Methadone for CRPS/RSD
 

My pain mgt. doctor, in whom I repose all the trust in the world, has recently switched me to methadone, where like so many drugs that had gone before it, Oxycontin was no longer working for me: a 20 mg. tablet would give me 90 minutes of pain relief, as opposed to the advertised 12 hours. As I expressed on another thread, when I asked for an increase in my prescription, which was quickly turned down on the grounds that the drug was simply not working for me anymore (I remember years ago when the same thing happened with Vicodin) and to increase the amount of the dose would be simply to invite something called Hyperalgesia or "abnormal pain sensitivity manifested as increased pain from noxious stimuli and as pain from previously non-noxious stimuli." http://neurotalk.psychcentral.com/thread87018.html And as noted in the other thread, in addition to being a strong relatively opioid, methadone is also an antagonist of NDMA (Nmethyl-D-aspartate) receptors, which makes it particularly interesting in the treatment of CRPS. Opioid Guidelines in the Management of Chronic Non-Cancer Pain, Andrea M. Trescot, MD, et al, Pain Physician, 2006; 9: 1-40, at 14, http://www.rsds.org/2/library/articl...sician2006.pdf

And for what it's worth, after some fiddling around and consultation yesterday with a clinical fellow (where my doctor is out of town at a conference) it's been determined that I will take a total of 20 mg. a day: 5 in the morning, 10 in the early afternoon (when my pain is almost always at its worst), and another 5 at night. So far it seems to be working fairly well, although I'm not yet in a position where I would feel comfortable driving on the 10 mg. dose, and that's even with a 200 mg. Provigil. And on bad days, I still have to dip into the oxycodone, in 5 mg. increments.

Now, I'm not particularly looking for lectures on the dangers of methadone, where I think I'm pretty familiar with them. Here's the current FDA "Prescribing Information" sheet for physicians, which I've more or less tried to commit to memory: http://www.fda.gov/cder/foi/label/20...134s028lbl.pdf I commend it to anyone who is interested. And as to the concern about respiratory depression that I expressed in the prior thread, I have been assured by docs, as well as my pharmacist, that it is no greater than it was for the levels of Oxycontin/oxycodone I was on, save and except that the risk continues even when the analgesic effect of a particular dose has completely dissipated.

What interests me is the experience of people who have actually used methadone, and in particular for CRPS or other chronic pain. (If you personally know someone who has used it, whether for chronic pain or addiction control, that may be helpful as well.) All issues are open, including effectiveness of pain control; alertness, mental clarity and concentration once you have become accustomed to the medication; bowel motility; male sexual functioning, etc. Any comments along these lines would be greatly appreciated. Thank you.

Mike

Hey Mike!
I've got rsd, tos, cervical, and lumbar discs (both lower quadrant), tbi...

I've been on Methadone since about 1991, started @ the "standard dose" (I know, what's that?) 60 mg. Wow, I got my life back, kind of!
I was busy, a single parent and running a business.
I was in another accident, as time went by, I first lowered ALL my meds to the lowest possible levels, and that brought my methadone down to 10-15 mg/day..
I also took and still do, diazepam.
After the second accident which caused the tbi, my dose went up to 100mg/day.
As long as I was busy, or on that (imho) "Evil Provigal". (for me, incredible migraine, and it was just legal "speed"). It did it's job with the tbi for a few years. Now, I can't even lick a pill without getting ill.
back to the methadone.
Now, I'm back to 50-60 mg. / day.
Along with diazepam, zonegran at bedtime (prophylactically for migraine), I recently stopped Keppra, due to behavioral side effects (Thanks Allison), and migraine meds as needed.
Also, some altzheimer meds for the tbi.

The methadone has always had a "Male sexual effect" on me, as I would imagine it would for a female. What numbs you, numbs you. I never had any "performance issues", I had "enjoyment" issues. (Wife ALWAYS finished before me, if I even did, how's that for role reversal?)

It does NOT fog my brain or thinking at all. No Buzz, No High.

Now that I'm more sedentary, and eat less healthier (bachelor) I use Miralax for my bowels. I use just what I need, no more.. And, I use it daily, Never prn!

