Nightdancer what do you think

[beady3]

Hello nightdancer, I am asking for your advice , I was on 100mg tramodol 150pregablin and 2mg patch Well the night I were having something wasn’t working, went to docs who doesn’t know much about rls , came away starting to come of Tramodol and increaseing pregab to 300 and patch 2mg, should I have a break from the patch say a month then go back on it , I could do this on my own without going to docs as he. expects me to know what I want. I have had rls for 48 yrs so the prob is difficult , thank you so much xx

[Hidden]

Hi beady, i have sent you a PM on here.

[beady3 in reply to Hidden]

Thank you Elise where do I look for your post x

[Hidden in reply to beady3]

beady click on the chat its at the top of the page. thats where private messages are. x

[nightdancer]

Well, first of all, hi. You have a lot going on med wise. I am not sure that Tramadol should be the first med you get rid of. If you are augmenting, then it is the patch not working. If you are thinking about a vacation from the patch, which a lot of people do with some success (Pippin does vacations) then I would NOT be reducing the tramadol. Stopping the patch will out you into DAWS (dopamine withdrawal syndrome) and that withdrawal will be HELPED with the tramadol. You still will have withdrawals, but since the doctor expects you to know what you want, tell him about the patch, the vacation, the tramadol should actually be increased during the vacation, because the word "vacation" makes it sound kind of nice and it is not. xx And the pregabalin will not help much, if at all, during the vacation, as RLS will increase and the tramadol should be the med to help with that. This is also what DR Buchfuhrer and Dr. Silber have in the paper. "When it is appropriate to use opiates in the treatment of RLS" But, only one med change at a time, or you will never know what is working and what is not. It is all a puzzle, a never ending puzzle. That is how it is done in the majority of RLS Quality Care Centers also. (in the US)

[beady3 in reply to nightdancer]

Thank you nightdancer for all the information, it’s a bit complicated isn’t it , I do get nights when I sleep all night and I get nights when rls doesn’t go untill 3,00 in the morn, so do you think I am augmenting or what should I do, a bath always helps me

[nightdancer in reply to beady3]

IF you are still getting nights where you sleep all night, then that is not in the context of augmentation. Augmentation means worsening symptoms, and usually starting earlier in the day. I just think that maybe the patch is not working as well as it could, since you have been using it for a while? Since you will be talking about this with your doctor, I do not think you are augmenting, just becoming a little tolerant of your patch, especially. So the vacation idea will reset some of that tolerance, and the usual "drug holiday" should last for about a month, average. BUT, I do know messing with 3 different meds at once, stopping one, reducing the dose on another and going to increase another, that is 3 changes at once. Dr. Earley, Dr. Buchfuhrer, Dr. Silber, and many, many more RLS experts and doctors with active RLS practices all believe that "drug holidays" help, and I have seen it many people. A lot of the people in the Facebook groups do it regularly, and schedule their holidays with their doctors. It just does not sound like augmentation. Everyone has a few nights that are bad, and no one gets quiet nights all of the time, including me. My meds are as tuned as they are going to get, with all this pain med business over here in the US, and still there are bad nights, sometimes days. Also, the top dose for the patch is 3 mgs, so if 2 mgs is failing, the idea is not to raise the dose, since THAT can cause augmentation, it is only in the dopamine meds that augmentation happens 99% of the time. So, that is my humble opinion, and what I have observed, and learned. x