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  • methadone, anyone?

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    Old 02-19-2004, 01:11 PM   #1
    TragicQueen
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    methadone, anyone?

    I've just been prescribed methadone for chronic pelvic pain.
    I'm a bit tentative because the only thing i've heard about it is it's role in helping people get off herion.
    Has anyone taken it for pain control, and did it help?

     
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    Old 02-19-2004, 04:52 PM   #2
    tyler7
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    Re: methadone, anyone?

    Tragic,

    Hello. Unfortunately your naive view seems to be shared with most of the general public (ie - non-chronic pain people), but it's good that you've come here to ask. Because the fact is thousands of people (at least) use Methadone in America for the treatment of chronic pain, their situation has nothing to do with addiction.

    Many people here at HB use Meth, including myself. It has been especially effective against nerve pain. You said you have pelvic pain, is it nerve related at all? There are several possible reasons why people prefer it over other pain meds. It's very cheap, even paying retail (if you have no RX insurance) for even a month's supply. It also lasts a long time, though technically it doesn't act on your body the way other long-acting meds do (like MSContin, OxyContin,etc); it has no time release mechanism, it's essentially an immediate release drug like Vicodin or Percocet, it just generally lasts several hours. Along the same line, it also has what I think might be the longest half life of any opiate med. What this means is it can take up to 5 days for your serum level to empty (you take a dose on Monday, it could not entirely leave your body til approx Fri - this doesn't mean you'll feel pain relief that long from one dose, just a portion of the drug stays in your blood stream that long, as in, if you stopped it suddenly, you wouldn't feel w/d symptoms for a few days).

    Also, as I'm sure you'll discover dealing with your doc, it should be titrated slowly until you find the appropriate dose for your pain level. Perhaps the best advantage to Methadone is its NMDA Receptor blocking ability. Studies have shown that when this receptor in your body is blocked, you can both have your threshold for pain increase, as well as seeing your tolerance to the med decrease, as in you won't need to keep upping your dose as often to achieve the same pain relieving effects. Although on this particular detail (and the whole topic of Meth, really) I defer to "The Man" around here, Shoreline, who is a virtual expert on Meth, and he has made a myriad of posts both about Meth and specifically the issue of the NMDA Receptor. Do a search using that as a keyword and you'll no doubt find a wealth of information.

    The last two things I have to say are, FYI, there are those that believe that Methadone is perhaps the only opiate pain med that will not produce a feeling of euphoria as a side effect; this is very untrue. Granted, you may not, it all depends upon your body chemistry, and the timing of your personal titration, but it is possible, I've felt it at times. Luckily, I've discovered in my 3 years of dealing with CP I handle narcotics very well, none of them make me loopy or tired - I can get a 100mg shot of Demerol and be driving within 15 minutes (and actually have done that before, leaving the ER). As with anything, there are many possible s/e, which you may or may not get. Some of the more common ones are constipation (sometimes even a little worse than with other opiates) and drowsiness.

    Finally, and actually perhaps the most important note of all, when you pick up your RX, do your best to make absolutely sure it is Methadone manufactured by Roxane that you receive (your doc may even be writing "brand specific" on the script). Because what else can happen is being given "Methadose" by Mellenkrofft (sp?). MANY PEOPLE have said, and myself included, that Methadose, which is sort of a generic version of Methadone, is simply not as strong, even mg for mg. You would notice that the "dose" is literally a bigger pill than the "done", and I believe it's due to less actual narcotic and more filler ingredient. The price between the two should be negligable. Many have received less (and not as long lasting) pain relief from Methadose.

    Ok, that's all I can think of right now. I'm sure more folks will be around soon.

     
    Old 02-20-2004, 11:04 AM   #3
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    Re: methadone, anyone?

    Hi Tragic queen, Like Ty said it's only thought of as a drug for addicts by people that don't know much about pain medicine. It was developed as a pain reliever, It's a pure opiate agonist and a good NMDA blocker which will slow tolerance to opiates and raise tolerance to pain.It works particularly well on nerve pain that other opiates may not be able to touch, and also works on other types of pain like crushing spinal pain.

    The pharmacist that fills it knows your not a heroin addict. Meth clinics that treat addicts only use liquid meth so that addicts can't stockpile a supply to abuse and federal laws prohibit meth clinics from dispensing pill form meth. The only way addicts get meth is through the meth maint clinics. They don't take prescriptions to the drug store so the pharmacist knows it's being prescribed for pain.

    It takes several days for your serum level to rise and stabilize as each dose builds upon the previous dose because of the long half life. And yes meth can produce euphoric feelings when your not used to or accommodated to methadone. During dose increases you may feel a bit warm and fuzzy but that disappears rather quickly and the only way to maintain that feeling is to continuously increase the dose. You don't need to feel warm and fuzzy to obtain pain relief.

    You would probably find more people able to stabilize on a dose of meth for longer periods of time than any other opiate. I used the same dose for several years before needing an increase but that was only after breaking another screw in my spine which increased my level of pain. For the uninsured, it's the only affordable med used to treat long term pain that hasn't responded to any other treatment. I went from 1400 a month for long acting morphine to 60 dollars a month for an equivalent dose of methadone.

