I hate Tramadol. Officially.

Old 09-14-2017, 07:56 PM
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I hate Tramadol. Officially.

Hi, everyone! I'm RapidTwitch! You can call me Rapid, or Twitch, or whatever you want, really. I'm not going to hold any weird nicknames against you. (There's this terrible story about my middle school nicknames and how they became acronyms and then merged into a single, all-encompassing-meta-nickname, but...I digress. I'm good at that, by the way. It's the creative writing background.)

Since December 2016 I have been on a Tramadol prescription to manage chronic pain (the source of the pain is still unknown - current working diagnosis is something like "Fribromyalgia secondary to ___________," but the "secondary to" part is the sticker, and might be some kind of autoimmune condition like an inflammatory arthritis of some kind, or might be an inherited connective tissue disorder, or might be something they haven't thought to check for yet). Regardless, the treatment options for each potential diagnosis have been consistently limited to things like "manage the symptoms as best we can," so that's fun. Fingers crossed that my appointment with a geneticist in October bears some fruit. I think I may have mixed a metaphor there (or three).

Anyway, on Friday, September 8th, I came to the hard realization that the Tramadol prescription that I had been taking to manage the pain (and continue to do things like work, and go to school, and go grocery shopping) had become so ineffective as to be almost as useful as a strong blow to the head in the "reducing pain levels" effect scale. This was made clear when, after taking over twice my prescribed dose throughout the day (my prescription has since around the beginning been for 400 mg Tramadol daily - the maximum allowed) and supplementing with some codeine/acetaminophen/caffeine pills from Canada that my concerned parents helpfully brought down for me the week before (so around 96mg of codeine, spread out throughout the day), I was still in pain.

So, like a genius, (or as my mother said when I told her, like "Someone who doesn't do things in half measures") I decided to quite all opiates, cold turkey. Because if they're not helping with my pain, really, there's no point for me in taking them.

I have no idea what the Morphine-equivalencies of 800-1000mg of Tramadol + 100-or-so-mg of Codeine would be. I'm sure it's possible to look that information up. What I can say, 5/6 days in to my withdrawals from all of this (on Saturday, the 9th, I took a single 50mg Tramadol to try and alleviate some of the way-not-fun acute withdrawal symptoms - then called my consulting nurse line, and was instructed to get my ass in to Urgent Care, because "are you an idiot," only in slightly gentler words), is that I really, really hate opiates, and Tramadol in particular.

I'm not allowed to go back to work until Monday the 18th at the earliest (pending review by my doctor/care team, who seem stuck in that place where they're both angry that I decided to do this without consulting with them, and also glad that I'm not trying to get them to just give me more opiates and that I stopped on my own after "only 9 months or so," which, definitely testifying hand-up on this one, is plenty long enough for some ******, ****** physical dependence to be firmly established). I have almost no leave left in my leave bank at work, because the reduced effectiveness of the Tramadol resulted in me missing a lot of work the last couple months. So all in all, it's going to be fun dealing with the financial fallout. On the plus side, I'm only halfway worried about losing my job, since this should be covered under FMLA, so that's something. Though my HR department has a history of being overly-invasive and way not compliant with things like FMLA and the ADA and just Laws In General, so not going to completely put my faith in that one until it's over and done with.

The best part about the whole "hopefully not losing my job" thing is that I'm like...two months away from my five year mark with this employer, and once I hit that, I'm vested in the retirement/pension plan. I mean, at only five years, it's something like a whopping while $200 a month, and I've still got decades to go before I hit the age where I'd be allowed to pull from it, but it would still be nice to actually HIT that mark, ya' know?

I have an amazing support network here, in my partner, my family, and my friends. Once my partner (who has not had any issues with addiction/recovery himself, but who has seen multiple coworkers walk down this particular road) had a moment to express his disappointment that I decided to cold turkey without telling him first (and I explained that in retrospect I understood that that decision was wrong, and why), we had some really, really good conversations about why this had become a problem, and what we were going to do in the short (and immediate-long, and longer-term) to deal with it. We also had conversations with my family and friends about the whole "I'm in withdrawals" and "please take back the Canadian codeine - no, seriously, thank you and all, but take it back I don't want it and we're going to be looking at other options for pain control in the future," and I'm feeling good about that end of things.

I'm not feeling any cravings for the opiates/opioids/Tramadol, which is a relief. I am in pain, which sucks, but isn't surprising. I'm really not liking the whole withdrawal/detox thing, but that's to be expected - if people enjoyed this process, it would probably be a lot more popular, right?

I think the hardest part for me is the complete, total, bone-crushing exhaustion. The occasional, unpredictable drops in blood pressure - with the accompanying "get to a chair or get horizontal before you pass out like OH MY GOD RIGHT NOW" ear rushing noises are fun, too. Oh, and the feeling like I have too many cells in my spine and they're trying to climb out through my skin. Or are moving around in there. Or something. But the exhaustion, definitely. And the double-vision.

Did I mention at some point that I have a background in creative writing? Like seriously, I can just keep going like this. Open-ended, timed, write-until-we-tell-you-to-stop exercises are a pretty basic approach to "turning off the inner editor" in most programs nowadays. Actually, I might incorporate some of that stream-of-consciousness journaling (or at least freewriting - I've always been crap at journaling) into my own approach to recovery. But I'm going to stop writing for now. Thank you for listening.
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Old 09-15-2017, 07:32 AM
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Hi and welcome again Rapid Twitch

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Old 09-15-2017, 08:27 AM
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Hi , Sorry about your issues .
I once went through some weird whole body symptoms and pain .
My GP,s werent too keen on the term fibromyalgia so they put everything down to stress and hypothyroidism .

