Aa
chronic pain, tapering off opiates, and multiple medications
I am a 38 yr. old female and have multiple medical problems including Rheumatoid Arthritis, Crohn's disease, and primary immune deficiency requiring IVIG infusions q 3-4 weeks. I have been on opiate pain managment for about 20 years = 2 x 100 ug fentanyl patch q 48 hrs. & 120 mg per dose of plain oxycodone prn for B/T pain, generally BID.
I have been seeing my APRN PCP for PM for the past 8 years. My problem is I now want off of opiates. My PCP will support me but she is concerned because she saw how my quality of life improved from effective pain managment. However, although my life span is limited due to the severity of my conditions, I am concerned about the long term effect of opiates on all the body systems, especially hormone suppression. .
Anyway, I saw my APRN PCP today and I wanted to do a more rapid taper but she convinced me with the fragiity of my health I need to plan a 6+ month taper. The initial fentanyl reduction was from 200 ug to 175, however, I am very sensitive to any reduction. (I tried going from 200 to 150 and was in severe withdrawal.) . I have heard many benefis of clonidine and asked for a prescription of .1 mg BID. I also asked for an rx for gabepentin, i know this is for nerve pain but I have heard it used off lable for arthritis. I have also heard it is excellent for treating withdrawal symptoms. My PCP was hesitant to rx this because she has had limited experience with gabepentin, especially for withdrawal/arthritis.
My question is what are your thoughts about using gabepentin in my situation for withdrawal and/or pain managment. Can clonidine and gabepentin be rx'd together? what dose for the gabepentin would you recommend? Also, I have terrible time with muscle spasms/cramps and would a muscle relaxer be helpful, perhaps Soma or diazepam? Again, what muscle relaxant would you recommend and what dose? Also, can clonidine, gabepentin and a muscle relaxant all be safely used?
The Phoenix
I have been seeing my APRN PCP for PM for the past 8 years. My problem is I now want off of opiates. My PCP will support me but she is concerned because she saw how my quality of life improved from effective pain managment. However, although my life span is limited due to the severity of my conditions, I am concerned about the long term effect of opiates on all the body systems, especially hormone suppression. .
Anyway, I saw my APRN PCP today and I wanted to do a more rapid taper but she convinced me with the fragiity of my health I need to plan a 6+ month taper. The initial fentanyl reduction was from 200 ug to 175, however, I am very sensitive to any reduction. (I tried going from 200 to 150 and was in severe withdrawal.) . I have heard many benefis of clonidine and asked for a prescription of .1 mg BID. I also asked for an rx for gabepentin, i know this is for nerve pain but I have heard it used off lable for arthritis. I have also heard it is excellent for treating withdrawal symptoms. My PCP was hesitant to rx this because she has had limited experience with gabepentin, especially for withdrawal/arthritis.
My question is what are your thoughts about using gabepentin in my situation for withdrawal and/or pain managment. Can clonidine and gabepentin be rx'd together? what dose for the gabepentin would you recommend? Also, I have terrible time with muscle spasms/cramps and would a muscle relaxer be helpful, perhaps Soma or diazepam? Again, what muscle relaxant would you recommend and what dose? Also, can clonidine, gabepentin and a muscle relaxant all be safely used?
The Phoenix
MEDICAL PROFESSIONAL
You need to talk to your doctor (preferably a rheumatologist) about better management of your pain. You apparently have serious physical issues that need to be addressed and if they are addressed properly you should not so miserable. You should discuss other treatment modalities specific for rheumatoid arthritis pain.
There is really no easy way of detoxing from home. I have dealt with hundreds of addicts who have all told me horror stories of doing it by themselves. I would only guess that if are successful in doing it at home you don't end up in my clinic.
Just in case you are curious, it takes us three to four days to detox a patient and get him/her back home drug free and feeling well on Naltrexone therapy (no opiates).
At home, the basic technique is to space out the pills you take on a consistent manner until you take only one at night, than half at night, than every other night and then none. Fentanyl patches also must be tapered in a similar gentle fashion. See if your doctor can write you a prescription for some Requip for restlessness, Neurontin (up to 2700 mg a/day in divided doses) for anxiety and malaise, some Flexeril or Soma for a few weeks for muscle spasms and maybe some Seroquel low dose, for sleep.
Clonidine is very helpful for the creepy-crawly feeling and control of blood pressure variations. It will make your withdrawals easier. All of these can be taken simultaneously. Valerian and Magnesium is sometimes helpful remedies over the counter.
