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  • switching from fentanyl (duragesic) to methadone

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    Old 08-15-2006, 02:20 PM   #1
    threewingedfury
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    Exclamation switching from fentanyl (duragesic) to methadone

    Hello,

    Kinda new here, so if someone has already answered this, I'm sorry.

    My husband has a lot of pain issues, and some times I think he is really addicted to pain medications because hes been on them for so long. He was shot in his knee when he was 13 years old, and has a lot of tissue damage which causes his knee to swell and bruise 6-10 times a month, and give him horrible pain. Since we've been together, every time he would get this pain, we would be in the hospital, he'd be getting percocets or vicodins, whichever they would give, and he would take 20 in 2 days. When he ran out, he complained all the time. Sometimes I felt like he was hurting his knee on purpose because the MRI and X-Rays couldn't find anything wrong with his knee, yet his knee looked like a basketball, color and shape.

    He has now started seeing an orthopedic doctor who was put him on a fentanyl patch, which the 25 mcg/hr stopped working, and hes now on 50 mcg/hr. He uses a TENS unit when needed. The only problem with this, is its like hes getting hurt every day. He fell 2 ft out of a chair a week ago, and it still bitching about the pain. He HAD to go to the doctor to get pain medicine because he didn't sleep for 4 days due to his pain. Back on the percocets we go. A doctor at the emergency room told him to seek a methadone program, because he is addicted to the pain medicine, and is becoming immune to everything he takes.

    I don't know what to do. He wants to try the methadone program to try and get off of pain medications. I don't know if it will work or not. I'm afraid hes going to be stuck on methadone for the rest of his life. Hes on so many antidepressants, mood stabilizers, anti-psychotics also, that I think hes going to be messed up for life, and could eventually overdose on this stuff.

    We have an appointment in 2 days to see the people at the methadone clinic, but all I can think is, is this putting him deeper in the pain medicine hole of addiction(which he doesnt intentionally get addicted to them, it just happens), or will this help?

    He cant take any pain at all! He stumped his toe the other day and thought he would die for 2 days. I just don't understand it, but I wont even take tylenol. I hate dealing with this, and I feel like by him going to the doctor, I'm feeding an addiction, but I live in hell otherwise. He's willing to try and stop these medications, but I need some other peoples input on this. I don't know anything about methadone or than its used for heroin addicts and those trying to get off of pain meds.

    Hes been on avinza, hydrocodone, oxycodone, flexeril, skelaxin, neurontin, and god knows what else. Nothing really cures the pain, hes so immune to them.

    Any suggestions?

    Last edited by threewingedfury; 08-15-2006 at 02:33 PM.

     
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    Old 08-15-2006, 02:54 PM   #2
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    Re: switching from fentanyl (duragesic) to methadone

    You don't say how old your husband is, but you express a concern he could be on Methadone (or other pain meds) for the rest of his life. Methadone is still trying to overcome the bad rap it has by people who think it's only used by heroin addicts and to detox off other medications. That couldn't be further from the truth.

    You don't paint a real good picture of your husband, but assuming his pain is legitimate, Methadone just might be the med for him. I am on Methadone and have been for over three years. Before that I was on Oxycontin and Fentanyl (Duragesic patches) plus several short acting medications. I take 180 mg of Meth per day for chronic pain and this allows me to function in life. Although I am on Social Security Disability, I take care of the house while my wife works. I do all the cooking, pay the bills, clean, and generally do all that needs to be done to take care of the house. When my wife comes home from work at 5:00, she knows we'll eat dinner in a half hour.

    I am not an addict, but I am dependent on narcotic pain medications. Methadone would probably be an excellent medication for your husband. If he goes to a doctor that treats Chronic Pain patients, he will probably have to sign a contract with the doctor, stating he will use one pharmacy to get his meds and not get any narcotics from any other source. This is designed to keep people from doctor shopping. If he is put on Methadone, he will be started with a low dose, about 10 mgs three times a day. Assuming this doesn't take care of his pain, he will be increased until his pain is managed. Also, he WILL NOT get a high from Methadone. That's what makes it so attractive to not only patients, but pain doctors as well.

    Please let us know how your husband's appoinment works out and if he is put on Methadone. Also, let us know if he is going to a clinic, individual doctor dealing with pain patients or a pain clinic. I hope he finds some relief for his pain and he won't have to worry about where his medication will come from next.

    Last edited by Rrector; 08-15-2006 at 02:55 PM.

