Seeking Tapering advice post ADR

[scduggan]

Hello Everyone,
At first glance this post will appear to be me complaining. I am not because I am pretty sure I signed up for this and still consider myself lucky to even have had the surgery. I am just seeking advice from those of you who have already been in what is uncharted waters for me. Today I am five weeks post op from a one level ADR at Texas Back Institute. I received the Freedom disc. Here is my dilemma and question. First, I seem to be having more pain in my low back and hips in this last week. I am pretty sure this is because I am getting back to my life and responsibilities. My hip pain is all over the place and is probably due to nerve issues. My low back is just sore and achy....especially after increased activity.

Now to my question. I know tapering from narcotics is extremely individual, so I will not ask when. My question is HOW?
I had hoped to start tapering by this point. It is pretty clear I am not ready because of my increased pain. I am taking 4 Norco 10's per day. A logical way to reduce seems to me to reduce dosage instead of increasing the spacing between doses. Would it be wise to try to cut, splice and dice my pills in order to do this? I was thinking I could go to 35 mg's per day for a week, then 30, then 25 and so on. Is my logic sound? Is there a better way? Most of the time I still feel really excited about my future. Sometimes (when I get that old familiar back pain) I am pretty afraid. Thanks for your help with this.
CD

[Cindylou]

You know, you are right......it is such an individual thing, however, if I were in your shoes (and I have been) I would specifically ask the doctor who performed the surgery for advice on tapering. There are lots of ways to do it by spacing the number of hours between doses like you mentioned, just remember to taper slowly if you are going to start now. I know you didn't ask for this advice, but I will humbly offer that it sounds too early to start tapering, given your increased pain levels as you resume activities. You are such early days. please give your body time to heal. If you don't have addiction issues you will do fine when it's tapering time. Just my 2 cents. Remember, it is a roller coaster ride back to good health with this type of surgery. Good luck!

[scduggan]

Thanks Cindy,
Your two cents is worth a lot more to me. I know you are absolutely right about it being too soon. I am really bad about picking some random date and setting a random goal. Then I feel disappointed when I cannot meet it. Last time I checked, there were no awards for being off the drugs by a certain date. I am going to stay right where I am for a while. My current dosing schedule is adequate. I do not have any addiction issues, but I do have a family member with major issues. She is a classic addict and has been for years. Seeing her and how she has run her life into the ditch is always in my mind.
CD

[Cindylou]

scduggan, nothing like a reality check of a relative with addiction issues to remind you why you won't go there, that's for damn sure. Glad you are doing well with your current dosing schedule, and little by little you will be able to start tapering. I have no doubt you will do fine with it. It's funny (not really) how it's the folks w/o addiction tendencies who are the most worried about it, isn't it? And it's definitely okay to be concerned about it. Many an unsuspecting person has fallen into that hole, unfortunately. Hang in there. Little by little, you will start to get your life back, thank God, and I mean it, for SPS!

[Jack-of-all-trades]

I'm sure this subject is quite controversial and is very close to my heart. There seems to be the physical and the mental part of opioid meds. Physically, anyone who partakes of opioids for an extended period of time will experience withdrawal symptoms to some degree. The severity being related to dose and length of time your body is exposed to them. Someone who takes them as medicine, and not recreational, will have an easier time of it if the reason they started on their medicine is resolved.

I successfully quit all opioids back when my back pain first started. I went from 30 mg of hydrocodone a day to none in one step. It wasn't that big deal as I had only been on this med about 6 months or so. I tried twice, but still had intractable back pain to the point life wasn't worth living without something to attenuate my pain. As time went by, I was on fentanyl 75 mcg and oxycodone 30 mg at my maximum dose. Since my surgery, I am without pain 60% of the time and getting better as time passes. I'm now on 20 mg of oxycodone (Percocet) a day, equal to about 25 mg of hydrocodone (2.5 Norco 10 mg) per day. For about ten days after surgery, I was taking 120 mg of oxycodone a day and last year about this time I was on the fentanyl patch 75 mcg with 30 mg of oxycodone a day for breakthrough.

The following post is from a website that deals more with substance abuse but you may be able to glean some helpful info from this post. I have also added a few tips of my on to the list. As always, the info is from the internet, review with a jaundiced eye.


SAMPLE HOME DETOX RESCUE OPTIONS

Substance Abuse in any form substantially depletes your body of nutrients. In order to be effective during WDs most people state they needed to increase doseage levels beyond the recommend dose level; some substantially. Levels are for intensity of Detox WDs; post-detox WDs would be less. Use your own judgment about your needs and what you feel is best for you and what you are comfortable with and customize your own detox list to your preferences/needs. These things may help lessen WDs; others have reported good success.

