Vicodin Addiction – Pain Management during Opiate Tapering

Tapering off Vicodin is hard. Tapering while still in pain is harder.

But if opiates aren’t working or if they do more harm than good then you need to move on to different pain-control interventions and you need to get past your dependency – or dependency and addiction.

Read on to learn more about:

• Common reasons for opiate tapering while still in pain
• Tapering schedules that minimize rebound pain
• Why you should consider the multidimensional pain treatment offered at most pain clinics
• How to know if you need specialized pain treatment
  
• A brief overview of alternate pain control strategies
• Lifestyle changes that ease living with pain

Reasons for Wanting to Taper while Still in Pain

So if your pain hasn’t diminished, why consider getting off Vicodin?

Well, common reasons for ending opiate therapy before the end of pain include:

• You find the side effects intolerable.
• The opiates don't control your pain
  
• The opiates cause hyperalgesia (a state where chronic opiate use worsens pain)
• You develop an opiate addiction. While anyone who uses opiates daily for more than a couple of weeks will develop a dependence, most chronic opiate users never get addicted (read here if you’re not clear on how addiction and dependence differ). People with opiate addictions use compulsively, lose control over their use and become fixated on getting and taking opiates. With addiction, personal, legal and health-related side effects tend to mount.

An Example of a Slow Tapering Schedule

If you decide to taper off Vicodin for reasons other than the end of your pain (you’re still in pain but you can’t or won't take opiates any longer) then you probably need to:

1. Taper down more slowly – allow yourself more time between dose reductions for stabilization and pain management.
2. Increase your use of non-opiate analgesics and alternative means of pain control.¹

You should consult with your doctor to develop a personalized tapering plan, but as a resource illustration, here’s an example of a conservative opiate tapering schedule:

• Reduce your daily dose by 10% every 1 to 2 weeks.
• Once you get down to a third of your starting dose, slow the taper down to a 5% (or less) reduction of your daily dose every 1 to 2 weeks.
• Slow the rate of taper or hold on a dose for longer than scheduled if you experience strong withdrawal symptoms or anxiety.²

If you are worried about your ability to stick to a planned schedule, ask your doctor about frequent dispensing intervals – even to the point of a once a day medication pick-up. If you don’t have more than you’re supposed to take then you won’t exceed the day’s recommended dosage. Of course, frequent dispensing schedules only work for those who never take illicit (street) opiates.

Should You Consider a Pain Clinic?

You have better odds of tapering successfully if you control your pain, so it makes sense to seek out specialists that can help minimize your discomfort.

A good pain clinic offers a multidisciplinary team of experts and a wide range of non-opiate based therapies. The types of professionals you might find in a pain clinic include:

• Pain specialist doctors – To diagnose pain, assess general health, order physical tests, prescribe medications, help you with a tapering plan, etc.
• Pain specialist nurses – To provide information and advice and to provide specific therapies, such as acupuncture and others
• Psychologists and other therapists – To help you manage your mental health and emotional reaction to pain. To offer techniques and suggestions to improve quality of life.
  
• Physiotherapists – To provide manual movement therapies and advice on fitness, stretching, posture and general activities.
• Occupational therapists – To offer advice on how to perform everyday activities despite pain and to minimize aggravating pain
• Alternative practitioners – Chiropractors or osteopaths, for example³

Non-opiate pain-control interventions these specialists might recommend include:

• Non-opiate medications - OTC pain relievers like aspirin or acetaminophen, anti inflammatory drugs of the NSAID family (ibuprofen, for example), topical pain relievers, corticosteroids, some antidepressants and some anti-epileptic drugs.
• Exercise – Specific exercises to build muscles and movement around localized pain or general exercises to increase overall health, flexibility, energy, mental outlook and pain perception.
• Massage – For short-term muscle tension and pain relief.
• Physical mobilization and movement therapies – Working to improve joint range of movement to reduce pain. Working to improve flexibility.
• The use of orthotic devices
• Other physical or aquatic therapies
• Transcutaneous electrical nerve stimulation (TENS) – TENS machines send electrical signals to interfere with pain transmission.
• Acupuncture
• The use of cold (ice) or heat treatments
• Anesthetic injections – to block nerve groups or to reduce irritation, swelling and muscle spasms⁴
• Becoming more mindful of psychological factors that influence pain perception and changing routines to incorporate behaviors and practices that reduce pain and promote well-being.
• Stress reduction techniques – to reduce pain-provoking muscular and autonomic nervous system tension.

