Going off meds to reduce tolerance?

[ChronicPain1]

Has anyone done this at the recommendation of their doctor? I've been offered it as an option if the Fentanyl 25mcg/hr patch I'm on doesn't work, and so far it doesn't seem to be.

I'm not worried about withdrawals, I'm more worried about going a month in pain with nothing to quell it and keep my life in order. When I've been off the meds I get dragged down by fatigue to the point where I have no enthusiasm to do just about anything from the pain.

Thoughts?

[kydiver]

I take my meds as told for two weeks, then reduce dose to 1/2 for a week, then 1/4 last week every month.  Keeps me from going into withdraws too bad and always reduces tolerance to the same level during the first two weeks.  I do this mainly out of fear from getting cutt off.  Laws in florida are getting tough and a year ago I was taken off pain meds with one days notice because doc was being looked at by DEA I think, I was doing as told, never over took or anything.  Was just told when I went in to make an appointment with another doc and sorry.  Took a week to get back on meds and dropping from 120 MG of OXY to zero sucked so bad I never want to deal with it again.  Im on a patch now with a few roxy's a month for breakthrough pain but having a few week of back-up really helps with the worry and by stopping patch after after 5 (get 10 a month) and shifting to 3 roxy's a day for a week, then only one at night to sleep keeps tolerance low.

[BOK2Bjan]

I can't believe I am reading these posts.  I went to the expert CP site last night for the first time to ask about tapering off narcotics to deal with tolerance issues and it was full.  I tried again this am and it was still full.  Then I posted here.  As soon as I hit Post comment and went to the forum, here was the same topic.  My insurance wouldn't cover the Fentenyl patch (after divorce - put on medicaid) after having been on it for years.  I used the actiq sucker for break-through pain also and that wasn't covered either.  The patch was working!!  Before it, I'd been on Pallidone, which was taken off the market due to a death, so I've been in a lot of binds trying to find meds.  My Pain Dr. started me on Avinza a few years back, and it seems to work pretty well.  But my doses are a lot higher than all of you, which makes me very concerned.  But my dose has been stable for a few years.  When on the patch, I wore 2 100mcg patches!  Yikes.  I did go down to 150 before I was forced to stop using it.  Now I use 2-3 capsules of Avinza (120mg) @ bedtime.  It is a long acting morphine that is very even in its release.  I have Oxycodone 30mg for breakthrough and Morphine Sulfate for emergencies (hardly ever use it though).

Your posts echo what I thought - when you need the pain relief, going off would give you only a short time of reduced metabolic speed.  My liver clears the stuff so fast, it's crazy.  I've had many surgeries and it is always a shocker to the anesthesiologists to try to get me under, much less control my pain afterwards.  I know it takes at least 6 months for the liver to get to any semblance of normalcy.  But, you're right, take narcotics again, and you'd rapidly travel up the scale again.  I'm very frustrated.  I have Systemic Sclerosis, MS, Osteoporosis, Interstitial Cystitis, Pulmonary Hypertension and some other junk - spinal degeneration too.

One comment I had about the patch for 'Chronic Pain'.  Body heat causes the drug to cross the membrane into your skin faster,so if you have a fever, you get more drug etc.  I'm on the MS forum and some others usually, I just found this one, so I'm not familiar with any of you, but I'd like to check in some, as I definitely have serious problems with Chronic Pain.  My Dr. wanted to try an implantable pain pump, but I wasn't very keen on it.  I guess I should keep an open mind about it, though.

Blessings to you all, I too know all too well how completely demoralizing chronic pain can be.  It takes your life and turns it upside down.  I wish you all relief.

Jan

[ChronicPain1]

Thanks, I just hope it doesn't take a month and a half like it did for you. Yesterday it worked a bit better, but right now my spinal pain is getting through. I still have to wait until monday to hear from my PM doc if I can get something for BT pain in these instances.