What Symptoms To Expect
Vicodin has a half-life of 4-8 hours; therefore, WDs will begin for most between 8-16 hours after last dose taken. Most people express that detox feels like the worst flu they have ever had in their life. You will likely experience severe achy joints, weakness, restless legs syndromerestless legs syndrome, headaches, lack of clarity in thought, irritability-does not play well with others, severe “coffee jitters” to the extent that it is difficult to sit still and some experience involuntary muscleinvoluntary muscle twitches, general feeling of “the all overs”, nausea but most do not report vomiting, and most report diarrhea. WDs will increasingly worsen up to about days 3-4 and then begin to turn the corner and stabilize.

It is best to plan your detox needs and shop in advance of starting. When you externally provide the body with chemicals that alter the brain, the body reads the signal and reacts by stopping its own natural production levels. So, when you cold turkey and stop the external source, it jolts your body and whiplashes your system into wakeup mode. All those little workers have been snoozing for however long you have been administering the external supply source. Now the alarm bells are ringing all throughout your system, and they are running around like keystone cops screaming “oh s**t!!!!” They will get back on the job for you again, but it takes a while for them to get synchronized and functioning efficiently again.

1-2 weeks Ahead of Planned Detox
If possible, plan your detox 1-2 weeks ahead and commence with the Multi-Vitamin, Multi-Mineral, B-Complex, 100mg, Zinc (pain-take only after eating food), & St. John's Wort (depression; but do NOT take if you are taking SSRIsSSRIs) to build a solid base level BEFORE you start the detox. Many who have not built a solid base in advance have reported a more difficult time during detox. It took them a minimum of 1 week to achieve maximum relief level when days 1-4 are likely to be your worst WD days during detox. You may not feel depression now, but detox WDs usually results in the onset of depression until your body acclimates and can regulate itself. Building a nutriment base BEFORE detox will help lessen WDs and lessen the level of additional supplements you will need to help you cope. Waiting til you are actually in WDs to start taking supplements will mean that the supplements will be less effective and you will likely need substantially increased levels.

About Work
You should plan to take time off work to detox, usually a week. Options on work are plan to take off or call in sick with the flu, or the hybrid plan is time detox where you take last pill late the night before, go to work jittery and leave work early “with flu”---since you went home sick w/flu no one will be terribly surprised when you aren’t able to make it in most, if not all, of the following week.

During days 1-2 (and possibly day 3)
Most detoxers say it is best if you can try to sleep as much as you can during the first couple of days at least. NyquilNyquil, BenadrylBenadryl (not w/Benzodiazepine Detox!), Valerian Root, 5HTP (do not exceed 300mg daily) are types of things that may help you to sleep. Select other things from the OTC Options list as needed use other things from the list.

Days 3-5
You will likely start to stabilize. When you feel that you are starting to level off begin the L-Tyrosine/B6/D-Phenylalanine/Sublingual B-ComplexB-Complex w/B-12 to help w/pain and energy.

THINGS THAT MAY HELP

-HOT baths several times a day to help with aches; add Epsom Salts or vingear

-Heating Pad & warm blankets to keep muscles warm and relaxed.

-Hot Rice Socks for muscle warmers. Fill cotton socks w/rice, stretch and leave room on ends to loop and self tie sock end. Heat rice socks in microwave for approximately 2 min. Heat check & apply to achey areas.

-Keep nourished; drink lots of water. Water is perhaps the best overall supplement for detox. Add 1 tablespoon of Apple Cider Vinegar for body PH rebalancing & pain; and if you can, add 1 tablespoon Honey for energy

-Relaxation Exercises to help lessen muscle cramping ,pain, & restless legs syndrome. EASY exercise regimine to activate your own natural endorphins & dopamine to help w/pain, While in bed work your muscles-tighten the muscles in your entire body all at once as hard as you can---hold it for several seconds(hold breath)---slowly release muscles and breath. Do entire body 5 times and then repeat doing one area at time--both legs then both arms-then low back/abdomen area; repeat cycle/one leg-one arm, etc.

SHOPPING LIST OPTIONS TO HAVE ON HAND DURING DETOX
Print out list to shop and to use as a tool to track what you take & its effectiveness.

