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Dose - Problems with Tramadol

Discussion in 'Tramadol' started by CCApollo, Feb 27, 2010.

  1. CCApollo

    CCApollo Silver Member

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    Hey there fellow SWIM'ers

    I am a Chronic Daily Headache sufferer of 2 years now, and have recently been prescribed Tramadol for the pain, after 2 years of failed attempts to find relief. SWIM's problem is a tolerance issue I believe. From day one, SWIM's had to take 4 pills (200 MG) to achieve any effect. At this dose, it took the edge off of the pain, while still allowing SWIM to function, although SWIM had the usual narcotic effects to some extent. SWIM didn't get the "speedy" effect that others he's talked to experience, and it really doesn't do much to SWIM at all, for pain or pleasure if you will.

    SWIM's doctor refuses to switch SWIM to a different medication, but as allowed SWIM to take 2 (100 MG) every 8 hours, with a max of 6 per day. SWIM gets a 180 pill prescription per month.

    SWIM took 6 pills about an hour ago, as he has a very bad headache right now which has ruined his day, and doesn't feel any better. That is the max dose for the day, so SWIM doesn't know if he should take even more, but he really needs the help. Should I take more?

    So, what should SWIM do about this situation? SWIM wants to be able to take a lower amount of this medicine, but still get the adequate relief/effects. He does also enjoy the effect of Opiates, and likes the "nod" when he's having a bad headache, as it takes away the stress he's had to deal with.

    Thanks for the help everyone
     
  2. Helene

    Helene Gold Member

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    Hey there CCApollo, welcome to DF.

    The maximum safe dosage for tramadol is 400mg per day. So that would be eight of your 50mg pills. The reason for this hard and fast maximum dosage (other opiates don't tend to have such absolute maximums) is that tramadol can trigger fits. And at higher doses, tramadol can cause ones seizure threshold to decrease, thus making a seizure more likely to occur. Higher dose = greater risk.

    So to directly answer your question, you should be okay taking up to 400mg of tramadol in any 24 hour period - that's an extra two 50mg tablets on top of your current six a day (300mg) dosage - as long as you have no history of seizures, epilepsy etc.

    Just a quick note on the tolerance issue - a high opiate tolerance does not mean that one could take more tramadol without having a seizure. Opiate tolerance will not increase seizure threshold. With something like codeine, as long as the dose is calculated accurately and the tolerance is judged realistically, an increased dosage is comparatively safe, but this is not the case for tramadol. There is no way of knowing what your seizure threshold is, and so sticking to this maximum safe dosage is the only way to try and avoid potentially fatal fits.

    Do you think that an extra two tablets (an extra 100mg) a day would be enough to keep the pain at bay? If so, this should work out well for you. Have you ever been prescribed codeine or dihydrocodine for this issue? Did that work out well, or not? If not, why not see if switching over to one of those might be acceptable? Dihydrocodeine is, if anything, slightly weaker than tramadol, but there isn't the added concern of a seizure risk at higher doses. Codeine would probably be too weak, as it's ceiling dose (maximum dose at in terms of efficacy) is pretty much level with your current tramadol dosage.

    You should definitely avoid making the move to a stronger opiate. From "weak opiates" such as codeine, dihydrocodine and tramadol, there's a fairly big jump up to the next group of opiates, which include hydrocodone, morphine and oxycodone. And making this jump just makes things more complicated, in terms of tolerance, dependence, addiction and withdrawal.

    Hopefully an occasional extra 100mg of tramadol a day will do the trick - in which, best thing to do is to tell your doc you're needing slightly extra, and ask him to up your script. 400mg is still within the safe daily dosage - this is what someone I know rather well was prescribed for post-operative dental/ jawbone pain, and it did the trick nicely. Bear in mind she has a rather high opiate tolerance (heroin addiction, methadone script etc) - it still worked well. If this increase doesn't help, then speak to your doc about maybe switching to codeine, dihydrocodeine or similar.

    Good luck,

    H
     
    Last edited: Feb 28, 2010
  3. missparkles

    missparkles Platinum Member & Advisor

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    Is it possible to get a scan or for you to see a neurologist? Cos not all headaches are best treated with strong pain meds. For example, Neuropathic pain can actually worsen with strong opiate pain meds.

