fyrelight74 Posted June 29, 2011 Share Posted June 29, 2011 In the office where I work, the doc typically avoids Vicodin, Percocet and other opiates for long term pain as much as he can. An alternative he has been using is Ultram or tramadol. We discovered a day or two ago that patients can snort tramadol just as they do Vicodin. Were you guys aware people were abusing it in this manner? We were just shocked and now leery of patients requesting tramadol. We do refer our PPO chronic pain patients to pain management, but many of our HMO ones don't "qualify" for pain management (according to their insurance), and come to our office the first time having been on high amounts of opiates for many years. It's just sad that another option (tramadol) is also now being abused as well. Link to comment Share on other sites More sharing options...
xxbowiexx Posted June 29, 2011 Share Posted June 29, 2011 disappointed, yes....shocking, no Link to comment Share on other sites More sharing options...
cinntsp Posted June 29, 2011 Share Posted June 29, 2011 I think Erowid would open your eyes to quite a few things. Link to comment Share on other sites More sharing options...
EMSArtist Posted June 29, 2011 Share Posted June 29, 2011 It seems to me that people have been doing whatever they can to alter their perception as long as we have been around. It is most sad for people who are genuinely trying to find relief from pain because they are immediately suspected of drug abuse. Especially when insurance companies tie the hands of both providers and patients in finding the best solutions and forcing poor substitutes (that are cheap) instead of real relief. Link to comment Share on other sites More sharing options...
Contrarian Posted June 29, 2011 Share Posted June 29, 2011 The PA-C that I replaced at one of my jobs 2yrs ago lost her license due to Tramadol abuse. The State tried to work with her in the "Impaired Provider Program":couseling, rehab, suspensions, remedial training etc... In the end... she just wasn't stronger than her addiction. It was kinda pathetic... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 29, 2011 Moderator Share Posted June 29, 2011 yup, tramadol is a bad drug. doesn't control real pain well, lots of interactions with commonly prescribed meds like ssri's(causing seizures), fairly highly addictive. there are folks on suboxone to get off tramadol. Link to comment Share on other sites More sharing options...
Planteater Posted June 30, 2011 Share Posted June 30, 2011 I have a good friend who is a recovering alcoholic who needed surgery (tonsillectomy) this week. She was terrified to receive pain meds b/c of her history. She said no narcotics- no matter what. They sent her home with tramadol. Only 5 doses, but still they assured her she'd be "safe" with it. Is that the right course of action in this type of situation or would you recommend something different? Link to comment Share on other sites More sharing options...
Hemegroup Posted June 30, 2011 Share Posted June 30, 2011 I have a good friend who is a recovering alcoholic who needed surgery (tonsillectomy) this week. She was terrified to receive pain meds b/c of her history. She said no narcotics- no matter what. They sent her home with tramadol. Only 5 doses, but still they assured her she'd be "safe" with it. Is that the right course of action in this type of situation or would you recommend something different? I've never taken Ultram so I can't say from personal experience, but since probably only two out of hundreds to thousands of patients have told me Ultram works to any significant degree, I'd probably just recommend Ibuprofen 800. Link to comment Share on other sites More sharing options...
blburns Posted July 1, 2011 Share Posted July 1, 2011 When I was a pharmacy technician there was another technician working there who was abusing tramadol. The pharmacist explained that tramadol is classified as an opioid and works on the same pathways as other opioids (Vicodin, morphine, etc.) Even though it is not a controlled substance/narcotic in FL there is still a major problem here with abuse of tramadol. Link to comment Share on other sites More sharing options...
bradtPA Posted July 1, 2011 Share Posted July 1, 2011 4% of those taking tramadol become dependent on it.... Link to comment Share on other sites More sharing options...
UllrPrincess Posted July 5, 2011 Share Posted July 5, 2011 Dependency and addiction are two separate things. I'm guessing most people on tramadol become dependent on it (if they are on it for any length of time). Link to comment Share on other sites More sharing options...
CAdamsPAC Posted July 7, 2011 Share Posted July 7, 2011 I see this all too often here in Connecticut, patients receiving 100's of tablets every month! Link to comment Share on other sites More sharing options...