    The initial dose may seem a bit low but because half is still in your system on day 2 your serum level continues to rise until you stabilize by about the 4-5 day.
    It basically works like this.
    If you take 40 mgs on Monday you have 40 mgs in your system all day,
    When you take 40 mgs on Tuesday you still have a good 20 mgs left in your system from Monday, now your serum level is equal to taking 60 mgs at once.
    On Wednesday you still have 10 mgs of meth from Monday, 20 mgs from Tuesday and the additional 40 mgs on wed. equaling about 70 mgs.
    When you take 40 mgs on Thursday, you still have 20 mgs from wed dose, 10 mgs from Tues dose and 5 mgs from Mondays dose=75mgs
    On Friday you take 40 mgs, add the 20 mgs from Thursday the 10 mgs from wed, the 5 mgs from Tues and 2.5 mgs from Monday=77.5 mgs.
    By Saturday, you are pretty much at a stable level as Mondays dose is completely wearing off and then you have a pretty good idea of the amount of analgesia obtained by taking 40 mgs a day. About twice what you experienced on day one "Monday" Docs usually won't increase meth any faster than every 2 weeks because you need time to become accommodated to side effects like respritory suppression.

    You do have to dig past allot of methadone maint information to find articles about it's usefulness as a pain med.

    The charts you may find on the internet comparing strength of opiates, called equianalgesic charts tell you what the comparative strength is to other opiates. Morphine is the gold standard to which other opiates are compared in strength. Every chart I have seen is simply a single dose comparison when it comes to meth and doesn't account for the long half life of meth. So although a chart may say it's roughly equal to morphine in strength but that's very misleading. More recent studies show it's closer to 5-10 times more potent than morphine.

    It's a good med for addicts because it sustains enough opiate in their system that they can break free from having to inject heroin every 4-6 hours and can go 24 hours between doses administered at the meth clinic without experiencing significant withdrawal, this is supposed to allow them to function more normally without the need to continuously redose to prevent withdrawal syndrome.

    Methadone has the same side effect profile as just about any opiate, sweating, flushing, nausea, constipation, drowsiness, respiratory suppression, etc. The only side effect that never goes away is the constipation and that's true with all opiates. The have an effect on the smooth muscles and prevent the needed contractions to move things along. Anyone on opiates around the clock should take something to prevent constipation. Becoming impacted from opiate use is something that every CP patient on opiates needs to avoid through the use of stool softeners and laxatives that cause the needed contaction of the bowels. Staying ahead of the problem is much better than having to be manually un-impacted.

    After you have reached a steady serum level and dose then you can determine if the dose is appropriate. Although it has a long half life it doesn't mean it's analgesic action lasts for 24 hours. When administered for acute pain or cancer pain it's dosed every 3-4 hours. I can actually feel the anelgesia wearing down around 4 hours.But each dose builds on the previous doses during the day and days before. When dosed for chronic pain, Docs aren't at a consensus, but most patients require dosing 3-4 times a day to maintain steady analgesia.

    Here are a couple articles about meth used for analgesia. Do use the search feature and look for discussions on this forum using the key word "methadone" and discussions using the key word "NMDA receptor."

    [url]http://www.mainehospicecouncil.org/MaineLink/vol2no2/methadone_rediscovered.htm[/url]

    [url]http://www.ampainsoc.org/pub/bulletin/sep00/upda1.htm[/url]

    It's never a good idea to make the prescriptions you take public knowledge. It can bring out all your well meaning "friends" That think you can afford to share a pill every now and then for their headache or back ache.If you feel cornered, Used the brand name for methadone which is Dolophine, nobody will know what it is making it less attractive. If someone asks you for meds explain you are only given enough to take an exact amount for 30 days and giving up even one pill could not only harm an opiate naive person but have consequences on you when you run short.

    There are no such things as early refills when it comes to pain management. 30 days means 30 days, no more no less. The docs have already heard every excuse for running out early that you can imagine.Self medicating and running short is a sure way to be discharged without notice and then you get to experience opiate withdrawal.

    Any of us that use opiates for intractable pain are at the end of the line and physical dependence is unavoidable. It's a price we pay for pain relief. Understanding the difference between addiction and dependence is important. Addiction is a psychological problem which entails a bunch of abnormal behaviors like doc shopping, Hoarding meds to take large doses instead of as prescribed, etc etc.

    The process of finding the right dose may leave you a little uncomfortable until they find the right dose but even the most severe chronic pain doesn't make for an excuse for self medicating and running out early. If your in terrible pain report it to your doc and make an apt to see him to discuss your options. Very few docs will authorize an increase over the phone. So bear with it until you find the right dose.

    Most initial unpleasant side effects will diminish with time. Be very careful driving on meth. When you not active it's very easy to fall asleep behind the wheel or while watching TV.