Soup & Frozen Meals- enough for a few days

Liquid Nutritionally Balanced Meals; e.g., Slim Fast or Ensure

Gatorade (replaces electrolyteselectrolytes)

Benadryl (50mg w/hydro; taper ease aide)

Robitussin DXM-helps WDs; taper ease aide

Tagamet, a taper ease aide; slows absorption of Hydro

Tylenol PM (but not w/Benzodiazepine Detox!)- during WDs you can take this during the day w/o it making you sleepy

Imodium (4-6 hours after onset; first few hours let body purge toxin concentrates) [detoxers have posted that 4-6 tablets x3 daily substantially helped them not only control diarrhea, but also lessened WDs]

Salonpas Patches For Muscle PainMuscle Pain

Aspercreme For Joint PainJoint Pain (does NOT have Aspirin in it)

Airborne-3 boxes= (4 day supply @double doses3xdaily)

Nyquil-2 bottles since you will need it both day & night for first 3-4 days (will help joint pain & sleep)

Orange Juice w/Calcium-2 (will help joint pain & helps stabilize central nervous system)

Oranges-Natural Vit C and other nutrients

Apples-Natural Vit C and other nutrients

Bananas-2 bunches (potassium source; eat 2-3 daily; will help joint pain & helps stabilize central nervous system)

Sweet Potatoes-great nutrient source for Vit A and other things; canned or fresh to cook. Can be microwaved)

Blue Berries-fresh or dried -Great antioxidant

Spinach-Leafy Salad Mix, Frozen, or Canned (Vit. A-eat as much as you can)

Mini Carrots (good VitA and fiber source)

Green Tea-great antioxidant to help cleanse your system of toxins.

Peppermint Tea & Peppermint Candy-Nausea

Chammomile Tea-Sleep

Hershey’s Dark Chocolate Bars-has antioxidant & central nervous system coping properties.

Zinc 50 or 60 mg (3x daily ONLY W/FOOD; will substantially help joint pain)

B-Complex 100B-Complex 100 mg. (helps stabilize central nervous system)


*L-Tyrosine [avoid if already taking any SSRI RX ] (Health Food Store-will help joint pain & nerves). One hour before eating start w/2000 mgs; scale up/down based on how you feel up to 4,000 mgs. Take w/B-6 to help w/absorption. It will give you a surge of physical & mental energy that helps counteract malaise feeling. If you experience "coffee jitters" reduce to comfortable level.

*5HTP 100mg 3x daily. No more than 300 mg daily as it could create/risk elevated seratonin levels [avoid if already taking any SSRI RX m], Walmart for best price; otherwise pricey; helps joint pain & nerves)

D-Phenylalanine (Health Food Store-helps joint pain) Compliments effectiveness of L-Tryosine and 5HTP

B-6 (needed for aborption & effectiveness of L-Tyrosine/D-Phenylalaline)

B-Complex w-B12 Sublingual Liquid Drops (Walmart-Spring Valley Line-key ingredient here is the B-12 which helps central nervous system & energy level. B-12 can only be absorbed by the body through natural dietary sources, injections, or liquid sublingual-under tongue

Calcium (helps joint painjoint pain & nerves)

*St. John's Wort [avoid if already taking any SSRI RX meds]-will help w/onset of depression which will also affect level of joint pain)

Multi-Vitamin Formula (Costco/Sams/Walmart) -helps joint pain, nerves, and depression)

Multi-Mineral Formula (Costco/Sams/Walmart) -helps joint pain, nerves, and depression)

Valerian Root (Walmart-helps nerves; increase dose leves @night to help w/sleep)

Hyland's Leg Cramps-Walmart-Homepathic Supplement has Quinine in it which helps w/leg syndrome; sublingual under tongue. RX levels of Quinine available from doctor.

Fish Oil-OMEGA 3-Helps w/legs syndrome &pain

[*These products impact serotonin levels and therefore if you are on any SSRI medications do NOT take these additional supplements as it could alter your RX medication]

Mindless Comedy Movies-mental distraction aids; make sure you get 1 week rentals unless you have someone who can return them for you.

Note: Its a good idea to have Activated Charcoal & Benadryl on hand. If at any time you feel you may have exceeded a level on anything the Charcoal functions like a system sponge for absorbing toxins and carrying out toxins; it will turn stool a charcoal color. The Benadryl is antihistamine and is sometimes given for adverse reactions to other medications. These things are almost always never needed but provided safety and security to just know they are on hand.
However, NO antihistimines if you are detoxing from Benzodiazepines. Some online medical reports suggest that antihistimines (Benadryl, TylenolPM, sleep aids) may increase risk of Benzo withdrawal and Benzo withdrawal seizure. Benzo withdrawal/detox is felt by some to be harder and more dangerous due to risk of seizures than opioids. Therefore, probably best to do under a specialists supervision.