Acebecker Posted July 7, 2011 Share Posted July 7, 2011 This is a good topic for discussion - I am finishing my final rotation in a markedly underserved population and I note that the number of people on chronic opioids and those who are suspected of "drug seeking behavior" is difficult to comprehend. Some are on opioids legitimately, but they are in the minority I'm afraid. As a result, we as providers have resorted to utilizing Tramadol as our first line for acute pain syndromes (aside from Fx, lacs, burns, major injuries, etc.) to avoid the stigma of being licensed drug dealers. Has this worked? To some extent it has. But there are still those among our patient population who become dependent upon and who will make up stories in order to get their Ultram. I am not familiar with any cases of patients who have been given Ultram for a new pain complaint only to abuse their Rx and end up in seizure, but I'm sure it has happened. That said, the amount of effort that the "regulars" have put into bamboozling us has definitely declined and we have a better handle on opioid abusers than we have ever had in the past (so I'm told - only been here 3 months). In my mind, Ultram has it's place. It is a poor medication for real pain, but it can help those who we are most concerned about to avoid the stumbling block that opiates can be. If we save even a few people, it is a success in my mind. In any case, the NNT regarding addiction seems to be relatively low and the NNH appears to be fairly high, so the benefits outweigh the risks. Andrew Link to comment Share on other sites More sharing options...
Omppu27 Posted July 18, 2011 Share Posted July 18, 2011 One of my good friends from school this year was doing this... Complained about bad "back pain" and how he needed Tramadol to do anything... total BS. Link to comment Share on other sites More sharing options...
Omppu27 Posted July 18, 2011 Share Posted July 18, 2011 One of my good friends from school this year was doing this... Complained about bad "back pain" and how he needed Tramadol to do anything... total BS. Link to comment Share on other sites More sharing options...
Hemegroup Posted July 19, 2011 Share Posted July 19, 2011 One of my good friends from school this year was doing this... Complained about bad "back pain" and how he needed Tramadol to do anything... total BS. I had a friend whose complaints of back pain used to make me roll my eyes and scoff at him ... until my own back went out. Years of lifting boxes, concrete, hay and people, finally caught up with me. My most recent MRI showed two severely compressed discs, and one disc that protrudes ... and let me tell you, when there's a subluxation and that protrusion hits my spinal cord ... there are no words to describe that pain. There have been times when I couldn't get off the floor to get to the restroom, without crying out. And remember, any pathology of the spine/discs can lead to irritation/inflammation which can in turn cause muscle spasm that in itself is very painful and lends to further adverse effect on the spine. I'm not knocking your situation, but I learned firsthand what it means to have to eat my own words. I've never tried Ultram, and until recent times have been staunchly against any types of narcotics (I've only requested Toradol and Lidoderm in the ER). Ibuprofen 800 and muscle relaxants are usually enough for the occasional ouchie-throbbing after being on my feet all day, but when my back goes out ... a short course of Norco is what is most useful. If your friend truly does have a bad back and they say that Ultram works for them, I'd inquire as to their prior work history and start out giving them the benefit of the doubt. Link to comment Share on other sites More sharing options...
Hemegroup Posted July 19, 2011 Share Posted July 19, 2011 One of my good friends from school this year was doing this... Complained about bad "back pain" and how he needed Tramadol to do anything... total BS. I had a friend whose complaints of back pain used to make me roll my eyes and scoff at him ... until my own back went out. Years of lifting boxes, concrete, hay and people, finally caught up with me. My most recent MRI showed two severely compressed discs, and one disc that protrudes ... and let me tell you, when there's a subluxation and that protrusion hits my spinal cord ... there are no words to describe that pain. There have been times when I couldn't get off the floor to get to the restroom, without crying out. And remember, any pathology of the spine/discs can lead to irritation/inflammation which can in turn cause muscle spasm that in itself is very painful and lends to further adverse effect on the spine. I'm not knocking your situation, but I learned firsthand what it means to have to eat my own words. I've never tried Ultram, and until recent times have been staunchly against any types of narcotics (I've only requested Toradol and Lidoderm in the ER). Ibuprofen 800 and muscle relaxants are usually enough for the occasional ouchie-throbbing after being on my feet all day, but when my back goes out ... a short course of Norco is what is most useful. If your friend truly does have a bad back and they say that Ultram works for them, I'd inquire as to their prior work history and start out giving them the benefit of the doubt. Link to comment Share on other sites More sharing options...
