Looking for info to copare OxyContin and Methadone

07-10-2003, 10:21 PM

Hi all,
Since I got some real good advice and info. from my last thread, but it unfortunatly turned somewhat ulgy, I was afraid that this question might get lost in the heat of battle. I therefore have posted this new thread, in hopes of gaining only this specific info, and avoid the fighting.
I have posted before about my bulging discs, L4/L5 and L5/S1, with a tear in the L4/L5 disc. I would like to know if someone has any info or links to info comparing Oxycontin and Methadone, (specificly 20mg OxyC vs equivalent amount of Methadone). I would like to find equivelent doses, side effects of each, withdrawal duration, and basicly everything that can be provided to compare the 2 meds to each other. I ask because my PM dr. presently has me on percocet 7.5/325 every 4 hrs. At present, I do not get adaquate releif. Strangely enough, I have gotten adaquate releif in the past taking less Oxycodone, just in a different form, (Oxycontin 20mg, 2 times per day). I know that I cant go on forevertaking the percocet at this quanity, because I am concerned about my APAP intake. I brought this up to my Dr. and asked if their were other meds I could take, that would last longer and provide adaquate releif. He mentioned Methadone and I am not comfortable with the prospect of taking it. I would prefer the Oxycontin, since I know what I can expect from oxycodone (percocet) and have had a positive pain releif experience with the Oxycontin. I would like to have the requested information to prepare my "argument" when discussing my prescription options with my Dr. at my next visit. Thanks in advance for your help.

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1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.

07-11-2003, 05:03 AM

hello from lostsoul15204, You and I have the same injury,execpt I also have tear in L-5S-1 . I contracted an infection from discogram and had my good L-3-4 disc removedbecause that is where infection settled,this happened in 12-02,I was sent home from hospital on 100mg of oxycontin 2 times per day plus 150mcg oer hour of fentyl patches, my pm doc at that time was uncomfortable prescribing those dosages for me. I fired him and got a great pm doc now, I had tried methadone in 12-01 for 1 month and was amazed at the level of pain relief it gave me,so I asked my new Doc aabout converting to methadone, He was very open to this suggestion and started me on 160mg of methadone with 2 4mgs of dilaudid for breakthrough pain,I am now taking 140mgs divided over 4 times a day of methadone with the dilaudid still for BT pain. I am getting a lot more relief from methadone than I di from either Oxycontin or the patches, and I don't have that drugged feeling, I just feel normal with less pain now. As for withdrawl from methadone,I did that in 1-02 from 80mgs per day of methadone to 0 in 13 days by tapering down daily, It was rough, but I made it through it, I did that to find out how much pain I had without meds as my work comp insurance co was trying to settle my case, I lasted for almost 3 months taking only neurontin and ibprofen before crawing back to another pain clinic. Well that's my story and I hope it answers all of your questions. Don't be afraid to try the methadone, you will be amazed at the level of relief it gives. good luck and God bless, Rick

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Rick

07-11-2003, 10:58 AM

Hey Griff!

I was just wondering if looking in the mfg web-sites might not help somewhat. I know they're going to be giving all 'bells & whistles' about Their med.... but, perhaps that info... along w/ what you're able to glean from here, and web searches will better enable you to make informed choice? Just a thought!

Karen

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9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone prob is dif issue - wants x-ray - THOUGHT I had one - didn't!! They are ordering.

07-11-2003, 11:42 AM

Thanks for the suggestions folks. Great ideas. I will give them a try. Looks like I have got a lot of reading ahead of me. Thanks again and here's wishing you a life free from pain.

------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.

07-11-2003, 09:06 PM

When I used to have Insurance,I was able to take Oxy and it did a good job.This was before all the hoopla began.I was on close to the same dose for almost 2 years till I had to have surgery on my Elbow.The surgeon raised my Oxy from 20x3 to 40x3 and OxyIR 15mg every 4 hrs.for BT.I had a lot of trouble gettin over that surgery and my tolerance got on up there.After 8 months,I was up to 80mgx4,then 80mgx6 and finally 80mgx8 each day.My ankles were swollen and my joints ached like crazy.My pain doc talked to me about Methadone and just in time,too.I lost my insurance,so I had to go to Methadone.He put me on 40-50mg every 6-8hrs.I tried but I never had to take that much to relieve the pain.Methadone stays in your system for a long time so I could still feel it,s effects the next day.I settled on 80mg a day,taken as 20x4.I,ve been on that dose for 18 months and never increased it,until 2 weeks ago,went to 80-100(he gave me a 20mg spread)mg a day.Other than drowsiness,it,s the best med I,ve had.Hope that helps,Igriff.Jack Beanstalk

07-11-2003, 11:54 PM

Jack Beanstalk,
Great info, thanks a million. What if any side effects have you felt with the methadone? Any anger, or ilicit dreams? Itching, or hives? How about withdrawals, if you have ever ran out? I have heard of all of these symptoms to varing degrees with some of the people I personally know that takes Methadone. Thankyou.

07-13-2003, 08:08 AM

Igriffincsa,I have detoxed off 80mg to 0 in 13 days of methadone last year.I won't lie to you, it was pretty rough once I went to 0. I took neurontin and Ibprophen foo 3 mo. before running to another pain clinic. Since I had disc removal and fusion in 12-02 I have been on methadone again, started at 160mg per day and now down to 140mg per day. The only side effects I have is drowsiness,constipation and urine retention but it is worth the pain relief I get. I hope this helps you, Good luck and God bless, Rick

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Rick

07-13-2003, 07:31 PM

I think the wierd dreams,itching,drowsiness are standard opiate SE,s,I,ve had them with any opiate,including Methadone.Never had the anger part,unless maybe I was feeling a bit of WD about to come from gettin in a late dose of meds,but I,ve never ran out of Meth,I,ve always made sure I had the bases covered.I did run out of Oxy once,for 1 day,but you just gotta be careful with your stuff and count them pills each time you get a script.The worst thing ,in my opinion,about Methadone is the drowsiness.My doc gives me Dexedrine to combat that.Jack B.

