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Please can someone tell me how to deal with tolerance

Hi

I have just started to use tramadol which is helping with my pain, I am on very very worried about tolorence and how to cope with it, is what to do when it stops workong.

I take 2, 50mg on the morning and 2 at night time which is helping really don't know what to do

Thank you

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1

Comments

  • What is your purpose for taking Tramodol? A bulging or herniated disc? Is the intention to have a monthly script for it, for many months to come? Are you treating acute pain or chronic pain?

    Tramodol is a Schedule IV medication so I wouldn’t worry too much about tolerance/addiction. The amount you’re taking daily is only slighter more than what the equivalent of a 10mcg/hr Butrans patch would deliver.

  • memerainboltmemerainbolt IndianaPosts: 3,437

    jonisingt
    Welcome to Spine-Health

    Please click on the Welcome link below as well as the Tutorial to start on the forum.
    Welcome to Spine Health

    It is very difficult for anyone to respond when we do not have enough information to go on.
    If you could share a little more information with us, it may improve receiving responses from members with shared experiences.


    Sandra
    Spine-Health Moderator
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  • jonisingt35rjjonisingt35r Posts: 165
    edited 11/25/2017 - 12:23 PM

    I suffer sciatic pain all over really in my kneck legs and lower back severe pain.

    I am very frightened to take it to be honest I did start to take 2 at a time but I'm trying to get away with taking just 1.

    Bit I know I should be taking 2 at a time for a better quality of life.

    I'm starting to read good things about methodone.

    People have bees using it for 19 years or still

    Works. Frightened to ask my doc about this if I am honest.

  • sandi123ssandi123 Posts: 474
    edited 11/25/2017 - 12:50 PM

    Jon, What are the dosing directions? 1 or 2 tramadol at a time? Typically, if the directions say Take1-2 tablets every X hours, the doctor wants you to start with the lowest quantity (1) and ONLY if that fails to relieve your pain levels enough to function in your daily activity, should you then take the 2nd. We ALL have to follow the dosing directions on the bottles exactly, or risk losing our pain meds.

    Doing that helps prevent tolerance, because YOU aren't getting your body accustomed to having a steady higher dose of the medication in your system. It also keeps that 2nd dose to relieve flare ups quickly if you aren't taking it on a regular basis.

    A jump from tramadol to methadone is HUGE, and most pm doctors won't consider it at this point.

    Methadone has it's own problems and concerns, as well as risks. If you are managing with Tramadol, stay away from methadone.



  • Well I had a discuscussion with my doctor and asked him if I could take 2 at a time which said was OK.

    I normally take 2 when I awake and 2, 6 hours later

    I'm just petrified about tolerance it makes me cry, about the fear of pain.

    I just see lots of people have got their lives back on methadone and have been using it for many years.

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  • Jon,

    Reading your posts, it seems the tramadol is relatively new to you, as far as how long you've been on it and you are worrying about building tolerance pretty quickly.

    Tolerance issues occur over extended periods of time, not in relatively short time frames, unless you consistently supply more medication than your body really needs.

    The goal of treating chronic pain is to REDUCE it, manage it....not eliminate it. Chronic pain management goals are typically a reduction of unmediated pain levels by around 50%. With ANY pain medication therapy, less is more. The least amount of medication you can use, that allows you to perform activities of daily living- self care, minor housework, work, school, is the goal.

    If you are consistently taking 2 tramadol, twice a day, you are leaving nothing for really bad flare ups. You are also artificially creating 'tolerance ' concerns because you are teaching your body to expect a set level of medication, and your brain will quickly set about convincing you you are no longer receiving the same pain relief you once were.

    I have been on oxycodone for breakthrough pain for 16 years. It is just as effective today, as it was in the beginning, because I seldom take it, only when absolutely necessary, and I always start with half...if that relieved a flare, great, if not, I wait an hour, and take the other half.

    As far as methadone goes, there are major concerns with methadone, because of its extended half life, in some people it causes changes to heart rhythms, and it is typically used when lesser options have failed.



  • Methadone can interfere with your QT intervals.

    In pain management it’s used at much, much lower doses than at a methadone clinic.

    Because of its very long half-life, as sandi pointed out, it’s commonly dosed just twice daily by PM docs (for example 5mg twice daily to start).

    And the doctor may even suggest splitting the pill in two so you’re initially taking 2.5mg twice daily.

    Always best practice to take the minimal amount of any opioid, not just when initiating treatment but at any time.

    The lowest amount to make life/pain more bearable (not perfect).

    Pain management is just that: pain management.

    The goal is not to get rid of your pain but to manage it.

    Having said all that, I would stay with Tramodol.

    You don’t want to go from a Schedule IV to a Schedule II overnight, especially when Tramodol is helping.

  • jonisingt35rjjonisingt35r Posts: 165
    edited 11/29/2017 - 5:49 AM

    Well the problem is I'm in pain all the time how do I use it then ?

    I managed to use just 100 mg yesrerday

    I'm hopefully getting a pain pump asked my doctor about it yesterday.

    I'm 48

  • Jon,

    WE ALL are in pain, all the time, regardless of the type of medications. That's why it's called chronic pain.

    The reality is that we are going to always have some level of on going pain, even WITH medications. The difference in treating chronic pain is understanding that some level of pain is tolerable, and normal and as long as we can perform most of the activities of daily living, we can function, making adjustments in activities and ways we do things. There is no magic answer in managing chronic pain, it is a series of things, used together that help manage the pain levels. Ice, heat for some, muscle relaxers, nerve pain meds, physical therapy, injections, regular exercise, topical treatments, ointments, TENS .

    The meds help, yes, but they can not be the sole method you rely on.



  • I just really struggle to take my meds I know I should take them 3 rimes a day to function properly but I am petrified of tolerance

    I'm trying to just take them at night time 2/50mg tramadol to help sleep

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