Tramadol

Hello. This is my first time here.  Just joined today.  I have sarcoidosis and have RA flareups with it and daily chr pain in my ankles, knees, hands and elbows and I'm a nurse!!!  I wanted to get off Tramadol so I quit taking it 4 days ago and am having horrible anxiety, insomnia and having a hard time forcing fluids. Although I'm a nurse, I want someone to take care of me now! I was taking two 50mg Tramadol three times a day for a year and a half. I am seeing my PCP this Tuesday and was wondering what I can ask her about helping me these horrible unrelenting anxiety attacks and what is there that I can take for this daily chr pain that is not addictive.  I was thinking about asking her for a low dose of ativan and darvocet?? What are your thoughts?
Thank you so much!!!

[J T Junig, MD PhD]

Ditto....  
Benzos are often a curse--  the tolerance makes them dangerous, as people tend to chase the dose higher and higher, just as happens with opiates.  The withdrawal consists of severe anxiety, which people think is their own anxiety disorder, creating a cycle of use and withdrawal and more use...

I suggest searching for articles about 'chronic nonmalignant pain', as that is your issue, and there is much that has been written on the topic.  Darvocet is not a great option either, unfortunately, as it is a weak narcotic that probably won't offer much more analgesia than would nsaids.  

Usually the answer lies in healthy living, exercise... but with rheumatoid arthritis, you will likely need some type of anti-inflammatory med and some type of analgesic, perhaps even an opiate.  The challenge will be staying at a constant dose over a long period of time.

[NATTY24]

Oh Tramadol is a mixed blessing. It helps pain but you will have withdrawl (withdrawal) symptoms for about a week.

[NATTY24]

Tramadol is a sort of mutant analgesic which can cause severe physiological withdrawl (withdrawal) if it has been taken for a significant period of time & then abruptly discontinued. Tramadol is an addictive synthetic opioid analogue which both binds (weakly) to opioid receptor sites (just as narcotics do) and which also acts a lot like an SSRI antidepressant by inhibiting the synaptic re-uptake of dopamine and serotonin in the brain.
So when you just stopped taking the tramadol that day, you went into 'dual' withdraw, comparable to just suddenly going off Prozac and Tylenol #3 one day, after taking them for over a year. Doing that makes for a  pretty hardcore crash, as you've unfortunately found out for yourself now. Hang in there.
Do not let your PCP convince you that tramadol (Ultram) is not an addictive synthetic opioid painkiller, because it definitely is, despite the fact that it is not a scheduled controlled substance.
Just one thing: I would be very careful to avoid taking any prescribed benzodiazipine tranquilizer such as Xanax or Librium for your panic for more than a week or two at most. You don't want to switch addictions. Tramadol should be gradually discontinued through tapering over some time. Your PCP hopefully knows this.

Be well.