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replacement for Tramodol
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replacement for Tramodol

Hi,
This is my first post, my name is Bill and I've been dealing with back pain and leg pain for about 22 years. The last 10 or so I've managed quite well with Tramodol, Ibuprofen and herbal sleep stuff (passion flower, 5-HTP). Recently my leg pain has gotten significantly worse. I started taking a bit more Tramodol but it was still difficult to sleep and function at work. I am missing at least one day a week of work. My PCP was an orthro but I changed to a pain management doc last week. In addition to more Tramodol he gave me Gabapentin and Celebrex. Sorry for the long post. I started taking the Gabapentin at night and it helped right away with the leg pain, enough where I thought I could stop the Tramodol. I only was taking 25mg of Tramodol in the morning and 25mg at night but sometimes a 1/4 of a pill more. I am very sensitive to meds. Long story shorter, I am second full day without Tramodol. I have read about WD from Tramodol and I am dealing with it but I am not getting enough pain relief from the Gabapentin or I am still in WD from Tramodol, I don't know. Its been so long that I have not taken a pain reliever I do not know how much pain my body is really in. Since I am mostly over the WD from Tramodol I don't want to take it again but I need more pain relief for leg pain at night. What would you suggest as a replacement for Tramodol? I know no one is a doctor, I am just looking for suggestions that I can research. Thanks for taking the time to read!

Bill
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82861_tn?1333457511
Hello Bill, nice to meet you but sorry it was chronic pain that made the introduction.  What is the underlying cause of your pain?  Is it a spinal problem?  Any chance of surgery improving your pain?  Since it's gotten so much worse, I think you may need some tests to see why it's changed so much.

Depending on the cause of your pain, there are different approaches to treating it aside from medication.  Many people get great relief from epidural shots for lower back pain.  They're generally done in a series of three with 4 to 6 weeks between injections.  The affected nerves are bathed in a steroid solution which helps stop or reduce the nerve response.  It's done under anesthesia so you won't feel it, but that also makes them somewhat expensive.

Gabapentin (neurontin) is a medication specifically for nerve pain.  It doesn't have the immediate results that something like tramadol or an opiate will give.  It needs to be titered up slowly to therapeutic levels and that process can take a good month or more.  

My mother had horrible spinal stenosis and scoliosis.  Every last lumbar disc and a couple in the thoracic region were blown out and impinging the associated nerves.  She ended up unable to walk more than a few steps before seeing a doctor.  She managed to get in two rounds of epidural injections and they really did help her.  Surgery was the only option but she passed away before it could be done.

Pain management is kind of a last resort when nothing else can be done to help the cause for the pain.  If surgery or some other treatment might help you, it might be beneficial to get an neurosurgeon's opinion.  Surgical techniques have improved tremendously in recent years.  My sister just had multi-level cervical fusion with plating a few weeks ago and she's doing great.  I know there's a lot of stories on the internet about failed surgery, but remember that most people recover with no problem.  Since they're out living their lives, we don't hear much about the successes.  Hope you hang around awhile.  :-)
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Avatar_f_tn
Hi Bill,

I want to Welcome you to the Pain Management Forum along with Jaybay!! I'm GLAD that you already know that there AREN'T any Doctors on here. It saves a LOT of typing!!.LOL

Well you are ALREADY very familiar with CP ( Chronic Pain). There are A LOT of us on here that have been there RIGHT along beside you all of these years.

Jaybay asked a lot of REALLY good questions and CERTAINLY led you down the right path.  

You need to get with your PM Doctor and find out what he has to offer you in the way of TREATMENTS.  As Jaybay said, SOOO many new advances for treatment have come along during the past 22 years.

I have DDD (Degenerative Disc Disease), Osteoarthritis thruout my entire body and assorted OTHER problems!! :)

Recently, I had the RFA (Radio Frequency Ablation) to "kill" the nerves in my lower back. They do it by "burning the heck out of them". I didn't feel ANYTHING because of the Local Anesthetic that I was given.  They can give you MORE of an Anesthetic than I had but I didn't need it.

It has TOTALLY worked on that portion of my back. I was so HAPPY to FINALLY get that relief down there. It STOPPED my leg pain that I've been having for YEARS!!

Whether or not YOU are a candidate for that DEPENDS on what Diagnosis your Dr. has given you. That's the reason that Jaybay asked what the cause of your pain is.

