re tapering off opiates

[Autienotnaughty78]

hi I have severe pain from a prolapsed disc. I spent ten days in hospital in November and left with 300mg tapentadol a day (2 tablets) plus paracetamol. I’ve since started having oc ibuprofen too which definitely helps. Over the next two months with physio and movement plus the meds my pain went from a ten to a very manageable 2 - 4.

Saw consultant 3 weeks ago who said I needed to start dropping the tapentadol so to start by going down to 2 x 100mg tablets. I did some reading and this felt like a big drop so did 50mg instead. So 100mg at night and 150mg in the day and was fine for a couple days then my pain started to increase going upto an 8. But mostly settling around a 6.

A week later I saw a different consultant who said I shouldn’t have started to wean without something to replace it but then also said I need to get offfthe tapentadol and on to something lower over the next few weeks. He said to see GP I have an appointment in ten days but never feel like the GP knows much.

Reading online suggests dropping 10% every week or two, but how do you know when to stop? And how do I know what’s pain and what’s the receptors in my brain reacting to the change? I’m really scared to drop further as whilst I can cope with being a 6 on pain scale I don’t want to be a 8 or higher as it’s awful.

Any advise on tapering safely?

[Autienotnaughty78]

and also if I am replacing it with something less strong what is the next step down from tapentadol? And how long can I take ibuprofen for?

[Bevvy in reply to Autienotnaughty78]

You need to discuss all of this with your gp. Or if you have a pharmacist at gp surgery they might be helpful. I don’t know the main medication you are on but it sounds to me like 10%is a big drop over a relatively short amount of time. If it is anything like Tramadol you have to wean off very slowly. You might find it much easier if you drop down and keep it at each new level for more like 3 weeks.

With regards ibuprofen. Whilst it is an over counter medication it needs to be treated carefully. Really you should only take it for a few days and not long term. At one point I was taking it long term but that was with the knowledge of my gp. Plus I had been given other medication omeprazole to protect my stomach.

You have an appointment soon so I would be hesitant to reduce your medication any further until then. Also I do think you should consult a pharmacist about taking ibuprofen to gauge their opinion as to whether it is safe to continue until you see gp.

[Autienotnaughty78 in reply to Bevvy]

Thank you good advise, I’ve decided now the pain has stabilised to take ibuprofen if needed rather than every dose. I’ll not drop further until I see GP. I’d be reluctant to until my pain drops a bit more.

[OSTEOARTHRITISRA]

Hi i agree with the consultant with something to replace it Where going to do that with me ,then decided to increase a med i was on to max dose and halted the other med at same time Seemingly another way to taper without tapering apparently I questioned it but no they said it would be fine ,I'd contact doc and mention about the settling at 6

[kev60]

Hi, I have just weaned off buprenorphine 30mcg patches, I started on 5mcg per week and worked up to 35mcg but that turned out to much (made me sick) came down to 30mcg which worked just took the edge off the pain so about 6-7/10 . My consultant told me to rip it off but my gp said no had to drop 5mcg per week. So took me five weeks over Christmas as well, the pain hit as soon as I dropped the first 5mcg (8-9/10). Week 5 they gave me nefopam but no help they have since upped the nefopam twice but still no change just lots of pain. I dealt with the practice pharmacist and have to update them weekly. Unable to take ibuprofen due to reflux but take 8x500mg paracetamol. If your practice doesn’t have a pharmacist use the local chemist they are always willing to help. Good luck. Kevin

[Autienotnaughty78 in reply to kev60]

Yeah pain going back upto a 9 is my worst nightmare. No pharmacist there is one in local chemist I can ask advice for but they don’t have any involvement in my care.

[CinnamonRose]

If your pain goes up when you lower the dose you definitely need something else if you are intending to lower the dose. Have you Googled it? There's lots of info if you do, I had to as I hadn't heard of it before. I'd wait for them to take you through the lowering the dose rather than going it alone, especially if you say the pain goes up. Living with pain at 8 is unbearable and far worse for your body!!If you're in more pain when you reduce the drug there's no benefit to you for lowering the dose, pain is so miserable and wearing!!

If the drug suits you and means that you can function better in every day life I would want to make very sure that the Dr would prescribe them again if what they offer as an alternative isn't as successful/or if lowering the dose increases the pain.

Don't be afraid to ask, it's your life, your body and only you know how you feel and function whilst in pain, and really if you think about it, why should you have to live in pain?

