Augmentation or opioid withdrawal?

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ViewsAskew
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Augmentation or opioid withdrawal?

Postby ViewsAskew » Tue Jul 03, 2018 5:29 am

I decided to take a 2 month break from methadone; I actually would prefer to switch to a short acting opioid and withdraw from that, but that is out of the question at this time.

So, I went from 20 mg to 15 to 10 to 5 over the last 6 weeks; am using pramipexole to take up the slack. I have been at 5 mg for about 8-10 days, I'd guess. I really oughtta wanna stop completely now, but it's not much fun, so I've been putting it off. During the taper, I have had worsened sleep - as the opioid reduces and I take more pramipexole, I get the manic ADD brain that I dislike so much from pramipexole.

A couple nights ago, I woke up only 2 hours into sleep and had a nasty feeling in my right arm - all the way to the shoulder. I couldn't tell if it was RLS - which would mean I was augmented - or opioid withdrawal. It feels VERY similar - many people call it RLS, even though it isn't. I got back to sleep around 8 AM and at least got 2-3 more hours. Same thing last night.

I have not had any increase in symptoms during the day or evening - same as usual. Nor have the symptoms been worse, really. So, that leads me to think it's opioid withdrawal....but I'm still taking some. Last time the arm involvement didn't start until I'd completely stopped it.

Can you start having withdrawal symptoms while reducing? It seems most likely, given that I have no increased RLS and no PLMW - which is usually horrible during augmentation. My ferritin is solidly high - close to 300 - so it seems unlikely I'd be augmenting this soon. I know I did initially, but my ferritin was 8, then!
Ann - Take what you need, leave the rest

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legsbestill
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Re: Augmentation or opioid withdrawal?

Postby legsbestill » Tue Jul 03, 2018 10:38 am

I haven’t withdrawn from methadone but have from a high dose of OxyContin and I found the symptoms very close to those of augmented rls. One difference for me was that withdrawal symptoms presented more randomly through the day and at night. They weren’t identical (to rls) but only very subtly different. My withdrawal symptoms were different to yours being more located in the torso and they were sometimes accompanied by hot flushes and/or panic attacks. But that may be because of a different opioid and different people.

For me, they definitely started before I was fully off the OxyContin. Reducing the dose to any significant degree could trigger them. It took me ages to take the plunge and remove the last 5mg.

I would suspect it is withdrawals with you bearing in mind that you have been reducing reasonably expeditiously.

ViewsAskew
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Re: Augmentation or opioid withdrawal?

Postby ViewsAskew » Tue Jul 03, 2018 10:03 pm

Today it's more clear. The symptoms are in my arm now - started at 1 PM. No RLS - just the sort of painful feeling in my arm. In the past, the withdrawal symptoms have been different in that they are more painful - but my RLS is electrical, not painful, so not sure how someone with painful RLS would tell the difference. They also are more constant whereas RLS seems to build into a crescendo.

Fortunately, the only other symptoms is a headache - but I get those regularly, so who knows.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

legsbestill
Posts: 476
Joined: Tue Aug 30, 2016 7:22 pm
Location: Dublin Ireland

Re: Augmentation or opioid withdrawal?

Postby legsbestill » Tue Jul 03, 2018 10:16 pm

It may be worth stopping at 5mg of methadone for a while to allow those symptoms to settle down before reducing further (if you decide they are withdrawals). I hope they don’t trouble you for too long. With OxyContin, I found withdrawals lasted about 6 weeks.

Of course if it is actually augmented rls then pausing at 5mg may be the absolutely wrong thing to do as you are using pramipexole to manage while you are not taking full dose methadone. I guess if it is augmentation you will notice symptoms imperceptibly worsen whereas if it’s wds they should gradually improve.

ViewsAskew
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Re: Augmentation or opioid withdrawal?

Postby ViewsAskew » Wed Jul 04, 2018 3:16 am

Yep - same here - about 6 weeks. I've been here at 5 mg for about 2 weeks now. This didn't start until the end of week 1, beginning of week 2.

The last time I did this, I likely didn't stay at 5 mg so long, so missed this. Not sure which is better - this isn't full out withdrawal, but am I delaying the inevitable? Not sure. Almost wish I could see a pain doc who is really familiar with it...but worried that withdrawal from an opioid is on my record, I will NEVER get an opioid again! Even though I am doing the most responsible thing, lol, and trying to keep my dose low.

I think as long as I don't have increased or earlier RLS in legs OR PLMs while waking, I'll assume withdrawal.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

legsbestill
Posts: 476
Joined: Tue Aug 30, 2016 7:22 pm
Location: Dublin Ireland

Re: Augmentation or opioid withdrawal?

Postby legsbestill » Wed Jul 04, 2018 11:31 am

I find of the (many) miseries of rls is the endless uncertainties it throws up. Maybe you would be right to take the plunge and stop the 5mg as you are going to be miserable whether you do that now or wait for current symptoms to settle down. On the other hand would you make the whole business much worse than it needs to be by adding additional withdrawals on top of what you’re going through now. I wonder are there withdrawal forums where you might get help with this? Or even websites?

ViewsAskew
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Re: Augmentation or opioid withdrawal?

Postby ViewsAskew » Thu Jul 05, 2018 5:53 pm

Long ago I tried an opioid forum - they had NO help for me at all because they take so much more than we do. They basically said they had no idea, how lucky you are to only take that much, good luck and goodbye, lol.

I've done it before several times - I usually do it more quickly because I am concerned about the augmentation. This is the first time my ferritin has been this high, so I thought I'd go more slowly and see if it minimized symptoms. I just feel slightly less "painfully buzzy" from the opioid withdrawal parathesia than before...but not much. So, seems silly to wait.

Yesterday I had almost no buzziness, so I thought - great! Today? Different story! Only difference was the night before I used kratom and last night I did not. It had been packed from our latest move, so I just dug it out. Going to try some white sunda today and see if it gets rid of this nastiness!
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

legsbestill
Posts: 476
Joined: Tue Aug 30, 2016 7:22 pm
Location: Dublin Ireland

Re: Augmentation or opioid withdrawal?

Postby legsbestill » Thu Jul 05, 2018 9:57 pm

There is a lot of hearsay out there to suggest that kratom can be very helpful when withdrawing from an opioid.

ViewsAskew
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Posts: 15262
Joined: Thu Oct 28, 2004 6:37 am
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Re: Augmentation or opioid withdrawal?

Postby ViewsAskew » Fri Jul 06, 2018 8:45 pm

legsbestill wrote:There is a lot of hearsay out there to suggest that kratom can be very helpful when withdrawing from an opioid.


I think it is. I have used it the last two times - and I'd say that it dulls the parathesias so that you can actually get some sleep. Without it, I get almost none. With it, I get between 2 and 6 hours.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.


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