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Possible vicodin withdrawal?
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<blockquote data-quote="Marguerite" data-source="post: 171821" data-attributes="member: 1991"><p>Heather, whether three is a huge amount, or nothing much, really depends on you and how sensitive you are to the medications.</p><p></p><p>mother in law can't take opiates at all, When she is in severe pain she takes paracetamol and finds that just 500 mg paracetamol sedates her. This is good, because when she had open heart surgery, the only pain medications she could take to help, was paracetamol. And for open heart surgery, it barely did a thing.</p><p></p><p>On the other hand, I take large amounts of heavy opiates and have done for many years now. I understand about addiction and withdrawal, not so much from personal experience as from sharing your fears in the early stages, and also from trying to ease the fears of one of my specialists (who kept using the term "addiction" in his letters to other doctors about me, which really got me riled).</p><p></p><p>I started taking ongoing pain medications in 1988. Back then I was taking Panadeine Forte, which is 500 mg paracetamol and 30 mg codeine phosphate. I was taking up to 8 a day.</p><p></p><p>My pain was episodic back then, it would ebb and flow over a period of 8 weeks. There were times when I was not in much pain and would cut right back; there were other times when I was taking the maximum. On days with little pain, I would just take less medications. On days with a lot of pain I would be watching the clock for the time when I could take more.</p><p></p><p>An addict generally takes far more than is prescribed. An addict also takes it not for pain relief, but for the euphoria or other 'feel good' response. When their physical pain eases, they still take the medications for the euphoria.</p><p></p><p>If you're taking the medications primarily in response to pain, and if you stop increasing your dose before you get to the euphoria point, and if you cut back your dose when the pain is less, then you are most unlikely to currently be an addict or to develop addiction. </p><p></p><p>I found when I began taking it, and at times when my medications have been changed to something stronger, there was a period during which I did feel a small amount of euphoria as well as some sedation. There was also a corresponding period when pain was COMPLETELY relieved.</p><p></p><p>I learned tat for me, it was best to take just enough medications to get the pain to manageable levels. Trying to totally eliminate the pain was not a good idea.</p><p></p><p>Another thing I did wrong initially - I tried to hold off on taking pain medications until I just couldn't stand the pain any longer. A doctor finally nagged some sense into me - if you know the pain isn't likely to have subsided, then you should take a single, larger, loading dose and then take a regular smaller top-up dose. In this way, your pain will be better managed and you also will take less pain medications overall.</p><p></p><p>I have found in the years since, that she was right.</p><p></p><p>That doesn't mean you're not going to get habituated to long-term pain medications. Your body does get accustomed to them and it does take more to get the same level of pain relief. This is not addiction. If your dose can still drop back to a lower level on days when pain is not so bad, then you are not addicted.</p><p></p><p>But you CAN get withdrawal symptoms, even if you're not addicted.</p><p></p><p>If someone waved a magic wand and all my pain vanished overnight, I wouldn't need my pain medications. But if I stopped taking them, I would get withdrawal symptoms. </p><p></p><p>The fist thing you notice on opiates - they bind you up. Constipation. Your body does adapt (at least mine does) so after a few weeks on them, my body has adapted back to a more normal pattern in terms of bowel habits. Of course, the first few times you feel like your body is trying to pass the Rock of Gibraltar, and the fallout of this is bleeding, small tears and discomfort next time as well when the tears open up again.</p><p>You can alleviate this by making sure that if you're taking opiates, you also take A LOT of fibre and drink a lot of water.</p><p></p><p>The constipation is caused by the opiates slowing down your gut motility. Peristalsis is slowed and transit time greatly increased. This means more water is absorbed, everything backs up and it can be very uncomfortable.</p><p></p><p>If you're only taking a small amount, this effect will be minimal.</p><p></p><p>But as I said, your body adjusts to it and over time, the constipation is no longer a big deal.</p><p></p><p>But if you suddenly STOP the opiates, then this adjustment of your body suddenly has to deal with the sudden cessation of the opiate-induced suppression of peristalsis. In other words, everything gets moving again, very fast, much faster than normal.</p><p></p><p>So the first thing you will notice, when you drastically cut back your opiates (or are just late with your medications) is diarrhoea and sometimes GI cramps. Maybe it's all you will notice.</p><p>I find that this hits about the same time as the pain kicks in (pain from not taking my pain medications).