Pain Medication Part Three: Withdrawal is Real, but Still No Regrets

When we last left off, I had finally found what I hoped (what I still hope) was the actual answer to my debilitating back pain and had a revision surgery performed (specifically, a posterior lumbar fusion and laminectomy w/ screws and rods to revise to a prior anterior lumbar fusion w/ cages).

• Post-Op Pain, Medication Anxiety

Having been on pain medications for some time and having a tendency towards becoming adjusted to medications quickly, I'll readily admit the first days were torture.  It is harder to control pain when you've already been on pretty high levels of medication and while the press-for-more-meds pump helped a bit, it was rough going.  I had to remind myself repeatedly that the post-op period ends and appreciated my doctor's simple reassurance that "It WILL work" (I'd sworn I was going to scream "YOU did this to me!" when he came in, but he's simply too nice and truly has a stellar bedside manner).

I stayed on the same level of medication for a while, despite being a bit anxious to start decreasing the dosages.  My surgeon, my GP (who continued to write my pain med prescriptions both because he was local and because consistency is key in pain-land), and the clinical pharmacist (who served as an intermediary and really handled the medication management) all told me to give it time before I started to drop my dosages.  I asked about it more than once and they urged me to wait till a couple months had passed and then wait again as I started physical therapy.  They were right.  I couldn't have handled the next part earlier in my recovery.

• A Quick Aside on Pain Medication, the Body, & the Brain 

There are a LOT of traps with serious pain medication, but I'll reiterate that I don't regret the path I took and believe pain medicine helped me survive years of terrible pain by making it awful-but-survivable instead of completely paralyzing (note: I did need to go on disability, a topic for another day...).  I've already mentioned that my body quickly adjusts to new meds and new dosages meaning medication becomes decreasingly effective.

I don't like the word "addicted" as a descriptor for someone using pain medications as medically indicated, but "dependent" is pretty accurate.  Missing a dose of the longer-acting pills leads to pretty awful things...shakes, sweats, chills, and the incessant feeling of ants crawling inside your skin.  I'll get to the process of withdrawal in the next bullet-point, but suffice it to say a sudden stop is not only difficult but dangerous.

One more point on the "science" of pain medications.  I can't tell you the detailed reasons, but pain medications can actually cause pain....a lovely cycle, no?  When you go off pain medicine, you may face increased pain because of the changes in your brain chemistry and it is tough to know what is "real" and what isn't (the folks on House talked about this once and I believe House said something like "The torture is the cure.").

• Withdrawal

It would diminish the reality of this stage to make that heading anything other than the single word.  

Eventually, my team and I agreed it was time to start decreasing my medications.  This was done with a LOT of supervision and advice.  It was done slowly and actually slowed down more than planned because of how difficult the process was for me.  We started with the long-acting meds (oxycontin) and would adjust the dose down every few weeks....at first trying to decrease both AM and PM doses at once and then moving to doing them separately to ease the change.  It wasn't a matter of weeks, it was months.  

There are images we see in the media of withdrawal and dependence.  We see the recreational addict sweating and hallucinating through a complete, sudden withdrawal.  We might see a "Very Special Episode" where grandpa is confronted for using his hip surgery meds for too long and agrees to stop and all is well.  It is a bit different when you decrease properly used, long-term pain meds under medical direction. 

Truthfully, it was a pretty horrendous process.  I suffered night sweats, chills, nausea, and the aforementioned feeling of bugs crawling inside my skin (think severe pins-and-needles that last for hours and hit each limb in turn).  During one of the early stages, I called for help and wound up in line at CVS visibly shaking and feeling like an addict (again, I WAS dependent, but addiction implies a different mental state).  They added in a medication to help with the withdrawal (clonidine), though ironically I had to taper off the withdrawal meds to avoid withdrawal from them...

Simply put, withdrawal sucks.  I got through it by focusing on the goal, including proving to everyone (myself included) that I truly intended the medications as a temporary solution.  I also gave myself permission to wallow at times...sometimes you just need to allow yourself to feel sorry for your lot.  You can't stay there forever, but it is okay to "visit."  If I needed a treat to make myself feel better, I tried to allow it guilt-free.  And I may have had more than my usual share of red wine both as a mental treat and (honestly) to help my muscles relax (note: I'm not telling anyone to drink on meds, but I'd be lying if I said I didn't.  Knowing how the meds effect you on their own and paying careful attention to the impact of alcohol is critical if you choose to drink.  I'd also recommend not using formulas that include acetaminophen if you consume alcohol because it does bad things to your insides.).

• Withdrawal, Part Two

I celebrated the day I was finally off all the long-acting meds and probably announced it way too often.  But, despite the fact that I was still coping with the withdrawal symptoms, I was proud (and rightly so!).  I did continue to use the shorter-acting pain meds (oxycodone) as needed (typically twice a day, though I was permitted up to three per day by the label) for about a month and then we started in on reducing those.  Week-by-week, I went to 1.5 pills, 1 pill, .5 pill, and then none.  

This second stage of medicine reduction was been a bit different.  The physical symptoms did show up, but much less than they did at the height of the prior stage.  What I found hard here was the mental side -- I needed to face some of the pain head-on.  I'd gotten used to knowing I had a weapon when the pain got too high and I only wielded it (i.e. took the oxycodone) when I felt overwhelmed.  On the dreaded pain scale from 1-10, it was usually over a 7 before I'd "give in."  While the meds never erased the pain, they eased it.  I had to, over the weeks of this stage, pull on inner strength as much as I ever had in the years prior (ok, I also wallowed and indulged cravings a bit).

• Me, Drug Free 

I'm writing this a few several weeks before I plan to post it, but the day I'm starting this post is the third day I've been pain-med free in years (Tuesday on the week I went to 0 pills).  I've been urged to use a much lighter prescription medicine for the worst of days, in part because my history of hives puts a lot of OTC stuff of limits...it is another mental challenge to accept the "help."  I'm still pushing hard in physical therapy and we're readying to move and that is NOT going to be easy on my body and my stubborn mind insists I do my share of the packing

The truth: I still have a lot of pain, but I NEED to believe this is "my brain on drugs" (that phrase and the image of a fried egg it provokes totally date me...)....or perhaps more accurately "my brain off drugs."  The hope, expressed and believed in by my entire medical team, is that the pain will start to fade as my brain chemistry evens out.  

Postscript to come....

(Image Credit: Sue Clark)