Opioid Tolerance

[Oozz]

I started to ask the very first question above and figured that the poster had no idea why the doc said that. I REALLY want to know if there are any studies...I surely haven't seen any!

I bet a lot of it is just personal experience. Which shouldn't be discarded lightly. Even though I fully agree that we need more studies

My neurologist (who is a RLS specialist) is dead set against changing anything in my medication, on account that my RLS is contained right now. (I wanted to change something several times, so I had many discussions.) He says that he has seen patients struggle for months and years even after seemingly simple changes as going from one opioid to another, or being exposed to higher doses for a short time (for example in patients who got oxycodone after surgery). Yet I don't know any literature on that.

To say that something is truth, however, means you have proof. No doctor should say that something is X without qualification if there isn't proof. All the doc has to say is, "In my experience, when we use opioids to control the symptoms prior to getting the dopaminergic out of the system, the person has more problems and for longer. Blah blah blah. That is why we do XYZ." (Or whatever the experience is).

This is basically what my doctor said. He is very well known for RLS. He said in, his experience, that it could have an impact and gave a theoretical basis for why this could be the case. Generally, he does not recommend patients go from medication to medication without taking a drug holiday to return to baseline.

[Oozz]

I was told my doctor that going straigh ... baseline.

When I hear this sort of statement, I often wonder several things:

1. Does the doctor have any studies or data to justify the statement?
2. Does the doctor apply this equally to all patients, regardless of the severity of their RLS, their max DA dose, the length of time they were augmented, etc.?
3. Does the doctor understand the degree of suffering that a patient with severe or very severe RLS will undergo during a month long withdrawal and drug holiday?
4. How much of this is being done to justify the doctor's theory of the use of drug holidays, which do not appear to be supported by all of the RLS experts?

He’s very experienced treating RLS. I think his approach is justified and his rationale makes sense - particularly, given the context of my situation.

I’m not here to advise people in the wrong direction; however, I do share whatever new information comes my way and this was one thing that could help someone out with a similar problem.

[debbluebird]

I take gabapentin 1800mg at 7:30 pm. Originally I took 600mg three times a day. My pain Doctor had me take it all three times a day. I had stopped methadone and got a spinal stimulator to replace the methadone.
I also later added buprenorphine film .5mg at 2:30 pm to prevent insomnia.
You might have to switch your codeine to something better.
I started with Darvocet years ago. You can't get it anymore. Then methadone. I couldn't get it anymore after I moved to NM.
Good luck

[Oozz]

I’m wondering if the tolerance is at the opioid receptor or if it’s somewhere else in the RLS dysfunction.