</p><p></p><p>Other symptoms I've noticed - increased sensitivity to noise, irritability, anxiety - are all due to the increase in pain, I believe. </p><p></p><p>A lot of withdrawal symptoms are generally due to your body adjusting back and overshooting (because after a long time on the medications, your body has adapted in other ways too). Dilated pupils, for example - addicts' pupils tend to clamp right down to pinpoints. It's a sign of overdose, to have contracted pupils. So going off the drugs - your pupils go the other way, and dilate.</p><p></p><p>I just did a bit of checking online and came up with this reference:</p><p><a href="http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm" target="_blank">http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm</a></p><p></p><p>"Symptoms of withdrawal include:</p><p></p><p>Abdominal pain</p><p>Agitation</p><p>Diarrhea</p><p>Dilated pupils</p><p>Goose bumps</p><p>Nausea</p><p>Runny nose</p><p>Sweating</p><p>Vomiting "</p><p></p><p>Looking at this list, I've only ever had abdominal cramps and diarrhoea. Maybe some agitation, although it depends on why I'm withdrawing. I know I do get agitated if withdrawal is due to a gastric attack, because the combination of the vomiting from, say, food poisoning, means that my medications are not able to be kept down. This speeds up diarrhoea which speeds up the loss from my body of any medications which made it past the point of no return. Any medications they try to get into me orally are going to keep on going, fast, and not get absorbed. And the biggest problem this causes for me - PAIN. A lot of it.</p><p></p><p>So if I'm desperately trying to persuade the hospital to give me an injection of pethidine to stop this process, and they're not listening, then yes, I get agitated. But once the pain gets away from me, I go into shock. This is not a withdrawal symptom. it's purely a reaction to the pain.</p><p></p><p>And symptoms of shock - raised blood pressure (sometimes) or alternatively, much-lowered blood pressure. Raised pulse. Sometimes, low-grade fever (or that could be the infection causing the vomiting).</p><p></p><p>Your description could simply have been raised BiPolar (BP) and pulse from the return of pain severe enough for your doctor to prescribe vicodin.</p><p></p><p>You took a nitro pill as well as the vicodin. And you began to feel better. It is entirely possible that you began to feel better as your pain eased.</p><p></p><p>A few years ago I was able to completely stop my morphine, cold turkey, to the consternation of health professionals at the time. However, I happened to be on the immunology ward which included a lot of HIV patients, a number of whom were also, coincidentally, heroin addicts on methadone. So they also were thinking along the lines of my being an addict, instead of a chronic pain patient. Some kidney X-rays had been ordered and the prep for this was fairly drastic - purgatives. The form of morphine I was taking was in sustained release form, which means one dose was supposed to last 12 hours. But those purgatives meant that anything I ingested was being shunted through to the exit sign in about two hours. That meant the medications weren't going to have time to work. So if it's not going to work, why take it? That was my logic, anyway.</p><p></p><p>So on the morning of the tests, with the laxatives given the night before now well and truly doing their job, I refused my morphine. Added to the problems caused by the laxatives was the withdrawal diarrhoea caused by the morphine (previous night's dose) being shunted from my system extra fast. It meant those laxatives hit me very hard.</p><p></p><p>The nursing staff were in a panic. They were used to patients trying to con more medications out of them; not used to patients refusing it.</p><p></p><p>I was in pain. But it was going to happen anyway, with the purgatives.</p><p></p><p>I had the tests. By the time it was all over, the purgatives had done their worst. I got back to the ward at about 2 pm. My next medication dose wasn't due for another four hours. But because I hadn't taken the morning dose, I was able to ask for it at 2 pm. And because the purgatives had worn off, the pain medications were able to work. The diarrhoea began to stop about an hour later at about the same time as my pain eased.</p><p></p><p>If I'd taken my morning dose I would have still been in as much pain, but wouldn't have been permitted to take my next dose until 6 pm. Another four hours of pain.</p><p></p><p>Since that time another ten years have passed. I now take a stronger dose. My pain levels have increased too, to a point where I try to avoid missing my medications, because the pain now can be so severe that I go into shock much faster and need hospitalisation, purely for the pain management.</p><p></p><p>But I still have days when either I'm too busy, or my pain level is lower, and I forget to take my morphine. The diarrhoea is what lets me know, at about the same time as I'm aware that I'm in more pain than usual.</p><p></p><p>If I'm able to put up with the pain, I sometimes take a lower dose of medications. Hey, maybe I've been tapped with that magic wand! But there is always some pain, unfortunately.