It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Suboxone vs. Methadone vs. ?

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 09-04-2016, 02:11 AM   #1
    Lois
    Junior Member
     
    Join Date: Aug 2003
    Location: Auburn, WA 98092
    Posts: 14
    Lois HB User
    Suboxone vs. Methadone vs. ?

    Hello. I have chronic pain from Multiple Sclerosis. It began after my second MS attack and comes from lesions in my spinal cord. I've had it for 24 years. Six years after that attack the pain became so difficult to deal with I went to a pain specialist and was prescribed Oxycontin. I have used a low dosage of that (10mg twice a day) for many years and while it never completely alleviated the pain, it managed it well enough for me to work and have a normal life with some occasional bad times. However, in 2014 I had to have surgery for another condition and things went out of all out of whack with the MS. The pain intensified-- a constant burning sensation in my entire left leg as well as spasticity, a common MS symptom which I hadn't experienced until the surgery. The doctor increased my medication to 20 mg twice a day which helped until the past 3 months. The Oxycontin just stopped working. And I developed more symptoms (feels like a thousand wasps stinging my leg, low back pain from spasticity) which have destroyed my quality of life. I've learned many non-medication therapies over the years to help with the pain but the intensity of this new pain has me exhausted, depressed, and discouraged. My pain specialist will not increase the Oxycontin. Compared to others the 20mg twice a day seems like a low dosage but I think the new laws have made all doctors in WA state clamp down on Oxy and in discussing this with other MS patients no doctors will prescribe or increase Oxy anymore. My doctor has suggested switching to Methadone or Suboxone. I thought these were only used for drug addicts and while I am dependent on the Oxy after using it all these years, I have never abused it or even felt high from it. I've never taken enough of it to completely relieve the pain from my own choice because I was concerned about addiction. So I'm confused about the Suboxone and Methadone suggestion. My doctor assured me that these medications are also used for pain not just for addiction. But I'm worried about what other doctors or even hospitals will think if I have an accident or need some other hospital treatment. Plus things I've read about these medicines on this message board and others frightens me. Please let me know your experiences with these two drugs. Do either of them really help with severe pain? Is there some other kind of medication that works for neuropathic pain from the central nervous system? I'm already on gabapenton which does not seem to help at all. Thank you for any advice and information. I'm so worried, depressed, and my life is so restricted now because of the pain. I'm looking for help everywhere.

    Last edited by Lois; 09-04-2016 at 02:13 AM. Reason: Wrong message board

     
    Sponsors Lightbulb
       
    Old 09-04-2016, 11:42 AM   #2
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Suboxone vs. Methadone vs. ?

    Methadone has commonly been used for chronic pain for years. The prescription will even say so. You can only get a month's supply from a pharmacy if its for pain; for addiction, patients need to go daily to a clinic. Suboxone on the other hand is a bit newer to the pain game, and is more often used in pain patients who are also addicts. For insurance to cover Suboxone, it needs to be scripted for opioid dependency. Although everyone on daily opioids is dependent, that could be taken to mean addicted. Methadone is more likely to work for pain. Suboxone doesn't allow the patient to take any opioids for breakthrough pain, as it blocks their effect.

    For all those reasons, I'd highly recommend Methadone over Suboxone, if your doctor gives you a choice. Methadone has personally been the only pain med to significantly consistently help my pain. I actually tried Suboxone awhile back and it did nothing (plus it was a big mess of withdrawal during the switch, and caused a constant migraine). I've heard of very few on Suboxone which say it manages their pain well. Methadone is known for helping some folks pain when nothing else worked, as it is quite different from all other pain meds.

    Methadone does however have some added risks (which can be mostly mitigated). It needs to be started at a low dose and increased slowly. The good news is your tolerance is very low, so you likely won't have any withdrawal. Its also typically recommended to have an ECG after starting it to ensure you don't get the serious but very rare prolonged qt syndrome. Methadone commonly causes sedation, especially just when starting it, so be careful driving and such until you'd know how you tolerate it.

    Suboxone has to be started when the patient is in moderate withdrawal, but has a very low side effect profile.

    The pain management climate is moving away from using opioids for chronic noncancer pain, so a lot of pain docs are tapering their patients down on their meds, taking them off of them, or switching them to Suboxone.

    As for nerve pain, what Gabapentin dose are you on? Maybe it can be increased. Otherwise, Lyrica is more effective for some folks. Best wishes.
    __________________
    Kate
    constant headache since 2006

     
    Old 09-05-2016, 01:17 PM   #3
    Lois
    Junior Member
     
    Join Date: Aug 2003
    Location: Auburn, WA 98092
    Posts: 14
    Lois HB User
    Re: Suboxone vs. Methadone vs. ?

