Tuesday, August 3, 2010

Drugs are Bad

When I first saw the orthopedist, despite the pain they did not want to prescribe any narcotics. I understand why and I did not want nor ask for them. Having worked in a facility catering to many opiate addicts I have seen a good deal of back pain sufferers to know better. So I stuck with it until I received the cortisol shot. After it wore off at only two weeks, and I saw the orthopedist again at the 4 week followup, then he recommended Ultram (Tramadol). Supposedly so weak its not even considered a narcotic. I remember taking it after my shoulder surgery 10 years ago and knew I was ok with it (I took for 2 weeks then). The choice then is either to medicate until surgery or go out of work early since I could hardly stand it any more due to the hip/leg pain. So I took the pills for the short term.

Tramadol is considered so weak that in many countries it is not considered prescription--you can get it next to Tylenol on the shelf. The potential for abuse is low according to the literature, and dependence did not seem to be an issue in my brief search online prior to filling the script. Taking it I can't say it took away the pain, but it did make it just bearable enough so I could function until surgery when combining with some ibuprofen. This was in March. I figured surgery was going to be in a month or so, but the doc did not want to do it until July. Followup in May revealed some details that made me seek a second opinion, however getting in took a month. Then it was another 6 weeks to surgery. By then I had been on the Tramadol for nearly 3 months or so, on a regular basis. I In my pre-op testing, I inquired whether I should detox myself from it or not, and they said why put yourself in pain for 3 weeks unnecessarily.

As you might have read in my posts below, when I awoke from surgery they had no idea why I barely responded from narcotics. They looked at me like I was hiding an opiate problem from them--and I would have done the same given the amount of oxycodone it took to get the pain under control. I was asked more than once, that I should be upfront about everything I was taking since that's what determines what I need--I told them, "Advil and Ultram, 200-300/day on average" (400/day is max dose, gave me relief from a 8 to a 5 or 6 maybe.) Strange, I thought.

Fast forward to a week after surgery. I'm trying to cut my dose of narcotics down. First 30mg oxycodone every 4, down to 15 every 4, down to 15 every 6, then 8. In that first week I was able to walk miles, no leg pain some back pain, overall controlled well enough so I could recover and do my walking. But as I tapered to the 8 hour window after hour 6 the leg pain became atrocious, and I started shivering and profusely sweating. Mentally I was all over the place. What the hell...I was incredibly worried, did the surgery go bad, did the nerves get messed up or a screw went through one? The pain in the left leg was horrendous, far worse than before surgery. Christ, I thought, I go to one of the best surgeons in the country and this is what happens...So I stopped tapering for a day, got the pain under control, and hit the internet. Not an hour later it all clicked.

First off, lets discuss Ultram (Tramadol). Is it a narcotic? YES! It is an opiate agonist. Done. Narcotic. Why is it considered weak? In your body and brain there are several receptors that opiate agonists affect. Lets say 1, 2, and 3. 1 is the pleasure center that gives you that opiate high, 2 and 3 are pain sensors, and there are a few others that we won't mention. What makes Tramadol unique is that it acts very little on 1, but still a good amount on 2 and 3, the pain ones. So it can give pain relief without so much of the high, which is why my doc felt it was a good option since I can then still have a sound mind and still work. But nothing is free. Apparently this drug also contains some anti-depressant like effects, and strong ones, to the point where the company that initially made it actually tried to say that their narcotic is good for depressives. Yeah, real good...

So what's the problem? Well the problem is that the pain receptors in my brain have been so used to the opiod activity of Tramadol that by the time I was hit with real pain killers I had the tolerance of a long time user without even knowing it. Further research revealed that withdrawl symptoms from Ultram can be no better than from any other opiod pain killer. So now I was out of surgery, with lots of pain, and on tons of narcs. Since I'm taking this I have no way to know what is a real symptom of a surgery gone bad, or hypersensitivity to pain due to narcotic withdrawl. From what I remember working with all the addicts is that while symptoms vary, one cardinal symptom is indeed hypersensitivity to any pain, excruciating leg pain, and diarrhea etc....

This left me with two choices, taper slow, or quit and suffer. I have no intentions of being on these drugs, I want nothing other than my life back. However I also know it can't be immediate since so fresh from surgery the pain magnified is beyond tolerance. So I did a gradual taper. 7.5mg oxycodone, every 6 hours, then 8, then none, over 36 hours. The pain--terrible. But by day two it got a little better. The left buttock, thigh, calf all hurt like no tomorrow, but it was a sacral rather than lumbar pattern so I knew it was just inflammation from surgery and the remodeling from the reduction, magnified by the opiate withdrawl. The diarrhea, sweating, emotional fragility all came as well. I was in full blown withdrawl. Damn, who would have thought.

Now, it has been nearly a week since I stopped. I am able to walk again, miles instead of just a couple of blocks. The leg/glut pain is still there a bit, and is nagging that's for sure, but believe it or not, two weeks out of surgery and I'm actually feeling better than pre-op (though I can't bend/lift). I take Tylenol a few times a day, and while I can't honestly say its doing anything I suppose it can't hurt since I'm not drinking and it doesn't affect bone regeneration.

I had my followup appointment with some x-rays, everything looks good and on track. I'm able to sit for a good while now (and type this long entry), I can walk, I can stand, I can sit in the car and even drive. Wow.

If this leg pain goes away entirely I will be truly amazed. When it first hit as I was detoxing I read all the horror stories, and while I won't know the true result for months (successful fusion, no nerve scarring) for being a little more than two weeks out I remain optimistic.

But the moral here is this: Don't stop your search after page 1 of Google, and don't believe a single damn thing the drug information from the manufacturer says. The other pages contained the horror stories that I myself will  have ended up experiencing. That is not to say it doesn't have uses. Perhaps if I was only on it for a few weeks it would have been ok, but it certainly left me with a bad taste.


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