Alternatives for Intractable Pain?
 

Hi folks,

A dear friend in my support group is losing her medical insurance, and will no longer be able to afford the oxycontin she has depended on for several years. Needless to say, she's pretty freaked out about the whole situation. :yikes:

She believes her only viable (affordable) alternative is methadone. She is currently on a dosage of 240-280 mg. oxycontin/day (depending on breakthrough).

1. Does anyone know of any other affordable alternatives?
   
2. I have made her aware of the wisdom of getting an EKG, but I do not understand the part about "QT events" I've seen mentioned in posts here.
   
3. She has concerns (fears) about the conversion process (withdrawal, pain, reactions). Any comments/experience?
   
4. What else can she expect in the way of side effects, long-term effects, or anything else?
   
5. Anything else she should know or be aware of about methadone (or any other suggested alternatives) for chronic pain?

She has been told she will be on these medications for the rest of her life, barring any major miraculous surgical breakthroughs.

I have provided her with everything I have, but I want her to know as much as possible in order to make an informed decision, be safe, and have effective pain control.

Thanks folks,

Doc

AS long as she has a valid rx , there are ways to get discounted and possibly free meds, I suppose you have to show income to prove the need.

I don't know about the methadone or converting to it.

sticky thread -
Links and Tips For Free Medications
http://neurotalk.psychcentral.com/thread13042.html

It is tricky to switch a person from such high Oxy levels, safely to
methadone.

Presence of other drugs may also contribute to the risk of QT events. Low potassium and low magnesium will also push a person into QT risk.

There was a woman on another forum we used to visit, who did this (spinal patient) and she died the first night at home on methadone.

It is impossible to predict how a person will do when huge doses are needed IMO. Methadone remains in the body a long time, after the pain relief actions decrease. It is this factor that complicates things.

This site maybe helpful to give approximate dose conversion, but it is not 100% reliable with methadone because of methadone's complex metabolism etc, and QT risk.

http://www.globalrph.com/narcoticonv.htm

I would wish/hope that her management doctor has good experience with methadone. Generic morphine is not so expensive and may be safer.

Is she able to switch to something like oral morphine or a fentanyl patch?
I wish her all the best! Hopefully her doctor will try to help her out as much as possible

Her concern (which I can understand) seems to be cost. Generic MS Contin may be doable. I think (she thinks) fentanyl would still be too expensive for her. I've also suggested she have a discussion with her pharmacist.

This is a common situation when people suddenly go from insured to uninsured status (for any of a number of reasons).

Doc

Demerol?
 

Now someone has suggested Demerol (meperidine) for my friend. AFAIK, this is only a short-acting analgesic that's mostly fallen out of favor (though I'm not sure exactly why) except sometimes for breakthrough pain. It doesn't seem appropriate for long-term chronic pain; I've never even heard of a longer-acting version of it.

Comments/Info?

Doc