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