UllrPrincess Posted July 19, 2011 Share Posted July 19, 2011 Very good post Hemegroup. As a healthcare professional (not a PA) who has been in chronic pain since the ripe old age of 14/15 and who has worked in mental health and addictions I would urge everyone to give your clients the benefit of the doubt. I realize that there are tons of drug seekers out there and can be hard to differentiate between those who are in pain and those who are seeking. If you've never been in chronic pain you cannot empathize with the clients. I'm lucky that if a doctor were to do a physical exam they would be able to find quite a bit wrong with me but the trouble is the people where you can't seem to find a source to the pain. I would recommend suggesting to your client the possibility of being referred to a chronic pain clinic and see how they react. Once you send them to the clinic and you have recommendations from the chronic pain specialist you might feel like a weight has been lifted off of your shoulders because you now are following the orders of someone who deals with people in pain (and those who are faking it) every day. You also need to realize that if someone is faking pain to get pills for an addiction that this too needs to be addressed. As I posted before it is beneficial to understand the difference between addiction and dependence. On a side note, tramacet is really not that effective for chronic pain from what I have found. I was one of the one's on 100's of pills a month. I unfortunately have health issues that really prevent me from taking anything besides narcotics however I'm a firm believer that you need to help yourself to help your pain. For example, exercise, eat healthy, actively participate in physiotherapy, massage, etc. I wish there was an easy way to convince all the clients that these things will help. Unfortunately motivation tends to be a big barrier in the chronic pain population, rightfully so for many reasons. I know this also would take more effort and I'm not sure if you are able to do it within your practice but what about providing chronic pain workbooks and having your client work through sections between appointments and come to the appointment with the section done? You know the clients will do it because they want their pills and it's a good education tool that helps provide insight for the client into their pain. Link to comment Share on other sites More sharing options...
UllrPrincess Posted July 19, 2011 Share Posted July 19, 2011 Very good post Hemegroup. As a healthcare professional (not a PA) who has been in chronic pain since the ripe old age of 14/15 and who has worked in mental health and addictions I would urge everyone to give your clients the benefit of the doubt. I realize that there are tons of drug seekers out there and can be hard to differentiate between those who are in pain and those who are seeking. If you've never been in chronic pain you cannot empathize with the clients. I'm lucky that if a doctor were to do a physical exam they would be able to find quite a bit wrong with me but the trouble is the people where you can't seem to find a source to the pain. I would recommend suggesting to your client the possibility of being referred to a chronic pain clinic and see how they react. Once you send them to the clinic and you have recommendations from the chronic pain specialist you might feel like a weight has been lifted off of your shoulders because you now are following the orders of someone who deals with people in pain (and those who are faking it) every day. You also need to realize that if someone is faking pain to get pills for an addiction that this too needs to be addressed. As I posted before it is beneficial to understand the difference between addiction and dependence. On a side note, tramacet is really not that effective for chronic pain from what I have found. I was one of the one's on 100's of pills a month. I unfortunately have health issues that really prevent me from taking anything besides narcotics however I'm a firm believer that you need to help yourself to help your pain. For example, exercise, eat healthy, actively participate in physiotherapy, massage, etc. I wish there was an easy way to convince all the clients that these things will help. Unfortunately motivation tends to be a big barrier in the chronic pain population, rightfully so for many reasons. I know this also would take more effort and I'm not sure if you are able to do it within your practice but what about providing chronic pain workbooks and having your client work through sections between appointments and come to the appointment with the section done? You know the clients will do it because they want their pills and it's a good education tool that helps provide insight for the client into their pain. Link to comment Share on other sites More sharing options...
