Hi all,

Well my girl is having a major flare and her doc wants to put her on methadone for her pain, rather than oxycodone. I am a little leary considering she is only 18.

Any help or advice would be greatly appreciated.

Thanks

Sandy,

Iam so sorry for Lindsay's flare...Is her tummy not feeling well either??? I tried Methadone and could not take it...it made me very sick to my tummy... I tried it twice matter of fact and results were the same both times!! It is a major narcotic and I truly agree with your concern!!! ESP at Lindsay's age..

Again, I'm sorry....

Hugz, Kathy

Hi Kathy,

She just had a pacemaker adjustment. She is better, the pacemaker was the best thing we have done. She has had such a great summer and has totally abused her RSD with fun! I am worried about the Methadone. She hardly every takes pain meds. She is on Cymbalta only for the RSD. they added Neurontin for a few weeks to try to calm it down. I fear the only hope right now is Ketamine. Unfortunately, I have to go back to work and the only time I can take her is in November. Last year was crazy with missing work.

Hopefully, the flare will calm down, I have contacted her OT/message therapist, she can usually get it in check.

Sandy,

NO WAY ON METHADONE for her.

It's a great useful medication in many cases, but has some risk of FATAL cardiac arrythmia issues.

I'll try to find some good articles for you

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

Sandy

I was on opana er 40 mg for 1.5 years it was no longer working for me giving me major headaches, foggy head all the time just to name a few side effects and most of all little help with my pain would work for only up to 3 hours. My PM Dr. change me over to methadone starting at 10 mg. 3 times a day and after 30 days uped it to 20 mg 3 time a day. For me it is working well with no side effects.

Cost for the opana was very high vs the methadone. It works for me without any problems. Hope this helps you.

Good luck finding the right pain med.

Thank you for your response hurting. She has taken everything with no help. She hardly takes any pain meds, just when it gets to be too much. I guess the work methadone just sounds frightning.

I took methadone for a while, just 5 mg. Twice a day. It was the ONLY med that took the horrible sting out of my head, it was a miracle! Methadone works well on nerve pain.

I was also freaked out about the thought of methadone. But it worked really well. Good luck.

Xoxo. sandy