from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831670/
"As in this case, the etiology of torsade is most often multifactorial. A multiplicity of risk factors have been identified.14,15 These include female gender, hypokalemia, hypomagnesemia, structural heart disease, stroke, brain injury, bradyarrhythmias, and a wide variety of prescribed drugs and drug interactions."

Is the pacemaker for a bradyarrhythmia ?

from: http://www.merckmanuals.com/professi...methadone.html
"• QTc prolongation: [U.S. Boxed Warning]: May prolong the QTc interval and increase risk for torsade de pointes. Patients should be informed of the potential arrhythmia risk, evaluated for any history of structural heart disease, arrhythmia, syncope, and for existence of potential drug interactions including drugs that possess QTc interval-prolonging properties, promote hypokalemia, hypomagnesemia, or hypocalcemia, or reduce elimination of methadone (eg, CYP3A4 inhibitors). Obtain baseline ECG for all patients and risk stratify according to QTc interval (see Monitoring Parameters). Use with caution in patients at risk for QTc prolongation, with medications known to prolong the QTc interval, promote electrolyte depletion, or inhibit CYP3A4, or history of conduction abnormalities. QTc interval prolongation and torsade de pointes may be associated with doses >100 mg/day, but have also been observed with lower doses."


I consider myself fairly knowledgable about most medications used in pain management because of my years as a hospice nurse. I usually avoid these types of topics because I don't want to say anything that might offend someone and because some comments could be taken as giving medical advice.

Different pain medications work well for different people, but I've read many cases where I question a doc's judgement for choosing a specific med/method of administration over another. To give an example, I'll make one up using me. My pain would be decently, if not perfectly , controlled using oral meds IF I took them at the max prescribed, but I don't.....because some days I want to drive and because I want to keep my tolerance as low as possible for as long as possible. Say my doc wanted to put me on IV Morphine via a peripheral IV. Woo Hoo ! I'd be pretty comfy cozy ! Unfortunately, that would be a DUMB choice for him to prescribe for ME at this time. I can walk around. My dog and my teen boys run by me all of the time. My IV would be out more than it would be in. I can swallow pills fine. I am lucky to not get any stomach upset taking meds. Reasonable doses of oral meds control my pain. I should NOT be on IV Morphine when oral MS Contin does the trick. It would also be ridiculously expensive to keep me on that, when other drugs provide relief. For MANY people, IV Morphine is the right drug/route, but I'm not one of them.

Methadone is a very useful drug. It's cheap (a factor for those of us without prescription coverage) and longer acting than breakthrough pain meds. Some people have negative feelings about it because they know it only as a treatment for drug addicts. They should get over that ! It is the right med for many people.

I just bored you with that little story to stress that I normally don't voice my personal opinion on whether an individual and a med are the perfect match.

It doesn't sound like your dd is one of those people. I wouldn't risk the combination of Methadone (with it's risks of QT prolongation and torsades de pointes) on a young lady with cardiac issues necessitating a pacemaker unless there were NO other options. Not on a child of mine.....or anyone else I cared about.

Do some reading......google 'Methadone and tosades de pointes' It will scare the bejeebers out of you.