| ASKTHE EXPERTS Q: I use OxyContin on a regular basis for 2-3 years now for chronic pain. Am I at a higher risk of difficulty coming off of the meds, and possibly need rehab to discontinue them? | Answer: Prolonged, appropriate, use of any opioid, including OxyContin, for a legitimate medical purpose can lead to a situation where you might undergo withdrawal if you stop the medication. This situation should not be considered "addiction." It is a normal response to the use of the medication. There are many medications we use which should be tapered off (slowly discontinued) when no longer required. For example, if you are on steroids, certain high blood pressure medicines, or anti-seizure medications; these drug dosages should be slowly reduced (tapered) rather than abruptly discontinuing the drug. This is a medical issue and should be handled by your prescribing doctor. In like manner, tapering off of your OxyContin is a medical issue and should be handled by your doctor in case you do have any withdrawal symptoms. There are many ways to wean off of medications. Generally, if you have time, gradually lowering the dosage of the drugs is the easiest. Rehabilitation centers tend to focus on people who are taking the medication because they have a craving for the opioids, where they give up social activities because of the opioid use and center their life around getting the drugs �?rehabilitation centers focus on people who are addicted. As a rule, people who are taking the opioids for a medical reason don't need to go to rehabilitation centers to get off the opioids. If they do, it is because they find the withdrawal symptoms to be a problem rather than that they need the support to control any desire to keep taking the medications. Thank you for your question. Medical Author Dr. Standiford Helm II
Medical Editor Dr. Melissa Conrad Stöppler Last Editorial Review: 2/20/2007 v v v Q: How do I withdraw from Percocet? | Answer: Percocet is a combination of oxycodone and acetaminophen. Oxycodone is a Schedule II opioid and can lead to physical dependence. It is very likely that if you abruptly stop taking Percocet ("go cold turkey") that you might have withdrawal symptoms, including flu-like symptoms, bone ache, tremors, goose bumps and diarrhea. While withdrawal from opioids is not fatal, it is also not pleasant. To avoid withdrawal symptoms, you should consult with the physician who prescribed the Percocet to discuss what options you have to taper off of it. These would include a gradual tapering (reduction in the dosage), entering a detoxification facility, or switching to a medication like Suboxone to wean off the medication. If you have been using the Percocet recreationally rather than for a medical purpose, you should consult with either an Addictionologist or your personal physician on how best to deal with the addiction issues. Suboxone was specifically developed to allow for office-based treatment of opioid dependence. It is most effective if combined with counseling, including Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Thank you for your question. Medical Author Dr. Standiford Helm II
Medical Editor Dr. Melissa Conrad Stöppler Last Editorial Review: 2/20/2007
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Q: I suffer from chronic back pain and take pain medication frequently. I often suffer severe pain episodes, or spikes in pain. I was told this is "breakthrough pain." What is breakthrough pain? And is there treatment for it? | Answer: For people who suffer pain all of the time, the concept of breakthrough pain addresses the fact that the level of pain experienced can vary throughout the day. The pain can vary because of different activity levels, medication wearing off, or just "because it does." If a patient were given enough medication to treat all of these spikes in pain, they run the risk of having side effects from being over-medicated. Because pain medications are provided to help improve overall patient function, these side effects are undesirable and should be avoided. The goal is to provide enough sustained release medication to meet the patient's baseline needs, and then add supplemental short acting medication to take when the pain spikes occur. The only study on breakthrough pain was done in cancer patients. It found that up to about three spikes in breakthrough pain occur during the day. In general, the limit on prescription of medications for breakthrough pain is about three or four doses per day. Thank you for your question. Medical Author Dr. Standiford Helm II
Medical Editor Dr. Melissa Conrad Stöppler Last Editorial Review: 11/28/2006 v v v Q: How does pain medication lead to "rebound" headaches? | Answer: Rebound headaches are one of the most common causes of daily headache. They occur when you take a medication for a headache, the headache goes away and then returns; and you take another pill and ultimately become dependent on the medication to avoid having the headache. Instead of taking the medication to get rid of the headache, you are now in a situation where the absence of the medication causes the headache. This can be caused by any of the medications used to treat headache, including over-the-counter anti-inflammatory drugs, narcotics, and anti-migraine medications. The treatment is to wean the patient off the medication. The mechanism by which rebound headaches occur is in unknown. Some writers have suggested that the body becomes tolerant to the medication, but that does not explain why so many different types of medication can cause rebound headaches. Thank you for your question. Medical Author Dr. Standiford Helm II
Medical Editor Dr. Melissa Conrad Stöppler Last Editorial Review: 11/17/2006 v v v Q: I've read that pain medication affects men and women differently, is this true? | Answer: There is no gender difference in how pain medications affect men and women. However, you bring up an interesting topic which will be a major issue in the future, which is the difference in how different people metabolize drugs and how this difference determines their responsiveness to drugs. Many drugs are metabolized in the liver by a process called the cytochrome P450 system. This system has many different subtypes, with different drugs being metabolized by specific subtypes. One issue is the interactions which can occur when two drugs using the same metabolic system subtype are given to a patient. A second issue involves the variations which exist within any subtype. One person might breakdown a pain medication into inactive by products very quickly. Such a person would have little of the active drug present and would get no effect from the medication. Another person might be unable, because of the genetic variation, to metabolize the drug at all and would be at risk for overdosing. One of the exciting new frontiers of medicine will be the ability to determine, which genetic variant of a cytochrome P450 subtype any given person has and then, from that, determine how they would respond to a specific drug or combination of drugs. Thank you for your question. Medical Author Dr. Standiford Helm II
Medical Editor Dr. Melissa Conrad Stöppler Last Editorial Review: 11/14/2006 v v v |
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