    Here's a link to a site that explains what Neuropathic pain is.

    http://www.patient.co.uk/health/Neuropathic-Pain.htm

    This is just one of the causes of migraines. If this pain continues I'd advise you to ask the doctor for a referral. Sometimes taking meds just masks problems. Hope you feel better soon love. :)

    Sparkles.:vibes:
     
  4. CCApollo

    CCApollo Silver Member

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    SWIM has spent the last 2 years going through all sorts pot
    medications, diet/lifestle changes, and 3 hospitalizations with no relief. SWIM has had all
    sorts of scans, with none revealing anything abnormal. He experiences constant headache pain which varies in intesity at seemingly random intervals.

    SWIM is on the maximum amount of Tramadol as this
    is being written, but is still in enough pain that it hurts
    to look at my monitor.

    SWIM has experience with stronger opiates (Oxy and Hydrocodone). Just like the Tramadol, He needed a large dose to get any relief. Even after a month of not using any narcotics, it still took 40 MG of Hydrocodone to be suffient. This is SWIM's preferred
    method, since he has found it to be the most effective. It's the
    closest to being pain free he's been in years. But every doctor
    i've gone too is against using this regimine, and for good reason. It's
    obviously dangerous, but I don't know what else to do.
    I need to get control over this so I can move on with my
    life.
     
  5. missparkles

    missparkles Platinum Member & Advisor

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    Does anything (apart from strong opiates) help at all? I know pain can be so debilitating, it just takes all of your energy. Every ounce of strength is needed just to cope with basic day to day living. Till you get the pain under control you can't possibly look for alternatives. Has SWIY had substance misuse issues in the past, cos I can't see what the doctor has against prescribing suitable pain meds...that would be the only reason. But then pain should be treated regardless of past substance misuse.

    Maybe suggest to the doctor that until you get some relief from pain, you can't get enough sleep, it affects your appetite, and it generally impacts (in a very negative way) on your day to day life. Tell them that you cannot develop any other pain relieving techniques (you can't focus on reading a book) until you can concentrate. And with crippling pain that's not an option. Maybe if your doctor sees it from this perspective, maybe they'll show a little more understanding?

    Sparkles.:vibes:
     
  6. CCApollo

    CCApollo Silver Member

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    SWIM has done all of this, since it is all true. (Does SWIM need
    to use a psudonym, even though the situation is completely legal in nature?)

    The reason doctors won't perscribe stronger meds is definatly my age. Being only 18 years old, they don't trust me with the responsibility
    involved (neither do my parents, who have done very little to help
    me).

    Thank you for the suggestions. The help is much appreciated.
     
  7. Psychonaut72

    Psychonaut72 Newbie

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    SWIM has tried tramadol before and in SWIM's opinion, it is not a very effective drug for pain. Pain relief is weak at best and it takes forever to kick in for SWIM (2-2.5 hours even on a completely empty stomach).

    What kind of headaches does SWIY have? Tension, migraine or cluster?

    Where is the pain located? All over or is it confined to the left or right side of the head?

    Is the pain constant or throbbing/pulsating (like every heartbeat sends a pulse of pain)?

    Is the headache accompanied by any jaw pain or neck/shoulder pain?
     
  8. CCApollo

    CCApollo Silver Member

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    My headaches have been diagnosed as a Mixed headache syndrome, so tension and traditional migraine.

    Throbbing pain on both sides of my head, mostly forhead/temple area.
     
  9. Psychonaut72

    Psychonaut72 Newbie

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    For SWIM Excedrin works better than tramadol on tension headaches and sometimes worked when even 25 mgs of hydrocodone didn't fully relieve the pain. When SWIM didn't have access to any opiate pain medication, Excedrin was the next best alternative.

    The problem with opiates and over the counter headache meds is that they can cause rebound headaches when they wear off.

    For migraines, has SWIY's doctor prescribed a triptan medication like Imitrex or Maxalt? SWIM has two friends who suffer from migraines and both say those triptans have helped them immensely.

    Wikipedia's article on migraines has a good explanation of all the triggers (stress, food, weather, not enough sleep, skipping meals causing low blood sugar, alcohol) for migraines.

    SWIM's number of headaches has decreased considerably once SWIM stopped drinking alcohol completely, slept a lot more, and reduced stress.

    Also SWIY can ask SWIY's dentist if there is any evidence of teeth grinding or jaw clenching on SWIY's teeth. Grinding and clenching during sleep turned out to be a cause of a lot of SWIM's tension and migraine headaches. SWIM was then prescribed a blood pressure medication (Guanfacine) by his psychiatrist that almost completely stopped the nighttime teeth grinding and jaw clenching.

