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.

Pete's post is great - take note of his drug lists folks - although I'll admit to being in the minority who gets more relief from shooting nerve pain with Xanax: a benzodiazepine that has no discernible psychotropic effect on me, unlike Klonopin which I also take for anxiety.*

But neither should Pete's caveat concerning constipation be taken lightly. That, and at least for me, Methadone packed a wallop compared to anything I had known before then, basically Oxycontin/oxycodone, which had largely stopped working for me at one point, due to what we later figured out was my irregular consumption of Oxycontin, which I wasn't taking enough of "on good days" for much the same the reasons outlined by finz.

In any event, I was put on an initial dose of oral Methadone (10 mg.) [3/day] which just left my staggered and totally shut down my GI track - to the point that I promptly developed a small hernia - and was no better when the dose was cut in half four days later. Finally, a week after the Methadone experiment began, we realized my error in having taken Oxycontin only when I was in pain, and returned to the appropriate dosing schedule of the drug, without further incident.

I don't know if my experience with Methadone is at all typical, in fact I suspect I may be simply a poor metabolizer of the drug, but would simply emphasize that it must be taken with RESPECT.

Mike

* Generated either by fluctuations on my blood levels of oxycodone or the general level of gray matter atrophy in my right ventromedial prefrontal cortex (VMPFC), including the anterior insula (AI), over the last 10 years. See, The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions, Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV, Neuron 2008;60:570-581, FULL TEXT @ http://www.rsds.org/pdfsall/Geha_Baliki_etal.pdf

Hi folks,

This may also be helpful....
http://www.jpain.org/article/PIIS152...08316/fulltext

Doc

FYI everyone - Sandy's daughter's pacemaker is implanted somewhere along her digestive tract to help her digest her food - it's called a gastric pacemaker. She has Gastroparesis from her RSD. The pacemaker has helped her quite a bit.

Just wanted to add that info since there seemed to be a general consensus that the pacemaker was cardiac related.

Regards Sandy C.

Just curious... which came first - the gastroparesis or the opioids?

I ask because all opioids are known to cause constipation (even when used "as needed") and can also, in some cases, be a cause of gastroparesis.

If they are unrelated, then I spoze it's possible the gastric pacemaker might even counter/negate these digestive side-effects of whatever (methadone or any other) opioids are prescribed, but I really don't know... Those would be questions/matters to discuss with her doctor(s).

Doc

I believe at the time her primary analgesic was a prescription dose of Dextromethorphan HBr, on the order of 450 mg./day.

Well hello everyone.

First I want to say how much I love you guys, FMichael, SandyRI and Pete...You three know my girl so well. Right now she is back in the hospital getting her Gastric Pacemaker adjusted. In a major RSD flare and it just never ends. She tried the Methadone 5mgs...It was prescribed once a day as needed for pain. As most of you know she doesn't take may narcotics for her RSD pain...Just every so often. As far as what came first the gastroparesis or the narcotics...Of course she has always had stomach issues. So who knows. I don't think she has taken enough for long periods of time to cause the Gastroparesis, but I understand it is showing up more and more in RSD patients. I love all of the articles...Thank you Finz and Dr. "Lost in Space!_ (One of my favorite shows as a child!)

Not sure about the Methadone when we head home. They are giving her Toridol for pain IV and Benedryl at night to help with sleep. The Benedryl is an amazing drug through IV, she slept like a ROCK!

You all have help me through so many bumps in the road over the years. I have had to watch this beautiful girl suffer so much. I will keep you posted.

Love you all xoxoxox
Sandy

Sandy....

This breaks my heart!!! Iam so sorry for Lindsay's set back.... This is just terrible news and I'm so sorry.. I wish there was something I could say or suggest that may help give you answers. As you know, I just continually try medicine to help with my pain but they have all made me ill to this point. So I really don't have much advice on helpful meds for our RSD. I do understand the gastropharsis end of this and it is a new spin on our already RSD troubles... I will continue to hope and pray for Lindsay, yourself and your family to get thru this latest flare and move forward to less pain...It is so frustrating and so much worse to watch your beautiful young girl have to suffer with this.....You are a wonderful Mom!!!

Hugz, Kathy

Thank You Kathy,

The doctor just came in and adjusted her pacemaker, gave her some good pain meds and now she is taking a nap. Something momma should do as well. It has been a really tough life for her, but she is so strong. The GI just gave me the name of a pain specialist here in Florida that he said is the "YODA" of pain. So I am making an appointment with him and I will let you know how that goes. LOVE YOU ALL.

Sandy

Oh I'm so sorry...I didn't realize had truly sick Lindsay had become. Please remember to take care of yourself, Mom...you are the best...I wish I lived closer so I could help you with more all of this. XOXOX. Sandy