    Thank you so much for this information. It actually explains some of what has been confusing me. three months ago my pain specialist brought up switching to Methadone. But I was surprised that he suddenly brought up Suboxone. Also his demeanor during my office visit was very different this time. I am beginning to believe this has to do with the recently published national guidelines about pain medications. Suboxone was mentioned as the drug of choice for switching patients in everything I've read about these..
    But I think it is entirely wrong for me. I'm 60 years old and there is likely going to be future illnesses and surgeries. I don't want to worry about getting off the Suboxone before I can be treated for pain for other reasons than my MS.
    I'm still worried about the potential dangerous side effects of the Methadone but since the Oxycontin at the dosage I'm at is no longer working and the doctor won't increase it I see no other choice.
    It is so hard to deal with chronic pain and then to have the stigma, red tape, and interference in between the doctor/patient relationship--it all feels like being kicked when you are down. It's unlikely there will be a cure for MS in my lifetime plus the damage to my nervous system is done. Why can't I obtain adequate pain control since there are few other options?

     
    Old 09-05-2016, 05:53 PM   #4
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Suboxone vs. Methadone vs. ?

    I think the risks of Methadone can mostly be mitigated, and especially at a low dose, will be low. Hopefully your doctor gives you a choice on Methadone vs. Suboxone. If they seem set on Suboxone, definitely bring up your concerns about the issue with other pain meds not being able to be used. Although there are some alternatives, it definitely isn't as easy, so I don't see a reason for Suboxone to be used for pain unless its really indicated (like in a patient with addiction). I too find the current state of pain management discouraging. Too many patients are being tapered off of and taken off of meds that are the only thing helping them live their life. I'm scared for the day I'll get cut off. I think doctors are making these decisions out of fear. I get that they have to protect their license/practice though, and it would be worse for all their patients to be left in the lurch than many to be tapered down. Best wishes.
    __________________
    Kate
    constant headache since 2006

     
    Old 09-08-2016, 12:24 AM   #5
    Kyle524
    Junior Member
    (female)
     
    Join Date: Sep 2016
    Location: NC
    Posts: 23
    Kyle524 HB UserKyle524 HB User
    Re: Suboxone vs. Methadone vs. ?

    Methadone has a really long half-life, it stays in your system for a very long time, so the dosing is generally only 2 times or so per day. Its been used for a while very successfully for back and neck pain.

    When using Suboxone for pain you have to keep in mind that it has Nalexone in it, and that will stop any other narcotics your taking from working effectively. Nalexone is what addicts are given to counteract the effects of narcotics.

     
    Old 09-11-2016, 07:17 PM   #6
    grandma A
    Newbie
    (female)
     
    grandma A's Avatar
     
    Join Date: Sep 2016
    Posts: 6
    grandma A HB User
    Re: Suboxone vs. Methadone vs. ?

    Quote:
    Originally Posted by Lois View Post
    Hello. I have chronic pain from Multiple Sclerosis. It began after my second MS attack and comes from lesions in my spinal cord. I've had it for 24 years. Six years after that attack the pain became so difficult to deal with I went to a pain specialist and was prescribed Oxycontin. I have used a low dosage of that (10mg twice a day) for many years and while it never completely alleviated the pain, it managed it well enough for me to work and have a normal life with some occasional bad times. However, in 2014 I had to have surgery for another condition and things went out of all out of whack with the MS. The pain intensified-- a constant burning sensation in my entire left leg as well as spasticity, a common MS symptom which I hadn't experienced until the surgery. The doctor increased my medication to 20 mg twice a day which helped until the past 3 months. The Oxycontin just stopped working. And I developed more symptoms (feels like a thousand wasps stinging my leg, low back pain from spasticity) which have destroyed my quality of life. I've learned many non-medication therapies over the years to help with the pain but the intensity of this new pain has me exhausted, depressed, and discouraged. My pain specialist will not increase the Oxycontin. Compared to others the 20mg twice a day seems like a low dosage but I think the new laws have made all doctors in WA state clamp down on Oxy and in discussing this with other MS patients no doctors will prescribe or increase Oxy anymore. My doctor has suggested switching to Methadone or Suboxone. I thought these were only used for drug addicts and while I am dependent on the Oxy after using it all these years, I have never abused it or even felt high from it. I've never taken enough of it to completely relieve the pain from my own choice because I was concerned about addiction. So I'm confused about the Suboxone and Methadone suggestion. My doctor assured me that these medications are also used for pain not just for addiction. But I'm worried about what other doctors or even hospitals will think if I have an accident or need some other hospital treatment. Plus things I've read about these medicines on this message board and others frightens me. Please let me know your experiences with these two drugs. Do either of them really help with severe pain? Is there some other kind of medication that works for neuropathic pain from the central nervous system? I'm already on gabapenton which does not seem to help at all. Thank you for any advice and information. I'm so worried, depressed, and my life is so restricted now because of the pain. I'm looking for help everywhere.
    Gotta get busy cleaning up dinner dishes but wanted to reply to your post as Ive had experience with methadone and suboxone both, which I was using to get over my addiction to hydrocodone. I vote methadone, hands down. I only took one dose of the liquid methadone daily (from a clinic.) it totally controlled all my pain for 24 hrs and I never had to take any type of medication to sleep at night as it solved that problem as well. I was on what most considered a very small dose (25 mg) considering how much hydrocodone I had been taking. Any larger dose and I would throw up all day. I hated suboxone. Not only was there no pain relief at all.... I literally COULD NOT POOP. It got really scary cos nothing helped n that department. Also on the gabapentin vs Lyrica question.... I do know gabapentin is generic and much cheaper than Lyrica which hasnt gone generic yet. My hubbys copay monthly is $35 but he is diabetic and has bad nerve pain n his feet and legs. The Lyrica works really well for him. I hope this helps u out. I go to pain mgt now for bad lower back issues and would gladly trade my hydrocodone for the efficiency of methadone. I have never been offered that option but may ask about it. I am having facet joint injections on the 21st and that usually gives me complete relief for 3-6 months where I need little to no pain meds at all.

