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    Old 04-20-2005, 03:56 PM   #1
    cardinal
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    Methodone, just started tonight

    I am desperate for help, saw a pain specialist today and got a script for methodone 5 mg. I do not tolerate meds well and have suffered for 20 yrs with pain. Now after failed cervical fusion and lumbar herniated can not go on. Has it helped anyone? I am feeling "groggy" right now and scared about side effects. In for double surgeries again. Does the sedation get better with time?
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    Old 04-20-2005, 04:10 PM   #2
    klh121560
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    Re: Methodone, just started tonight

    Cardinal -

    Were you one of the cardinals that elected the pope? Ok, just kidding. I take methadone (20mg/day). It is great and has helped me alot. It takes 5 days to get into your system. The sedation will slowly get better. Mine took about a month or two, but it was worth it due to the years I had of pain, and all the drugs and docs I saw in the mean time. There is so much too say about methadone, how it works, half life, side effects, etc... and my hand hurts from typing today. So I am cutting and pasting an excerpt from another post of a guy who wanted to know about meth aslo, and this is part of the reply which answers some of the points I menetioned earlier. It is from Dave "Shoreline" who has a wide breath of knowledge on the subject of chronic pain.
    Thanks dave for this info, I am sure it will help cardinal out!

    -Ken



    "Re: Question about methadone

    --------------------------------------------------------------------------------

    Hey Cajun, I took meth for several years and have used morphine for over a year, and tried OxyC and Duragesic. Pain wise, meth works well when dosed properly "to suite your needs" if you can handle the side effects, just like any med. Some side effects are more bothersome to others or more profound with specific opiates. But side effects and reponse are very individual.

    There isn't a gaurenteed conversion that will manage your pain, it's all pretty much trial and error. There are some ball park guidelines for converting from one opiate to the next , but these guidelines simply get you in the ball park and then it's very normal to have to make adjustements to your dose or dosing schedule to get the max benefit with the least side effects.

    Although meth has a long half life, when used for pain, some people can get by with 3 times a day and some need 4 times a day dosing. I wouldn't recomend increasing any med to try to make it last longer, It just doesn't work that way. If you only get 6 hours of relief between doses, doubling the dose isn't going to make it last twice as long. You would be better off taking more frequent doses and keep your daily dose down than to increase and increase trying to make it last 12 hours. Some people are able to go 12 hours between doses or some docs believe anyone can go 12 hours if the dose is right. Not all docs are as knowledgable or as confident when prescribing opiates. Some have limits, like they won't exceeed 200 mgs of morphine a day, some know that their is no ceiling on any pure opiate as long as you aproach the dose safely and can tolerate the side effects.

    The confusion is that meth used for addiction is dosed once a day, It doesn't mean it relieves pain for 24 hours, it simply prevents withdrawal from occuring when dosed every 24 hours. For acute pain, the recomended dosing schedule is 4-6 hours, but you will be able to feel the dose wear off and know how frequently you personally need to dose. Acute pain and chronic pain are different in many ways.

    Hydro is roughly the same strength or a little weaker than morphine, most conversion are 1:1 or .8:1 meaning 8mgs of morphine is equal to 10 mgs of hydro.
    Morphine is the gold standard to which other meds are compared, most have you equate whatever med you are on to an equal dose of morphine and then convert it to whatever med you are going to be taking.

    There are conversions for methadone but the latest articles suggest they are only good for single dose conversions.Most of these have meth being about 1:1 to morphine but again, that's only for a single dose. They don't take into acount the long half life of meth and the build up that occurs over the next 5 days, after 5 days you have the remainder of the previous 5 days still in your system and that's what they need to be looking at when converting.

    Because of the build up of meth in your system, you have to adjust doses slower than other meds that terminate in 8-12 hours.
    This is just ballpark but will help you understand what I mean about meth.
    120 mgs of hydro would be equal to say 100mgs of morphine, Using a safer calculation "5:1" you would likely start around 20-30 mgs per day. 5mgs 4 times a day or 10 mgs 3 times a day should be a safe starting dose.

