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Are Percocet And Tramadol Right Choice Of Treatment For Neuropathic Pain?
Question: Thanks for your time. I had lower back surgery a little over five years ago. I have Cauda Equana Syndrome. I have been on 10 Mlg Percocet and Tramidol for the last 5 years. I was taking 4 Percoset a day with the Tramidol for break through pain. In November of last year my dr. ( surgeon) sent me to a pain specialist. The appointment was two and a half months from the last visit with my Dr. In that time span the Dr. Stopped my Tramidol, without warning. In the next two and a half months I ran out of my Percoset before the end of the month. When I saw the pain specialist I relayed this information to her. I informed her that the last month I ran out after two weeks and could I be put back on the Tramidol ? The answer was no. Try Lyrica. That made my vision blurry and did nothing for the aggregation in my legs and feet. She did give me a perscripttion for Percoset. Knowing already I would run out early. In two weeks she called me up for a pill count. Knowing I wou run out. I feel it was a trap .No idea that was coming since I haven't had one in five years!! She sent me to a Suboxen clinic .after three urain samples and giving three viles of blood I was told I was not a candidate for that program. Now I have been without any type of relief of my pain and aggregation in my legs, for three weeks. The Pain specialist has now released me saying there is nothing I can do for you anymore !! My quality of life has gone way down. In your opinion what would be my next option?
Brief Answer:
Treatment for neuropathic pain with antidepressants is 1st choice.
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at your previous treatment with Percocet and Tramadol I must confess I wouldn't have agreed with it either. They are both opioids carrying a potential for tolerance and addiction. Neither is recommended as a first choice for the treatment of neuropathic pain present in cauda equina, they can be added only as a second (Tramadol) or third choice (oxycodone which is present in Percocet) when all other treatment fails.
Anticonvulsants like Lyrica or Gabapentin are a good 1st line option for neuropathic pain. If that wasn't enough for you or caused many side effects I believe antidepressants should be used which are also a first line option, like SNRI group (Venlafaxine, Duloxetine) or tricyclic group (Amitriptyline, Nortriptyline). Combinations like Venlafaxine + Gabapentine are also possible.
2nd line option which can be added is Tramadol with Percocet only as a third line option.
So I do agree that new therapy should be instituted and Percocet interruption should have been done, however its interruption should have been gradual to avoid the withdrawal symptoms.
I am not sure by your story what was the proposed plan from the pain specialist initially, did she give you a prescription for a lower daily dose of Percocet with the aim of reducing it gradually? Did she become "upset" because you took a higher dose than she advised?
Even if you didn't comply with her prescription I don't agree with her quitting you, a pain therapist should be prepared to accept to a certain point dealing with patient addiction issues and should try to deal with that.
So to sum it up I recommend starting treatment for neuropathic pain with an antidepressive, if that fails Tramadol OR Percocet can be added later, but under regular dose supervising due to the potential for addiction (because of which those call ups which you called a trap are necessary).
All of those are prescription drugs though, so you need to be prescribed and followed by a doctor preferably pain specialist.
I remain at your disposal for further questions.
Treatment for neuropathic pain with antidepressants is 1st choice.
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at your previous treatment with Percocet and Tramadol I must confess I wouldn't have agreed with it either. They are both opioids carrying a potential for tolerance and addiction. Neither is recommended as a first choice for the treatment of neuropathic pain present in cauda equina, they can be added only as a second (Tramadol) or third choice (oxycodone which is present in Percocet) when all other treatment fails.
Anticonvulsants like Lyrica or Gabapentin are a good 1st line option for neuropathic pain. If that wasn't enough for you or caused many side effects I believe antidepressants should be used which are also a first line option, like SNRI group (Venlafaxine, Duloxetine) or tricyclic group (Amitriptyline, Nortriptyline). Combinations like Venlafaxine + Gabapentine are also possible.
2nd line option which can be added is Tramadol with Percocet only as a third line option.
So I do agree that new therapy should be instituted and Percocet interruption should have been done, however its interruption should have been gradual to avoid the withdrawal symptoms.
I am not sure by your story what was the proposed plan from the pain specialist initially, did she give you a prescription for a lower daily dose of Percocet with the aim of reducing it gradually? Did she become "upset" because you took a higher dose than she advised?
Even if you didn't comply with her prescription I don't agree with her quitting you, a pain therapist should be prepared to accept to a certain point dealing with patient addiction issues and should try to deal with that.
So to sum it up I recommend starting treatment for neuropathic pain with an antidepressive, if that fails Tramadol OR Percocet can be added later, but under regular dose supervising due to the potential for addiction (because of which those call ups which you called a trap are necessary).
All of those are prescription drugs though, so you need to be prescribed and followed by a doctor preferably pain specialist.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I never talked directly to the Dr. After taking more than perscribed, just her assistant.then i was sent to the Suboxine clinic. I am going to find a new Doctor in my area. I agree with your answer. I just called and asked for a copy of my Medical records.i would like to let you know the outcome in a few days. Thanks for your help .
Brief Answer:
Thank you!
Detailed Answer:
I would be pleased to try and be as helpful as I can.
Feel free to get back to me whenever you see fit.
Wishing you good health!
Thank you!
Detailed Answer:
I would be pleased to try and be as helpful as I can.
Feel free to get back to me whenever you see fit.
Wishing you good health!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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