50mg Tramadol and 10mg Citalopram

[harjulhar]

Some 11 years ago I had an accident and damaged my back, after several months of trial and error with different medications, my doctor and I concluded that, because of the nature of the injury and the circumstances of my situation, the above option was going to be the best for me on a long term basis, as it gave me the ability to control the pain, but also have a life without being asleep all day.

The pains in my back started to increase late last year, with longer periods of it, it went from just about bearable to "Jesus Christ, hit me with a shovel". My medication was reviewed and the doctor decided that the Citalopram wasn't helping, so I was weaned off them over a few months. Several more trips to the doctor later, I was offered a 6 week session on a pain management clinic, this involved talking, interaction, light stretching and mindfulness. I've been on 2 other "pain clinic courses" before and got nothing from them, so wasn't expecting much, but, I went in with an open mind and willingness to try anything.
As time moved on, I felt myself feeling listless and uninterested in anything, but because of the pain increasing, my sense of wellbeing felt dulled and I wasn't thinking properly. In early March, the doctor decided I should go onto MST Morphine and Oromorph, I wasn't happy, but as I'd tried most of the other pain medications over the years and I was worried about the long term.
For the last month, I've not been in a good place, with a decreasing interest in myself or life and I'm thinking it's either one or both meds, with my suspicions pointing towards the withdrawl of the Citalopram.
Monday gone, after a weekend of very little sleep I made an emergency appointment at the doctors, I was sent for an x-ray, which I did on the same day. It takes a week for the results, so I have that hanging over my head. Since then, the pain is increasing and sleep has been in very short supply, what sleep I've had, has been interrupted by some very scary and vivid nightmares, one was so violent, I dove out of bed to avoid being ran down by a huge truck, landing on my wrist and spraining it.
Yesterday, I could take no more, called the doctors and was offered a call from the ECP first, an hour later, she called and we had a chat about my situation and what I thought, I mentioned going back into the Citalopram and she told me she would have a word with the doctor and get back to me asap. True to her word, she called back, instead of a getting an appointment for sometime in the day, the doctor suggested I dropped the morphine meds and went back into the Tramadol as I still had some left over, plus I was given an appointment for 4pm on Monday, so I'm going to be having an uncertain few days until I get to the surgery on Monday.
I tried the CBD oil from H&B, it was next to useless. I have a friend who uses the same morphine product I was taking, but his dose was three times more and he's fine, he works, drives a bus for a living and has a good life. However, he tried Tramadol and it made him ill, I wonder if some drugs are not suitable or work for everyone.
Could I ask the learned members, has anyone has a similar experience with the same medications, if so, what was the outcome?
Could I ask the learned members, has anyone has a similar experience with the same medications, if so, what was the outcome?
I've had about 2 hours of broken (shattered) sleep, I'm worn out, very tearful and I'm looking for options or inspiration about what I can do.
To be honest, it's become so bad, I did an hours research on Dignitas during the night, 99% of the time, I'm always upbeat and happy, recently, I've become flat and uninterested in anything, which is not the guy I typically am.
Throw any ideas at me, I'll listen to anything that leads to help.

Ta.

[missy111]

I have no real advice, but sending you what feels to me like a much needed hug. If you were a friend of mine feeling so bad that you're researching dignitas I'd be telling you to phone 111 today and demanding an OOH appt today:
You need some immediate medical advice....

[OytheBumbler]

This sounds so awful for you. I presume you've exhausted all surgical options with the back injury? Have you had any second opinions on treating the cause of the pain?

In the meantime it looks like you do need to address the low mood and feelings of disassociation. Unfortunately it does take time for these kinds of meds to take effect so be kind to yourself while you're finding what works.

[OytheBumbler]

This sounds so awful for you. I presume you've exhausted all surgical options with the back injury? Have you had any second opinions on treating the cause of the pain?

In the meantime it looks like you do need to address the low mood and feelings of disassociation. Unfortunately it does take time for these kinds of meds to take effect so be kind to yourself while you're finding what works.

