1. < Chronic Pain

Questions & Comments about tapering off morphine (Kadian)

Posted by elsa @elsa, Feb 18, 2018

Hi. I'm a new member of the Chronic Pain Discussion Group and I will be going through the 3-week pain rehab program in Rochester next month. Knowing that Mayo requires patients in Pain Rehab to taper off their opiates, I decided I would begin the tapering in advance, under supervision of my local pain management doctor. I was taking 60mg Kadian daily (3 times a day: in the morning, mid-afternoon and bedtime) I was also taking up to 3.5 hydrocodone per day for "breakthrough pain". My local doctor had be drop from 60mg to 40mg for 2 weeks, then from 40mg to 20mg for three weeks, and I have been off all opiates for 4 days now. Only in the last 2 days have I been experiencing the following withdrawal symptoms: 1) sleeplessness in the early morning (e.g., 4:00 am for 3.5 hours. Finally took 2 xanax to fall back asleep), 2) diarrhea 3) increased nerve pain 4) marked increase in anxiety.
When I was at 40mg daily I felt optimal. I was calmer and my pain was not as bad as when I was at 60mg!! Then when I dropped from 40 to 20mg, I began to have higher pain but I toughed it out. Four days ago, when I dropped to zero, was the first time during tapering that I developed diarrhea, high anxiety, higher pain and an inability to sleep through the night.

I wish I had waited to begin the taper till I arrived at the Pain Rehab Program because I think my local pain MD is not aware of "best practices" for tapering off opiates. It's my observation that my local Pain Clinic is still predominantly in the business of writing Rx's for opiates and does not know nearly as much about getting patients off opiates. That said, being a former university librarian, I was able to search the medical literature and came up with the following power point presentation on "Weaning Off Opiates" by David Gilcrest at UMass Healthcare: http://masspaininitiative.org/files/DGilchrist_MassPI_Spring2017.pdf
as well as this "open access" review article:
Suttner, J. et al. “Best Practices in Tapering Methods
in Patients Undergoing Opioid Therapy”. Advances in
Pharmacology and Pharmacy. 2013;1(2); 42-57.
After reviewing these sources (which, by the way, you can simply cut and paste into your web browser), I realize that I think my MD should probably have decreased the amount of Kadian I tapered as I approached lower doses. I also wish he had warned me about the diarrhea and sleeplessness in advance. These withdrawal symptoms hit on a Friday night and I'll have to wait till Monday to call my doctor and tell him what's happened. In the meantime, I'm heading to Walgreens for some Pepto Bismol and Melatonin and to speak to the pharmacist.

BTW, I haven't used any hydrocodone in 5 weeks (haven't felt any negative effects!) and I'm planning on trying low-dose naltrexone when all the opiates have washed out of my body. Overall, I'm feeling better than I would have predicted at this point and I'm really looking forward to coming to Mayo in a few weeks.

I'd welcome any insights or comments from members who've already gone through the Pain Rehab Program and tapered off their opiates. In particular, I'm wondering how long will it be till the withdrawal symptoms end? Thanks much!!

Interested in more discussions like this? Go to the Chronic Pain Support Group.

Gary, Alumni Mentor | @gman007 | Feb 20, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

Did you have some clearing of brain fog? Better short term memory? I recognized both in the extreme - I had been on the max dose of about 3600 mg/day.

REPLY
Gary, Alumni Mentor | @gman007 | Feb 20, 2018

I agree with Jim. If I were off my opiates, it would only be because my pain level had become significantly lower and then I would not need pain rehab. I know you were just repeating, but it sounds odd to me, but what do I know?

REPLY
1 reply
elsa | @elsa | Feb 20, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

I'm not sure to whom you're addressing your question. Are you referring to 3600mg of **gabapentin**? I assume so because I know that 3600mg is the label max for gabapentin.

I started this discussion thread about tapering off **Kadian (morphine)**. Other people are posting about getting off Lyrica and gabapentin, neither of which is an opiate. The posts are interesting and I have no objection to them, but I'm disappointed not to hear anything about tapering off opiates, and specifically, morphine.

I do very much appreciate suggestions about waiting to taper till I get to Mayo. Unfortunately, I am now on Day 6 on zero morphine. I began to experience withdrawal symptoms on Day 2 of zero morphine. By "withdrawal symptoms" I mean: wakefulness during normal sleep hours, heightened anxiety, heightened pain, diarrhea. It is the heightened pain that is most distressing.

I've been waiting more than 24 hours to receive calls back from a nurse at Mayo Pain Clinic and from my local pain doctor. What I want to know is: at this point (i.e., Six days off all opiates) can I expect the pain to still improve and how long is it likely to take? I have no objection to returning to 20 or 40mg per day of morphine but I'd really appreciate some **guidance**, particularly from any nurse at Mayo Pain Clinic, but also from my local pain MD.