     
    Old 09-12-2016, 05:03 AM   #7
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Suboxone vs. Methadone vs. ?

    I thought I'd chime in that for pain, Methadone is typically prescribed to be taken 2 or 3 times a day. Although it has a very long half life (8-59 hours), its effectiveness for pain is much shorter acting (4-8 hours). It takes at least 3-5 days of dosing to reach steady state in the system. I have ended up needing to take it 4 times a day, which apparently isn't too unusual (my pain doc had no problem with it), and I'd probably do better with even more often as it typically lasts me only about 4 hours.

    However, every once in awhile we hear of folks who say that only once or twice a day is effective for them. I'm curious if they would do better on more but that is just significantly better than nothing. Similarly, Suboxone for addiction is typically only taken once a day, but for pain, 2-4 times a day. The great thing with both meds is that in case of an emergency or something, withdrawal takes quite awhile to start, so you don't have the issue of waking up in withdrawal. Methadone has been a great med for me. Best wishes.
    __________________
    Kate
    constant headache since 2006

     
    Old 09-12-2016, 06:34 PM   #8
    Kyle524
    Junior Member
    (female)
     
    Join Date: Sep 2016
    Location: NC
    Posts: 23
    Kyle524 HB UserKyle524 HB User
    Re: Suboxone vs. Methadone vs. ?

    Methadone, how you take it and the efficacy of its long half-life are different for different types of pain. When using this drug and most others for chronic headache pain 24/7, its very hard to find one that gives long bouts of pain coverage....there is tons of rebound pain and neuron receptor & nerves misfiring to deal with.

    Methadone use for back, neck pain and pain that we have from MS is different. It lasts longer and generally 12 hour dosing is about all that's needed. Narcotics/Opioids work differently on different types of pain. A decent dose twice a day, once its built up in your blood plasma level after a couple of days usually helps. Sometimes the mg's may need adjusted in the beginning.

     
    Old 09-13-2016, 04:47 AM   #9
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Suboxone vs. Methadone vs. ?

    Quote:
    Originally Posted by Kyle524 View Post
    Methadone, how you take it and the efficacy of its long half-life are different for different types of pain.
    You think effectiveness and how long a dose lasts is primarily related to the type of pain, not how the patient metabolizes the medication? They have some great tests now where with just a cheek swab they can do a genetic panel on how you metabolize different pain meds. They have shown huge differences between different people, showing why some can take high doses without relief and others are very sensitive and could easily overdose.
    __________________
    Kate
    constant headache since 2006

     
    Old 09-13-2016, 09:06 PM   #10
    Kyle524
    Junior Member
    (female)
     
    Join Date: Sep 2016
    Location: NC
    Posts: 23
    Kyle524 HB UserKyle524 HB User
    Re: Suboxone vs. Methadone vs. ?

    Yes the cheek swab tests are very good, several of the Dr.'s in our office use them. And yes different types of pain, coming from different pain nociceptor's and the signals sent to the Spinal Cord & Brain, depending on where and what system is affected, can effect the way a long half-life medication like Methadone works.

     
    Closed Thread

    Tags
    methadone, multiple sclerosis, suboxone



    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 12:13 PM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!