And, I won't lecture you on the dangers, all these drugs are dangerous if not respected!
With my tbi, however, I developed sleep apnea, and I DO stop breathing!
I use a cpap machine now, and it makes all the difference. Don't get Drunk using methadone.


There are some "pains" that it does absolutely nothing for. Headaches, Migraine. I also occasionally worry that it "masks" other pain that might raise concern, normally, because I take a lot, everyday. (Although there are others who take 3X what I take). My teeth for example, it can mask tooth pain.
It won't do anything for "upset stomach", I still take a Tum or two, about once a week..

Other than that, any questions, I"m here for you!
I've been using it for close to 20 years. I've never found that I "needed more" just because.
I'm very happy with it.

I wish you Be Well, Mike!

Pete
asb

A week and a half ago I went on 5 mg Methadone 3 x a day for my head pain. Prior to starting the methodone, my head pain was excrutiating, and the 5/325 Percocet (lightest dose) that I had been taking for my RSD since I was diagnosed a number of months back was not controlling it at all. I thought the head pain was migraines. But Pete says that the methadone doesn't touch migraines, so perhaps my headaches were not migraines but just RSD of my head membranes? In any case, the methadone does work so much better than percocet alone, but like I stated in a previous post this afternoon, I still need to take the percocet in additon to the methadone to control my pain, and I am never completely pain free. My head pulses in the back behind my ears, more on the right side than the left, right above the shoulder where my RSD started. I take 1/2 a perc at a time when I feel I need one, and probably take a total of 3-4 percs by the end of each day (I don't count, I just bite a pill in half when I want one).

I may need to eventually increase the mg of methadone I take to eliminate the need to take so much perc for the "break-tru" pain, or get a better break-thru med. But for now the methadone is much better for pain relief than what I was trying to use a few weeks ago. This has had a huge impact on the quality of my life - it is so much better than what it was. Of course, it would be even better if I could get rid of the RSD altogether.

I've noticed that Methadone does make me feel much more tired than percocet did. I am OK driving, and working, but I fall asleep most evenings by 9:00 at the latest. I get up and walk around a lot when I need to at work to stay alert, and drive with the windows open in the car if I feel I should. I do not feel too dopey or stupid, and I rarely drink (thanks to Topamax, which nixes that urge altogether!), and on the rare occasions that I do, I stick to sipping a bottle or 2 of Amstel or Sam Adams Lite, so I do not worry about mixing drugs and alcohol.

I do not have any experience with other opiods or morphine derivatives yet, so I can't opine on those.

Good luck, Sandy

Sandy,
Quick note:
Maybe it just doesn't work for MY migraines?
(I know you and I both have some head pain issues).
Maybe yours is like a muscle pulling up the back of your neck/head, I think those are called "Occipital" Headache. If it's muscular, methadone works for me. Just not MY migraine.

As it goes.... We're All different!

Wish you all well,

Pete
asb

Pete -

Thanks for your response. And sorry to hear about the tbi on top of everything else. With the recent unpleasantness in Mesopotamia, I imagine there have been tremendous advances in treatment and long-term care just in the last few years. I know that conflict really popularized continuous regional anesthesia. Are you keeping up with what's been coming out of Walter Reed for tbi? (I understand that tbi is the defining medical condition of the war.)

I noticed that we're on a number of common meds, where I've been taking a benzodiazipine (Xanax) for years for the control of "shooting pain" and am also on Altzheimer meds - Namenda (memantine HCL) and Razadyne (galantamine HBr) - in what's probably a vein attempt to hold back the well-documented loss of grey matter in the brain secondary to chronic pain.

It's funny how people react differently to meds, whether because their bodies produce certain enzymes at different rates, or what must be a host of other factors. For example, I am barely aware of having taken a Provigil, and certainly don't get migraines from it. On the there hand, I can't tollerate any SSRIs (or even SNRIs) because they incredibly exacerbate the cramping/spasms in my legs, for which I an completely dependent upon bacofen. And I'm now wondering if there isn't some interaction going on between the baclofen and methadone, where - only three days into this - I can be loopy 5 hours after taking a 5 mg. methadone and I know that the 10 mg. I just took will knock me on my posterior, not right away perhaps, but maybe in 2 - 3 hours.