--Elsa

REPLY
elsa | @elsa | Feb 20, 2018
In reply to @gman007 "I agree with Jim. If I were off my opiates, it would only be because my..." + (show)
@gman007

I agree with Jim. If I were off my opiates, it would only be because my pain level had become significantly lower and then I would not need pain rehab. I know you were just repeating, but it sounds odd to me, but what do I know?

Jump to this post

A nurse at Mayo told me I could begin tapering at home (before getting to the Mayo's Pain Rehab Program) if I wanted to. Seeing I have a local pain medicine MD, I thought it would make starting the Rehab program easier if I'd tapered off morphine + hydrocodone before I got to Rochester. I stopped taking 3.5 hydrocodone/day >5 weeks ago, without consequence. I dropped from 60 to 40mg and felt less pain! Pain increased again when I dropped from 40 to 20mg but I persevered. It's only now, at zero opiates, that it's gotten really hard.

REPLY
Gary, Alumni Mentor | @gman007 | Feb 20, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

@elsa, I did post a response to tapering and discontinuing morphine (mine is/was Dilaudid which is a synthetic that the body converts into morphine. I think my original post shows just below this one. I posted about gabapentin as I did not realize my reply was in the original thread of your question about tapering off morphine. Sorry if I created any confusion.

REPLY
elsa | @elsa | Feb 20, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

Hi Gary, thanks for your clarification. I apologize for not paying closer attention to your post. I didn't know Dilaudid is an opiate!!

(I'm a bit confused about how these "threads" work. In particular, when you post a reply, is the convention that you're replying to the person who posted directly above you? It seems if one person's reply diverts the original topic to a *related* topic that doesn't address the original topic, then other members reply to the off-topic post, and pretty soon the majority of posts can be about a number of things that are really quite different from the topic of the thread. Correct?)

BTW, I spoke to a nurse at Mayo this afternoon as well as my local pain doctor. Am going back up to 20mg Kadian tomorrow morning. If my pain isn't better controlled at 20mg after a day or two, I'll go back up to 40mg/day. Glad that I don't have to tough it out at "zero" for much longer!

REPLY
Mentor
Jim, Volunteer Mentor | @jimhd | Feb 20, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

@elsa

In order to respond directly to a comment, you need to put their @name somewhere in your post. I always do what I did here, putting the name at the top.

Jim

REPLY
Mentor
Jim, Volunteer Mentor | @jimhd | Feb 21, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

@elsa

I have peripheral neuropathy, with pretty serious pain in my feet. I started taking morphine sulfate contin at almost the same time as Cymbalta, so I had no way of knowing what effect each one was having. So, I tapered off morphine, 30mg three times a day, over the course of a few weeks. I learned that the morphine was probably doing most, if not all, of the pain treatment. I later stopped the Cymbalta, and found that it was doing less than nothing.

I don't remember what withdrawal was like because I was just trying to learn if it was the morphine or the Cymbalta that was helping my pain. In the process, I figured out that Cymbalta was having another undesirable side effect, that being ED. I went back to morphine, but I was able to stop at 15mg twice a day.

Jim

REPLY
Moderator
Justin McClanahan, Moderator | @JustinMcClanahan | Feb 22, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

@lioness and other members discussing Kratom, you may find the following news release from the FDA on Kratom worth reading,https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584970.htm.

REPLY
elsa | @elsa | Feb 22, 2018
In reply to @cdcc "You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think..." + (show)
@cdcc

You sound like me coming off Lyrica: my withdrawal symptoms were so severe you would think I was a heroine addict! Started coming off 300mg in Oct, tapering using the schedule I was given. I went into a month of severe diarrhea, depression anxiety panic. I am still suffering with these three. I still have to withdrawal from 50 mg starting tomorrow with decreasing to 25mg for a week then no more. I lost 28 lbs in a month down to 101 now not good, my skin is sagging, my boobies shrunk lol. I finally had to get a psychiatrist to help me with panic and anxiety. I know now why people commit suicide , I was even in the ER for dehydration and severe nausea, gagging you name it. So each morning when I awake I wonder what the day will bring me. The psychiatrist has given me a very low dose of Ativan to help. I do a lot of deep breathing, and I still cry a lot wondering how this prescription drug Lyrica could do this to me let alone anyone else trying to come off of it. I. Surprised I haven’t ended up in a mental institution sitting in a corner doing jigsaw puzzles. I. So thankful and cry I have such a loving caring husband of 48 years

Jump to this post

Jim, I'm glad you were able to get down to 15mg morphine sulfate contin 2X daily. That's a big decrease! Yeah, so many antidepressants have sexual side-effects. I've taken antidepressants for lots of year (since before the chronic pain which started 8 years ago). The sexual side-effects are a real pain, but I'd take them over being in a hellish state cuz of depression. Now I take effexor and sertraline. I hope I can stop the sertraline at some point, or at least reduce the dosages.

REPLY
View MoreView Less
Please sign in or register to post a reply.