DEAR DR. GOTT: I took Tramadol for years for osteoarthritis pain and found if I were late for a dose, I would start getting flu-like symptoms. I was taking three 50-milligram doses a day. Finally, with my doctor’s help, I tapered off totally but began having awful nasal allergies and constant water running out of my head. One night, because I was sick and hurting, I took two of the leftover Tramadols and, lo and behold, by morning I felt terrific. I’m 66 years old and started taking one Tramadol a day to try to keep the allergies away, but I feel better if I take two of them. My doctor doesn’t seem concerned one way or the other, but I want to know why I cannot stop taking the drug. I cannot find anything on the subject anywhere. It doesn’t seem to help the pain much, but I cannot stop taking it. HELP!
DEAR READER: Tramadol is an opiate agonist, a narcotic-like pain reliever used to treat moderate-to-severe pain. In the United States, it is marketed as Ultram, Rybix, Ultracet containing acetaminophen or Ryzolt; in Canada, Ralivia; in Mexico, Durodor Retard and Trexol. The regular tablet is generally taken every four to six hours. The extended-release tablet should be taken once daily.
Side effects can include blurred vision, lightheadedness, dizziness, uncontrollable shaking, drowsiness, headache, nausea, vomiting and constipation. Overdose may include chest tightness, wheezing, fever, itching, cough, swelling of the face, tongue, lips or throat and cough. It can be habit-forming.
Dosing should be under the strict guidance of the prescribing physician. When discontinued, the Tramadol should be decreased gradually. Sudden withdrawal can lead to insomnia, runny nose, paresthesias of the hands or feet, chills, nausea, hallucinations and more.
Before beginning this medication, a physician should be advised if the user consumes alcohol or takes any medications containing alcohol, or has a drug addiction. Should this be the case, he or she will likely recommend another drug for pain control.
The flu-like symptoms you experienced were not flu — they were from withdrawal. The water running out of your head is likely because you didn’t taper the dosage downward but attempted sudden withdrawal.
Osteoarthritis is a chronic disease of the joints that results from a breakdown of cartilage. It causes pain and stiffness of joints. The problem should be addressed for what it is. You might consider rubbing castor oil onto your affected joints, using over-the-counter Castiva, liquid pectin and purple grape juice, or glucosamine/chondroitin. Therapeutic exercise is important, too. Consider yoga, tai chi or water aerobics, which will keep your joints flexible while reducing your pain. Perhaps a visit to the physical-therapy department of your local hospital will be beneficial. Then, despite the fact that your doctor isn’t concerned, I recommend you make appointments with a rheumatologist to discuss treatment of your arthritis and a drug counselor for help with your addiction to Tramadol.
To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “Understanding Osteoarthritis.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.
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