    If all esle fails, has SWIM tried going to a neurologist or a Pain Management clinic instead of a regular doctor?

    Hope that helps. Good luck, I know how debilitating constant headaches can be.
     
  10. CCApollo

    CCApollo Silver Member

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    I've done all the reasearch on my condition a hundred times over, and tried dozens of meds, including many of the triptan meds, such as Imitrex and Maxalt. Steroids, ergotamine, anti-depressants, depakote/other anti-siezure
    meds, and more. I'm done wasting my time trying drugs
    on a whim, which have little evidence to support their
    use for my condition.
     
  11. Dr_Janus

    Dr_Janus

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    Swim has been prescribed Tramadol in exactly the same way and has the exact same problems!

    He was referred to a neurologist and given an MRI as the Tramadol merely took the edge off.

    The problem here is that swiy is treating the SYMPTOM not the CAUSE. Swiy must seek professional advice and find out what is causing the headaches, then hopefully swiy can move forward and get some better treatment.

    Swim wishes you all the best luck and he hopes you find some treatment that works for you! He is still on tramadol/diazepam combo at the moment and the tolerance issue sucks!
     
  12. CCApollo

    CCApollo Silver Member

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    My doctors have given up searching for the cause, and I
    don't have the money to continually change drugs/test/ect.. I'm already in debt
    for spending a month in the Diamond Headach Clinic hospital in Chicago.

    I'm glad to have someone I can relate too, although Im saddened to know of others that suffer with constant pain without an accurate diagnosis or management regimine to
    provide relief.

    I recently started seeing a Pain Management Doctor, who is perscribing the Tramadol. He is against perscribing anything more, and it has been a pain in the ass to get my refills. They just don't answer the phone, and won't call back. My
    last refill was 5 days late. I left 4 voicemails, and never recieved a call back. It's
    rediculous. I am so tired of swithching doctors, because
    no matter what I do, it's always the same thing. No proper
    meds, poor service. The last 2 years have been beyond frusturating.
     
  13. Psychonaut72

    Psychonaut72 Newbie

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    SWIY can try Kratom
     
  14. I_8_my yellow crayon

    I_8_my yellow crayon

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    Do a search on torodol, or it could be spelt toradol, Im not sure, I just took my girlfriend to the E.R for a migraine, and thats what they gave her, it took it right away. All it is, is an anti-inflamitory.

    As for the other drugs mentioned, dihydrocodeine is very very rarely prescribed in North America. For some reason doctors don't see much use in it. It is no good for migraines IMO because it takes so long to start working, up to two hours.

    Codeine may work. SWIM is prescribed Codeine for headache's (tylenol 4). Its very sad, but it seems as though our southern neighbors doctors are really starting to throw any solution the involves narcotics, out the door. This dangerous drug tramadol is being prescribed more and more because they are so afraid to prescribe Lorcet, Vicodin or other like drugs. Which is ashame, because SWIM is no doctor, but he thinks Vicoprofen is perfect for SWIY. Its a combination of Hydrocodone and Ibuprofen. Its works very fast, and is potent enough that if one don't do it, then two definitely will.

    SWIM thinks that SWIY needs to try and find a doctor that is more understanding and willing to prescribe such a drug. That doesn't mean SWIY needs to go all out doctor shopping, or manipulating, but just needs to see a few different doctors, always tell them what the previous prescribed and turn in the meds. Don't matter where SWIY goes, nobody is going to treat them all day long with such narcotics just for headaches or migraines, the usual prescription boundries for such ailments are 15-30 per month.

    I realize the problems you guys are having down there with doctors and prescribing narcotics, and its also not your doctors fault, you have the DEA and all the junky''s faking pain to thank for that.

    There are hundreds of doctors in just one city, it may take some time, but keep looking. My uncle spent 4 years and thousands of dollars before he finally found one that was considering.

    Another solution, would be to contact an online consulation service(NOT online pharmacy) and they will tell SWIY where one of their closest doctors are located. Just do some homework. These outfits are pretty much offering pain med prescriptions legally in an "un-said" way. They are the most understanding, and not afraid of SWIY's country's law enforcement. These are people who are fighting for people like SWIY, so they can get adequate care, and medicines. This is actually a huge booming business in the USA right now. SWIY will still have to go see their doctor face to face, and may even have to travel hundreds of miles to see him, but its worth it. My uncle went this route, and he finally leads a pain free quality life. SWIM was actually the one who found the service for him, and they gave him a doctor. They are very expensive though, but no different then PM docs.