[Mollyrae]

ChronicPain:

I can't tell you enough that the Fentanyl si causing your discomfort. You tell me that when you went off of the Morphine previously, you didn't have the discomfort and now that your on the patch you do.
The Patch made me feel the very same way as you and Tuck. It lasted for a good 1.5 months. I feel normal now though.
The Fentanyl is not distributing the meds unevenly, it's your system. It will take a while for it to get into your system and make you feel comfortable all the time.
Remeber, it is a very powerful drug and not like that of other opiates.
What you are experiencing is normal and I have read that you understand this now.
Please take care and I really hope that the patch will work for you. It  has worked for my horrific pain.
Molly

[ChronicPain1]

Yes this would be my 3rd patch which I will change tomorrow into my 4th. The patch works well when it does, and I noticed that seems to be when I wake up mostly. I also tend to feel warm body wise, similar to how one feels with a fever when it's working. It seems like at night time is when the pain sets in, which is aggrivating because it does work a lot of the time.

No BT meds yet, the doctor has to get back to me on monday. I'm hoping the patch just isn't fully absorbed yet, because on the Morphine I never needed BT meds.

Thanks tuck and audrea, it's good to hear that this can be normal. I was afraid of having these patches for a month when they don't seem to work all the time. I realize pain control isn't usually 100%, and even with the morphine it wasn't always but it was generally consistent. Yes tuck I was diagnosed with gastroenteritis which worries me as I had Eocillifallic(sp) when I was young causing me to be constantly ill. It went away long ago but that episode was very similar.

Either way I'll let you know how it goes in a few days. My computer at home recently had to be wiped clean and for some reason the wireless internet won't work, so I'll be on late at work. Thanks!

[Tuckamore]

Hi Chronicpain,

I am sorry that you are experiencing the "roller coaster" effect. It will get better. And I am also sorry that you are still having so much pain. If I recall correctly his is the first week on the patch. Correct? You became very ill and had to go into ER and were diagnosed with gastroenteritis? I hope that I am remembering correctly?? If I have you mixed up with someone else I apologize.

Your response isn't unusual to the patch. I had the same effect so please don't worry at this point. You did not say if your physician gave you meds for BT pain...or I'm blind and do not see it in your post.

My PCP started me at the 12mg dose (per my insistence) and than took me up to the 25mg's. I still had BT pain and she assured me that was normal. She claims (and I beleive her) that CP patients will in all likelihood never be pain free. The goal of opiates with PM is to control your pain and allow you more function.

The "roller coaster" is common initially. It will take time for your system to adjust and for you and your PMP to find the right med combination and dosage for you. Don't be discouraged, it's early in the trial and error period.

We are here to support you in any way we can. I am often on during the night. If you have any questions feel free to post at any time. Hang on there and please let us know how you are doing.
Take Care, Tuck

[nurseaudrea]

That is why it is so important to have bt pain meds. It sounds like you are having flare ups that the patch does not cover. If the patch does make you drowsy and loopy at times the doctor is doing the right thing by being cautious. You would not want to have an accidental overdose while you are sleeping. How long have you been on the patch? Is this your first time? With the fentanyl patch, when you first start using it, your body will store the meds in your fatty tissue and then it will release into your blood system. It's kind of like it is a reservoir in your body holding the medication. Once your fatty tissues have absorbed what they will, it will then go into your blood system and start working. You have to be cautious if this is your first time to use it. Better to be safe than sorry. At the same time, you would need short acting meds to help control your pain until the patch kicks in properly. I know this can be frustrating, titrating to the right dose is never a comfortable procedure. Even if the patch is working consistently well, you may still have some flare ups that you will need break thru meds for. Most doctors know this and will prescribe what is needed. When switching meds it's like a trial and error kind of thing and you have to find what works best for you. Just make sure you keep the doctor in the loop and tell him everything that is going on. Hopefully they will find the right balance of meds for you and will be comfortable when they do. It just takes some time and patience. I know that's easy to say but hard to do, especially when in a lot of pain.

I am glad to hear you got some bt meds. Hopefully that will help you in the meantime.
We have all been there. Good luck to you.

Audrea

[ChronicPain1]

The doctor kept me on the 25mcg patch despite telling them it works only at times. I'll have periods of 2 hours where it's as if it doesn't exist. I called them today and have to wait until monday, but I asked for something for BT pain in the meantime.

They already gave me the script for a month (10) 25mcg patches so they knew it wasn't working great and stuck with it, maybe they're just being cautious. The doc assumed maybe it was because the patch got messed up when I got sick and wasn't on consistently, but I'm not sure. It seems like it releases medication in a very uneven way, I'll feel drowsy/loopy one hour and in pain the next, it doesn't seem to stay the same.