[roundligament]

You may go into withdrawal if you stop the slow release morphine, has he tapered down the dose? I wouldn't recommend stopping it like that. That will make you feel emotionally worse...
You poor thing

[harjulhar]

Hi all, for a few weeks before I swapped to the morphine, I was taking up to 8 (max dose) of Tramadol a day, so I would reckon I was about on a level as I would be with the morphine. The only surgical option was removed as the success rate was only 2-3%, failure would result in being a wheelchair user for the rest of my life. Not very good odds at all.
I've tried several medications over the years and none offered me anything like Tramadol does and I suffer no side effects from it, or I don't seem to. Pregabalin, Gabapentin and Fentanyl have been tried, all had too many side effects, so were binned. I want a quality of life and to be able to live, but if I'm doped up to the eyeballs, I'm useless and do nothing but sit in the chair and sleep, then cannot sleep at night. I used to do a lot of walking, cycling, riding motorbikes, loved driving, fishing, in fact, just being outdoors or busy. At the moment, nothing is happening and apart from doing a little shopping, I do nothing and go no where, so my social interaction is not happening and I cannot be bothered with anyone.
The doctor has to act and fast or I could be on the slippery slope. Fingers crossed.

I've not been taking the morphine for very long, say 9-10 weeks, but really over the last two weeks, I've on occasion, been aware of my low mood and the pains increasing. I think the tiredness, pain and uncertainty I was suffering last night were overwhelming and I just got fed up, hence my looking at Dignitas, I feel a little better in the cool light of day! I've not had any morphine based medication since Wednesday night and back on the Tramadol from Thursday morning. As mentioned, the morphine might take a few days to get out of my system, so I am being gentle on myself and trying to avoid any difficult situations. I know that when I saw the neurologist, he said I could suffer from highly active referred pain, so, if the Citalopram offers me the addition of better control of the pain, I have to wonder why my doctor took me off them, I'll be asking on Monday and making a request to go back on them. I've tried Sertraline, Fluoxitine, and Duloxetine, none at all helped and made me feel worse, listless, aching and no interest in anything, so, counter productive I would say and I'll be getting very assertive with the doctor.

[roundligament]

Sorry I took so long to reply the app hasn't been working properly.
Have you had any success with steroid injections?

I've taken all the medicines you said. I used pethidine (oral) when I have a desperate flare up of the pain.

Nerve blocks and steroids have helped me enormously. I went to see Dr Singh @ The London Pain clinic on Harley St

He saved my life. I didn't want to live. I can't empathise with you enough.

[unweavedrainbow]

I take MST and Oramorph, Tramadol makes me manic. I imagine that your doctor took you off the Citralopram as Citralopram and Tramadol together put you at risk of serotonin syndrome. Opioids (synthetic opiates, like tramadol, rather than natural ones, like morphine) and antidepressants are generally a bit of a tricky mix as they both affect the central nervous system. Have you tried co-codamol? Depending on your dose of morphine, the higher levels might be about the same amount of active ingredient and could be tolerated better.

[harjulhar]

Thank you for the replies, each one offers a little more information and hope. Just update you all, the only injection I've had was many years ago and went into the spine, I was knocked out for that. I don't think it offered me anything.
I was taking co-codamol in the early days, but again, they weren't offering me anywhere near enough relief. When I was taking the Tramadol and Citalopram, I didn't seem to be suffering from any side effects, the doctors were more concerned about getting me off Naproxen, which I'm still taking.
I'm feeling a little more human now that I've stopped the morphine and oddly, the pain seems to have eased, but still causing me a lot of discomfort, that has me gritting my teeth.
The morphine I was taking is MST Continus 10mg 2 per day and I do not want to go back on them, they scare me.

[MountainDweller]

I agree with the pp who said that tramadol and citalopram are not a great combination as they both act on serotonin. I also wonder if some of your earlier symptoms could be withdrawal from the tramadol - it's quite a complex drug and the morphine may not have compensated enough.

There is some thought among doctors that it's better to be on a low dose of a strong med than a high dose of a weaker med, because at the max dose of tramadol you were more likely to get side effects. I'm not a doctor, I hasten to add, just an experienced patient with multiple pain problems, including my back. I've tried everything in the opiate family and am now on a low dose of OxyContin - have you tried that? I have fewer side effects on that than I did on morphine. You'd also be less likely to have problems combining it with an SSRI.

I'm on a mix of pain meds - the OxyContin with oxy norm for breakthrough pain, pregabalin, slow release ibuprofen and I'm on an anti depressant called Valdoxan. I can't take SSRIs or similar any moe because I developed a tremor - probably due to the reaction between the SSRI I was on and the OxyContin.