    Dislaimer: Please think about everything, and please note that narcotics should only be used as a last alternative. They are highly addictive, and many people start out with ailments that require them and do fine for some time, then all hell breaks loose. SWIM is a prime example. Be carefull. SWIM would stop the tramadol. Tolerance builds rapidly to this drug, and the withdrawal is hell, bad enough that not even morphine made SWIM feel much better, when suffering from tramadol withdrawal. SWIM hates tramadol, and thinks it should be pulled off the market. It is way overprescribed in the states. Thank god canadian doctors see no use for it, and prescribe codeine instead.

    Take care
     
  15. CCApollo

    CCApollo Silver Member

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    SWIM hate Tramadol too. Tolerance has built up very fast, for SWIM and won't go down. It makes SWIM's stomach hurt and his throat/mouth really dry, all while not helping very much. And the withdrawl SWIM went through last month when the doctor didn't bother to answer his phone/call back was one of the worst things SWIM's ever experienced. SWIM has been taking different Opiates (the most effective being Hydrocodone) for years now off and on. SWIM hadn't used in months before going on the Tramadol, but he still needed to take 4 pills to get some small relief. It's as if SWIM's tolerance level will never go down.

    Only once or twice did SWIM get nasty side effects from Hydrocodone, as apposed to Tramadol, which I get every time. I have to carry a water bottle with me everywhere to keep my throat/mouth from getting too dry, which makes the throw up. Add that to the stomach issues and the lack of appitie associated with it, and SWIM has a bad deal. Oh yeah, and SWIM's HEAD STILL HURTS! He wants to get on a proper pain management regimine, that will let him function in the real world again, but be safe and follow all legalities put in place by the DEA. SWIM is not a junkie, and he's not doing this for the drugs (although he's come to love it, he really is in this to get better, not to get high.

    My grades are awful now due to my condition. I scored a 29 on the ACT, one of the highest in my school, but my actual grades suck because of the time I spend out of school/lying in a dark room with a pillow on my head, trying to escape from the pain for even just a minute.

    This condition (and the lack of proper treatment) has already ruined my life. Because of it, SWIM has lost the chance to make it into College (which is OK , since he wouldn't be able to handle it), and SWIM doesn't have any money to spend anyway, thanks to the useless hospital stays and countless drugs. Ever since he started having this, he's spent more and more time alone, because he doesn't like to be suffering in front of a friend. SWIM doesn't want to make them have to try make him feel better. SWIM can't make plans for the future with friends anymore, because he never know when it's going to get worse, incapasitatng him for the rest of the day/days. SWIM's friends have all turned their backs on me because I'm never around anymore.

    Add this up to the recent death of my friend Andrew Koenig, and you can easily see why I'm upset right now. SWIM wishes he had some Lortab right now, just so he can have even just a half hour of relief.


    Anyway...sorry for the rant. I'm just really frustruated right now.
    Back to the topic at hand...


    I've heard of taking 50-100 mg of DXM before SWIM's dose could help with the tolerance, and extend the half-life of the drug. Is this true in any way?

    CCApollo added 11 Minutes and 0 Seconds later...

    For those interested, here is a Wiki page about CDH.

    SWIM has used every drug on the page besides Gabapentin, with no substantial results. This led his former doctor at Diamond Headache Clinic to diagnose SWIM with Chonic Daily Refractory Headache, due to the lack of responce to medications.

    CCApollo added 5 Minutes and 53 Seconds later...

    SWIM can't post the link due to being a neuuubie, so if interested, just search for Chronic Daily Headache at Wikipedia. Look for the page about management.
     
    Last edited: Feb 28, 2010
  16. Paradox

    Paradox Titanium Member

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    Do NOT combine DXM and tramadol. DXM + SSRI's can cause Serotonin Syndrome, a possibly fatal condition.

    SWIM can identify with what SWIY is going through. He has an undiagnosed condition that during flares amplifies all of the pain he feels. SWIM is also young and has similar problems with doctors being unwilling to prescribe stronger pain medications. SWIM was also pidgeonholed with the tramadol and had to beg and plea to get his hands on pain medications which actually provided relief.

    SWIY definitely needs to find a different doctor. It is very clear from SWIY's posts that SWIY does not have a proper, trusting relationship with SWIY doctor. SWIM went through two or three before he found a doctor who identified with him and was willing to understand that the issue was pain, not drugs. SWIM would also encourage SWIY to try to get a prescription for the gabapentin, SWIM found that it reduced the baseline pain and allowed him to take less of the strong drugs.

