IMO, choice of medication(s) and/or dosage/increases are best left to your doctor for a variety of reasons. If methadone is working for you, does not cause intolerable side effects, and you are being monitored for
cardiac arrhythmia/prolonged QTc interval, it may be the best choice for you (i.e. meralgia paresthetica).
Quote:
We are blessed with opiate receptors in our brains that allow our bodies to respond to opioid pain medications. The majority of these receptors are classified at mu and delta receptors and a smaller percentage are NMDA. Nociceptive pain is primarily mediated by the mu receptors and neuropathic pain by delta and NMDA receptors; morphine binds to mu receptors only*, while methadone binds to mu, delta and NMDA. Morphine does an excellent job of treating many types of pain, but because of its ability to bind to 100% of opiate receptors, methadone may do it even better.
http://dying.about.com/od/opioidpain...doneVmorph.htm
|
* Fentanyl also binds primarily to the μ (mu) receptors.
Also...
Quote:
Opiates, such as morphine [and fentanyl], produce metabolites when they are broken down within the body. These metabolites can build up in the body and cause symptoms of opiate toxicity. Opiate toxicity is essentially an overdose of an opiate leading to poisonous levels in the body and causes symptoms such as restlessness, hallucinations, tremors and lethargy.
Methadone doesn’t produce metabolites and therefore doesn’t have a “ceiling," or maximum dose. Methadone is also easier to metabolize by the liver, and its lack of metabolites makes it an excellent choice of pain medication for many patients with decreased liver function or renal failure.
Ibid.
|
Methadone does, however, have a longer half-life than other opioids, which must be understood and considered in order to avoid accidental overdose.
Aside from
fentanyl's inherent risks, it is far more expensive (than methadone) and its delivery system (the patches) poses further complications/inconvenience; a pill is (IMO) just less hassle/mess.
Doc