[pebblebeach2]

Hi all. I need some advise.
First of all I have had severe spine issues for almost 25 years. I have had several surgeries to the cervical/thoracic area and the lumbar region.

I have Harrington Rodss placed in both areas. Recently I started to see a new pain doctor who first of all to help control the pain put in a Intrathecal Pain Pump. The Catheter is at T-10 I believe and the device is in the stomach area. It was put in such a spot to help with the pain in the mid to low back area.

I also still have cervical issues which include focal cord atrophy and myelomalacia.
From prior studies - EMG - it showed that I had severe nerve damage to the cervical and lumbar area; arthritis; and peripheral neuropathy due to the spine issues and my diabetes.

As to the neck my symproms include weakness in the arms; radiating pain to the shoulder areas general pain that is centralized around the spine itself. My legs again there is neuripathy which includes severe numbness; pins and needles in the foot/toes burning sensation on ocassions; severe cramping at times of the upper thigh.

The pain pump seems to help for where it was implanted.
As to the neck the doctors are afraid to touch me surgically any more because of all the surgeries that I have already been thru; and I have other health issues as well. I have Type II diabetes and was diagnosed 10 years ago. I was born with 1 kidney and the kidney that I do have I have kidney disease. I am not on dialysis yet but just waiting for things to progress tot hat point.

As to medications I have been on tons over the years which included Neurontin; Percocet; Oxycodone with Acetaminaphen; Tizanadine a muscle relaxant; Fetanyl Patches which I had trouble tolerating from what I remember. I know there are other meds that I have been on but the names escape me at this point in time.

I did have A Spinal Cord Stimulator placed in the lumbar region but it was taken out since it wasnt helping. The Intrathecal pump is a combination of Dilaudid and Bipuvacaine a very low dosage and for the most part I am happy with the results. While I do have moments where it doesnt work I fell it workds 80% of the time.

In todays visit with the Pain Doctor he indicated that most of the medications are the same in that they all tend to work on the same receptors. Thus since they are all bascially the same they do very little to help in other areas. The Oxycodone 7.5-325 I believe is the dosage I have to say really doesnt do a lot for me in relieving the pain in the neck.

So today I left with a script for Methadone. I am looking for any input on others experience with this medication. Did it seem to help? In what ways did it NOT help? What about side affects?
Any input on this medication for pain mangagment would be appreciated.

I think I am at the point that no one really knows what to do for me. Surgery I've been told is out because it is too risky. Some doctors I cant even get my foot into the door for an appt. When they hear my history up front its bascially See YA. Or some ask for my records ahead of time and the office staff comes back saying the doctor wont see me and certainly wont offer any advise for me.

So I feel like I am at a loss at times. I go back to my neurosurgeon at times just for a checkup to see how things have progressed then its basically see ya next year.

Again any help would be appreciated. Thanks in advance

[mg neck prob]

[My aunt --broke both hips-- back and neck and jaw in car accident --she has been on it for 10 yrs ---and calls-- it her life saving miracle drug and it has been the only thing that works. No bad side effects you want to drink alot of water on it. They tried to change her meds once and took her off she said the withdraw was most horrible exp in her life----they put her back on. Its cheapier then most opiates --the effects are long lasting 24-hrs or longer with one dose.

[pebblebeach2]

Thanks for the input. I've been on other opiates before. But from what my pain doc tells me they all work on the same nerve receptors so whether its percocet; hydrocodone; oxycodone or one of the other on the list they all are basically the same medication. But sounds like "morphine" is one of the few or only pain medication that works on "more" pain receptors that the others dont.

The only thing I have to double check on is I am limited on what I can take in the way of medication because of my kidney disease. I just need to make sure that it is safe to take and that there are no health risks for me.

I'll keep you posted.

