Chronic pain opiate therapy & serotonin relationship???

[mp91163]

Greetings again, everyone! It's been quite a few months since I've been around here, and would like to thank everyone for their help and opinions. I have a bunch of issues and questions, and hoping that y'all can provide some insight and thoughts...

First, my story is here: http://www.soberrecovery.com/forums/2143485-post61.html , so I'm not going to re-hash the whole thing. However, I've had quite a bit of time to ponder the WHY behind my problems in 2008. I did not mention in my original post that I had been on Lexapro 10mg since 2005...and during 2008, my wife insisted that I see a psychiatrist/therapist to deal with "communication" issues (story for another day...) Anyhow, I discovered a condition known as serotonin syndrome/toxicity; while it is best known for severe levels of it being fatal, the Hunter Serotonin Toxicity Criteria describe a graduated scale of serotonin toxicity. Here's the timetable:

March 2008--Taking Opana 20mg BID; psych doubled Lexapro dose (10mg to 20mg)...keep in mind that I had been on this same Opana dose for over TWO years effectively!

April 2008--Work-related stresses (economic) getting worse, rheumatoid arthritis worse, pain mgmt doctor increases Opana ER to 40mg BID. Later that month, psych adds Wellbutrin XL 150mg to the mix.

June 2008--As stresses pile up, I endure a nasty arthritis flare, requiring Medrol Dospak (Medrol is methylprednisolone, a corticosteroid used to control inflammatory flares). Psych increases Wellbutrin to 300mg.

July 2008--Psych switches me from Wellbutrin to Buspar 15mg BID; does NOT warn me of MAJOR interaction between Buspar and Lexapro--serious risk of serotonin syndrome.

August 2008--Pain mgmt doctor switches me from Opana to Oxycontin 60mg BID, then to TID three weeks later. I remain on this regimen until December, when my wife issued the ultimatum, and I began my taper.

Now, here are some of the symptoms of serotonin syndrome that I experienced:

Mental state changes--yep, the wife says I was cranky, irritable
Myoclonus--involuntary movement of limbs; gee whiz, my wife said my legs were "jumpy" while sleeping...the irony is that opiates are sometimes prescribed for "restless legs syndrome"!
Diaphoresis/shivering--Last summer, I always felt cold; unless the room temperature was 80+ degrees, I'd feel chilly

Now, when I tapered off the opiates early this year, I decided that since I was going to be somewhat miserable anyway, why not get it all out of the way in one shot? Well, it really took until April to completely eliminate the "brain zaps" and other pleasantries of a Lexapro taper...but, I have to say that MENTALLY, I have never felt better! Antidepressants in the SSRI and SNRI families are the most EVIL drugs ever created--you think coming off opiates might be bad? Folks, opiates are a walk in the park compared to weaning off antidepressants! For several MONTHS, you deal with the zaps, vivid bad dreams, and other nastiness!

My question for the group is this: For those of you who were taking opiates, and had an antidepressant drug added OR increased, did you find yourself having the issues I described? Did you also find yourself requiring greater doses of your pain medicine?

Many, many thanks in advance for all your input!!!

Mike

[sunshine2481]

I don't know if what I will tell you will help or not, but here goes:

I am bi-polar and have SAD. I am taking topamax 100 mg; Paxil (I don't know the doseage); and Xanax 1mg. I was abusing Vicodin 5's, 7.5's, or 10's...shooting, snorting or eating them. I was also occasionally smoking marijuana and drinking. I have extreme mental state changes which i attribute to the bi-polar. I used to sweat my butt off at night, I attributed that to the pain pills. I also had problems with RLS...so much that it wakes me up at night. I have been sober from my non-prescribed meds, weed, and alcohol for 5 days now and the RLS is gone; the night sweats are getting better; and the mood swings are improving as well.

Hope this helps

[ChillyBones]

I had all of the above symptoms whilst quitting opiates; The restless, jumpy legs, the ice cold sweats, fever, itchy skin, the feeling bugs were crawling under my skin, massive depression and I wanted to scream at night.

That was 2 weeks ago now, I feel 95% at the mo and I truly believe that 5htp helped out a load!

[Dee74]

There's been a lot of posts about 5HTP lately, not only in this forum or by any one poster.

Lets be careful not to blur the line between experience and medical advice.

