Ultram/Tramadol reduction

[scotsman]

Following some of the discussion threads around Ultram usage, I thought it might be interesting for me to post about my current action of reducing my dosage.

I'm reducing my dosage for a number of reasons, one being to see how low a dosage I can live with and the other to try and give my system a little bit of a clear-out of Ultram, which might increase it's effectiveness if/when I take it again.

Some background: I've been taking Ultram/Tramadol now for around 30 months now - and at my peak I was taking 250mg per day - 100mg in the morning, 100mg at lunch and 50mg at dinner.

After a period of time I reduced this to 200mg (cutting out the evening dosage) then finally down to 150mg (100mg in the morning and 50mg at lunchtime). I've been 'comfortable' at this level now for over a year. My pain diary for a normal day would read as:

• * When I wake up, there's no pain but it comes back again after about 10 minutes. I have my 100mg Ultram with breakfast and the pain will increase for about 30 mins before the Ultram starts to kick in and soon I'll not be in any pain at all (little discomfort but no real pain).
  
  * Around 11am to 12 noon my pain level will start to increase again. I then take 50mg at lunchtime and my pain decreases to about a 2 on the pain scale (of 10).
  
  * In the evening my pain level will either stay around the 1 or 2 mark but over the past 3-4 months I've had the odd evening when my pain level would be close to zero. I'd still have 'discomfort' but nothing I was really class as 'pain'.
  
  * My pain level would increase to around 3-4 after doing my physio sessions at night.

I found the above pretty easy to cope with - so thought it was time to drop the dosage again. I started doing this 3 weeks ago.

• * I reduced my morning dosage from 100mg to only 50mg and kept my lunchtime dosage at 50mg (so 100mg for the day, instead of 150mg). The first day of doing this my pain level in the morning was around a 5 - very uncomfortable.
  
  * After taking my lunchtime 50mg the afternoon pain level was around a 4. A couple points higher than it was when I took 100mg in the morning. Due to having less Ultram in the system and the nerves not being quietened down in the morning as much as they usually are when taking the higher dosage.
  
  * In the evening my pain level would be around a 2-3. When previously it would be close to zero.
  
  * After a couple days I'd say that my morning pain level settled down to a 4 in the morning and 3 in the afternoon with the evening around the 2 mark.

After 2 weeks on that dosage I've reduced it further and for the past week I've only taken 50mg in the morning and nothing at lunchtime.

• * The morning pain level is still around the 4 mark but now the afternoon can increase to a 5 and into the evening I'd say it was 4. So a general increase in pain throughout the day (as you'd expect from the reduction in pain medication).

I've got to say that I don't think I'll be able to continue at this level going forward, it really is a big impact on my quality of life. I feel I could be comfortable enough on a 100mg a day (50mg in the morning and 50mg at lunchtime) - which is a 50% decrease from the 150mg I was on.

However, I'm going to stick it out in the short term. My plan is to stay at 50mg for another week then try to come off it entirely for a few weeks (or as long as I can stand it). Of course, another reason for coming off it slowly is that it's important to taper off any medication that you've been on for a long time, to ensure the withdrawal effects are minimised.

What has been interesting though is that I'm now much more aware of my pelvis throughout the day and probably much more active in relaxing my pelvis all the time as I'm constantly aware of the pain - whilst before the Ultram was masking it.

I'll post updates on my progress.

Richard.

[treynor33]

Thanks for the update Richard and best of luck with the reduction...your doing it right

[MB]

I wouldn't stress too much about Ultram addiction. I have been taking 100mg of Ultram daily for 2 years and sometimes I have forgotten to take them on business trips and did not experience withdrawal symptoms.
My prescribing doctor (who is a pain specialist) tells me that it is very difficult to get addicted to Ultram at such low doses (100-150mg/day). Some people self prescribe doses in excess of 600mg/day and yes that is a problem.
Better be conscious of the slight dependance on Ultram you may have then fighting pain and associated depression.

[scotsman]

...Better be conscious of the slight dependance on Ultram you may have then fighting pain and associated depression.

Very true.

My doctor also told me that 50mg a day is virtually a Homeopathic dose.

[scotsman]

Well, a week further on and I'm still on 50mg a day but starting to cope much better on it. The pain levels haven't decreased but I'm more used to it and in a strange way, I'm enjoying being much more in touch with my pain levels than having the Ultram cover it up.

It's forcing me to be more careful of how I sit, I make sure I do relaxation sessions every day and I'm constantly checking to make sure my pelvic floor is relaxed.

I'm very aggressively treating the area around my sphincter with a Theracane, so that's causing an increase in my pain level but I'm coping with it.

I'm going to stay on 50mg for the next week then I might try a weekend not taking anything and see how that goes. I don't expect I'll then stay off it for good, but it will be an interesting experiment.