You said that YOU stopped your Tramadol.  Did you consult your Dr. BEFORE doing this? I hope that you did or you could be in a LOT of trouble with your PM Dr. The PM Doctors are SOO different than ANY of your other Dr.'s and MUST be kept apprised of EVERYTHING that happens with your Pain Meds that they have prescribed for you. :)

I'm telling you this ONLY because I don't want you to get in TROUBLE with yor PM. If we don't follow,EXACTLY, the directions that they have given us with our meds they can Red Flag us and kick us out. I just want you to be sure that you UNDERSTAND how IMPORTANT it is to FOLLOW the PRESCRIPTION instructions "to the letter"!!

I hope that  you will check with your Doctor and WORK up a plan with him for what is BEST for you!!

I hope that you will keep us updated on how you are doing!!......Sherry



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1391401_tn?1280161900
Hi Jay,
Thanks for the reply, I have severe disc degeneration at L3-4, L4-5 and L5-S1. I have had probably 6 or 8 epidurals over the past 10 years. They used to help more. I haven't had one for a couple of years and hopefully will have one soon if workmans comp decides to approve it.

Surgery may help me but I'm too scared to do it. If I were going to, I would probably try for a fusion at L5-S1 and two artificial disc's at Texas Back Institute again if workmans comp would approve it.

The gabapentin at first seemed great but last night it wired me up instead of making me drowsy and I didn't sleep much. It did help with the leg pain but not enough and I don't know if its really the leg pain or still the Tramodol WD, they kind of have the same nerve sensation. I really don't want to start the Tramodol again but then I don't even know if I am really off of it yet! Its only been two days and I've been taking it for 10 years at least.
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82861_tn?1333457511
Wow, that's a tough call on the tramadol.  You've been on a low dose but for quite a long time.  I'm not familiar enough with the withdrawal symptoms to offer much help with that.  You don't have an addiction problem, but you might read through some posts at Med Help's Addiction-Substance Abuse forum.  There's lots of detox info there and apparently tramadol is pretty difficult to discontinue suddenly.  Again, you are not an addict, but withdrawal is still the same thing whether a medication has been abused or used as prescribed.  If you have any left, talk to your doctor about a taper schedule.  I hate to see you suffer through extra pain and symptoms if it's unnecessary.

Are you talking about the X-Stop implants for your back?  That's what my mother's surgeon here in Houston wanted to do for her.  Apparently there aren't all that many surgeons yet who do this, and the FDA only allows two discs per year to be implanted.  Everything I've read about is truly amazing.  The surgeon says his patients go home the same day because it's so minimally invasive.  The same surgeon did my sister's surgery and I am shocked at how well she's done.  I knew both of them were in good hands when every hospital staff member gushed about how great he is.  LOL!  When nurses and other staff praise a doctor to the skies, it pays to pay attention.

I really think it's time for you to take a serious look at surgery.  At the very least it wouldn't hurt to have another MRI and see why your pain got significantly and suddenly worse.  Obviously some changes have taken place and you don't want to let a possible cure pass you by until it's too late.  
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Avatar_f_tn
You've been going thru the rounds haven't  you!! I certainly hope that W/C comes through for you and the epidurals!!  Hopefully, the epidurals will  give you some MUCH needed relief and longer lasting than the last ones did.   When is your NEXT appointment?

They haven't even suggested any surgery for me. I'm VERY thankful for that!!

You know the VERY best thing that you can do would be to go to your PM Dr. and let him know that you may have FINALLY become immune to the effects of the Tramadol. Ask him if it would be possible to try the NEST step that HE would suggest in HIS treatment plan for you!! ALWAYS, let your Dr. lead the way with the suggestions. You, of course, should be KNOWLEDGEABLE about ALL the meds available to you in case he asks for your opinion!! You just have to be OPEN to HIS suggestions!

When you talk to him BE SURE that he understands that it's at NIGHT that you are having your problems and NOT in the daytime. That will make a difference in what he might suggest.

I know that after 7years on the Hydrocodone I'd become immune to it so we switched to the Percocets.  

I will be looking forward to your updates on how you are doing!

I'll be ANXIOUSLY looking for your updates on how you are doing!!....Sherry
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1391401_tn?1280161900
Hi,
Thanks to both you of for your care for me.