    The most important thing though is to not give up. You can not let this disease beat you. I would highly encourage you to reconnect with your friends. I know that showing pain around them can be very hard, but in my case, I found that most of my friends were supportive. Pain conditions are very strongly related to mood. I found that if I could do anything enjoyable, I would be in less pain and the pain would effect me less. It sounds like you have been going through a lot of things in addition to the pain and honestly, that can seriously worsen the pain. I would encourage you to find someone who you can talk to about your emotions regarding this situation. I can tell you that many of the members of this forum are some of the most supportive and caring people I have witnessed anywhere; especially online. I would suggest a professional also, but if you are tight on money, it can be much easier to open up online sometimes.

    Please don't give up. That is the number one worst thing you can do. And never accept that your life is wrecked. I strongly believe you will find relief and be able to move forwards with your life. You can take classes at the local community college and transfer into a larger institution. You ALWAYS have opportunities, sometimes they are just very hard to see.

    SWIM would also note that he has heard interesting things about psilocyblin and cluster headaches. Possibly something to look into.

    Good luck to you.
     
    Last edited: Feb 28, 2010
  17. Psychonaut72

    Psychonaut72 Newbie

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    SWIM's friend with migraines takes Neurontin (gabapentin) and Cymbalta daily and Maxalt if she feels one coming on and that greatly reduces her headaches.
     
  18. missparkles

    missparkles Platinum Member & Advisor

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    I8MYC...is dihydrocodeine prescribed in North America? Didn't think it was available there love? And it does begin working in 25-40 mins...usually, certainly not anything near 2 hours.

    But I do agree it's not that good for headaches. Personally, I've found that NSAIDs (non steroidal anti inflammatory drugs) work best, as you've already suggested. Usually a prep of pracetamol/codeine or ibuprofen/codeine works quite well. But people believe because it's an OTC (over the counter) meds, it's weak, and therefore useless for major pain.

    Level of pain doesn't give a very accurate indication of what pain meds will work. Basically, just cos pain is extremely severe doesn't mean strong opiate meds are required. For example, really bad toothache (crippling pain sometimes) doesn't respond well to strong opiate pain relief.

    Different types of pain, due to the various causes, may be better treated with non drug therapy. Some severe joint pain can be helped with manipulation therapy (physio) just as musculatory pain can be helped by steroid injections. Although the pain may be incredibly severe, until you find the cause, you're gonna be struggling to find a cure. Kinda hit and miss really.

    But always work up to stronger pain meds, cos as has already been stated, some pain meds can actually cause headaches. Bit like some benzo's can cause anxiety.

    The other thing, do you suffer from any sickness, notice any unusual sensory disturbances (visual or auditory) or notice any strange smells not normally present when you don't have a headache? I've found a link to a migraine site. It is a UK one, but the info is quite good, and it has some helpful tips.

    http://hcd2.bupa.co.uk/fact_sheets/html/migraine.html

    I hope you get something sorted soon sweetheart, to be honest I hate toothache and headaches, they're the only kinds of pain I find hard to function with. So I do sympathise...totally.

    Sparkles.:vibes:
     
  19. CCApollo

    CCApollo Silver Member

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    Not trying to ignore the above posts, SWIM is just in a hurry and looking for a quick answer.

    Would it be a better idea to space out small doses, instead of taking larger amounts (400 mg) at once? Like, say 100 mg, and another 100 an hour later, ect..until the desired effects are achieved, without going over 400 mg?

    CCApollo added 13 Minutes and 25 Seconds later...

    Also, is using small doese of Diphendydramine to potneitate the tramadol a good idea? SWIM can see how this could cause a problem, since it also acts as a mild SSRI, I've read.
     
    Last edited: Feb 28, 2010
  20. Paradox

    Paradox Titanium Member

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    SWIM has taken diphenhydramine while on tramadol and did not have any problems. Not that it's safe, mind you, but in SWIM's case nothing bad happened.

    In SWIM's case with the tramadol, he took two(2x50mg), then 3-4 hours later two more, repeating until it was close to bed time. SWIM was never able to sleep on the tramadol, hence the diphenhydramine.

    SWIM's body chemistry seems to be well suited to the tramadol though. He found doses around 200mg to be more recreational than his hydrocodone. The first time he took it he called his family and announced "I want to hug a puppy!" so SWIM's advice on tramadol might not be entirely relevant.