Did you ever get that sort of a response to methadone?

Frankly, I'm just hoping that it's just because I'm a newbie. Time will tell.

thanks again,
Mike

PS I wouln't think of doing any serious drinking on methodone, and as luck would have it, am already on a BiPAP machine (sort of a modified CPAP). Now I'm thinking about getting a battery back up with alarm, in case of power failures. I never thought about this little device as a life or death matter, but with the right combination of depressed breathing and sleep apnea, it may very well be.

Hey Mike,

Glad we can "compare notes"!
Thanks for the info on Walter Reed. I'll look that up. I don't know what continuous regional anesthesia is?
However, You're right, TBI IS the defining medical condition of this war! Sadly.

I have Namenda, bedtime, more for pain. Then Razadyne and/or Aricept to help the tbi. (My doctor is great with samples on these expensive meds).

As for the Provigal, I'm sensitive to a cup of coffee! That tells ya.

I do take 60mg of Cymbalta/day.

About the Methadone knocking you out. Hmmm. This I've never heard of. I take Zanaflex prn for sleep. I understand that's quite different from Baclafin, am I correct?

This is the "problem" with a cocktail of meds.
When you add a new one such as Methadone, (Anything for that matter), some thought must be given to how it will affect the rest of the mix?


Also, with my CPAP, I have an O2 concentrator, and often (not always) connect it, to add some oxygen to the mix. A friend of mine just got a BiPap, and she is still adjusting to it. Not low O2, but high CDioxide.


I don't take any muscle relaxer during the day, because the tbi made me naturally "drowsy". Sometimes a 5mg diazepam, or a half of one. Just to calm my nerves, or, some Topomax, I have a "Tremor" from the tbi as well. (which is kind of funny, people ask me why I'm shaking, mostly, until it gets painful, or interrupts my typing I don't notice. I guess my eyeballs shake at the same "tempo" as my hands! :o:cool:

And the ankle bone's connected to the shin bone.....

Hope you're feeling better, and get by that drowsiness, Mike! (And SANDY!)
I've NEVER had that with methadone!

We're all a little bit different, we're all a little bit the same...
:grouphug:

Pete
Asb

Methadone is the only opiate that affects QT of heart.

So you should have a EKG before starting it, and avoid drugs that are additive for this effect.

Dehydration and low potassium and magnesium increase this risk.

This website has complete lists of drugs, and explanations:
http://www.azcert.org/medical-pros/d...drug-lists.cfm

Otherwise methadone is a viable opiate alternative. Just use it safely.

Dear Sandy -

Your Percocet use with Methadone sounds exactly like my ongoing consumption of oxycodone, for what it's worth.

And we are both having similar responses to Methadone, except that (at least initially) mine is more extreme. As in, "you know those four brownies I had an hour ago, they did have a funny taste to them . . . ."

Major kudos for hanging in there and working through all of this.:Tip-Hat:
I had to give it up after a year and a half. At which point I exchanged the world of being a busness bankruptcy lawyer for my neighborhood meditation sagha in Santa Monica, something I was introduced to by a pain psychologist, specifically a "Mindfulness Based Stress Reduction (MBSR)" class, set up initially at the Univ. of Mass by Jon Kabat-Zinn, PhD to bring the insight that could come from meditation and very gentle yoga to people in chronic pain. Since then we moved to "the Valley" so that one of my son's could take advantage of a great high school opportunity, but little is happening locally in terms of buddhist communities, etc. To say that life's quieter than when I was working a a litigator would be something of an understatement.

so hang in there,
Mike

Hi Mike,
 

I was on Methadone for over 6 years. I've said this many times on here.

I love it. I have since been able to get off of it but I do keep it around for flairs with my RSD, pelvic pain and shoulder pain. It does the job. I can take it and get out and function like a normal person.

