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Avatar universal

Ultram for Post Surgical Pain

Dr Junig,
I would like to know if Ultram is a better alternative for pain relief than opiates? And is it addictive?
I was in pain management for about 3 years for chronic low back pain. I was prescribed Oxycodone 5mg IR (maximum 4 day), and Tramadol 50 mg (maximum 6 day). I never took the maximum amount allowed daily on either drug as I was afraid I would get addicted. I had discectomy surgery 5 weeks ago (lumbar region), but I am still having some pain at the incision site. I am currently taking 4 Ultram  a day and an occasional Percocet, but I am worried because of all the negative things I have read about Ultram (withdraw, addiction, etc.). Unfortunately NSAID's are not an option for me due to cardiomyopathy from chemotherapy treatment for breast cancer.
I thank you in advance.........
17 Responses
666151 tn?1311117976
MEDICAL PROFESSIONAL
Hi, and thanks for your question!

Gosh, you have been through about enough.  About the opiates-- I read a large meta-analysis recently that found incredibly low rates of addiction in people treated for chronic pain-- on the order of 1%!  I have a hard time believing numbers that low, but I recognize that my own perceptions of very high rates of addiction are likely clouded by the types of patients in my small town, where we have a large problem with opiate dependence.  Your concern about addiction-- have you ever had problems in that area?

If a person can take a constant, relatively low level of an opiate medication-- say only on the 'bad days'-- and if that person doesn't have problems with running out early, or with staring at pills on the counter, trying to avoid taking them, then the person is an appropriate candidate for opiate medication.  

Looking at the medications themselves, beyond the addiction and tolerance concerns opiates are very safe and easy on the body.  Particularly if you take something like plain oxycodone, without the acetominophen.  On the other hand, tramadol does have some toxicity when taken at doses about about 400 mg per day.  Likewise, many of the non-narcotic medications have side effects, including weight gain, risk of liver toxicity, effects on blood components, etc.  Given that you are only out 5 weeks from major surgery, an occasional immediate-release oxycodone 5 mg-- an extremely low dose, by the way-- would be entirely appropriate.

Just for information's sake...  when opiate addicts come to my office seeking help they are usually taking anywhere from 60 mg oxycodone per day to 600 mg oxycodone per day!  Yes, a person can become 'addicted' on lower doses-- but according to large studies looking at the experience of thousands of pain patients, a very small percentage of the patients taking opiate pain medication actually become addicted.

Thank you again for writing.  I hope you are feeling much better soon.

JJ
604266 tn?1236362585
I just wanted to say that I too had a hard time believing that number because of my work but it really is true because while those who are addicted are running from life, those who are taking narcotic pain medication to treat their chronic pain are trying to run to it. The body interperates those side effects that can be brought on by narcotic meds differently than someone who is soley taking them to feel those side effects.
But you have a TON more education and experience than I do so I'm sure I'm not telling you anything you don't know!

I've taken oxycontin for a while now because of endometriosis and Interstitial Cystitis and know how lucky I am to be treated with those kinds of medications as not all MD'd or pain specialists believe that treating non-malignant pain with narcotics is appropriate.

But medical research has shown that the pain resulting from IC can be equal to cancer and that the quality of life of an IC patient is equal to end stage renal failure.
With that medical research and that done on the probability of addiction in a patient suffering such devestating pain without a history of substance abuse I believe that more patients need to be treated as seriously as their pain is.

Untreated pain can lead to many other problems and they're finding those problems aren;t just psychological or that of reffered pain but that because the brain isn't ment to maintain such an overactive state of fuctioning when pain signals are being sent in such a constant rate damage can be done making decision making more difficult because the brain isn't getting the rest it needs.

Sorry to hujack your question worthmorenow. I just wanted to agree that I found that percentage very hard to believe at first also.

But since I did hijack your thread I'll add my opinion:)

Ultram can be addicting. But if you're using it only when you need it and as it's prescribed and then stop taking it when you no longer need it and can use OTC pain meds instead than it's a safe medication.
If it's only being used post-op than you should have no issues with withdrawls as you shouldn't be taking it long enough for your body to become dependant.