    Starting on the low side is better safe than sorry. If you start too high , you may be fine the first few days and not wake up on the 3rd, so you may have to put up with some additional pain and what seems to be too low of a dose the first few days.. If you started at 20 mgs a day with a 24-30 hour half life, which means 24 hours after you take a dose, you still have half in your system, 24 hours after that you have half of that and this continues on for 5 days.
    Day 1 you take 20 mgs
    Day 2 you take 20 mgs and have 10 mgs left in your system from day 1.
    Day 3 you take 20 mgs, have 10 mgs left from day 2, and 5 mgs left from day 1=35mgs
    Day 4 you take 20, have 10 left from day 3, have 5 left from day 2 and 2.5 left from day 1=37.5mgs
    Day 5 you take 20mgs, have 10mgs left from day 4, 5mgs left from day 3, 2.5mgs left from day 2 and 1.25mgs left from day 1=38.25. Your serum level on day 5 would be the same as if you took 38.5 mgs in a single day. It takes this long to figure out if the dose is effective and to reach a steady serum level. This is why the conversions are not accurate you see on most equianalgesic tables, because they don't take into acount the build up over the first 5 days of using meth, which virtually doubles the serum level of what you take each day.
    I use a 5:1 conversion because it has worked for me both times I swtched back and forth from meth to morph and then back to meth.
    I was taking 120 mgs of meth , swtched to 600 mgs of morphine after several adjustement, when I lost insurance, I switched back to a lower dose of meth and titrated right back to the same 120 mgs of meth, which is a 5:1 conmversion rate.

    120 mgs of meth, provided the same or better relief as 600 mgs of morphine.
    If the docs had followed most published conversion charts I would have gone from 600 mgs of morphine back to 600 mgs of meth which would have killed me by the 2nd or 3rd day after my serum level began to rise.

    Everyone does respond differently to opiates and meth produces the widest range of response. If you had 10 people taking 100 mgs of morphine a day switch to meth, some folks would need twice as much meth as the other, making the titration or adjutment phase slower in order to be safe.

    The nice thing about meth is that switching to meth is very easy, meth covers all the same receptors that hydro and most other opiates do and then some, so although you may not feel your getting enough pain relief, it's unlikely your going to experience withdrawal. Adjustment upwards can always be made, but starting too high may not give a doc the opportunity to make a downward adjustment unless you or your family recognizes the over sedation and other risks associated with any opiate, mainly respirtory supresson.

    What meth has that other opiate don't is NMDA receptor blocking ability. Blocking this receptor has been studied and is believed to help control tolerance to opiates, help raise your tolerance to pain and helps better with nerve pain, "neuropathic pain" like radiculopothy or leg pain from a bad back. Or some of the other forms of nerve pain like diebetic neuropothy, RSD, shingles and many other nerve pain generators. Compounded long acting hydro is compounded with dextromathorphan because of it's NMDA blocking ability, It makes it stronger , more effectve and last longer.

    You have to do alot of digging past methadone maint for addiction to find pain management info about methadone, but it is out there.
    If you cut and paste these addys into your browser, you should be able to find what took me weeks and months to find.

    Methadone: History and Recommendations for Use in Analgesia
    [url]http://www.ampainsoc.org/pub/bulletin/sep00/upda1.htm[/url]

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

    This article explains about the NMDA receptor and the differences between chronic and acute pain.
    [url]http://www.hosppract.com/issues/2000/07/brook.htm[/url]

    This is part 2 which talks about opiate selection and the difference between addiction and physical dependence.
    [url]http://www.hosppract.com/issues/2000/07/brook.htm[/url]

    AS far as side effects, Meth has the same potential to produce the sam side effects as any opiate, Constipation, Urinary retention, itching, sweating and flushing, etc. Each persons response to different opiates is different. One person may not tolerate meth but do great on morphine or Hydro, or vice versa, Some folks can't stand the side effects of morphine but do great on meth.

    Nobody can really predict how you will respond or how well you tolerate the side effects and how bothersome they are. Synthetic opiates, Hydro, Oxycodone, Oxymorphone and Hydromorphone tend to be stimulating and cause less drowsiness. Morphine and meth tend to cause more drowsiness and you need to be very careful driving if you not accomadated to the side effects or you don't know how the new med effects you. But drowsiness does deminish as most side effects do with any opiate. You have to give mth at last 5 days to see how you tolerate a dose, then it would be best to stay at that dose for a few more days before increasing it to allow your body to become acommadated to the med and side effects to deminish.

    The only side effect that doesn't get better is constipation. All opiates cause this and the only way to to deal with it is to get on a daily maint program to prevent it. More fiber, stool softeners,laxatives etc. etc.