Omppu27 Posted July 22, 2011 Share Posted July 22, 2011 I had a friend whose complaints of back pain used to make me roll my eyes and scoff at him ... until my own back went out. Years of lifting boxes, concrete, hay and people, finally caught up with me. My most recent MRI showed two severely compressed discs, and one disc that protrudes ... and let me tell you, when there's a subluxation and that protrusion hits my spinal cord ... there are no words to describe that pain. There have been times when I couldn't get off the floor to get to the restroom, without crying out. And remember, any pathology of the spine/discs can lead to irritation/inflammation which can in turn cause muscle spasm that in itself is very painful and lends to further adverse effect on the spine. I'm not knocking your situation, but I learned firsthand what it means to have to eat my own words. I've never tried Ultram, and until recent times have been staunchly against any types of narcotics (I've only requested Toradol and Lidoderm in the ER). Ibuprofen 800 and muscle relaxants are usually enough for the occasional ouchie-throbbing after being on my feet all day, but when my back goes out ... a short course of Norco is what is most useful. If your friend truly does have a bad back and they say that Ultram works for them, I'd inquire as to their prior work history and start out giving them the benefit of the doubt. This guy doesn't do anything though... Never went to class, did physical activity, or anything. He just sat around and played video games all day. He also have made it very clear that he loves taking drugs or doing anything that alters his state of mind. I also specifically remember an instance during the end of the school year. He didn't take his tramadol for about a week since he ran out and he began to feel very sick, almost as if he had food poisoning (vomiting, diarreha, etc...). I'm not a doctor, a PA, or even in the medical field for that matter, but it sounds like he was withdrawling. Link to comment Share on other sites More sharing options...
Omppu27 Posted July 22, 2011 Share Posted July 22, 2011 I had a friend whose complaints of back pain used to make me roll my eyes and scoff at him ... until my own back went out. Years of lifting boxes, concrete, hay and people, finally caught up with me. My most recent MRI showed two severely compressed discs, and one disc that protrudes ... and let me tell you, when there's a subluxation and that protrusion hits my spinal cord ... there are no words to describe that pain. There have been times when I couldn't get off the floor to get to the restroom, without crying out. And remember, any pathology of the spine/discs can lead to irritation/inflammation which can in turn cause muscle spasm that in itself is very painful and lends to further adverse effect on the spine. I'm not knocking your situation, but I learned firsthand what it means to have to eat my own words. I've never tried Ultram, and until recent times have been staunchly against any types of narcotics (I've only requested Toradol and Lidoderm in the ER). Ibuprofen 800 and muscle relaxants are usually enough for the occasional ouchie-throbbing after being on my feet all day, but when my back goes out ... a short course of Norco is what is most useful. If your friend truly does have a bad back and they say that Ultram works for them, I'd inquire as to their prior work history and start out giving them the benefit of the doubt. This guy doesn't do anything though... Never went to class, did physical activity, or anything. He just sat around and played video games all day. He also have made it very clear that he loves taking drugs or doing anything that alters his state of mind. I also specifically remember an instance during the end of the school year. He didn't take his tramadol for about a week since he ran out and he began to feel very sick, almost as if he had food poisoning (vomiting, diarreha, etc...). I'm not a doctor, a PA, or even in the medical field for that matter, but it sounds like he was withdrawling. Link to comment Share on other sites More sharing options...
JenPA1984 Posted July 31, 2011 Share Posted July 31, 2011 I thought I would add to this- my sister in law has been highly addicted to trams. She takes as many as 9 a day to combat what she says is chronic pain. I think it is a huge problem because I think if the drug hasn't already, it is about to become a narcotic. Patients will make the excuse that it is not a narc so it is okay to take them in excess, exchange/sell them and so forth. I think it is something worth taking very seriously! Link to comment Share on other sites More sharing options...
JenPA1984 Posted July 31, 2011 Share Posted July 31, 2011 I thought I would add to this- my sister in law has been highly addicted to trams. She takes as many as 9 a day to combat what she says is chronic pain. I think it is a huge problem because I think if the drug hasn't already, it is about to become a narcotic. Patients will make the excuse that it is not a narc so it is okay to take them in excess, exchange/sell them and so forth. I think it is something worth taking very seriously! Link to comment Share on other sites More sharing options...
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