Comprehensive pain interventions do not fixate on pain as the only variable – it’s improving quality of life that’s ultimately most important. To that end, multi-modal pain treatments can include interventions to reduce pain, improve sleep, decrease pain-provoked anxiety and depression and increase your ability and willingness to participate in important social, recreational and career/education activities.

Addiction Treatment during Tapering

If you’re dealing with addiction as well as dependence, you should strongly consider some form of addiction treatment during and after the tapering period.

Addiction treatment professionals can help you with your tapering goals by:

• Teaching cognitive behavioral techniques that can reduce pain and compulsive use (tapering takes control)
• Helping you develop and modify a treatment and tapering plan
• Introducing you to community self help programs
• Providing ongoing support and advice as you deal with shifting sands of the different phases of recovery

Since addiction erodes your ability to control your substance use, If addicted, you’ll likely struggle with the discipline needed for a long tapering protocol. Compensatory strategies taught in addiction treatment programs can help you retake control, but some people may find that medication management (with methadone or Suboxone) is necessary as an intermediary step.

How to Know if You Need Specialist Treatment

You are more likely to need specialist pain or addiction treatment if:

1. You have complex pain, pain lacking physiological source clues or pain without a clear pattern.
2. You have a current non-controlled psychiatric disorder (or as a precaution, with well-controlled current psychiatric illness.)
3. You lack social support or you have only negative support (living with other drug or alcohol abusers, for example.)
4. You are addicted and or abuse other substances (you may consider specialized care even if you are in recovery.)
5. You lack a stable and satisfying work or educational life. You lack a satisfying and stable recreational life. ⁵

If you regularly doctor-shop or abuse street opiates, tapering may not work for you and a substitution program of methadone or Suboxone may be a better fit.

Lifestyle Modification

Lifestyle changes may not significantly affect pain severity, but small changes can help you cope more easily.

To cope with pain, try:

• Pacing Yourself – Pain may intensify as you get overtired or emotionally overwhelmed. Pay attention to your pain cycles and if you notice that fatigue worsens pain, take care to pace your day – taking breaks before you need them to minimize fatigue.
• Organizing and Prioritizing – Make a daily or weekly list of what you need and want to do, in order of importance. Accept that you can’t accomplish everything and schedule your most important tasks first. This way you won’t get blindsided by an essential task when overtired and struggling with pain.
• Sleeping Regularly – Because pain can worsen at night it’s easy to develop altered sleep/wake schedules. However, you get the best chance of a restful sleep by maintaining a normal sleeping schedule: going to bed at the same time each night, waking at the same time each morning and avoiding daytime naps.
• Staying Social – You have to pace yourself and prioritize, but remember to stay social, even when you don’t feel like it. A 30 minute visit with a good friend can do wonders for your mood.
• Being Patient and Kind…to Yourself – Don’t expect as much from yourself during this temporary period of intensified pain. Though you won’t be your optimum self for a short while, long-term gains will more than compensate for short-term deficits. Keep your eye on the prize!
• Making Relaxing Activities a Priority – Relaxing activities ease muscle tension and soothe frayed nerves, so make daily relaxation periods an essential component of your regular routine. Try: reading, gardening, listening or playing music, cooking…etc, etc.
• Keeping a Pain Diary – Take a couple of minutes each day to write down how you’ve been managing your pain - what’s been working and what’s been ineffective. Having a written record of your success can increase your self confidence.⁶

Beating Addiction Can Reduce Pain

Here's a silver lining to the difficulties of the taper - some people find that pain dissipates as addictive behaviors get replaced by healthier daily activities.

Some examples of how addiction influences pain include:

• Addiction and intoxication can diminish sleep quality which may increase perceived pain.
• Addiction can increase anxiety and/or depression, which can increase pain perception.
• Addiction can result in a failure to meet life responsibilities. This leads to stress (from relationship problems, job loss, etc.) and stress worsens perceived pain.
• Taking opiates to get high results in 'peak and valley' blood plasma concentrations and a regular intoxication/withdrawal cycle. This cycle results in rapid shifting between periods of psycho-motor relaxation (while high) and periods of stress, sympathetic arousal and muscle tension (while in withdrawal.) This rebounding back and forth may increase perceived pain.
• People addicted to opiates may not comply as well with non-drug treatment recommendations (stretching, exercise, etc.) and this can increase perceived pain.⁷