I started out at 5 mgs. 3 times a day but as I got my pain levels down, I was able to go to 1.2 of a 5 mg. a day. I still take half of a 5mg for my pelvic pain which is nerve pain and it works when nothing else will.

I hope it does as good for you as it did for me.

Ada

Hello Mrs. D

I have to ask, because I don't understand your statement, and was even more confused by clicking on the site.

What exactly is QT of the heart?
And why is Methadone the only opiate that affects this?
(sounds kind of tough to believe). As the site you linked us to pointed out,
just because a drug is NOT listed, might only mean it has not been tested.
Methadone has certainly been around Long Enough for the medical community to know
more about it than they do about most other drugs! Especially the newer, more expensive ones, that end up on the streets.

Of course, everyone in this discussion has advised safe use of this medication, it's a strong drug.
However, Opana, and other's newer to the market, have far less safety trials, (and the test of time) behind them!

For now, I'll stick with Methadone, so long as I need it.
Thanks for your concern, and, respectfully, look forward to your explanation of my questions, or perhaps you can direct me? Thanks Again! (Always looking for more info!)
You're a big help!

Be well!
:hug:

Pete
Asb

This is a great thread, good questions and answers from all. I find it particularly helpful as I was recently told by a pain physician (outside of the Ketamine coma) that methadone is most likely the only alternative I may have if my Lidocaine stops working. With the nature of RSD being what it is I suspect that will will happen some day.

Thanks to all for your honest contributions.

MsL

I was suggested methadone a few months ago but it was ruled out because of my other heath conditions and the cardiac concern like Mrs D stated. If so he wanted to do and I am not sure if it was all together or in steps but ketamine infusions,methadone,and possible scs temp. I know a girl who was on methadone too and found it helpful with her pain and this was after she had the scs.

Hi Pete,

The QT is the letter designation of the heart tracing on paper.
You know the jagged lines etc?

Some drugs, some genetic errors, prolong the heart beat, slow the progression from beginning to end. When this slows beyond a certain point, the heart stops. You have possibly seen this during athletic stories or at events. All of a sudden, a seemingly normal person konks out. This is why now airplanes have defib paddles, gyms, some public places now.
Doctors measure this distance on the tracing according to time...nanoseconds sometimes to see if people are prone to this. Another name for this is Torsades de Points.

Drugs cause this. Anna Nichol Smith's son Daniel died of a non lethal amount of methadone mixed with the SSRI antidepressant Lexapro, right in her hospital room. This was all over the media.

The effects of methadone as an opiate are unique among them all. It also has a very long half life, and the pain relieving effects wear off BEFORE the drug leaves the body safely so with time if dosed wrong can build up in a serious way.

The original data on this came from Europe, from clinics providing Heroin treatment. One study I read a couple of years ago found their patients dying all of a sudden...and it was due to mixing cocaine with the methadone (outside the clinic). They started doing EKGs and found this QT effects and published.

Methadone has been around for a long time...My FIL took it as Dolophine when he had throat cancer in the late 60's. It and Dilaudid were the most often used back then.
QT effects have become more prominent lately. The old RX Seldane was on the market for over a decade and just about to be released OTC, when a doctor at Georgetown Univ discovered it was killing people when used with the antibiotic erythromycin!
No one had a clue, not the drug companies...no one until then.
They just thought people had an arrhythmia and died. They never connected it to Seldane. Now Seldane has been taken off the market in US, but some countries allow it still.
There are many drugs now, that have been discovered to affect the heart this way. The link I gave has 4 lists according to risk types.

I have a post on Chronic Pain here:
Post #4
http://neurotalk.psychcentral.com/thread1120.html
has some of the studies on it..
Some of the links may not work, the post is old and the net changes. The geniassance link with diagrams appears to be gone. It was really nice!
This is wiki entry:
http://en.wikipedia.org/wiki/Torsades_de_pointes

Its difficult to find the graphs I used to use... they don't seem common on the net.

I hope this answers your question. Long QT (aka Torsades de Pointes) is a sudden event. With all the newer drugs we have it is more common than before.