     
    Old 08-15-2006, 03:12 PM   #3
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    Re: switching from fentanyl (duragesic) to methadone

    hes only 23 - thats why I'm so worried, hes so young (Im even younger, so I'm even more worried)

    Its hard to explain my husband, he goes through so many problems, mostly mental health. Medicines hes on includes Wellbutrin 300 mg/day- for his depression, Trileptal-2400 mg/day for anger, Cymbalta- 60 mg/day for chronic knee pain and for premature ejaculation, Thoriazine - 50 mg as needed for anxiety, Risperdal - 4 mg at night for sleep. I'm also worried that the methadone will interact with these. The fentanyl does, but thats the only thing helping his pain now.

    As you said, you're not an addict, and I don't think he is either, I just feel as if he can't live without pain medicine because hes constantly in pain, and thinks hes dying from the pain that he gets. Hes never gotten high off of his medicine, and uses it as directed.

    He has been going to a pain clinic to get his fentanyl, which had an orthopedist seeing over his knee. They wouldn't put him on any oral narcotics because of his age. I think fentanyl is even worse though because hes getting immune to it so early. He wore the 25 mcg/hr patch for 2 mths before they had to increase the dosage. Also, because he sweats so much, the patch only lasts 2 days, we tape it, and it won't stay, and most of the time there is no fluid left in it because he gets so hot.

    I think hes just tired of worrying about his pain more than anything. Its like his life revolves around his knee, which shouldn't be such an issue. He was planning on staying on the patch for a while, but with this option, hes thinking seriously of trying it.

    And he just found out today from SSA that hes been accepted for disability, so he doesn't have to worry about that anymore.

    Last edited by threewingedfury; 08-15-2006 at 03:42 PM.

     
    Old 08-16-2006, 12:15 PM   #4
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    Re: switching from fentanyl (duragesic) to methadone

    Hi Threewinged: Sorry that your husband spends all of his time concentrating on his problems and knee pain. It sounds like his whole world revolves around his knee.

    I am a little surprised that he was given disability at his age. I've posted and read on the Disabilities Board about something like 98% of young people who apply for SSD are turned down on their first attempt. As I posted sometime ago, I think a lot of it is age. The older you are, the better chance you have of being approved. I was 58 when I applied and was approved on the first try. It took a little less than six months. I most likely will not go back to any kind of work. I will be between 63 and 65 when I am suppose to have a hearing. They had told me it would be 5-7 years.

    As far as medications, most docs shy away from people your husbands age and will not treat them with heavy duty narcotics. I had never received anything stronger than Percoset for pain when younger, except when I was hospitalized. If he can make the switch to Methadone, it will most likely work well for him. I was glad to hear what you said about him taking his meds as directed. A lot of people don't realize how potent Methadone is. I think it's one of the stronger drugs used in treatment of CP patients. It's one and a half times stronger than Morphine. You have to be careful when taking Meth to follow the directions of the doctor. I do have to say, in your husband's defense (speaking from my own situation with CP) when you have pain problems that you have 24 hours a day, every day, it's difficult to think of anything but the source of that pain.

    Best of luck to you and your husband. I hope if he is on Methadone, maybe he can expand his horizons in your marriage a little further than his knee!

     
    Old 08-16-2006, 05:01 PM   #5
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    Re: switching from fentanyl (duragesic) to methadone

    Hello Threewingedfury! Welcome to the pain management board! It does sound like your husband's whole world is now revolving around his knee and his pain as Director has said. But, when you are in constant pain, I guess that's all you can think of. I'd like to suggest something that is really helping me. Beside the methadone that I'm taking (the best medicine that I've ever been prescribed by the way), I've recently started seeing a pain psychologist at the pain management center that I go to. The doctor helps me find ways to redefine who I am....I've been a patient and a pain sufferer for so long that I felt like I had lost track of who the "real" me was. Whenever folks would ask me how I was I felt like I had to go into great detail about all my many aches and pains, even though I knew that they didn't really want to hear the details. Asking, "How are you", was just another way of them saying, "hello"! I realized that I had lost my personality and had nothing to converse with others about unless it had something to do with fusions, or hip replacements or pain management. So I would strongly suggest that your hubbie find someone he can talk to about his constant obsession with his disabilities. I'm sure he'd be alot happier (and so would you!) if he had other things to concentrate on in his life other than the negative. You might ask the doctor about someone he would recommend. I know that around here there are pain management support groups that meet once a month where there is usually a speaker and then folks can sit and share experiences and give support to each other. Maybe you could help him find a group like that. I hope he finds some relief quickly. Hang in there and let us know how things are going for you and him. All the best - KathyMac