Richard.

[scotsman]

Well, another 9 days have passed and things are going well. I've been aggressively treating the trouble spots around the sphincter and it's starting to reap rewards as the triggerpoints don't seem to be returning with as much fury as they did before. They are coming back though but not to the same level and I'm still doing physio every night. The success in dealing with these areas has helped decrease the pain levels I have through the day (still on 50mg of Ultram a day - taken in the morning). Note that I've had to do a lot of physio (months and months worth) around that area to release and stretch the muscles enough to enable me to even reach those deep triggerpoints.

* The morning pain level is probably around the 3 mark now once the Ultram has kicked in (which is a reduction to what it was a couple weeks ago) but now the afternoon will stay at a 3 (rather than increasing) and into the evening I'd say it was still a 3 though I've had the odd day when I'd say the evening was a 2.

So a general reduction of 1-2 'pain points' on the old scoring scale across the day.

Very positive as this is probably the largest step forward I've managed to make over the past 12 months.

I don't think I'll have to increase my Ultram dosage up again now and possibly in a months time I might try coming off it for a week (just see how things go). Being off the Ultram has certainly helped me be more aware of the improvements.

Richard.

[ectobia]

don't worry about it, you're doing good so far, remember junkies do 1000mg or 2000mg at once! congrats

[Sleeper Service]

Excellent progress, Richard. I guess the frustration for you must be these remaining pain points after the massive progress you've made over the last couple of years in other areas. It looks like those are starting to fade to though, it's just taken that wee bit longer to get there.

As for the Ultram, no shame in continuing to take a drug that has made life easier for you. As has been pointed out, yours is an acceptable pain management dosage and is nowhere near the level someone would use for recreational purposes.

[scotsman]

Thanks guys

Don't worry though about the Ultram, I'm not worried about its use as I'm aware that evern at 150mg a day the dosage was pretty low. The main reason I'm trying to come off it is to help measure where my pain level is really at and a smaller part is to give my system a little break as I'm not keen on being on any medication for a long time.

Interesting note is that I had a pretty painful flair on Friday there which needed about an hours worth of physio (external and internal) but it was pretty much back to the normal level the following day - whilst before flares would take a good few days to level off.

Richard.

[scotsman]

Another week has passed and still making good progress

I'm still on 50mg a day but I'd say my pain levels are now around the 1-2 mark in the morning once the Ultram has kicked in but now the afternoon it's around a 2 going down to a 1-2 in the evening.

I can have the odd day when it spikes up to a 3-4 but the norm is much lower.

It's mostly been down to finally being able to successfully being able to treat some very deep triggerpoints.

Richard.

[scoobysnacks]

Scotsman,

Thats awesome news!

SS

[scotsman]

Another week passes and going well. Actually found myself considering not taking my 50mg in the morning - but as it was a work day I thought it best to just take it. I'm going on holiday in a couple of weeks time so I think I might try not taking any pain medication a couple of those days and see how it goes.

My GP also practices acupuncture and has said he'll do a 6 session course of treatment for me for pain management - so I might consider giving that a try as well in the next few months. We'll see.

Still doing a LOT of physio every night but it's paying dividends. The area I'm treating has been triggerpoint full (3 big ones I found) and dysfunctional now for around 3 years now so I'm under no illusions that it will take a good few months for the muscles to recover.

Richard.

[DGC]

I have found Tramodol to be addictive and highly irritating to this condition.
I've suffered over 20 years with CPPS. Can't understand how anyone can function taking over 200 mg a day. Dr. Wise has mentioned "paradoxical" reactions to drugs...I don't know if this is an example but keep in mind that Tramodol is a narcotic drug in it's effect and one of the listed side effects in "The Pill Book" is "urinary difficulties".

[scotsman]

... Can't understand how anyone can function taking over 200 mg a day...

It didn't effect me at all (aside from taking the pain away) - no fuzzyness, no fog, nothing at all plus no urinary problems.

It's a shame it can effect two people so differently as for me it's been a godsend.

It's important though that before taking any medication that you research what the side-effects may be.

Richard.

[Richard.N]

I got hold of some Tramadol last week while on holiday in Spain. You can get the stuff over the counter there. I felt a bit naughty, to be honest

I took 50mg and felt a bit weird, but 100mg made me incredibly anxious. I later found out that it doesn't mix well with antidepressants (I am taking 30mg of Mirtazipine). In fact, it made me feel as bad as I did when I tried Prozac many years ago for depression. It wore off after about 4 hours, thakfully.

I do wonder if Tramadol helps people with chronic prostatitis / chronic pelvic pain syndrome not only because it is a painkiller, but also because it increases serotonin and noradrenaline levels i.e. it is in effect an antidepressant.