I hope I've answered your question..I am not a great writer. If you have other concerns you can PM me anytime.

mrsd
this is great info as i have found out in the last 2 years that my tackicardia wasnt just plain old tackicardia. that in fact that i have ventricular tackycardia and certain will cause my normal high HR to exceed 200 BPM
just like with long QT i cant take alburterol or things like it because it raises my heart rate.
carrie

MRS. D

Thanks so very much!
That's excellent information that everyone / anyone using or considering the use of Methadone should know.

My doctor did give me a short "lecture" about it recently, to be sure I was aware of how powerful a drug it is. You are a great writer, and drew a perfect picture!!

Thanks again!

Pete
Asb

erratum
 

In reflecting further upon the safety issues of Methadone, I realize that I could have been more thoughtful in the initial post at the top of the thread, when I referred to the "Prescribing Information" sheet, to which I then linked.

In retrospect, and as with Opana ER http://www.opana.com/pdf/opana_er_pi.pdf#page=16, I should have referred to fact that Methadone has a "black box" Prescribing Information sheet, so that the reader might be aware that there were potentially significant safety issues associated with the drug, including the possibility of death.

Apologies.

on the q.t.
 

My pharmacist reads to me from his text, that QT issues involving Methadone are "generally associated with higher doses," which in turn are defined as "> 200 mg/day."

Vel non Torsades de Points, I wouldn't want to know how 200 mg./day of Methadone even felt!

Please give your pharmacist the University of Arizona website.
Combination factors will potentially affect response to methadone.

200mg is really a high dose. Very few people get to that place.

Here is another link:
http://www.cdc.gov/nchs/products/pub.../poisoning.htm
This reflects the increased use of methadone to treat chronic pain.
I don't have figures past 2005 at this time.

I believe the increased use (as I've read) of methadone for chronic pain, is due to ins. co. pressure. It's very inexpensive.
This doesn't mean that methadone isn't as safe as more modern meds (imho) such as oxycontin, or opana. It simply means that there's more methadone out there, as time goes on.

It's potential for abuse, again, imho, is lower as well.

Again, this is my opinion.
"Talk to your doctor".

Methadone has a quirk in metabolism. The pain receptor effects wear off before the drug is cleared from the body.

So dosing may be ordered too frequently and hence the other potentially dangerous effects become more likely.

http://findarticles.com/p/articles/m.../ai_n29445367/
In practice this is what I see... Doctors do not understand the liver enzyme systems and often do not refer to charts which list which drugs affect which subsystem of the P-450 complex in the liver. Add to that that genetically there are people with errors in this system, which make them "slow metabolizers". For example when the statin drug for cholesterol ..the very potent Crestor... went on the market no one expected that slow metabolizers would not be able to handle standard doses of it.
So some people died, or were damaged.

For those here who are interested in the Medwatch reports on drugs...this website gives them:
http://www.patientsville.com/

Here are the reports on Methadone:
http://patientsville.com/medication/...de_effects.htm
Keep in mind some reports are complex and involve multiple disease states, and/or complex drug cocktails. But many are very representative of the drug cited. Most drug reactions are not reported, and it is believed around 1% up to maybe 10% are. So keep that in mind also. Doctors balk at reporting, thinking admission of error may lead to liability suits.

This chart shows the ethnicity of drug metabolism differences:
http://www.dnadirect.com/web/article...s/186/ancestry

This chart gives the subcategories of the P-450 system and the drugs affected in each:
http://www.dnadirect.com/web/article...574439B11AEAF2
We are approaching a time now in medicine where genetics of EACH patient makes a huge difference in therapeutic response, or risk from side effects or worse.
I foresee a computer eventually being used and testing of each person before prescribing drugs. Many doctors are confused by these charts and never test their patients to see if they are slow metabolizers. The tests remain expensive at this time and some insurances won't pay for them. So that hit or miss prescribing is still the norm.

Here is a link to methadone and drug interactions for it:
http://www.atforum.com/pdf/Drug_Interactions.pdf
It is complex however. But some posters here may want it, or want
to print it out, for reference.

In an earlier post someone made the distinction between "muscular type" of pain and how they found methadone to be most effective with this discomfort.