I found an Australian guy called Dan Neufers hypotheses worth reading .
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Old 09-15-2017, 10:13 AM
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Hi, Dee, and thank you for the warm welcome.

Thomas, thank you for the suggested reading, but at this point there's no reason to think that I have MECFS. The Fibromyalgia diagnosis, which may be incorrect as it was applied without a proper examination (no "tender points" check) by a rheumatologist who was looking at me for RA but who decided she didn't want to pursue that avenue of investigation when my blood work came back normal despite a strong family history of seronegative Rheumatoid Arthritis, is currently being viewed as a "shaky secondary diagnosis, but one that gives us a chartable code for appointments" by my doctors. (When I saw them earlier this week, the appointment was charted as "TDAP vaccine," although I did not receive a vaccine. This crew is so silly sometimes.)
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Old 09-15-2017, 12:10 PM
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I doubt your medical team was actually angry that you cold turkeyed off your pain meds, but they definitely were concerned, as well as adding codeine. Pain management is a delicate operation, managing tolerance, which is what you experienced, is part of it. I would strongly suggest you tell your doctors what's going on and let them handle it.
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Old 09-16-2017, 11:31 AM
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MindfulMan, thank you very much for the reply. My medical team is definitely fully involved in my recovery process and aware of everything I was and am taking (including all vitamins and supplements), and will continue to be. I think that keeping them informed is really important, especially since NOT doing that - trying to just continue on and ignore the reduction in effectiveness of my pain medication, and then deal with it myself, even though I KNEW that it was a clear warning sign that I had developed a tolerance, and probably a dependence - is what got me into this situation in the first place.

I did get the distinct impression that my medical team was Not Happy that I had decided to cold turkey off of the medications on a Friday, without tapering or telling them, when they weren't open again until Monday. There was a lot of, "Well, you're like three days in at this point, so I guess we'll just have to manage the withdrawal as best we can. I'm really glad you didn't have any seizures," talk, but it was mixed in with, "I'm glad you noticed something was wrong, and decided to address it, because we had no idea," talk, so I think there's kind of a mix there.

I've got an appointment with Behavioral Health in just over a week, and am looking forward to it. I'm dreading seeing my Primary Care Provider, though, as she was the one prescribing the Tramadol, and I'm pretty embarrassed on that front. But it's okay.
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Old 09-16-2017, 12:11 PM
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You sound like you are very self aware which is great.

Wishing you the best
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Old 09-17-2017, 11:01 AM
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Thank you, Silverback! I'm continually feeling better as I proceed away from Day 1 and the acute withdrawal symptoms lessen, which is wonderful. I'm getting more energy - I managed to spend four hours walking at the mall with my friend yesterday, which isn't a lot, but at the same time, isn't something I think I could have done on the day before that. So I'm definitely improving.

I'm also feeling better overall, physically and mentally, than I have in a while. The worst part is that I didn't even realize that I was so...slowed the painkillers. Everything literally looks brighter and more crisp. Also, there's a faint smell of chlorine in the air (like the smell of the air at an indoor pool), especially when I go outside, which is kind of weird, and which I'm currently putting down to my nervous system being Confused and Alarmed.
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Old 09-19-2017, 03:01 AM
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Day 10. I've been feeling wonderful for the last two days, aside from lingering physical symptoms (insomnia, some restlessness) and having to deal with the pain that was the reason I was on Tramadol in the first place. I thought it was that I was just, finally, clearheaded again, and hadn't realized before how much the painkillers were impacting my cognition. I was feeling emotionally labile, but wasn't surprised by that, considering the brain and chemical issues associated with opiate use and abuse, and cessation.

Turns out, no, I'm either manic or hypomanic. My partner recognized it immediately, as he has experience with bipolar family members (he's kind of like a dowsing rod for All Things Mental Health, actually, or maybe like one of those drug sniffing dogs - he can usually tell if someone has mental health issues within a few minutes of meeting them, and even give an accurate assessment of the broad strokes of the issues, sometimes even a specific "diagnosis" in that he recognizes the condition itself from his childhood, which is a strange adaptation, but makes sense given his upbringing). So that's kind of unpleasant - it's not post-opiate depression, which is nice, but it's also not something I've ever dealt with before. My psych state has been pretty moderate and balanced for my whole life. My partner warned me that the depression is probably coming, though, and the research I've done on mania/hypomania after opiate use supports that. Apparently a seesawing thing is not unusual as part of the endogenous system re-establishing itself. The good news is, it's temporary. Also, now that he has pointed out to me what's happening, has identified it, I've found that I can moderate it. I just have to make a conscious effort to remain calm, collected, and all that jazz. It's still unpleasant. I understand, intellectually, that mania is often expressed as (among other things) an overly ebullient mood, and I definitely feel like I'm on that end of things, rather than on the paranoid/irritable side. But it's not fun having my emotions be so high and having so much energy, as weird as that may sound.

Before anyone asks, yes, I do have an appointment with BHS/Mental Health already scheduled for next week, which is the soonest they had an opening. If I'm still "up" at that point, and haven't started the downward swing, I might talk to them about looking into a short-term treatment regimen with Valproate, which has apparently been effective for some patients in reducing or regulating hypomania post opiate withdrawal, or some similar medication.

Between the hypomanic insomnia and the return/increase in my painsomnia, I'm not getting much sleep, which sucks (especially since sleep deprivation increases mania). Tonight I managed 5 hours, which is way better than I've done the past few nights. I woke up about 2 hours after going to bed because my hands were aching so badly. I had to go run hot water over them and do finger and palm stretching exercises to get the pain to reduce enough to be able to fall back asleep.
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