JayBay, ADR or artifical disc replacement is actually a lumbar disc prosthesis that is implanted into the disc space, its different than the x-stop. AFA another MRI, I am hoping. They keep saying my condition hasn't changed enough. Well it has for me!

Sherry,
To tell you the truth, I really question what doctors say especially with drugs. It may be they are getting kick backs for selling whatever the hot thing is this month. I never take a full dose of whatever it is at first till I know how it will affect me. If I need to come off a drug, I will do it myself. I don't want to be put into a position where I have no control. Paranoid? Probably. I really appreciate your suggestions though!

My next appt is August 23, hopefully I will have the epidural approved by then. W/C is so slow and they loose things conveniently so who knows. Gosh I feel so sarcastic, sorry about that. Thanks again you guys for your support.

Bill

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Avatar_f_tn
Everyone gave great advice but I just want to add one thing about the Tramadol withdrawal. Your pain may be rebound pain. When you stop any medication, even Tylenol, your pain will get worse for a while. That's rebound pain. So yes you are probably going through withdrawal and you are probably having rebound pain. Which should go down once the withdrawals are over. It usually takes 72 hours for a drug to leave your system. So the worst will be over in 3 days. Your pain should go down and you should be starting to feel better. So I would give it at least 2 more days and if your pain is not getting any better with the new med alone than you may have to try something else. Maybe an OTC pain reliever first and if that doesn't work you maybe have to go back on the Tramadol.

Also I never ask my doctor before getting off medication. I'd rather do it myself. I just tell them at my next appointment that I'm not on it anymore. I've tapered a few times and just gone cold turkey a few times. I do research before to make sure there will not be any adverse effect besides normal WD. You're going to have WD either way so it's whatever way works best for you. Oh and my next PM appointment is August 24th so I know how you feel with the waiting. I'm waiting to get my TENS unit and do the trial of the spinal cord stimulator. So until my appointment all I can do is hope my meds keep the pain down enough to function. If you don't have a SCS already you might want to ask about it. It can work really well for low back and leg pain. I don't even have leg pain and my PM wants me to try it. I'm not a surgical candidate (too young) so this is my only option besides medication right now.
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1391401_tn?1280161900
Thanks for your advice regarding tramodol WD. Do you have a recommendation for an OTC pain reliever that will work for nerve pain?

My PM doc has mentioned SCS and yes I am going to do the trial as well, I don't think it can hurt.
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Avatar_f_tn
I'm so glad that you get to do a trial on the SCS!  That sounds like it might be a WONDERFUL option for you.  You know, I don't really see how it could hurt either.

I will be keeping my fingers crossed and I hope that you will give us an update on how well it works for you.

Have you set up a time for the trial yet? Will you be discussing it on Aug. 23rd?

I'm very excited for you. This may be the answer you are looking for!!

I can hardly wait to hear your update.....Sherry
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547368_tn?1332173665
Hi Bill,

Sorry I am late to the Forum tonight. Welcome to the community. It's nice to have you aboard but so sorry to hear about you increasing painful symptoms.

I do not beleive there is an effective OTC medication for nerve pain. Nerve pain is difficult to treat and it usually treated with the Gabapentin type medications and narcotics. I think I have tried every OTC medication there is and nothing was effective.

I am sorry that you stopped taking the Tramadol without your PMP advice. If I understand your post correctly it was managing the pain better. often it takes a combination of medications to successfully reduce nerve pain. I am sure you are experiencing some rebound pain. Tramadol, a centrally acting synthetic opioid analgesic. With multiple dosing it has a fairly long half life. It will take more than a few days to clean out of your system.

I encourage you to discuss this with your PMP. I do understand your concern regarding this medication. However if you chose not to take it or any other similar prescribed medication your pain may not be tolerable. The goal in pain management is comfort.
That is what I hope for you.

I am glad that you found us. I hope you will continue to post your questions and concerns. Someone is most always here.

Take Care,
~Tuck  
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Avatar_f_tn
I can't really recommend much besides going slowly with the tapering.  Although you were on such a low dose, it's probably not a problem.  
One thing I wanted to make sure you know regarding OTC pain relievers is that Celebrex is the same thing as Aleve (naproxen sodium), just a higher dose.  So if you take the Celebrex, don't take Aleve.  
Personally I have always preferred ibuprofen (or as some constant ibuprofen users call it "Vitamin I", but I can't take the liquid gels because they're rough on my stomach.  I also like ibuprofen because it's anti-inflammatory.  Although Aleve is as well.
I have also taken neurontin (gabapentin) and found it worked pretty well, it just made me eat a lot.

