
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#4
She literally tore up the prescription - but I wouldn't say it was an angry gesture, more like "this is finished". I have some spare tramadol around, so not an emergency yet. I know a lot about benzo addiction and what happens if you CT, but tramadol is less familiar to me (and apparently my doctor).

I'd appreciate anyone who can tell me more about tramadol withdrawal symptoms. I made a reduction of 50% and felt really agitated yesterday, but it was also a day when I was doing something scary in real life. The pain was breaking through so I'm worried about what I can handle. If I have some sense of what symptoms tramadol withdrawal commonly causes then I can make sure I report them properly to my doctor rather than assuming a problem is caused by something else.

Also, what would happen to me if I did an absolute 100% cold turkey?

I will be seeing another doctor in two weeks, but until that's sorted I intend to report every little thing to this one. I want to make sure all of this goes on file so if there is a bigger problem later on, it'll be obvious what happened. I'm thinking about putting my concerns in writing so the is a proper record of it. I suppose for now I should keep a diary or something.

With the next doctor I need to be very careful that this doesn't get labelled "drug seeking behaviour". How would you explain your need for a high dose of opiates, when another doctor has cut off your supply?

Any thoughts / suggestions welcome, especially on tramadol withdrawal effects.
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#5
barq-

No personal experience with Tramadol but mucho experience years ago getting off heroin, Methadone, and Suboxone.

Tramadol is bit different beast because it affects both the opiate pathways in the body and the serotonin/norepinephrine systems. It has anti-depressant like effects in addition to pain relief. So total withdrawal sounds like a double whammy where both the traditional opiate withdrawal effects come into play and also anti-depressant withdrawal effects at the same time.

IMO, your doctor should have offered you a taper plan or a referral to someone who can help you taper if you plan on stopping usage. Really would not suggest 100% cold turkey. If your supply dwindles I would suggest 10% dose reductions ever other day until you find a new doctor or figure out what you are going to do. This might involve grinding up the pills and using a scale that can measure to the hundredth of a gram to measure out doses. The only good thing I can say is that Tramadol has about a 7 hour half life which means the withdrawals would last days to a couple of weeks instead of months like with longer half life opiates.

If you are in the US, physicians are increasingly reluctant to prescribe ANY opiates or opiate like drugs due to various regulations and especially potential issues with their malpractice insurers. If it were me, I would insist on a referral from your current doc so you don't show up at a new doc and get labeled as drug seeking.
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#6
You cannot bring litigation at the doctor because she is following the law as she sees it.

But, you can contact in USA, the state medical boards and put in a complaint.

If you have something similar where u live, You must document what u plan to present, on the day it occurs or soon thereafter. Don't write up the journal of pain and fear in one day. The Courts insist, for it to be evidence, that people keep records on a daily or near daily basis.

I shall leave the tramadol suggestions to the experts. I would just research it. Tramadol is not a PK per se. Its an SNRI or such. An anti depressant really.

My concern is the possibility of seizures during sudden withdrawal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714818/

But, lyrica was for depression. And, is now given to people with pain. They thought tramadols had no addictive property. So they pushed them.

Same thing "they" said about xanax. But, they were wrong.

I hope a member whom has done withdrawal will see your post and make recommendations.

I can research it, if you would like. But, it is not a medicine that I would have given my parents or my sister when I was caregiving people so I have no info on it whatsoever.

Good luck. I pray someone with knowledge responds to you.
Angel  It is Well with My Soul  Angel
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#7
Thank you Ghost and Charon.

I am keeping a diary. For me, tramadol is/was used to treat an injury that included neurological pain, therefore the antidepressant qualities have been useful in acting as a neural pain blocker (unlike your average opiate). Due to the neurological element I am also on gabapentin so suspect I am reasonably protected against seizures - that is one of the things that would worry me most because I know the dangers and long term effects.

Ghost, that's a good point about grinding up pills and weighing them. I could get some of those scales quite cheaply from ebay or somewhere. Since all my pills are 50mg, crushing would give lots more flexibility for a smoother taper. I think this is perhaps the point I need to make to the new doc, I'll play ball and reduce my tramadol use, but cold turkey is utterly incompatible with holding down a job, and other responsibilities I have in life.

Does anyone know if there is a widely accepted/respected method of tapering tramadol? Ghost suggested 10% every other day, but I assume that is a fast taper in case of running out of medication...? I'm thinking if I can propose a reasonable schedule to a new doctor then they might be prepared to support that.

Thanks to everyone who has helped. I appreciate hearing from you. Even just knowing other people think the doc's cold turkey plan is stupid makes me feel a bit better!
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#8
The first thing you need to clarify in your own mind is what the goalposts are.  Up to the point you met with Dr who tore up prescription you didn't have plans to stop the pain medicine for the time being.  

Her behaviour was disrespectful, unprofessional and I think there might have been a bit of power-play going on.  You have a bona fide pain condition,  you've been taking your tablets at the right dosage and the right amount of tablets - you haven't been getting more tablets from elsewhere - you're a patient with a legitimate need for painkillers.  I don't think you should have to jump through hoops to get a pain med you need.  It's your choice:  you decide (think it out: how well do the g@b@pent1n and tr@m@d0l help with managing the pain levels - how much pain will you be in taking a decreased amount of tablets or none at all?

The doctor was judgmental and made a conclusion about you that isn't the case.  The "advice" she gave you was poor - if it was me, i'd seek another dr's opinion.  Sending best wishes,  ps. you don't need to explain to a new Dr why you need painkillers - find a Dr who's humane and tell them what your level of pain is, which meds you've been taking so far etc.
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#9
(07-21-2017, 11:19 PM)BlackSocks Wrote: Her behaviour was disrespectful, unprofessional and I think there might have been a bit of power-play going on. 

I think you nailed it right there. Don't want to go into too much detail for reasons of privacy, but I'm a PhD who works in an area allied to medicine. In a previous appointment she suggested something and I corrected her. At the time she seemed cool, but I wonder if I really annoyed her.

On that particular day she caught me by surprise, I was squeezing in an appointment between some other meetings. I was even doing paperwork in the waiting room, which is quite unusual (!), but I was very pushed for time and she was running late. I guess that might look a bit self-important. So yeah, power-play feels like the missing piece of the jigsaw.

BTW on the issue of reporting levels of pain, I really struggle when asked to rate it 1 to 10. Really I want to explain how it depends on loads of other factors. But I also know that I have to say 8 or 9 to get their attention. It is a silly game. Anyone else have the same issues with reporting pain?

Anyway, thanks again to everyone who has taken the time to reply and offer advice. This forum really is a great community.

All the best, barq
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#10
Barq pain levels change according to our pain thresholds - your pain threshold may be significantly lower when your anxiety is high or conversely higher when you're having a good day/days.

As to choosing your number on the 10 scale - it's chronic pain not acute pain.  You've been previously prescribed g@b@p2nt1n and tr@m0d0l.  Neither are prescribed for less than serious ongoing levels of pain as far as I know.  Is it more straightforward to reference what pain prevents you from doing when you're having a bad bout?  The activities you'd like to be doing?  

Sending best wishes,
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