Sorry to hijack your question!



Avatar universal
I find it IMPOSSIBLE to believe!  Studies have shown a huge rise in prescription drug abuse......Oiy!.  

Pharmaceuticals are Big Business (understatement)..... One hand washes the other, so I rarely believe anything I read anymore.

Remember "Cigarettes are not addictive & they don't cause illness"  lol. Oiy!

Nauty.............
604266 tn?1236362585

Oh it's just the percentage of those who are being treated with narcotic medications for true and devestating chronic paain.

The huge rise is prescription abuse includes teenagers getting it from their parents medicine cabnets, from dealers..other friends. And those who are scamming pain docs or other MD's to get narcotics. That's where the rise is coming from.

But those being treated for extream chronic pain with narcotics have a very low chance of developing a problem, as long a sthere is not prior history of abuse.
And of course it does happen where a CP patient will develop a problem but it's not as often as people think. The risk is very small.

But also make sure you don't count those who are on pain but know they could handle it on there own with OTC meds and other things like PT but who prefer pain meds instead because it;s quick easy and they like the side effects.
When were talking CP and that percentage, it's pain that's equal to or greated than that of any malignanacy for which narcotics are acceptably used as a treatment.

Not the man who hurt his knees playing HS football and swears the pain is killing hum when it's really more like he could be given a good NSAID or other anti-inflamatory and be okay but he insists they don't work and he needs the percocet.

But the problem in pain managemeng tis that pain is relative. There is no machine that can register pain. I believe there may be one in switzerland or something, but it's expensive and open to interpretation of course.
I'm looking forward to the day we can creat a machine that can register the amount of pain someone is experiencing, because although people feel paon differently there are pains that are universally severe. The most popular being maliganant pains.
But thos non malignant diseases such as IC have been meidcally proven to meet that pain extream also. Where the pain is still relative but wih an understanding of the severity by meidcal professionals.

The only reaosn people like me would be turned away having pain that is equal to that of cancer pain is because the people with cancer coould die. So it then becomes a more of a sympathy for the patient.
People like me won't die and we won't get better. Either way a cancer patients pain will end, ours won't. And we deserve to be treated as such. That we may have to live like this for life and just because we aren't in an immediat risk for fatality our pain isn;t as deserving.

Sorry, I guess I've gotten off topic. It just really hurts me to know how lucky I am and then see one of my friends suffer and loose everything because they'r etreated like lesser class citizens in the pain management world.
It;s really sad. Especially how many suicides each year result from untreated Chronic Pain.
I wuold give my medicines up in a minute if they would treat the other like me so they can get relief and a lottle life back. You have no idea what it's like to realize you weren't even breathing when your pains treated for the first time. It's amazing what you were doing to your body in order to cope.

680303 tn?1239988440
I have fairly recently found out that taking meds for chroinc pain is way less addictive and much easier to get off. Anyone who immediately says no to that has not read about it. It is true and I have tested it. I have been in pain for 3 1/2 years and found getting off meds very easy. I do need them, though they aren't doing their job well. I can function better with them. I wish I didn't need them at all. Anyone taking them with that attitude is not an addict and gives everyone who really needs pain meds a bad name and has caused doctors to hesitate helping needy patients.
604266 tn?1236362585
I'm glad you got off of them so easy. It's easier for those of us not psychologically addicted because we don't have the added stress of psychological wothdrawls.
And some being weened of their pain meds have an easier physical time and for other the efffects feel like the most awful flu that could ever be.

But that's where people mistale physical dependance for addiction. Physical dependance is free of psychological addiction unless the person is addicted then dependance is just a part of that addiction.
But the two are very different and many people end up believing they're addicted because they're body is dependant.

Try stopping cymblata or celxa or any other AD cold turkey, it's not a plesant experience bit it doesn't mean there is an addiction problem. Our bodies just become accustum to what we give it over a period of time.

