Why'd my Dr add Methadone ?

[ChrisLightoast]

My PMdr added 5mg methadone 3xd to my current 180mg oxyco IR pd. I also take xanax ,lamictal (psyche) , & zanaflex (m.relax) He says studies show low dose Md enhances effectiveness of oxyco. I DONT GET it. Firstly, i read Meth type drug suppresses other opiates. I read about breathing issues , which cant possibly be good if i already have suppression with the zanaflex ( which i use for spasms and a sleep aid) and oxyco, and i also read of possible interference with the benzos. The dr is aware of my concerns , but I really think this is a bad idea. I just started , and ive spent 3 days in a row on the sofa feeling like total s*%t , dizzy, nauseaus, and in significant pain. My questions are; has anyone else experienced a start like this, has anyone else had a combo like this, and is the methadone/oxyco combo providing better relief than just more of one or the other.

 

[T. Calderone]

I had a pain doctor add methadone 10 mg to take for breakthrough pain that would bother me at night. At the time, I was prescribed 60 mg oxycodone and he was reluctant to raise my dose. It really did help and I didn't wake up so much. If it's giving you bad side effects, it could be any of the other meds having a drug interaction. I would tell your doctor if this continues or becomes bothersome.

 

[d1nach]

(RS)-6-(dimethylamino)-4,4-diphenylheptan-3-one
(5R,9R,13S,14S)-4,5α-epoxy-14-hydroxy-3-methoxy-17-methylmorphinan-6-one

Methadone (top) is structually unrelated to oxycodone (bottom). My guess is given methadone is used a mixture of d and l that the hypothesis wouldbe by blocking the nmda receptors it could enhance the potency of mu opioid receptor mediated pain killing effects.i dont know if 5mg is able to significantly influence nmda receptor though

 

[Keif' Richards]

Methadone is actually a pretty sweet Opioid painkillers for oodles of reasons. It's a potent Mu receptor agonist, first of all. Just like Morphine and Heroin. The Mu OR is gnerally considered to be the receptor that induces the most euphoria and other pleasant aspects of Opioid intoxication, although this is a huge oversimplification. Methadone also has a very long half-life which allows it to provide longer-lasting pain relief than many other short-acting Opioids like Oxycodone.

For the Opioid-maintained individual, another big plus with Methadone is that it generally possesses significantly less cross-tolerance to many other Opioids. If you aren't aware of what cross-tolerance is, I would suggest doing a quick few minutes of research. The net will probably give you a more concise definition than I can. Suffice to say, absence of complete cross-tolerance can be a major advantage for a patient in the process of rotating through Opioids.

Lastly, it's cheap, cheap, cheap. A "friend" of mine gets 120 10mg tablets per month for $27.00 without insurance getting involved. However, none of this makes much of a difference if the drug is causing you significant discomfort. I would give it a fair shot before deciding to shut the door on Methadone forever. It takes about 5 days for your levels to normalize when beginning at a new dosage.

 

[d1nach]

^good info imo.

Ya perhaps if you have pain that is constant methodone wont have the fluxuations in levels like oxycodone does. Maybe you could make a hourly log of your pain level and when and how much opiates you take. Then you could see if a y correlation exsists between rising amd flling levels and pain.

 

[ghostandthedarknes]

Methadone is actually a pretty sweet Opioid painkillers for oodles of reasons. It's a potent Mu receptor agonist, first of all. Just like Morphine and Heroin. The Mu OR is gnerally considered to be the receptor that induces the most euphoria and other pleasant aspects of Opioid intoxication, although this is a huge oversimplification. Methadone also has a very long half-life which allows it to provide longer-lasting pain relief than many other short-acting Opioids like Oxycodone.

For the Opioid-maintained individual, another big plus with Methadone is that it generally possesses significantly less cross-tolerance to many other Opioids. If you aren't aware of what cross-tolerance is, I would suggest doing a quick few minutes of research. The net will probably give you a more concise definition than I can. Suffice to say, absence of complete cross-tolerance can be a major advantage for a patient in the process of rotating through Opioids.

Lastly, it's cheap, cheap, cheap. A "friend" of mine gets 120 10mg tablets per month for $27.00 without insurance getting involved. However, none of this makes much of a difference if the drug is causing you significant discomfort. I would give it a fair shot before deciding to shut the door on Methadone forever. It takes about 5 days for your levels to normalize when beginning at a new dosage.

this. my dad was put on it years ago and it literally gave him his life back (back injury). i don't think methadone blocks other opiates until you reach doses of about 60mg. I'd give it a try and good luck.