I've had many folk ask me about how morphine affects me and aren't I worried about getting addicted, getting brain frazzled etc, no I'm not worried, a good friend who was a Dr told me if your body needs it, it will utilise it, it's when people take it that don't need it they get addicted. I've also got a very old friend, she's now 100, she's got all of her buttons and is very alert and gets out and about but doesn't drive anymore (!) she's been on Morphine for over 40 years, just telling u that to reassure you.

Naproxen 500mg is probably a better/more effective option than ibuprofen and they'll give you the Omiprazole to go with it, I take 2 a day extra to Oxycodone when my backs ready bad.

Good luck, keep in touch to let us know how you get on

Kindest regards and a gentle virtual hug xxx

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[Autienotnaughty78 in reply to CinnamonRose]

Thank you I’ve been taking lansaprozle daily since I was in hospital. I’m ok with the pain being at a 6. I can do my physio, short walks and sit for short periods. I prefer lower as my quality of life is better obviously but I’m also scared of opiate addiction/tolerence. But I know I need them to keep moving. I think it’s worse that I’m on tapentadol as my gp doesn’t know anything about it . If it was morphine it might be easier

[110201]

Hi there, sorry to hear you’re in such pain but glad it’s easing some also.

I had a spinal fusion in May 24 and came out of hospital on 100mg x 4 daily of Tapentadol. I was also taking amitriptyline 25mg at night and paracetamol during the day.

My gp would only prescribe a weeks worth of Tapentadol due to it being a class b drug, when it came to tapering we did it very very slowly and by 50mg at a time. Some weeks were better than others, some were not so it seemed like an age to be off them completely.

So my tapering went from 100mg x 4 to 50mg x 4 tablet by tablet, then started dropping the 4 remaining tablets. My system from a nerve pain respect was however assisted with the amitriptyline during this.

At times I also switched out the 50mg to a 25mg before coming off them completely. Once off them I then found that I still had a pretty constant 7/8 pain level so moved on to codeine.

Tapentadol I was informed is a strong painkiller with a nerve pain killing element to it as well. Therefore it may prove beneficial moving onto codeine/tramadol and something for the nerve pain, similar to how my journey played out.

As much as I still take the amitriptyline I’m down to taking between 2-4 30mg codeine per day as my recovery is a 12/18month process. As others have mentioned and as with any anti inflammatory a stomach protector is wise also.

We’re all different and respond to these things differently. Please advocate for yourself with the gp, don’t rush it and go at your own pace and what you’re comfortable with.

I do hope you continue to improve and your pain eases over time. Please keep us updated with your journey, good luck! X

[Autienotnaughty78 in reply to 110201]

It’s so good to hear from someone with a similar experience (medication wise) how many weeks did you leave between reductions?

[110201 in reply to Autienotnaughty78]

My titration was easier as I was on 100mg x4 daily, I dropped by 50mg and took 3x100mg and a 50mg daily and spoke with my gp weekly. We reduced as and when I agreed when I was happy to drop another 50mg on one of the doses and subsequently got to 50mg x4 daily, post that I dropped one altogether or with a pill cutter dropped to a 25mg dose. It did take sometime but I was able to come off without any side effects at all. My gp was however reluctant to prescribe the codeine until I was off of the tapentadol completely. You could try suggesting you spread the 300mg over 3 doses per day then if/when you feel ready drop by either 25/50mg on one dose and so on. I would definitely recommend 2 x paracetamol 4 x daily to help some and if you’re finding anti inflammatories effective then they could also be introduced whist coming off the tapentadol. I believe morphine is stronger than tapentadol so a drop down I’ve read over and over on spinal pages tends to go to either codeine/tramadol. Obviously it will all depend on pain levels and what type of pain you’re experiencing, possibly a nerve pain med may be more effective, just be careful and they all seem to have some form of side effect… please let us know how you get on and if you’ve any other questions feel free to ask away… 😃

[Autienotnaughty78 in reply to 110201]

Thank you for your help. I’m on the slow release tapentadol so pill cutting or delayed dosing isnt an option. Weirdly though I was taking a 100mg at night and an150mg in the day and I had to swap my morning meds to a 100mg and a 50mg tablet, same dose but two tablets.. My pain has dropped to a manageable 4/10. No idea if it’s coincidence or if taking two tablets has made a difference but I’m taking the win for now.