Society and even many in teh medical community need more education on Chronic pain and teh use of narcotics in non-malignancy patients.
I think in med school unless it's your speciality there's about a semester(?) maybe longer that deals with Chronic Pain and narcotic treatment and most of that curcles around malignancies.

You neder read in the media the benefits of these medicines and how people get their lives back, have a good marraige are bale to play and spend time with tehir kids and hold down a job.
We need to see more of that.

And of course I'm not saying everyone experiencing pain needs to be put on a narcotic regimine. But there are severe cases of non-malignant CP that need to be treated with the same seriousness and severity.

When doctors make an oath to do no harm...what do they think leaving a patient in severe CP to lose their career, marriage, friends and having any quality of life is.

It is our right here in America to be treated for Severe Chronic Pain. I may be like this until they come up with a cure..if they ever do as IC research gets little funding compared to many other diseases. But I'd much rather take a pill than go back to wanting to kill myself because I can't handle the unending pain, mose my marriage and any hope of have any little bit of the quality of life I desreve. Even if the odds were higher for addiction when the situation is severe what matters more is that a person can have as fufuilling a life as possible with the meds.
And that's an option I'll take everytime.

Even in severe cases they will treat those with a substance abuse history but they just put a stronger placement team in place add maybe an addictions specialist to also specializes in pain management.
ust because someone has or had a drug problem in th epast doesn't mean they're not worth treating with the medications needed.
In severe cases it's not ethical or moral to leave a human being to suffer and lose all they worked so hard for only to be trapped in bed wondering what dying is going to feel like and if that will end there pain.

To me, CP is a serious subject that needs serious attention, not to mention positove media and medical attention.
680303 tn?1239988440
I think there are too many doctors that don't know a thing.They can't diagnose, nor prescribe the right medicines.
My husband weigh about twice as much as me, and the same doctor has him on about 1/3 of the medication I take for pain, plus has told him not to ask for any more pain pills. My husband has undiagnosed pain and can not even be given a decent dosage to allow him out of bed. I have my own pain problems but have to be careful not to hurt myself further, leaving me to do more.
It is easier weaning off a pill if you taking it for pain, I 'm not saying it's all that simple.
I found morphine easy (it wasn't a large amount) and tramadol not as easy.
I would think one pill would take care of the pain, but only today took 1/2 pill less of the tramadol and feel sick--and like my husband still not diagnosed, but have an idea that its from my back.
I think many doctors are not up on things and we as patients tell them, what to do. And it's not as simple to find a new doctor when your insurance isn't allowing it and you haven't the money for proper treatment.

And I agree with the above commentor--I think the quality of your life is worth way more than the fact that you are taking pills to relieve your pain. What good are you to yourself or anyone in pain constantly?  
Avatar universal
To address the above discussion all I know is chronic pain is real and can become very depressing. I also feel that after a period of time the medication actually made me feel more depressed. I'm off the oxycodone (after 3 years), and my dosage of Tramadol is currently 50 mg twice daily. I still have pain, but nothing like before surgery and mentally I feel like a different person.
604266 tn?1236362585
I'm glad for you worthmorenow:)
That's a great thing that the pain is nothing as it was beforea dn you feel like a completely different person(I assume you mean that positivly).

I'm sorry ylan that you and your husband are in this situation. It is truethat weight plat a role in prescribing medications but the double eged sword were in right now is the gov regulations over our pain doctors.
They are just looking for one mistake, one chart out of order one doctor who can't explain to their satisfaction the amount of meds they are providing a person.

And the problem with this is that, these doctors have spent years in school and years interning. They know they're job and the gov. needs to step back and let them do it the way they see fit.

There will always be doctors who have bad intentions. Like those that have killed their patients intentionally and those who over prescribe. But that's when you take away those doctors licences and not blame the whol of the medical community for those doctors wrongs and mistakes.

But with this fear of being shut down by the DA's dotors now are under prescribing. My pain doc is so afraid I was never even given breakthrough meds while on a long acting pain med. And that's considered undertreating a patient when your not providing the proper amount of treatment to keep the patient as comfortable as possible within legal and healthy safe limits of course.