</p><p></p><p>And on days when the pain is extra bad, my pain specialist has told me to take a little more if I feel I need it. He knows I will drop back to a lower dose again as soon as I can.</p><p></p><p>So, I recommend you see a pain specialist, to oversee your pain management. An expert lie this can reassure you and help you cope better not only with managing your pain but also with your concerns of addiction.</p><p></p><p>I am not an addict. I've also been on this same strength medications for the last few years and do not see any likelihood of needing to increase the dose any time soon. For me, this is a sign that my pain levels are currently stable. </p><p></p><p>But I do know about withdrawal. As long as I stay well, do not get a gastric bug or need to have purgatives for tests, and do not forget my medications or run out of them, I needn't worry about withdrawal, either. </p><p></p><p>But I really don't find withdrawal as much a hassle as the pain. It's really bad, these days. It locks me up, I can't move, it feels like someone is hammering spikes into every joint and stamping on every bone. I hurt to touch, every nerve feels like a line of fire along every limb and I get blinding, nauseating headaches which feel like my head is a large egg and a giant is cracking it open to have breakfast.</p><p></p><p>On medications, I function so well that people really wouldn't know. I don't get sedated (I avoid taking enough to sedate me) and instead, my brain is much sharper (not distracted by pain) and I do all the usual things people do. I drive my car. I organise family events. I cook complex meals. I give lectures, often speaking off the cuff. I go walking. </p><p></p><p>People don't know this about me. They really don't. Most people wouldn't understand, so not even my best friends know (apart from two). I've become so accustomed to being secretive about this, that even talking about it here, anonymously, makes me feel exposed.</p><p></p><p>husband & I see the same pain specialist. husband takes far less pain medications than I do, but his pain is also much more difficult to control. I am very grateful that at least one of us CAN be managed well, because at least I can function when he cannot. But I do wish the doctor could help him as much as I have been helped.</p><p></p><p>Heather, have courage. And hold onto this bit of information - it has been shown that when patients take opiates purely to manage severe pain, they do not become addicted. They may become habituated but as long as their main reason for taking the medications is to relieve pain, then if/when the pain goes away, the pain medications can stop without the cravings etc that addicts get. This research was done in Britain, where chronic pain patients (such as cancer patients) are given heroin. This enables them to go home from hospital and live a full, productive, happy life instead of a drug-soaked twilight in hospital somewhere.</p><p></p><p>Once I learned that, I felt a lot better about what I have to take.</p><p></p><p>Marg</p></blockquote><p></p>
[QUOTE="Marguerite, post: 171821, member: 1991"] Heather, whether three is a huge amount, or nothing much, really depends on you and how sensitive you are to the medications. mother in law can't take opiates at all, When she is in severe pain she takes paracetamol and finds that just 500 mg paracetamol sedates her. This is good, because when she had open heart surgery, the only pain medications she could take to help, was paracetamol. And for open heart surgery, it barely did a thing. On the other hand, I take large amounts of heavy opiates and have done for many years now. I understand about addiction and withdrawal, not so much from personal experience as from sharing your fears in the early stages, and also from trying to ease the fears of one of my specialists (who kept using the term "addiction" in his letters to other doctors about me, which really got me riled). I started taking ongoing pain medications in 1988. Back then I was taking Panadeine Forte, which is 500 mg paracetamol and 30 mg codeine phosphate. I was taking up to 8 a day. My pain was episodic back then, it would ebb and flow over a period of 8 weeks. There were times when I was not in much pain and would cut right back; there were other times when I was taking the maximum. On days with little pain, I would just take less medications. On days with a lot of pain I would be watching the clock for the time when I could take more. An addict generally takes far more than is prescribed. An addict also takes it not for pain relief, but for the euphoria or other 'feel good' response. When their physical pain eases, they still take the medications for the euphoria. If you're taking the medications primarily in response to pain, and if you stop increasing your dose before you get to the euphoria point, and if you cut back your dose when the pain is less, then you are most unlikely to currently be an addict or to develop addiction. I found when I began taking it, and at times when my medications have been changed to something stronger, there was a period during which I did feel a small amount of euphoria as well as some sedation. There was also a corresponding period when