     
    Old 08-16-2006, 05:45 PM   #6
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    Re: switching from fentanyl (duragesic) to methadone

    thank you all so much for your suggestions

    i hope that the switch will work for him, but we shall find out tomorrow - im not really even sure if the people will make the switch due to his age, but hes really not trying to switch for pain relief, hes trying to eventually taper down off of pain meds, instead of having to keep the patch on at all times, which is making him really sore - hes tired of wanting percocets with the patch, so i think this is our only option - and i figure it wont be as addicting, since when he takes his patch off, he feels the meds coming out of him in 5 or so hours

    he has seen a pain psychologist in the past and discussed his problems - the psychologist told him to just see his therapist instead, because he has pretty much discussed the same issues with my husband, and it was a waste to see both. my husband has learned to deal with some pain since he is 30% covered in tattoos now (self-done and by myself) and he likes piercings, but we have to focus on the not wanted pain

    it took him 17 months to receive his disability- but we went through a lot in the time between the app and the time of approval, lots of commits to mental hospitals and things dealing with suicide, so i think thats why he received his disability

    i really wish he could just be happy though, because he ends up sleeping all day because he hurts so much. he sleeps 20 hrs a day some times because of his pain, and hes just so unhappy when hes awake. maybe one day we will find a resolve.

     
    Old 08-17-2006, 10:37 AM   #7
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    Re: switching from fentanyl (duragesic) to methadone

    well we went to the methadone clinic today, which is supposed to be the only place that prescribes methadone within a 75 mile radius other than his pain doctor - oh god i was soooo scared there today - there were crackheads and drug addicts galore, and i felt like my car was going to get jacked - the people at the clinic said that even for chronic pain issues that we would have to drive to the clinic, 70 some miles away EVERY DAY for up to 3 years before he could have methadone to take home and he had to do weekly visits with a drug intervention group - so that wasnt a good idea

    i think were just going to ask his pain management doctor when we see her next time, because the clinic acts like hes some drug addict even though hes trying to help himself

     
    Old 08-17-2006, 10:56 AM   #8
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    Re: switching from fentanyl (duragesic) to methadone

    Threewingedfury: I guess I don't understand. So, I guess you are talking about an actual Methadone Clinic after all. One that supplies Meth to Dopeheads and addicts of all types. I sorry, I was way off base in giving you some of the information and suggestions I did.

    I get my Methadone from my doctor. I go in once a month and pick up my script for 540, 10 mg tabs of Methadone. That figures to 180 mg a day. I'm taking it for pain control and since I'm a chronic pain patient, there is no way I would go to a clinic like that. My PCP prescribes it for me, like he wrote scripts for Oxycontin and Duragesic.

    I think maybe the best bet is for your husband is to stay on the patches after all. Can regular MD's not prescibe Meth? I guess I'm kind of lost with this whole thing. BTW, are you in the US? Where?

    Last edited by Rrector; 08-17-2006 at 12:35 PM.

     
    Old 08-17-2006, 11:44 AM   #9
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    Re: switching from fentanyl (duragesic) to methadone

    yeah I'm in the US, NC to be exact- see, my husband was dying from pain the other night and we went to the ER - the ER told him to go to this clinic because they couldnt give anyone meds who was on a fentanyl patch, and that he was probably addicted to it if he was still having pain, and I had no clue about it, or what they did - I just figured they helped chronic pain narcotic users (which is what the website said)- I had no clue that it was just for dopeheads, which was really scarry - I figured his pain management doctor wouldn't prescribe it because she had to get approval from some board of directors before she could put him on fentanyl, because he is so young, she wouldnt even put him on BT meds because of his age, said that fentanyl was the only option if the directors approved it

    I figured it would be best to go and ask another opinion first, but god was that a bad idea - we're still going to ask the pain management doctor when he sees her next month, but i doubt she will do anything - she said she wouldnt go over 50 mcg/hr on the fentanyl and if it stopped working then she couldnt see him anymore - it took 2 years for him to get into this pain management place so someone would help him, and now they really dont even want to

    Last edited by threewingedfury; 08-17-2006 at 11:45 AM.

     
    Old 08-17-2006, 12:59 PM   #10
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    Re: switching from fentanyl (duragesic) to methadone

    I don't know what kind of rules this clinic has where your husband sees the doctor, but for her to get approval for Fentanyl, she should be able to put him or get approval for Methadone. Fentanyl is the strongest med out there, that's why it's measured in micrograms and all other meds are milligrams.

    Does you husband have a primary care doctor? That's who is handling my meds for me. I think the nearest true Pain Clinic is about 100 miles away. I did go there a couple years ago and was interviewed and examined. Their suggestion was to have a pump put in and go to Morphine or Fentanyl. They are keeping my records on file, but right now, I'm not ready to go to the pump yet. Methadone is doing the job for me. If your husband does have a PCP, like I do, maybe he/she could take over his meds. It just seems unreal that the only source of Methadone is this clinic for Dopeheads you went to today. There has to be another way for you, besides travelling to another town to get into a PM clinic or doctor.