And the pills aren't the whole answer, they won't take away all the pain. There will still be pain we have to learn to cope with in some way. Either alternatove medicines, PT, Yoga of medically able and OTC meds.
But narcotic pain meds sure do benefit those of us with serious diseases that cause devestating and serious amounts of pain.

Even mild pain if it's chronic becomes overwheming if left unmedicated on a daily basis and damages a person emotionlly, mentally, physically and socially. I'm not saying mild CO need to be treated with the stronger side of the pain med scale. But things like Tramadol(which is one of those meds that either works for someone or doesn't), NSAIDS, anti-convulsents, muscle relaxants..there are tons of medication combinations.
But if a doctor felt that yes, there amount of pain would be more successfully treated by using short acting meds without the APAP or a long acting med like a lower dose oxycontin, than that's between teh doctor and the patient and not between the DA, doc and patient.

They continue to make the doctors liable for patients actions. There is no way a pain doctor throughout their career will not treat at the very least two addicts who scammed their way in. Heck even as someone who specializes in the treatment of sunstance abuse I've been scammed before. And that's normal because addicts are good, very good.
But if a doc os treating a patient and following the law and their patient gies out and sells their meds or decides to take a bunch of other meds and even adds only one from their prescription and OD's, the doctor is responsible.
The doctor will be arrested, may have their liscence taken away and spend up to 25 years in prision.

Now, does that even sound remotly fair? It's not. The doctor asks their patients to signs contracts when being treated with narcotic meds, That helps them be a bit more at ease that the patient has agreed to follow the rules they have set.
And of they don't, let the responsability lie where it should. On the patient. Were grown adults and resonsible for our on actions.

That's why I try to keep my doctor safe by telling her if I see someone asking another about what meds they take, asking about buying meds...and all that. So she can do what she feels is appropriate.
But many of those :patients: are also undercover detectives trying to see what the doc will give em just for telling a story and without an exam and to see what they can get from the docs patients.

It's a whole mess of injustices twords our doctors. So yes, it really s u c k s that they under prescribe so much because of how afraid they are. Becasuse we suffer for it too when we have to miss a meeting because of a flare that could have been taken care of.

But to change anything. First we need to change the role the DA is playing in our treatment and the doctors practice.

But still I'm grateful to be treated with these meds as for the reason I've mentioned in my other posts. But My heart breaks for those that can;t find help because a doctor just think everyone in pain is an addict trying to scam drugs from them even when they have the medical proof infront of them.

There will always be a risk, no matter what. But to me, in my eyes, it's a much bigger risk to leave another human being without the proper treatment. To lose any quality of life they had had, lose possibly their signifigant other, their family and friends, the ability to feel freedom in their own body indtead of being a prisoner.
That's the real crime that's being done here.

I know I came close to being one of the CP suicude statistics before they found out what was wrong. Before that I was treated like I was just depressed. Ir a deug seeker by some doctors. Some would help. I was lucky even some of the time then. But it took alot of begging and crying.

Finding treatment for severe CP is truely the fight for your life. Were not made to handle or cope with daily severe pain physically, emotionally, psychologically or mentally.

I wish everyone here successful treatment, whatever that may mean for you.


680303 tn?1239988440
It is just so sad that those you are in legitimate pain have to beg or be spoke down to, like my husband and this doctor that gives him hardly anything. One ultram a day???? That is a joke. The same doctor is giving me more, why? I don't know. Now they have a freeze on the doctors here and you can't even change doctors. My husband can't get out of bed and we tell the doctor he's that bad. We can't afford to pay out of pocket. The doctor that we had before is coming back--but he would give you anything not to see you in pain. There's good and bad to that. None of us (well, most of us) don't want to be in CP, but keep us comfortable as can be. It's depressing enough to go from a full life to have it yanked away. We don't need to be told something is addicting, we know that. We just want some quality of life. We have too much pain to work, but can't get disability, what does one do? We ask our doctor what can it be, we get shrugged shoulders. It's been like torture. Thanks for letting me vent. I was fine and so was my husband, and we both got whatever about the same time! Very odd.
604266 tn?1236362585
One ultram a day..that's almost incredibly unprofessional when your under the care of a pain management doctor.