The residual symptoms of insomnia and depression can last another few months. Thus, it is not easy, but it gets better and better over time and you can look forward to a drug free healthy energetic you in the future. When you take opiates for a long time like you have, your body's physiology has been altered. Your central nervous system has created a multitude of opioid receptors that all are screaming for endorphins (opiates) to fill them, but your body has now forgotten how to make them by itself. It will take time - two to four weeks at least, for your receptors to down-regulate (for the brain begin to heal) and to start making its own endorphins. Brain heals pretty slowly, so it may take you as long as a couple of months to get rid of feelings of sluggishness, restlessness and depression. The best thing you can do is take good care of yourself, eat healthy food, stay hydrated, keep active and busy. Stay away from sugar, soda, and simple carbs. Do not consume caffeine at least 6 hours prior to bedtime.
Take a look at my blogs about options for detox and recovery. You may also take a look at my clinic website where I also have my blogs and a lot of other info about drug addiction and recovery. Look especially into the blog and the info on Naltrexone therapy after getting clean. It really improves your chances of staying clean for good by cutting down your physical cravings. Look into my clinic website as well. All this can be done by clicking on my name in blue and on clinic logo.
There is a injectable form available now that is covered by all major medical insurances called Vivitrol that you would need to get only once monthly to stay clean. Just keep it in mind for the future. Good luck to you.
There is really no easy way of detoxing from home. I have dealt with hundreds of addicts who have all told me horror stories of doing it by themselves. I would only guess that if are successful in doing it at home you don't end up in my clinic.
Just in case you are curious, it takes us three to four days to detox a patient and get him/her back home drug free and feeling well on Naltrexone therapy (no opiates).
At home, the basic technique is to space out the pills you take on a consistent manner until you take only one at night, than half at night, than every other night and then none. Fentanyl patches also must be tapered in a similar gentle fashion. See if your doctor can write you a prescription for some Requip for restlessness, Neurontin (up to 2700 mg a/day in divided doses) for anxiety and malaise, some Flexeril or Soma for a few weeks for muscle spasms and maybe some Seroquel low dose, for sleep.
Clonidine is very helpful for the creepy-crawly feeling and control of blood pressure variations. It will make your withdrawals easier. All of these can be taken simultaneously. Valerian and Magnesium is sometimes helpful remedies over the counter.
The residual symptoms of insomnia and depression can last another few months. Thus, it is not easy, but it gets better and better over time and you can look forward to a drug free healthy energetic you in the future. When you take opiates for a long time like you have, your body's physiology has been altered. Your central nervous system has created a multitude of opioid receptors that all are screaming for endorphins (opiates) to fill them, but your body has now forgotten how to make them by itself. It will take time - two to four weeks at least, for your receptors to down-regulate (for the brain begin to heal) and to start making its own endorphins. Brain heals pretty slowly, so it may take you as long as a couple of months to get rid of feelings of sluggishness, restlessness and depression. The best thing you can do is take good care of yourself, eat healthy food, stay hydrated, keep active and busy. Stay away from sugar, soda, and simple carbs. Do not consume caffeine at least 6 hours prior to bedtime.
Take a look at my blogs about options for detox and recovery. You may also take a look at my clinic website where I also have my blogs and a lot of other info about drug addiction and recovery. Look especially into the blog and the info on Naltrexone therapy after getting clean. It really improves your chances of staying clean for good by cutting down your physical cravings. Look into my clinic website as well. All this can be done by clicking on my name in blue and on clinic logo.
There is a injectable form available now that is covered by all major medical insurances called Vivitrol that you would need to get only once monthly to stay clean. Just keep it in mind for the future. Good luck to you.
Thank you for your response. Sounds like we have a lot of meds in common. Do you use the clonidine for pain control or opiate withdrawal? Same with the gabepentin? Do you think one works better than the other?
Thanks again - Phoenix
Thanks again - Phoenix
Thephoenix75, i have used gabepentin and clonidine and i am currently on clonidine and it does help so I would recommend it I am NOT a doctor so talk to your pcp and see what she says... gabepentin is also good to use for wd. I have Backpain coming from a car accident that occurred 14 years ago and i am on fentanyl 100 mcg q 48 hrs and percocet 10/325 8 daily mdd and also oxymoronphone 40mg 2 daily mdd... so i have been on a lot of medication and i too am talking to my pcp about decreasing my medication... i wish u the best and god bless...
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