Medical and Psychiatric advice includes giving a diagnosis, treatment plan, medication advice and dosage suggestions, over the counter and natural home remedies that should be approved by medical professionals.

Any google search can show you both the benefits, and the dangers, of 5HTP.
Thanks
D

[Leopard71]

Mike in NJ..an interesting post..and sorry I was a latecomer to this after months on a dead thread.

just curious..what was lead to the oxycontin usage?..I too am on this 20 mg 4 per day and after 5 yrs post fusion surgery..I can live w 3/day..seems as if some permanent nerve damage was done while in a ball game (I was 54 then) tring to beat out an infiled hit..then somethin went in my spine..pinched and ja,mmed nerves and it took them 15 months to diagnose it..the dark tunnel.

I'm lucky to be here but have a persistent seratonin deficiency and an occasional testosterone deficiency....so I hafta use L tryptophan for sleep w trazadone..Im attempting to tweak one or the other.

sorry the wife gave you the ultimatum..I wonder how those not in pain can determine whats comfortable for those of us who are

[mp91163]

Originally Posted by Leopard71

Mike in NJ..an interesting post..and sorry I was a latecomer to this after months on a dead thread.

just curious..what was lead to the oxycontin usage?

Joint arthroses (damage) from psoriatic rheumatoid arthritis. Psoriatic arthritis is an inherited auto-immune disorder; generally it skips a generation-my maternal grandfather had very bad skin psoriasis, but did not have the arthritic component. I, on the other hand, had some skin problems (many scalp), but the arthritis certainly nailed me. PA is triggered by long-term stressful situations; in my case, at age 24 I took a job selling construction equipment and supplies, and was assigned a new "cold" territory...was given a 6-month "salary" while establishing new business, but after 6 months, it would go to 100% commission-only...which means-you don't sell, you don't eat! Honestly, I loved the job...but subconsciously, I was putting stress on myself, and my immune system "fought back" by releasing antibodies that attacked my joints. And back in 1989-two years after noticing the joint pain and swelling, and getting diagnosed-there was NO "cure" or stopping PA-all that could be done was treat the pain and inflammation. It wasn't until 2002, when Enbrel arrived, that biologic agents were invented that stopped the arthritis in its tracks. Unfortunately, the damage remains...see here Flickr: Mike91163's Photostream for examples of the damage.

What's quite annoying about PA is the following:

1--It's "symmetrical", in that it affects left and right-side joints fairly equally, unlike other forms of arthritis which can bother specific joints;

2--It tends to affect the extremity joints (feet/ankles/fingers/hands/wrists) first and HARD, with some light to moderate effects upon knees/hips/spine...this characteristic makes PA very tough to deal with-after all, you use your hands and feet ALL the time!

Believe me, I am not minimizing what you're going through...but, there are procedures to fix pinched nerves and spinal alignment. Granted, the success rates are questionable, but something can be done. On the other hand, for me, there's not much-can't exactly "re-grow" bone in a joint...

As I indicated in prior posts, my increases in pain medication were 100% medically acceptable, as they fell in line with recognized "tolerance" guidelines. However, it wasn't until work stresses started piling up, and a psych increased my serotonin meds, that issues began.

I have now been opiate-free since February 2009, and SSRI-free since March 2009. Mentally, I feel pretty damn good...but physically is a whole 'nuther ballgame.

Originally Posted by Leopard71

..I too am on this 20 mg 4 per day and after 5 yrs post fusion surgery..I can live w 3/day..seems as if some permanent nerve damage was done while in a ball game (I was 54 then) tring to beat out an infiled hit..then somethin went in my spine..pinched and ja,mmed nerves and it took them 15 months to diagnose it..the dark tunnel.

I'm lucky to be here but have a persistent seratonin deficiency and an occasional testosterone deficiency....so I hafta use L tryptophan for sleep w trazadone..Im attempting to tweak one or the other.

sorry the wife gave you the ultimatum..I wonder how those not in pain can determine whats comfortable for those of us who are

Oh, you got that right! What makes it difficult for us GENUINE pain patients is the impossibility of measuring the pain that a person is in. Unlike medical conditions like anemia, high cholesterol, and others, which are quantifiable via blood tests, pain is an entirely subjective matter-and EVERYONE has different thresholds of tolerance. In one regard, you do have it much tougher than me; while I can show x-rays of my joint damage, which anyone can plainly see the problems, nerve and spinal issues are far more difficult to determine.