Good luck, I hope you get something sorted.

[Luscinia]

As others have said, Tramadol and Citalopram interact negatively. Have you tried a pain management course? It's not the same as a pain clinic and may help you.

[Trian78]

I've been on the max daily dose of Tramadol and 30mg Citalopram for a few years now, I also take co-codamol as needed. My different pain clinic Consultants and 2 GP's I see have all mentioned the associated risks and explained them to me, but all agree they work best for me after trying other medications in the past that either didn't help or gave me horrible side effects. As long as I'm monitored by them and they know I'm clued up and sensible and don't take any extra, they are all happy for me to take this combination.

I've had the opposite to you op, they told me not to touch morphine as it's "too strong" to be on for long term / chronic pain. The treatment that helped me the most once steroid injections stopped lasting long was having nerve ablation in my spine, I'm currently waiting for my next lot to be done as it's been over a year and the nerves have been growing back. I was still on the same medication after it helped my spine, as I have multiple conditions, but was able to drop down to 3 doses of Tramadol a day for a while, which as pathetic as it sounds made me feel like something had improved! It's lonely and isolating being in chronic pain and without taking the Citalopram as a crutch and having CBT to help I'd drown in the depression and anxiety of it to be honest.

[harjulhar]

Thank for the positive replies, to answer Lucinia first, I have been on 3 back clinic courses, the pain management course, which included CBT, but, because of several other issues including 2 seizures and an issue with trust. I had a very bad experience a few years ago, my ex partner cleaned out our bank accounts and forged my signature to get my pension fund, leaving me with nothing at all. I cannot seem to get my head around the way of thinking with CBT at all. I am a very sensible and intelligent person and I'm very open to trying literally anything to help.
I have tried the Pegabalin etc, but all made me like a zombie, staring into space, not being aware of engaging in conversation and having no interest in anything at all, this included my partner, kids, appearance, just nothing. I've not tried Oxy-contin.
I cannot take anything Brufen based, for a reason I can't remember.
I am very careful with my meds, I have my daily allowance in a dossett box. I feel much much better today, fresher and more awake/focused, but still have a strong headache. I do wonder if I've been the victim of "The Perfect Storm" with the timing of the change in medication and the cessation of the Citalopram. Thinking about it, I noticed an increase in my awareness of the pain following the withdrawl of the Citalopram and when I tried Sertraline, Fluoxetine and one other, I became "zombified" and unaware of what was going on around me. So, it's obvious that some of the meds I've tried are either singly not good for me or a combination is causing problems.
I've not seen my girlfriend for a month because of the situation and we had a really big argument last night, we're both frustrated as we're 30 miles apart and she doesn't drive, I'm very wary of driving very far at the minute, so nothing is going right. Because of this, I feel so under pressure, I know I'm doing the best I can, but cannot seem to get my point across that I'm in a great deal of pain and it cannot be switched off, this in turn affects me, as I feel I'm letting her down, a no win situation. She is completely aware of my condition and there are some days/weekends that we plan to be together, don't happen, I try to remain calm and not get upset, but she see's it as personal and gets annoyed with me. It was the same last night, in the end, I'd had enough, I got ratty and fed up of trying to get my point across and told her, "You have to accept the way I am and I cannot control it. Your obviously, like me, not happy, but I'm the one with the chronic pain and have to deal with it, plus, try and have as normal a life as possible. Go and find someone who hasn't any issues at all and carry on with your life." I then turned my phone off.
I feel horrible, not had much sleep, but as those with a lot of pain know, there are times when all becomes too much and you have to have some ME time, right now, with everything that's going on, I have to do just that.
Roll on tomorrow and I can hopefully get a positive outcome.

Thank you.

[Clankboing]

I don't think I've read your posts deeply but let me tell you what I have as I have back pain. I have 2 lots of tramadol 2 times a day, 2 amitriptyline at night and 1 gabapentin. On this I sleep at night, and manage to work in the day. I know that doesn't answer your Q but I would ask the doctors to review your medication.

[Clankboing]

I agree about getting injections for pain too - it works well.

[Clankboing]

Also I would ask about gabapentin - I too was odd on pregabalin, but gabapentin suits me well.

[harjulhar]

This is not related to my situation, but I am so fed up right now, some bastard has just smashed all the windows on my car.

I just wish I could go to sleep permanently.