    I guess if there aren't any other options for you and this doctor who has been writing scripts for his Fentanyl can't write for Methadone (even though it's not as strong), you can always ask her for a bump up to 50 mics. I understand his age is working against him, but why don't you see about finding a doctor there that would be willing to take his case and prescribe for him.

     
    Old 08-17-2006, 02:51 PM   #11
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    Re: switching from fentanyl (duragesic) to methadone

    Hi again - I really want to try and understand what's going on with your husband. Hope you won't mind if I ask you some of the same questions that Director has already asked - I'm not always the brightest person on this board!! Am I correct when I say that your husband STILL WANTS to be on some sort of pain medication? If the answer is yes, are you then saying that he would like to try methadone as a PAIN medication? Or is he interested in taking methadone as a way of getting OFF of pain medications all together?? As Director told you, he takes methadone as a pain medication and so do I. Our doctors write a prescription for methadone just like your husband's doc writes him a prescription for the Duragesic patch. I've never heard of a pain management clinic doctor that needed to get permission from a board of directors before writing a prescription for a particular drug, but I guess anything is possible. It really is ashame that your husband needs to go to the emergency room when his pain becomes unmanageable. If he's a "frequent flyer" in the er, he probably has gotten a reputation as a "drug seeker" whether he is or not. And, as you've mentioned, his age does work against him. I'm really,really concerned about all his past suicide attempts and his history of mental health issues. Sleeping the day away can be a way to get away from the pain, but it is also a way to get away from life. Even though he hasn't had good experiences with therapists in the past, I'd encourage him to find someone in the mental health field to talk to on a regular basis. Good luck to you and to him. KathyMac

     
    Old 08-17-2006, 03:47 PM   #12
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    Re: switching from fentanyl (duragesic) to methadone

    well hes trying to use it for pain, and also to help him get off of pain meds - i know im probably not making sense, but he really wants to stop his meds period, but cant, and I thought this might help because it does help with pain, but it also helps taper people off of opiates

    he sees a therapist at our mental health clinic every week along with his psychiatrist monthly

    his pain management doctor told us that no one under the age of 40 at their practice was allowed to be on fentanyl or morphine unless the board of directors made a special case, and no one under 30 could be on any opiates at all - which is why it was so surprising that they put my husband on these meds

    theres no one in town who will see him for his pain meds and with his psych issues, so thats why we see only the pain specialist and his psychiatrist - weve had a lot of problems with doctors/pa's calling my husband a drug addict and a narcotic seeker because of his age, and he would always be referred to the pain clinic, which took forever to get in

    sorry if im confusing people

     
    Old 08-17-2006, 04:47 PM   #13
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    Re: switching from fentanyl (duragesic) to methadone

    Hi Flyer...There's a lot of truth in the things Kathy Mac put on the table. Also, there are things I still don't understand. Like, is this a really small town you live in with just a few MDs? It would seem that he could be seen by someone that could at least take his case and prescribe what's needed and then work on sending hime someplace to be evaluated. That's what my PCP did for me when I was told I should have a pump implanted. It was on his referral I was able to get into the clinic. That same doctor is the one that said I would be better off, if I went on disability. I'm on Social Security Disability right now and because I'm closing in on 65, I don't think I'll be going back to work.

    Did your husband have all these emotionall and pain issues when you got married? If so, you took on a huge commitment. Someone in their early 20s is going to have a rough haul to get treated like they should be. I just thought if he could be referred to a large city nearby, maybe they have a clinic where he could get some help. Even if it meant an inpatient period to start, I would think he would go for it, if he really needs the meds for his pain.

    I still wonder if there isn't some GP in your area that could see him, at least for a period of time, before he could be sent to a true pain clinic. Maybe the lady doc he gets his patches from could be of some help or am I just grasping at straws now? At the very least, I would ask her for a bump to 50 mcg on the Duragesic and see if she'll do that. Also, it won't hurt to bring up Methadone to her too.

    Good luck to both of you and I hope you have some luck with this situation.

     
    Old 08-17-2006, 04:53 PM   #14
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    Re: switching from fentanyl (duragesic) to methadone

    well see, he is going to a true pain clinic, the only one in Durham NC, which I have to drive a while to get there, and they are handling his pain management, but he is seen by a PA

    he has been in a few different inpatient places before for his mental issues, but they wouldnt even think of dealing with his pain

    hes already on the 50 mcg, if i didnt mention that - he started on the 25 mcg/hr 3 mths ago and she went up on it this month, so now hes at the max dose they prescribe

     
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