pain was COMPLETELY relieved. I learned tat for me, it was best to take just enough medications to get the pain to manageable levels. Trying to totally eliminate the pain was not a good idea. Another thing I did wrong initially - I tried to hold off on taking pain medications until I just couldn't stand the pain any longer. A doctor finally nagged some sense into me - if you know the pain isn't likely to have subsided, then you should take a single, larger, loading dose and then take a regular smaller top-up dose. In this way, your pain will be better managed and you also will take less pain medications overall. I have found in the years since, that she was right. That doesn't mean you're not going to get habituated to long-term pain medications. Your body does get accustomed to them and it does take more to get the same level of pain relief. This is not addiction. If your dose can still drop back to a lower level on days when pain is not so bad, then you are not addicted. But you CAN get withdrawal symptoms, even if you're not addicted. If someone waved a magic wand and all my pain vanished overnight, I wouldn't need my pain medications. But if I stopped taking them, I would get withdrawal symptoms. The fist thing you notice on opiates - they bind you up. Constipation. Your body does adapt (at least mine does) so after a few weeks on them, my body has adapted back to a more normal pattern in terms of bowel habits. Of course, the first few times you feel like your body is trying to pass the Rock of Gibraltar, and the fallout of this is bleeding, small tears and discomfort next time as well when the tears open up again. You can alleviate this by making sure that if you're taking opiates, you also take A LOT of fibre and drink a lot of water. The constipation is caused by the opiates slowing down your gut motility. Peristalsis is slowed and transit time greatly increased. This means more water is absorbed, everything backs up and it can be very uncomfortable. If you're only taking a small amount, this effect will be minimal. But as I said, your body adjusts to it and over time, the constipation is no longer a big deal. But if you suddenly STOP the opiates, then this adjustment of your body suddenly has to deal with the sudden cessation of the opiate-induced suppression of peristalsis. In other words, everything gets moving again, very fast, much faster than normal. So the first thing you will notice, when you drastically cut back your opiates (or are just late with your medications) is diarrhoea and sometimes GI cramps. Maybe it's all you will notice. I find that this hits about the same time as the pain kicks in (pain from not taking my pain medications). Other symptoms I've noticed - increased sensitivity to noise, irritability, anxiety - are all due to the increase in pain, I believe. A lot of withdrawal symptoms are generally due to your body adjusting back and overshooting (because after a long time on the medications, your body has adapted in other ways too). Dilated pupils, for example - addicts' pupils tend to clamp right down to pinpoints. It's a sign of overdose, to have contracted pupils. So going off the drugs - your pupils go the other way, and dilate. I just did a bit of checking online and came up with this reference: [url]http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm[/url] "Symptoms of withdrawal include: Abdominal pain Agitation Diarrhea Dilated pupils Goose bumps Nausea Runny nose Sweating Vomiting " Looking at this list, I've only ever had abdominal cramps and diarrhoea. Maybe some agitation, although it depends on why I'm withdrawing. I know I do get agitated if withdrawal is due to a gastric attack, because the combination of the vomiting from, say, food poisoning, means that my medications are not able to be kept down. This speeds up diarrhoea which speeds up the loss from my body of any medications which made it past the point of no return. Any medications they try to get into me orally are going to keep on going, fast, and not get absorbed. And the biggest problem this causes for me - PAIN. A lot of it. So if I'm desperately trying to persuade the hospital to give me an injection of pethidine to stop this process, and they're not listening, then yes, I get agitated. But once the pain gets away from me, I go into shock. This is not a withdrawal symptom. it's purely a reaction to the pain. And symptoms of shock - raised blood pressure (sometimes) or alternatively, much-lowered blood pressure. Raised pulse. Sometimes, low-grade fever (or that could be the infection causing the vomiting). Your description could simply have been raised BiPolar (BP) and pulse from the return of pain severe enough for your doctor to prescribe vicodin. You took a nitro pill as well as the vicodin. And you began to feel better. It is entirely possible that you began to feel better as your pain eased. A few years ago I was able to completely stop my morphine, cold turkey, to the consternation of health professionals at the time. However, I happened to be on the immunology ward which included a lot of HIV patients, a number of whom were also, coincidentally, heroin addicts on methadone. So they also were thinking along the lines of my being an addict, instead of a