07-13-2003, 10:14 PM

Hi I'm not familiar with methadone but I've been perscribed oxy's. I was also worried about my APAP, my liver jumped upto 41, so I tried Oxyfast which has no APAP. It's liquid and you use an eye dropper which is great because you can accurately measure out dosages. I know this doesn't really answer your question but maybe it's something else to think about. Good luck (ain't finding good meds a pain?) Lake

07-15-2003, 10:56 AM

Methadone Rediscovered

Methadone is a potent synthetic opioid agonist that has been available for over 50 years. Methadone has been somewhat stigmatized by the medical and lay public as the “heroin addict’s drug”, but it is a very useful, cost-effective agent for treating chronic pain and cancer pain that is non-responsive or refractory to high doses of other opioid agonists (morphine, hydromorphone, oxycodone, fentanyl) due to tolerance or disease progression. Methadone is also useful for the treatment of severe neuropathic pain requiring high-dose opioid therapy where the addition of tricyclic antidepressants and anticonvulsants has been ineffective. It also has a role when high doses of other opioids produce significant financial impact to the patient or the patient experiences intolerable adverse effects from other opioids.

Methadone is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist and mu-receptor agonist. NMDA – receptor activation results in central sensitization, which is implicated in hyperalgesia, allodynia, and opioid tolerance. Blocking the NMDA receptors may reduce tolerance to opioids and improve neuropathic pain control, thus the current interest in methadone therapy for chronic pain syndromes. Methadone historically has not been utilized because of the risk of cumulative toxicity but more knowledge about its pharmacokinetics and equianalgesic dosing when switching from other opioids has led to its rediscovery.

Methadone is a basic and lipophilic agent that has a large initial volume of distribution. Tissue levels greatly exceed plasma levels with repeated dosing. It has a long elimination half-life that can reach 128 hours with continued dosing. This is due to a slow release from tissues into the bloodstream. This slow tissue release sustains the plasma level, which decreases in a biexponential fashion. The long half-life explains the cumulative toxicity and allows methadone to be administered once or twice daily. Methadone has an oral biovailability of approximately 80%. The oral route is preferred although methadone may be administered by the intravenous, rectal, epidural, intramuscular, and subcutaneous routes. The analgesic effect of oral methadone after single dose administration begins within 30 to 60 minutes and lasts for 4 to 6 hours. As mentioned previously, the long terminal half-life with repeated dosing results in a longer duration of action and subsequent dose changes take time to reach an effect, which makes methadone less suitable as an agent for breakthrough pain. Methadone has no known active metabolites and can be used safely in patients with renal dysfunction. It can be used in patients with chronic stable hepatic disease, but should be titrated to effect.

Once the pharmacokinetics of methadone is appreciated, one has to become familiar with the equianalgesic dosing conversion from other opioids to methadone. Currently, published equianalgesic dosing tables grossly underestimate the potency of methadone and are based on single dose conversions. Most tables for morphine to methadone conversion suggest a 1:1 or 1:4 ratio. The equianalgesic dose of methadone is much lower in patients treated previously with high doses of opioids:

Morphine – methadone conversion ratios

Daily oral morphine dose Approximate conversion ratio

< 100 mg 3:1

101-300 mg 5:1

301-600 mg 10:1

601-800 mg 12:1

801-1000 mg 15:1

>1001 mg 20:1

To initiate methadone therapy, a loading dose of 25% to 50% extra is used during the first 2 days to allow for saturation of body tissues. This should be avoided in the frail and elderly and in those on other sedating medications. For instance, a patient is taking sustained release morphine 300 mg twice a day. The predicted maintenance dose of methadone is 60 mg daily. A loading dose of 80 mg per day is given as 20 mg four times a day for the first 2 days, reduced to 20 mg three times a day on day three, simplified to 30 mg twice a day on day five. To highlight cost savings, the cost difference based on average wholesale price is $39.48 per day for MS Continâ 600 mg compared to $0.87 for 60 mg of methadone. Immediate release opioids (e.g. morphine, oxycodone) should be provided for breakthrough pain. Dose adjustments of methadone should be performed in the morning for monitoring purposes. Dose reductions should be initiated whenever indicated using standard assessment parameters.

Methadone shares all of the common toxicities associated with other opioid agonists. Patients over 65 years of age have reduced methadone clearance and need cautious dosing and supervision. Methadone, when dosed properly, is a valuable addition for clinicians treating severe cancer pain, cancer pain with a neuropathic component, pain that is poorly responsive to other opioids, or when finances dictate a change based on other high-dose therapies.

Hey griff,I changed names due to banning, I guess I've been forgiven. The major side effects of meth are sweating, loss of labido, dulling of your personality but when compared to the rapid tolerance problems of OxyC the negatives outweigh the positives.Plus meth is about 1/20th the cost of OxyC. This was an interesting article I thought you might enjoy.

Nothing I had said previously was meant to be a personal attack. Others felt you needed to be defended but I didn't get the feeling you needed to be defended. I was just pointing out some of the negative aspects of opiates and some of the consequences that can occur if you simply mask a problem that could be fixed. Just info, nothing personal, the choice is yours but you should be informed.

The idea of a doc waiting until your ready to blow your brains out is absurd, that's exactly what my brother did waiting on a doc to decide if his pain was real enough to operate.Waiting can have permanent consequences. Take care, Ocean

Looking for info to copare OxyContin and Methadone

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