[mg neck prob]

Originally Posted by pebblebeach2

Thanks for the input. I've been on other opiates before. But from what my pain doc tells me they all work on the same nerve receptors so whether its percocet; hydrocodone; oxycodone or one of the other on the list they all are basically the same medication. But sounds like "morphine" is one of the few or only pain medication that works on "more" pain receptors that the others dont.

The only thing I have to double check on is I am limited on what I can take in the way of medication because of my kidney disease. I just need to make sure that it is safe to take and that there are no health risks for me.

I'll keep you posted.

Im sorry I dont know about the kidneys. Im sorry you have been thru so much I feel bad------ and I really hope you find something finally gives you some relief. You must be one strong cookie!! I wish you all the best !!

[mrsD]

Hi, pebblebeach2,

I'd like to suggest you read this post of mine from the past:
http://neurotalk.psychcentral.com/post15298-4.html

Methadone is useful for many chronic pain patients, and is very
popular therefore.

However, if you have a hidden cardiac rhythm problem, it can
cause prolonged QT syndrome, and sudden death.
So it is a good idea to get an EKG before starting and have
the QT interval measured.

Another drawback is that Methadone has a long 1/2 life in the body and will fall off the pain receptors, first, and therefore be still active elsewhere for a time. The result can be getting another dose too soon or raising it to make up for this, and then the drug builds up and can affect the heart with more risk.

When people are converted over from other opiates, errors can be made so make sure your doctor uses a conversion table, for this. Giving too much methadone therefore when switching may cause a problem in some patients.

This link has a conversion app for example. But there are others too.
http://www.globalrph.com/narcoticonv.htm

Once these problems are looked at and you are cleared of them, you could see good results.

[Morgan Herritage]

The statement about every opiate hits pretty much the same receptors is false. Some hit only one, some hit 3. Some are pure agonists and some are synthetic.
The route of administration matters with some. The dose matters significantly, everyone is different. The bioavailability affects some.
That is why there is a list of many different types of opiate analgesics.

Methadone works very well for me. It acts on 3 opiate receptors if I'm not mistaken. I also take norco which only works on one. But my doc still finds it necessary to take both. Methadone works for nerve pain in my case.

Usually doctors implant IT pumps and get patients off all oral meds. Some just lower orals. You can have other medications in your pump and the dose adjusted if you and your doctor agree on it.

[pebblebeach2]

As to the Intrathecal Pump it was implanted at the T-10 level and was intended to work on the mid to low back area. The medication that is in my implant is Dilaudid and Bipuvacaine. I get a dosage of 0.48 mL thruout the day and I can give myself a Bolus of 0.1 ML 1 time every 8 hours.

I was told that the implant would only work on the mid to low back area. I do have cervical issues as well. I can't answer as to why the implant could not give me relief in the entrir spine. So that being the case I stayed on oral medications as well because of the cervical issues.

I was told that a majority of the narcotics used for pain management only target 1 receptor. The morphine targets 3 receptors. I can't specify which receptors they work on.

So since I was not getting any relief from all of the other medications that is why we decided to try the methadone.

[mrsD]

This link is very good for explaining more about methadone.

http://www.aafp.org/afp/2005/0401/p1353.html

It is written for doctors, but is understandable for most people, I believe.

It explains half life, and dosing and why it takes several days
to become effective. It has a table explaining which drugs to
avoid when taking methadone. Mixing the wrong drugs can lead
to a QT event or other side effect.

This explains the receptors:
http://dying.about.com/od/opioidpain...doneVmorph.htm

[kidshilleen]

I have had the scs implanted.I've been on all kinds of meds including morphine(hated it)until 6 months ago my girlfriend the ER nurse suggested methadone.I talked to my doc and we tried it .In my case it worked well for 3 months and i had to increase the dosage.I take it with Oxycodone but 3 months later Im back to extreme back and leg pain.I just had my scs recalibrated and that is helping but im not sure the morphine is the long term answer.My reply is all over the place because this is my first time. Good luck

[snowlily]

Pebblebeach, Were you allowed to start taking the methadone after checking with the kidney doctors?