None of these things will totally eliminate WD; but, may help lessen them.

[scduggan]

THANK YOU! THANK YOU for all this great advice. I have lots of times when I am PAIN FREE. Those times do not last because I am finding it is really easy to overdo it. Starting yesterday I switched my night-time hydrocodone 10 to a 7.5. I will do this for a few days and see how it goes.

JOAT-I have been on the hydrocodone for a LONG time.....almost 9 months. I think I will do well because prior to my surgery 5 1/2 weeks ago I only took two (sometimes 3) per day. I am going to go out tomorrow to get some of those supplements. I already take cod liver oil. I need a good whole food vitamin.

Thanks!
CD

[Justin]

Hi SD,

I must have missed this thread--sorry. In regard to tapering, I would first discuss this with a trained medical professional. If you have a pain management physician that you are seeing, you can sit down with them and ask them to help write out a taper schedule.

You are still very early post-op at 5.5 weeks. I understand about the concern regarding addiction; however, make sure that you are adequately medicated in the short-term. As you continue to heal, you will want to get off of the opioids due to the continued side effects of taking them.

It's great to see that you are eager to start tapering. I believe you will be successful and please keep your doctors in the loop about your change in medications. Good luck!

[Jack-of-all-trades]

Hi SD,

I must have missed this thread--sorry. In regard to tapering, I would first discuss this with a trained medical professional. If you have a pain management physician that you are seeing, you can sit down with them and ask them to help write out a taper schedule.

You are still very early post-op at 5.5 weeks. I understand about the concern regarding addiction; however, make sure that you are adequately medicated in the short-term. As you continue to heal, you will want to get off of the opioids due to the continued side effects of taking them.

It's great to see that you are eager to start tapering. I believe you will be successful and please keep your doctors in the loop about your change in medications. Good luck!

Justin,

It looks like from your signature you were on meds about 6 months before you were able to stop altogether. Seems like I remember reading somewhere you went the Suboxone route. In your opinion, can you from experience compare tapering vs Sub? When I tried Sub before I was at my max dose of opioids (Fentanyl patch 75 mcg changed q48 & Percs 10/325 tid). I think part of my problems with Sub was due to the doc I found in the yellow pages. Not the best way to locate a specialist. What dose of meds were you on when you switched to Sub?

[Justin]

Justin,

It looks like from your signature you were on meds about 6 months before you were able to stop altogether. Seems like I remember reading somewhere you went the Suboxone route. In your opinion, can you from experience compare tapering vs Sub? When I tried Sub before I was at my max dose of opioids (Fentanyl patch 75 mcg changed q48 & Percs 10/325 tid). I think part of my problems with Sub was due to the doc I found in the yellow pages. Not the best way to locate a specialist. What dose of meds were you on when you switched to Sub?

Hi JOAT,

Standard tapering & Suboxone are quite similar. I started Suboxone after I tapered off of Fentanyl. I was still on 20mg of oxycodone per day after getting off all of my Fentanyl and I wanted to avoid the horrible withdrawals that I had in 2003 while stepping off of oxycodone.

Stepping off of the Fentanyl was hard. However, the transition from oxycodone to Suboxone was pretty seamless. As I'm sure you know, you have to be in withdrawal to start on Suboxone (the Suboxone [a partial agonist] won't bind to the receptors that are occupied by full agonists [oxycodone]). It was a rough 24 hours of withdrawal, but once I started on Suboxone my coverage of pain was incredible. The key is to find a good doctor to write for Suboxone--it is an extremely powerful drug and it must be dosed correctly. It's a bit tricky to find your initial dose when stepping over. As such, I was severely sedated the first week on Suboxone (the dosage was too high initially).

Suboxone tapering is similar to tapering off of other narcotics. The half-life is much longer with Suboxone, so the drug stays in your system much longer. They make 2mg tablets that can be halved (and also cut into quarters) when you start tapering down to a lower dose. I noticed that some patients on Suboxone are successfully using a "liquid tapering method" to help step down to low doses (less than 1mg).

I completed stepped off Suboxone at 0.5mg. The withdrawals were easier as opposed to stepping off of the short-acting opioids. However, one thing I noticed was that my withdrawal period was much longer. Of course, this is attributed to the longer half-life, but I was withdrawing from Suboxone for the better part of 4 weeks (if not 5 weeks). I think the duration of withdrawals was a little taxing. For this reason, I would look into the "liquid dilution" method for doses below 1mg (there are some good physician-reviewed resources accessible on the internet).

I hope this helps and please let me know if you need me to clarify anything. Don't hesitate if you have more questions, or if I overlooked one of your questions.