My husband and I have been looking into ADR for me as well (in my cervical C4-C5,C5-C6) spine.  I have even looked at having it done in Germany as insurance may not pay for it.  If you do get it done, please let us know how it goes.  I've heard it can be wonderful.  
Best of luck.  I hope you find what works best for you and feel better!
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1391401_tn?1280161900
Thanks for your reply. I have been taking Ibuprofen for at least 20 years but lately its been giving me chest pain. The Celebrex is actually doing the same but it seems to work better. I am not taking the whole 300mg pill though, I dump it into water and sip it throughout the day. Seems to work fine. I do the same with the Gabapentin in the evening.

I too have checked over in Germany for surgery options and I can't get W/C to pay for it and I don't have 80k laying around. I even sent them my films and got surgery opinions. I would go to TBI though (Texas Back Institute). I have heard really good things about them.

Did you have any trouble coming off of Gabapentin?
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1391401_tn?1280161900
Thanks Tuck. I may have to start the tramodol again if I don't feel better. I'll just have to forget the anguish I went through and say I can do it again if I have to. I wish you all the best too and everyone else as well. Everyone has been great!
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Avatar_f_tn
I don't know of anything for nerve pain OTC, I just thought it might help with some of the withdrawal pain/rebound pain. If your rebound pain does not go away in a day or two you might have to take the Tramadol again until you can get to your next appointment to talk about a different nerve med.
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Avatar_f_tn
I haven't gone so far as to get the price quote because I became pregnant unexpectedly which put a kink in the surgery works.  I have heard of women having back surgery while pregnant, though and I did talk to the first point of contact there who said the doctor would consider it.  Financially it's not an option for me right now either, though.  I have heard it can be done for 1/4 the price that it would cost in the US, but I really can't afford that right now.
I didn't have a problem coming of the Gaba, but I do really well with coming off of meds like that, it did make me a little light-headed fairly often, though.  I tapered myself somewhat as well by taking less and less.
When I could take Ibuprophen and aleve I would alternate them so that when I built up a tolerance to one, I could go to the other for relief.  I can't take either of them now, though.
I'm with runitskat, I would take the tramadol until  your next appt and then see what else is available, but I understand if you don't want to take it.  I'm just the type of person who never suffers needlessly if I don't have to, so if I am prescribed the meds, I will take them unless they're causing a problem.
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1375159_tn?1311691944
Nerve pain is often difficult to control. I don't know anything that OTC that will control it either.

Jaded,

I had no idea that Celebrex is the same thing as Aleve. Thanks for the info!

Flower
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1391401_tn?1280161900
I appreciate your post Flower. Hope you are having a good day so far. God Bless
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Avatar_f_tn
I was wrong!  I'm sorry, it was something I was told and it's not true.  Celebrex is Celecoxib.  They are, however, related medications, and shouldn't be taken together, unless you are told by a doctor.
I apologize for not doing the research BEFORE I declared it was the same.  

Bill, please keep us updated on how things go for you.  Especially the Texas Back Institute and ADR.  I have read that multi-level DR is not approved in the US, except in clinical trials.  That is another reason I was looking into Germany.  It's approved there.
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1391401_tn?1280161900
Thanks for the clarification on the Celebrex. Its true multi-level ADR is not FDA approved in the US...but its still possible. Here is a link to the ADR support forum, you may already know about it but there is a wealth of info there:

http://www.adrsupport.org/forums/
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547368_tn?1332173665
Thanks for correcting your error Jaded.

Celebrex is NOT Aleve. The generic name for Celebrex is celecoxib. The generic name for Aleve is naproxen.  

They are both in the same family and are classified as a NSAID,  non-steroidal anti-inflammatory drugs. While their actions are similar they are not the same. They should never be used conjunctively. I don't even know of an instance that a physician has prescribed them to be taken simultaneously as their side effects individually can be worrisome.

There are some ppl that swear by the effectiveness of Aleve (Naproxen), while others obtain no significant, if any pain reduction. The same can be said for Celebrex (Celecoxib). Our individuality is also wonderfuly apparent in medicationsl!

~Tuck


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