I agree 110% and would go further that if you are having the radiculated nerve pain that many people with spinal issues or complications have - and I had an episode with earlier in my life - that methadone may be totally useless in helping with this.

My primary pain is a combination of severe muscular pains in both legs that is akin to feeling like they are literally being torn away from the bones. I take 240 mgs of Methadone a day so I can stay semi functional.

It wasn't until I found this board earlier this month that I began to fully understand how few options are left and how unsustainable my current path is long term.

Good luck!

Methadone use
 

Hello Michael,

I was in a motorcycle accident in 2003. I still own my house out in Sacramento, I'm still hoping fora miracle. After all the broken bones, torn liver, ruptured kidney and punctured lung healed. I developed RSD/CRPS. I was lucky that I had a really great Doc who tried me out on different drugs. I have been on Methadone for 5 years now. I take 300 mg Lyrica per day, 30mg/40mg Methadone per day depending on how bad the pain is. I never got any kind of high or dizziness from it at all. I rarely take the extra pill. I had many concerns about the dependency factor, but I have tried going without the Methadone. The pain goes up in a serious way. I have done the same thing with Lyrica and I have the same result. In the beginning, I was on Norco and that worked for the first 2 years. Then it stopped working. Oxycontin didn't work for me at all. Morphine didn't work either. I get the best result from the Methadone, Lyrica and Cymbalta. This pain however is insidious, it never stops it is sooooo sooooo painful. I will keep on looking for something else until I can get some relief. Have you ever tried Hyperbaric treatments? I'm not sure why I never had any kind of problems with the Methadone, but right now I can't do without it. Let me know if you have ever heard of Hyperbaric treatments.

Methadone intolerant
 

After a grand total of five days on methadone (long enough in light of the drug's long half-life to get the amount in my bloodstream up to its dose dependant maximum) my pain doctor agreed this afternoon to let me throw in the towel and go back to Oxycontin until I see him in a month, where methadone (for me) was worse than ineffectual.

I started it on Sunday, taking 10 mg. 3x/day. And as noted in the initial thread in this post, by Monday I was so stuporous that it was suggested that I change the dosing to 5 mg. in the morning and at bedtime, with 10 at mid-day, when the pain was typically at its worst. I was okay for a couple of days thereafter, but then by Thursday, as my blood levels continued to rise, I was totally messed up by my mid-day 10 mgs. (okay, I know a number of you folkj are on doses that are an order of magnitude higher) and was concerned where this arc was taking me. I called my doc. who said to skip the nighttime dose and then just stick with 5 mg 3x/day beginning today, commenting that the good news was that we had found an opioid I was sensitive to.

This morning, I drove to a store near my home, and realized that I was having trouble staying awake, notwithstanding a 200 mg. Provigil with the rest of the morning meds. Around 1 pm I took the afternoon 5 mg. dose and by 3 pm was totally out of it. Fortunately, I was able to reach me doctor who told me to get off of it entirely and go back to the at-best marginally effective Oxcycontin, where I still had enough of it to get through a couple of weeks. It's now past 5 pm, I'm still messed up, overheated, never did get any pain relief, and am dependent on enemas of all things, notwithstanding my regular use of various medications that should of addressed that issue.

Now, my reaction is no doubt atypical and might be due in part one or more of the many medications I take: Xanax being high on the lists Mrs D was kind enough to provide. Whatever the cause, I seem to have drawn up a whole bucket of side-effects without any pain relief to show for it. Strange daze indeed.

Mike

Sorry about your experience, Mike. For about the first week I took the med remember that I was very spacey. My dose is 5 mg 3x a day and I weigh between 130-135 lbs . But after that I settled down and could think better. I doubt I'm as sharp as I was before I started taking so many meds (I take a total of 3 or 4 Percs a day also), but I'm willing to swap some mental accuity for the improvement in pain relief I get from the Methadone.

I sincerely hope you find an answer soon.

BTW - what is Provigal? I've seen it mentioned a few times on this board. Do you use it as a sort of caffeine substitute?