    Here are a couple more articles by a renowned pain management doc that explains the difference and a little more about using opiates for chronic pain.
    Part 1
    [url]http://www.hosppract.com/issues/2000/07/brook.htm[/url]

    Part 2
    [url]http://www.hosppract.com/issues/2000/09/brook.htm[/url]

    welcome and good luck, Shore

     
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    Old 02-21-2004, 12:35 PM   #4
    Tom's Ex
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    Re: methadone, anyone?

    I was prescribed Methadone for severe back pain. I took it like the Dr. said, 1 tablet, 3times daily. I was on it for a year, and you guessed it, became addicted. I spoke with my Dr. about this and he tried to ween me off of it. Finally, I had to quit "coldturkey". It was the hardest thing I've evr had to do. I'm proud to say that I've been methadone free, for three weeks. I just thought you should know.

     
    Old 02-21-2004, 01:07 PM   #5
    Karla
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    Re: methadone, anyone?

    I took methadone 10mg am and 10mg pm for cluster headaches and migraine pain relief. It stopped the pain but I slept for 15 hours a day. I was like that for a year. I finally talked to my dr about that and I was put on the duragesic patch. I had no problem with withdrawls or anything switching meds. I like the patch much better.

     
    Old 02-21-2004, 02:47 PM   #6
    tyler7
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    Re: methadone, anyone?

    To Karla - excuse me, but you dealt with the excessive sleepiness for a year while taking the Methadone and then finally told your doctor? Huh?

    And may I comment on what Tom said about his addiction problems. Now, please bear in mind I don't mean to be directing this directly at you, but I feel like I should say this about addiction in general. You can't always necessarily point to the little white pill and say "evil", that it's the medicine that ruins you. For someone to become addicted to even a prescription drug, there has to be an underlying psychological problem that's already there, just waiting to be exercised. Thousands of people (at least) take prescription pain killers everyday, some even experiencing the euphoria as a s/e, and they do not become addicted. They take the meds exactly as prescribed and/or only as needed. When you become addicted to pills, you're running away from something, you're trying to kill a different kind of pain, and I dare say it's a pain you'll find that's never going to completely go away via the meds. I'll even go so far as to say that if you do fall into the hole of addiction, that angst you're trying to rid yourself of would've just found something else to latch onto eventually, had you not have had to take the pills in the first place. It was all just a matter of timing.

    Please understand I'm not trying to judge you at all, Tom, and I congratulate you on becoming healthy and getting on with your life. I'm just saying people don't become addicted just because they're taking a pill.

     
    Old 02-22-2004, 07:10 AM   #7
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    Re: methadone, anyone?

    Any long acting opiate you take around the clock for a year, physical dependence is inevitable. It's a price we pay. If you took opiates around the clock thinking you wouldn't become dependent you really can't blame a pill, It would have happened with OxyC, MSContin, Duragesic or any short acting med taken around the clock for a year.

    Meth is not an evil drug, no more than oxycodone, hydrocodone, morphine or fentanyl. Perhaps you really need to decide if you can't live with your pain before you ask a doc to help you to live with it. What's different between now and 1 year ago when you told a doc you couldn't live with your present level of pain? Was the pain removed so you discontinued the meds? Or perhaps the pain never justified using a med 5-10 more potent than morphine.

    Everyone wants immediate relief and then calls their med or doctor evil for doing this to them. Does it not take a patient telling their doc they can't live with this level of pain to obtain these meds. I thought it did. Perhaps you could have found something less immediately gratifying with a lesser price to pay for relief

    People post how mad they get when they can't find relief and a doc suggested exercise or physical therapy. There is no negative consequence to trying non opiate methods before claiming your pain is intolerable and you have no quality of life.

    Be careful of what you ask for or you may actually get it.
    I'm grateful for my doc, understand the consequences of every med, the risks involved, know about physical dependence and withdrawal and weigh the benefit Vs the cost. Perhaps if your pain isn't truly disabling you shouldn't describe it that way.
    I'm glad your pain is now manageable without opiates Tom, but this would have happened with any opiate used to treat intractable pain. Intractable means nothing else helps,No surgical solution, no procedure will help and palliative care is all we can hope for. Therefore the negative aspects of opiates are justified and the benefit outweighs the negative aspects of opiates.
    Congratulations on becoming opiate free. Perhaps those docs that said you should try other methods before climbing on board the LA opiate wagon were right.I don't see how you can blame a doc or pill when you were only given meds appropriate for what you described, If you had been given Motrin a year ago, would you have excepted that as appropriate for the level of pain you described?

    I don't mean to use your experience as an example, but everyone should know there is a price to pay, addiction is a psychological problem, not the same as expected physical dependence. Did every bag you picked up from the pharmacy not say, do not stop this med abruptly? How many times did you check the box and sign your name refusing counseling from the pharmacist because you already knew all about this med? You found this site, so you have the abilty to research anything your not clear about.

    Did you have a PM contract that explained about physical dependence? IF you didn't, you could do others a favor and suggest to your old doc that he develop a contract that explains these things. I really do hope your pain continues to be managable without the use of these meds. They should be the last line docs resort to when trying to improve their patients quality of life that claim they have none.
    Good luck, Shore

    Last edited by Shoreline; 02-22-2004 at 07:31 AM.

     
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