Wednesday, November 28, 2012

Trouble Sleeping

     It's been at least three weeks now since my husband has had a full night's sleep for more than two nights in a row. The pain in his back is as bad as it's ever been and seems to be particularly persistent in its attempts to bring him down this time. We've been together for just over three years and I've never known an episode to go on for this long with virtually no relief. I have no idea what that means in the overall scheme of all things Marfan. Maybe it's just been a bad couple of weeks; maybe it's deeper than that. Maybe the far-away second spinal fusion isn't as distant as we'd hoped. Maybe I'm overthinking this, as would be consistent with my usual mode of operation.

     The sleeplessness was originally the result of methadone withdrawals, we're pretty sure. See, my husband's pain doctor wanted him to transition from methadone to Nucynta, a different type of painkiller, for some reason. I think it had something to do with the exact dosage of his warfarin, how the Nucynta would be better for someone who takes the amount of blood thinners my husband does, but as it turned out, it didn't matter. My husband had mistakenly told his pain management doctor the wrong dosage during his initial visit and that's why the doctor was trying to wean him off one drug and onto another. Or something like that.

     So last month, instead of getting his prescription for methadone refilled, my husband started transitioning to the Nucynta. He'd been told that he would likely experience methadone withdrawals, but it would take awhile for his body to recognize what was going on. I suppose neither of us connected the dots when he started feeling less than well a few weeks ago, but that's exactly what was happening.

    It's a royal pain in the ass when all you want to do is go to sleep because A) you're dead fucking tired from days of minimal sleep and B) you're still hanging on to a futile hope that perhaps if you're not awake, the pain can't touch you and still, your body just won't physically allow slumber. I hated watching my husband suffer, hated that, as so often happens, there was nothing I could to ease the situation for him. I also hated that he was not the only one in the house whose sleep habits were being disturbed, and I'm not referring to the cats. And no, I don't feel guilty for thinking that - I'm long past the point where I feel it necessary to play the stoic wife, caring only for her spouse's discomfort and nobly putting her own needs aside.

     I did voice my opinion that I thought the Nucynta was perhaps not the best choice and that the methadone seemed to work much better. My husband seconded that thought and so made an appointment with his pain doctor to tell him that the new hotness was actually not doing nearly what we'd hoped it would. It was agreed that he would stop with the Nucynta and move back over to the methadone.

     He's now in the process of transitioning back, but methadone isn't like dilaudid or morphine, which is intended to work quickly, for acute bursts of pain. Methadone is used for managing long-term chronic pain and so needs to be built up in the body's system before it can really do its job. Obviously, because he's just started moving back, we're not at that point yet. I do think the vicious knot of muscles and tissue in his back is starting to loosen its grip, so that's something. I'm in that bad, potentially dangerous frame of mind, though, that makes me think that this isn't the end, but the beginning of worse things to come.