chronic pain patient. Some kidney X-rays had been ordered and the prep for this was fairly drastic - purgatives. The form of morphine I was taking was in sustained release form, which means one dose was supposed to last 12 hours. But those purgatives meant that anything I ingested was being shunted through to the exit sign in about two hours. That meant the medications weren't going to have time to work. So if it's not going to work, why take it? That was my logic, anyway. So on the morning of the tests, with the laxatives given the night before now well and truly doing their job, I refused my morphine. Added to the problems caused by the laxatives was the withdrawal diarrhoea caused by the morphine (previous night's dose) being shunted from my system extra fast. It meant those laxatives hit me very hard. The nursing staff were in a panic. They were used to patients trying to con more medications out of them; not used to patients refusing it. I was in pain. But it was going to happen anyway, with the purgatives. I had the tests. By the time it was all over, the purgatives had done their worst. I got back to the ward at about 2 pm. My next medication dose wasn't due for another four hours. But because I hadn't taken the morning dose, I was able to ask for it at 2 pm. And because the purgatives had worn off, the pain medications were able to work. The diarrhoea began to stop about an hour later at about the same time as my pain eased. If I'd taken my morning dose I would have still been in as much pain, but wouldn't have been permitted to take my next dose until 6 pm. Another four hours of pain. Since that time another ten years have passed. I now take a stronger dose. My pain levels have increased too, to a point where I try to avoid missing my medications, because the pain now can be so severe that I go into shock much faster and need hospitalisation, purely for the pain management. But I still have days when either I'm too busy, or my pain level is lower, and I forget to take my morphine. The diarrhoea is what lets me know, at about the same time as I'm aware that I'm in more pain than usual. If I'm able to put up with the pain, I sometimes take a lower dose of medications. Hey, maybe I've been tapped with that magic wand! But there is always some pain, unfortunately. And on days when the pain is extra bad, my pain specialist has told me to take a little more if I feel I need it. He knows I will drop back to a lower dose again as soon as I can. So, I recommend you see a pain specialist, to oversee your pain management. An expert lie this can reassure you and help you cope better not only with managing your pain but also with your concerns of addiction. I am not an addict. I've also been on this same strength medications for the last few years and do not see any likelihood of needing to increase the dose any time soon. For me, this is a sign that my pain levels are currently stable. But I do know about withdrawal. As long as I stay well, do not get a gastric bug or need to have purgatives for tests, and do not forget my medications or run out of them, I needn't worry about withdrawal, either. But I really don't find withdrawal as much a hassle as the pain. It's really bad, these days. It locks me up, I can't move, it feels like someone is hammering spikes into every joint and stamping on every bone. I hurt to touch, every nerve feels like a line of fire along every limb and I get blinding, nauseating headaches which feel like my head is a large egg and a giant is cracking it open to have breakfast. On medications, I function so well that people really wouldn't know. I don't get sedated (I avoid taking enough to sedate me) and instead, my brain is much sharper (not distracted by pain) and I do all the usual things people do. I drive my car. I organise family events. I cook complex meals. I give lectures, often speaking off the cuff. I go walking. People don't know this about me. They really don't. Most people wouldn't understand, so not even my best friends know (apart from two). I've become so accustomed to being secretive about this, that even talking about it here, anonymously, makes me feel exposed. husband & I see the same pain specialist. husband takes far less pain medications than I do, but his pain is also much more difficult to control. I am very grateful that at least one of us CAN be managed well, because at least I can function when he cannot. But I do wish the doctor could help him as much as I have been helped. Heather, have courage. And hold onto this bit of information - it has been shown that when patients take opiates purely to manage severe pain, they do not become addicted. They may become habituated but as long as their main reason for taking the medications is to relieve pain, then if/when the pain goes away, the pain medications can stop without the cravings etc that addicts get. This research was done in Britain, where chronic pain patients (such as cancer patients) are given heroin. This enables them to go home from hospital and live a full, productive, happy life instead of a drug-soaked twilight in hospital somewhere. Once I learned that, I felt a lot better about what I have to take. Marg [/QUOTE]
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