    Please read all 4 articles, If you have any questions or can't find one, I can just post the article here for you to read."
    Good luck and take care, Dave

     
    Old 04-20-2005, 04:10 PM   #3
    SheSparkles
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    Re: Methodone, just started tonight

    Quote:
    Originally Posted by cardinal
    I am desperate for help, saw a pain specialist today and got a script for methodone 5 mg. I do not tolerate meds well and have suffered for 20 yrs with pain. Now after failed cervical fusion and lumbar herniated can not go on. Has it helped anyone? I am feeling "groggy" right now and scared about side effects. In for double surgeries again. Does the sedation get better with time?
    Hey Cardinal,
    Yep the grogginess diminishes. The pain relief will increase over the next several days. It is a GREAT pain reliever. This is a pain med that a good Dr. will start low on and stay slow. Don't get impatient. What have you been on other than methadone? I am so very sorry your pain has taken up so much of your life. I hope methadone will give you some of it back.
    Have you a rescue medicine? a b/t med? Let us know how you do.
    In His Grace,
    SheSparkles

     
    Old 04-20-2005, 05:17 PM   #4
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    Re: Methodone, just started tonight

    Hey cardinal,
    Methadone is Cheap, Long acting and very effective. SheSparkles was right in that it takes just a few days to really build up nicely in your stystem. I mean it works 30-60 minutes after taking it and it will help right away, but waiting for it to build up is worth it, because the pain relief just gets better and better until you hit like a platuea where your normal. I have to take it every 8 hours or the pain starts to come back after 8 or so hrs (I take 40mg's q8hrs a total of 120mg's daily) I also have moments of Breakthrough pain, (I have bad sciatica from herniation) so I take hydrocodone for the moments of BT pain. But overall methadone is, for me, the best LA med I've yet to try and I've been on just about all the L.A. opiates. Actually though, one my next visit to the Dr's office, I'm going to mention a switch in the BT meds from hydro to oxycodone...it works just a little more effective for me. On that note, you just might end up needing a BT medicine. How bad is your pain? Do you have sciatica from your spine injury? Also that previous post that klh copied from Shoreline is very good, it helped me when I 1st started methadone. OH OH, one thing I wanted to mention...a BAD side effect that I've suffered from, while on methadone, is SEVERE insomnia. LOL, not severe where I never get a wink of sleep, but since on meth I havn't slept for more than 2 hrs strait. I had to ask for sleeping meds to combat that side effect. So now I take one Restoril (temazepam) before bed and it really helps alot. So if you have trouble sleeping, you know it's from the methadone.

    - JaMeS

     
    Old 04-21-2005, 05:57 AM   #5
    cardinal
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    Re: Methodone, just started tonight

    Thanks Dave, Ja, and She!!! Gosh you all are so "knowledgeable"!! I truly appreciate your help. I tend to give up too fast when trying a med. I just want to be able to function and have a clear mind while doing so. That's why I have suffered so long and resorted to several beers after any acitivity, alone and secluded. I found after my first dose last night, I was very "groggy" but a few hours later calm, not so foggy. But, yes, I couldn't get to sleep and took a small amt of xanax. I have to go out today so maybe I will take 1/2 and then alittle more when I get back? Is this a drug you can take "as needed" or does it have to build up? I felt the effect within a half hour of taking it. It sure has a "stigma": associated with it, after telling my 28 yr daughter I was on it her first response was: that's for drug addicts! she lives far away and has no clue how much pain I am in! actually nobody does, but now I found this pain doctor that understands, gosh he and his assistant were in awe of my past issues...One thing I still have is my humor and positive attitude that is the best remedy one can have!!!
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    Old 04-21-2005, 06:14 AM   #6
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    Re: Methodone, just started tonight

    Cardnial,
    When my mother 1st started taking methadone (I was only 17 at the time, I'm 26 now) I freaked out as well...thinking the exact same thing she did...'thats for drug addicts'. Because your right, there is a lingering stigma attached to the word methadone. Things are slowly changing though. You just tell your daughter to look up this website/board...do a search for methadone and tell her to just sit back and read. Then she'll see how beneficial it really is and how proper it is for people w/ chronic pain. Don't blame her, just open her eyes. And I TOLD YOU! LOL, about the 'no sleep'...it happens, it really really does. I once read that methadone inhibits the natural 'dropping' of our bodys own melatonin, for that deep sleep at night. So there it is, might just have to have help sleeping w/ and aid. Xanax is a benzo, I told you I take a benzo for insomnia (restoril), so I'm sure that will work just fine. Also, I wouldn't recomend taking methadone 'as needed', I think it's best to combat the pain before it even starts, plus...the more regularly you take it the less side effects you'll be having. Take care Cardinal, and just be patient w/ the meth AND your daughter
    -James

     
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