 

[ChrisLightoast]

Thanks for all the excellant replies. So, yes, as one of you said, i know it's a low dose. (Studies refferred to as an "ultra low" dose ) its just a companion dose. But its f^@*#n me up! For God's sake, I JUST WANT SOMETHING TO WORK without everything sucking the life out of me or Im gonna jump off a cliff with dynamite like Wile E. Coyote !!

OK so from here , its mostly a well structured rant , just warning you so you dont waste your time if your busy.

Im afraid to tell the doc to stop.Should i pretend to take it? Will he know? I dont want him to see me as just obstructing everything - i dont have a good track record for showing results, so im sure the letters " PIA " are on the top of my files in red. Heck, i had a morphine pump and made him take it out, y'know. I should have kept that stupid thing.
So, The more i think methadone, the more worried i get. Am i seeing the stigma part of it? Heck yeah. Am i afraid he's gonna yank the oxyco if i tell him methadone is helping Heck yeah.
IDK, Unless its a miracle drug, i dont want to lose the oxyco. I'll never get it back! Annnnd , im afraid its just gonna be;

A) just another drug that results in dependance. To make it worse, its evil highly synthesized gov't mandated chemistry like Tramadol. Just Crap.
B) another drug which you build tolerance to. And you know how that goes
C) another drug the pharmacist doesnt like filling.( Ive had problems, live in Fla, sux)
D) complicates xanax and zanaflex. Up til now everything played well together and i had a good handle on it.
E) a pathway for him to take away the oxyco. He slipped in a remark about titrating both if MD works.
Dammit, i need better pain control. And i couldnt care less about euphoria. After 7 yrs, there IS no euphoria for me anymore.
Im already in the ditch with depression/anxiety ,and now im totally de-railed
The extended half life is a reflection of my "crap" remark above. I dont like having this crap lurking in my body after its not doing anything. Had this with Tramadol, Lyrica, Gabapentin. These drugs were big time problems. Horrible.

 

[ChrisLightoast]

Ghost, thanks, and im glad your dad got relief. Youre probably right about higher levels needed for a full blocking action , but if you have a long half life and it builds up in your system i bet it still will to some degree. It's the result of the chemical composition . Seems one is working on one thing and the other is doing the opposite. Atleast thats what i have read. Check out opiods. Com , Good reading there.

 

[Keif' Richards]

It sounds like you really need spcecialist attention. The kind of attention that only a well-educated physician with a lot of experience in the field could provide, most likely. I'm not saying we won't do our very best to help you in your situation, but I think there are people, like doctors, who could do a way better job. I know people are often limited by factors like HMO's, financial issues etc. when seeking medical care, so I won't make any assumptions, but have you tried getting a second opinion or going elsewhere?

Even if you and your current provider have a good relationship, if your pain isn't being adequately treated, I think you need to take some kind of serious action to rectify the problem. There are all kinds of treatments out there that don't involve Opioid medication. Unfortunately, I'm no expert on the subject. Hopefully someone will come along with some better information for you.

I'll add that for a large segment of people, Opioids are plenty good enough at controlling pain. I know that for myself, if I get the right dosage of Hydromorphone after surgery, it's like I'm unable to process pain and the most I feel is a sort of pressure in my face (deviated septim srugery). My point is that because Opioids are so effective, I think it contributes to the medical community using them often as a first-line treatment for moderate pain and above. If Opioids are so effective, it might seem less necessary to investigate alternative methods of controlling pain, which is why you might have to seek out a different provider who can try something different. Just my opinion.

 

[ChrisLightoast]

Hi, keith, thanks for reply. This dr, who is the second at my pain management place. He is only a couple yrs out of school but this also means he is more likely to consider newer therapies. My first dr is old school, and considers oxycodone ir best for me. This may be because he knows im a responsible patient but im not sure. Many drs prescribe an er first, with a smaller ir for breakthrough. (He knows i can control my dosing and timing best, and even told me im basically makingmy own er with ir)
Ok, all said , its likely that long term oxyco use has induced hyper algesia, and of course tolerance. I have made it known to him i have no desire to go higher.
This results in continueing pain somwhat, but i also having worsening conditions.
I havent been the best patient in the past year. I stopped Lyrica mostly due to cost. So i have nerve pain and peripheral nueropathy under treated. I think i will go back on. There are subsides from mfg avaible.
I havent been best pt because im rather depressed . I dont exrcise enough, im sure.
I havnt been best pt because i recently declined nerve block. This results from my whole drug pump debacle. I may have to reconsider.
Now, my methd is clearly adverse reacting to my xanax and lamictal, no doubt in my mind. Im finally starting to feel normal again, its been 5 days? Since stopping.
Im going to ask for a rotation to morphine sulfate ir and er mix and see what happens.
I hope others here will find whatever good info from this thread.
I'll keep this thread updated as appropiate.
Thanks again everyone. Feel better.