The worst pain I have is related to my shrinking/bulging C6-C7 disc, the patch will help, then it won't, it's like a rollercoaster effect.

[nurseaudrea]

I hear your pain in your writing. I hope you find the right dose or the right medication. I know how hard it can be to deal with daily CP and the suffering it causes. I strongly suggest you talk to your doctor and describe everything that is going on. Will they increase the dose for you? If the patch is that bothersome maybe you should switch to something else. If the pain is so bad it may not be worth it to go off of the pain meds,as it will really not help that much with the tolerance issue, just for a short while at best. Within the first week your tolerance level will be right back up there again, so what have you gained? You will be suffering with pain while you are not taking anything only to have to increase your dose to cover the tolerance effect anyway.

I hope you find something that will make you comfortable and works great for you.
Good luck and best wishes.           Audrea

[ChronicPain1]

I think you get the wrong impression of me, the withdrawals are not my concern in the least. I posted about it because I became violently ill when I was switched from Morphine ER to Fentanyl, and I needed to know if w/d were causing it. Turns out, it wasn't.

I've gone off the Morphine for weeks before with no ill effects. I'm a smoker, and pain med withdrawals are nothing, to me, compared to nicotine withdrawals.

So far, I'm not a fan of the patch. It disrupts my sleep immensely, only helps my pain about 50% (too low a dose as was said, likely) and other things.

Believe me, the pain comes first, especially after years upon years of trying to get doctors to take it seriously. I realize you don't know me, but that's just a tad offensive because I've gotten into arguments with doctors before for saying similar things.

[Tuckamore]

I agree with Molly and Audrea. Certainly this is a decision that only you can make but it would be one I would not chose unless there was no other options.

Your Fentanyl dose is not that high. And I bow to Molly who has much more experience with it than I do. (I'm allergic to the adhesive). That said I might ask for an increase or an earlier change as Molly suggested.

I would suggest that you discuss the situation and options with your physician again before you make any decision. Your body quickly builds up the tolerance as Andrea stated. Will it be worth it if the reduced tolerance only lasts a few weeks or a month? I think I would want more answers from my physician. An educated decision is always the best.

Best of luck to you on this decision. Please let us know how you are doing and as always, Take care, Tuck

[nurseaudrea]

I have done that and it only decreases you tolerance for a very short while. It all has to do with your liver and how it metabolizes these drugs. Once you have been on them awhile it learns a pathway to metabolize the drugs to breakthem down. It would take more than a month to really reduce your tolerance, especially if you have been on these meds for a long while. And if you have severe chronic pain, most of the time, in my experience, it is not worth it.

I am tapering now because I have surgery soon and want my tolerance to go down too so my pain control afterward will be better. I almost feel like it will only help the day after, but it's worth it to me because the first 24 hours is the worst.

Like Molly said, it sounds like you are not on the right dose. I used to be on the patch and they had me up to 100mcg patch every 24hours and I had the Actiq 800mcg pops for bt pain. So you are not on that high of a dose really.

W/d's are horrible and I have still gone through them tapering down. I tend to go too fast. It all depends on what's more important to you. Me, I would rather have my pain under control and handle some of the side effects. Especially if I had to work and you still have to function for your family.

Good luck with whatever you decide to do.        Audrea

[Mollyrae]

Hi ChronicPain:

I have heard of patients going off all the meds to build the tolerance. Some had good stories to share and some not so good. I have read ALL your posts in this forum as well as others and it seems to me that you are more worried about the w/d and not having the energy to get things done. It seems (and I hope I'm wrong) that the pain comes second in all of this. The Fentanyl will make you tired...it is not like that of the Oxy or Morphine family. What the Fentanyl does do is take away the pain.
The Fentanyl is 80x stronger than Morphine and the discomfort you felt was the side effects of the Fentanyl. I know because I have been there. The Fentanyl will over power the Morphine and you are not having the w/d you think you are having.
Has your Doctor offered to increase the strengh of the patch? In most cases the Doctor will do so if the Patch is not working right of the get go. Maybe he might want to consider a 50mcg patch or go to changing it every 48 hrs.
I really hope you can find your comfort zone soon. It seems like your bouncing all over the place with your pain meds.
Molly