Sandy

Mike,
I started methadone, @ 60mg. / day.
I had no side effects. None.
I took no other meds, besides Diazepam, up to 20 mg / day.
Oh, and something Flex, to sleep.

I don't know and can't say.
I'd guess (I would NEVER take Xanax, instant gratification). But there's something in your mix, that's making the wonderful pain relief of methadone impossible for you. You'd hafto give a full list, and I'm not a doctor, but, that's what you need, a full list to your doctor to help.
Zanex is poison, as is provigal, IMHO.
And, they must be tapered off.

As I said, I'm not a doctor, but I do know that provigal, DROVE my pain!
I don't know why you're on it. You do.

There are of course, some of us, who cannot take methadone.
If that's you, I'm sorry, I'm not attacking you.

Just be sure you have a good neuro, or PM who knows what they're doing, and whom you trust, prescribe ALL your meds!

As far as almost ALL pain meds go,
if you're sedentary,
nothing like Miralax, to keep things "moving"....

Hope this helps!

Pete
Asb

Excellent Post. Very Informative. Thank You ALL:grouphug:

Sorry for being late to respond. I'm back on the Oxycontin and much better for it.

My pain doc. is one of the best in California, and I've had an excellent neurologist as well, although he is in the process of retiring, so I'm looking.

One thing I've learned from this experience is how different we are when it comes to meds. By example, Pete and I had virtually opposite experiences with both Methadone and Provigil: a "wakefulness-promoting agent" with cardiac effects somewhat but not - at least compared to the effects of most ADHD meds on adults - greater than the controls, e.g., Tachycardia appeared in 2% of the test subjects taking the drug, as opposed to 1% for the controls. http://www.provigil.com/media/PDFs/prescribing_info.pdf

Maybe it just in our hereditary profiles vis-a-vis drug metabolizing enzymes, but I suspect it's more than that, where I've been told that there are a number of pairs of drugs that share identical enzyme breakdown paths, yet I can tolerate one and not the other. Then too, when it comes to Xanax, most people use it to relieve anxiety - and some people abuse it - yet I can't even feel it: it just stops the shooting pain in my feet. (There was one study I came across some time back that attempted to explore Xanax's effect on neuropathic pain, but didn't come up with anything statistically significant.)

I guess that's why I have a difficult time condemming the off-label use of drugs, so long as they are prescribed by experienced clinitians.

And to Isabel, I would love to try HBOT, but for the cost factor, where one apparently has to do them more or less in series and they're not covered by insurance (at least not by mine). So with discretionary income going toward our kids' educations, there's not a lot of room for treatments that aren't going to be at least partially covered by insurance.

Finally, a note of thanks to Mrs. D: I went through your link to methadone and drug interactions carefully. It was excellent.

And my thanks to everyone who took the time to respond to this thread. Your information (and concern) was greatly appreciated.

Mike

Mike,

What you write is all true.

I want to add this.
At one point in my treatment, I went to a PM psychiatrist, to have her take me down, to least meds possible.
I got to the point where I stopped methadone completely for four months. I don't recall if I took some otc med, but that would have been the most.
I do believe I still took some diazepam for sleep, and headache prevention.


I was then, we thought, "clear enough" to make a decision.
That decision was, NO WAY!

God gave us these meds, I'm going to make use of the smallest amount I can!
(I had work to do, and a family to provide for).

And, so I did.
My opinion of Provigal is only that. It did give me benefit for three years! After the tbi!
Then, MY propensity to HA, forced me to stop.

To each, their own. What's right for me, might not be right for you!

I learned about HBOT, by actually diving.
I took lessons, and thought, ya know, there's NO WAY, I can do this tomorrow. I was exhausted. I woke up the next day, and felt great!
So I know that the O2, permeated into our muscles at "depth" is a great pain reliever, and, it's also good for our grey matter.

I use O2 with my cpap.

Also, Mike,
I've been on other ADHD meds, due to the TBI, and some helped for a bit. That was all.
Then, they drove me nutzo.

So, as you're stating, You do what' best for you, because you have a doctor you trust!

Very good observations, and writing Mike!
I thank you!!!

Pete
Asb