 

[ChrisLightoast]

FYI - i found out through some research that the dr rxd the methadone to address hyperalgesia specifically, not to improve the efficacy of the oxycodone. I have acute hyperalgesia and man it sucks , let me tell you ! Apperently, the meth is an NMNA receptor agonist (i probly have this wrong but close) and it can either unlock pain receptors that long term oxy use has rendered useless. In my case, he ultimately planned to switch me entirely to meth. It supposedly will not result in in OIH (opiod induced hyperalgesia) in the first place because of its different property in binding with receptors. With all the big hammers coming down on opiod over prescribing, this will likely be the new go to pain drug after tramadol. It just looks to ke like the feds are going to try to shift the whole pain mngmt methodology towards avoiding morphine based drugs altogether and using synthetic opioids when a must for pain. So we might be looking at Tramadol, Methadone, and Fentinyl being the choices. Ack.
I ended up not using the Methadone. I was discharged from his care for my unwillingness to go along with him. I am in the process of being accepted with a new pain mgt facility. I am still cruising on a stockpile of oxy prescription. I have quite a bit since i was on high doses for so long but always saved some each month. I have taken matters into my own hands to fight the OIH by titrating down dramatically. I have gone from 45mg 4xd to 15mg 4-5 x d in around 40 days. I think i will start a thread all about my OIH and what happens. Its a wicked thing to deal with.

 

[ChrisLightoast]

One more thing - i was suffering terribly with severe despair and anxiety because ive just been in so much pain and feeling hopeless . Considered suicide almost daily. When I last saw my psych dr and told him i was melting down , he wanted to cut my lamicatal in half and add duloxetine. I declined this also and titrated off the lamicatal. I have had a HUGE improvement in my daily feelings of despair , they are mostly gone. This improvement has given me the strength to grab the bull by the ballls and deal with OIH. I have a strong desire to get myself off opiods altogether if possible. I do have real pain , but i want to self medicate if i can, screw relying on these J/O drs. Im setting my sights on Medcann or kratom or something natural. One LAST thing, you guys - TURMERIC (the spice) is an awesome replacement for ibuprofen. Thread on this coming soon too!

 

[dopemaster]

I would be happy as fuck to get any methadone added.

You should probably feel like less shit between med doses and in the morning.

 

[Keif' Richards]

It's lame that I completely forgot to mention the fact that Methadone also exerts action on the N-Methyl-D-Aspartate (NMDA) receptor. This makes it function a little bit differently than most other Opioids. I think it's great that you're getting accepted into a pain management service. I think that we often look at Opioid dependence as comletely linear; you do more, you're tolerance goes up, what goes up, must come down with equal power and all that, but I know from experience that it's not always so simple.

I'll try to make this short. I was on Methadone Maintenance therapy for a while. I began titrating down at a normal rate for me, 10mg per week (I know that's kind of crazy) and everything was totally fine until I reached 25mg. Then, something really strange happened. Instead of "normalizing" (taking my dose, getting well, rinse, repeat) and not experiencing sickness at that level, every day in the afternoon I would get sick. It made no sense. I stayed on the same dose for weeks. This should in theory, cause me to completely adjust to the new levels and eventually not experience sickness. I know this is complicated, but follow me.

It was like, instead of taking a step down and staying there, I would fluctuate between well and sick every day. Again, this happened for weeks. At most, it should have been 2weeks of symptoms, but they didn't stop. My point is, it seems that the Methadone was making me dependent and withdrawing me everyday. It's contrary to everything I've experienced and read about Opioid withdrawal.

The big point of all this bullshit is that Opioids have elusive qualities that we don't usually discuss in depth. Hyperalgesia for instance, is an interesting one. Opioids actually causing someone more pain? So, case in point, you have to do what works for you and if your prescriber thinks their suggestions are the be all end all, your health will ultimately suffer. Keep us updated on the progress!

 

[d1nach]

Have you considered this level of depressants maybe helping your ain at the cost of your mood.every one I of those drugs supress pain signals but also signals in your . Head. And im trying to explain this in english one beer has no effect on mood a few beers might cheer you up a case of beer will leave you on the sofa the room spinning feeling flat angry and sad. I dont think itwas very considerate if your doctor maybe any jokes about euphoria as you seem to clearly be trying to get treatment for legitimate pain and your quality of life basically is in his hands. But how much xanax are you taking daily?