So for a few hours a fay hour husband get's a break for the pain an probably not even because if you don't get control of chronic pain it will become out of control and need to be knocked down professionally.

Does your doctor have any reason to think your husband has a problem with pain meds or pills in general.
It seems completely conter productive as far as tretment goes to presecribe an ongoing CP patient one ultram a day to treat daily CP.
And it especially makes me wonder as your seeing the same doctor and they're providing you with better pain tretament.

I've never heard of a freeze on being able to switch docs. I wonder why. I wonder if in your area the problem of addicts infaltrating the pain management system has become so out of control that they're trying anything to lower those situations and maybe investigating each doctor's records.

Just seems very strange and that's the only thing that ran though my head.
I'm so sorry that your husband is being treated so badly. It makes no sense. From teh docs perspective why treat him at all unless the CP only bothers your hubby at one time of day.

But still a pain dic knows better (or should) that by not treating severe CP sufficiantly it becomes out of control and with each hour, and day harder and harder to gain control over until you end up in the ER having to have it knocked down by meds that can overtake the hight of the pain.

That's happened to me when I refused to call my doc about my pain because I'm sick of taking pills and being in pain. So I tried to ignore it and 12 hours later it was so out of control I couldn't even get up to use the bathroom and would without being TMI, wee my pants because the pain was so excrusiating I pysically couldn't stand or walk. That's whe they told me to go to the hospital.

I wish you better luck in finding a doc. I'd help you woth resources but if there's some kind of lock down in switching docs that's not really going to improve your situation. Have tou tried finding one in a different county or something?

You deserve to live as comfortabley as possible, infact it's our legal right to be treated for true CP. It's immoral and certainly unethical to leave a patient with no quality of life and in severe pain if you've taken them on as a client.

Unless your doc is under investigation themselves and is undertreating. Who knows..those are all just random thoughts and guesses based off of what I know about the legalities of Pain management and how intent our country is to put a stop to the narcotic treatment of non-malignant pain.

It's all just ignorance on the legal end. Watch one of them get what I have and suddenly they're whole belief system gets turned upside down as they make an a pointment at a PM docs office:)
680303 tn?1239988440
I apologize to everyone that read and answered my post. My husband was given 1 pill 4 xs a day of tramadol, which still isn't great but I totally misunderstood him, I thought he said 1 pill a day. He's giving him morphine sulfate er now, which I was given first by this doctor. What I didn't understand, was why he allowed me to have 6 ultrams a day (though I never took that many) and the MS Contin and never told me to get off the tramadol.
Turns out I have been weaning off the tramadol myself. It doesn't look like I'm improving and the contin should be enough. It was only the other day that I got  a nerve damage test and that was after 3 1/2 years of pain. I suggested it after I found out about it. It seems if you don't research and ask for tests, they has no ideas. So, we are playing doctors. A good doctor would have known to give me that test, to rule out nerve damage.

The clinic is over crowded, that is the only reason no one is being allowed to switch and I heard my old doctor was coming back. There is a great lack of doctors there. He would give you anything that he thought would get you out of pain. I would often say no to many of them, because I felt sick coming down, but the er is much better and the ultram did help, but I've read too many negatives.

So, I still don't have a answer as why I have so much pain. The chiro felt it was because of multi level bulging disks. I read stnosis and foraminal dtenosis will give you the pain I have. This neurologist suggested exercises that I was told never to do with stenosis--he seems to think stenosis and multiple bulging disks isn't a big deal. If he could feel what I feel for a day, he would think differently. I read about myofacial pain and thought it could be that, if I bring that up, I get semi blank stares. I truely believe they just don't know.

Maybe somewhere, someone has intelligent doctors, I haven't found any.

Again I am sorry I gave the wrong info and caused you to give up your time to answer.
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