Opioids A Little Worried Here - Any Advice Before Changing to Methadone For Neuropathic Pain?

[Rybee]

Hey All,

First off, I do actually keep close tabs on, and post in, the Methadone Mega Thread as well as the Pain Management Mega Thread. However, not all Methadone users and pain management patients actively participate in the respective threads - so I'm asking this question as a new thread to reach a wider audience and hopefully catch some advice that I wouldn't otherwise have done so.

Keeping it brief, I have suffered from several spinal disc herniations as well as a pars defect (Spondylolysis) since I was 18 - I'm 25 now. I currently take 100mg Nortriptyline nocte, as well as 10mg Oxycodone q.i.d. - totalling 40mg, though sometimes more, and sometimes less if I can.

My pain management consultant doesn't want to increase the Oxycodone because in all honesty, I don't really feel the difference between taking 40mg and 60mg, the score on my pain scale doesn't improve with a dose increase of 20mg (50 percent). Opiate-wise, he's prescribed me Tramadol, Morphine, Tapentadol and Fentanyl in the past, with varying effectiveness - with Oxycodone being far superior in reducing my pain, at an equipotent dose to the other opiates. I don't know why that is, that kinda surpasses the limit of my opiate Pharmacology knowledge.

Unlike the US, we don't actually have a very wide selection of opiates in the UK, and as such, in his eyes, my only other opiate options are:
Buprenorphine - which he thinks will be inferior to the Oxycodone I currently take.
Diamorphine (Heroin) - which he thinks would be superior to Oxycodone, but administration and monitoring would become problematic.
And finally... Methadone - which he thinks would be far superior for neuropathic pain than Oxycodone, but has tried to avoid so far because of the associated risks and side effects.

However, we had a chat about my pain levels and subsequent management a few weeks ago, in which he gave me the green light to try Methadone in place of Oxycodone, if I so wanted to. He said that, in his experience, Methadone is 'probably the most effective opiate for neuropathic pain' that is available in the UK.

Initially, I was really grateful for him to approve the prescribing of it for me. However, since reading up on it - I'm genuinely scared shitless by the stuff. When reading up on its use in chronic neuropathic pain control, all I keep reading about is: 'death, life-threatening side effects, overdose, cardiac arrest/arrhythmia, respiratory depression, irregular heartbeat, palpitations, sudden death, seizures, irreversible damage, and sleep apnea.' Now I've been totally put off the thought of evening trying it and think I would rather not take the risk and just stay in pain on Oxycodone.

So the question is...
Should I really take note of these warnings, or take them with a pinch of salt and just be cautious when taking it? I'm also a bit worried that once I'm on it, I'm never going to get off of it and wonder about the long term damage/physiological changes that it could cause.

What advice do you have?
Has anyone got any advice that I could heed before making the jump of switching to it? Is there anything that in hindsight, you would do differently when you started? Do you regret starting it? Is it really as bad as it's made out to be?

After reading page, after page, after page, of negative reports and experiences of taking it, I just wonder whether it's such a good idea any more..?

Please be brutally honest in your advice, I'd rather hear the truth than have it sugar coated.

Thanks All,

 

[Whosajiggawaaa]

I was offered da 'meth too and I declined. Often wonder how things would be if I said yes to 'done. Ain't tried it, have a suspicion I would have loiked it tho.

 

[zzz101]

read that wrong but still stands.

ppl have harder time getting off methadone than H sometimes. Because of the depression and long half-life.
i would go with kratom for sure, but only if you find the strongest strain. (and still have meds on stand by)

Easy to come of kratom, over it two days max.

I haven't dealt with that kind of physical pain i am in no place to have say. But - i would try kratom(strong for me) for sure and weed. That's just me. seems better long-term

 

[spacejunk]

Please don't take this as the prompting of a dope-fiend...im genuinely interested in the (obviously very complicated and frustrating) pain management situation you find yourself in.
So... I understand the short half-life, relatively poor oral bioavailability and therefore frequent administration of (IV/IM presumably?) diamorphine is problematic - but could you possibly expand on why specifically you are ruling this one out?

Methadone has a pretty bad reputation for side effects as far as I'm aware (which is admittedly little)
Buprenorphine I have a fair bit of experience with (granted - not with pain management) but some people don't seem to respond well to it - though I may be talking about anecdotes of "non medicinal" users, so to speak.
In other words, not the most reliable cats to take medical advice from

I'm curious as to your reasons for not wishing to go down the diamorphine path...
I assume that it would have to be administered by a medical professional at least twice a day and/or so bound up in bureaucratic nonsense as to make your pain management significantly less....well, manageable?

Sorry about all the questions - but this is a fairly different problem to many of the others that arise on bluelight (specifically from our American friends).
I don't use any more, but I always did wonder what pharmaceutical grade heroin would be like - but please don't get me wrong, that is not the point of my post; I'm just interested at the options available to you and the pros and cons.
Bupe and 'done both have very long half lives; which is a very good thing for chronic pain conditions, but not such a good thing if your health improves and you need off the meds.

Is fentanyl (in the form of transdermal patches) an available in the UK? If so, could this be an option?

 

[zzz101]

If it was that bad I would follow GPs advice to a T on what drugs to take. they will ask you much better questions, just be honest and that would be the best way to get the best help
. you will still exp pain, it will be bad. just expect it.

I can't say why H is more problematic than morphine, i just don't like them both. If you find diamorphine better kinda sucks cause there wont be much legit pharmaceutical companies making it, let alone prescribing it. oxy works better if i had pain. or it just makes pain more manageable.

with this type of pain it's really just to follow a doctor's advice. it;s just generally better decision

 

[ghostandthedarknes]

Can't speak first hand, but a good friend has been on methadone for years. Tried all the others and swears it is the best for pain hands down. As for the death thing, i think this is due to the slow come up and people redosing too soon. My friend got the sweats pretty bad, and some sores on his arms at first. This all went away in time. Good luck.

 

[bukweat]

Oxyir for breakthrough pain relief.
Tried and true morphine er.
That's what I would use.

 

[AbqDave]

1. Most pain specialists are functionally retarded.
2. Don't use short-acting opiates for chronic pain.
3. Methadone is the ideal agent for chronic pain.
4. Don't use short-acting opiates for breakthrough pain. Works for cancer, not for neuropathic pain of spinal origin. Short-acting opiates promote tolerance, and they are cross tolerant with methadone. Meaning, if you keep taking immediate-release oxycodone along with your methadone, you will have to increase both the oxy and the methadone over time, and once you get up to 200mg of methadone per day your retarded pain doctor is going to freak out, accuse you of being a drug addict or dealer, and cut you off.
5. Don't stop the nortrip. Theoretically MTD could work all by itself but it works way way better with a central alpha agonist. Desipramine is better if you can get it but there's not a darn thing wrong with nortrip

Going on methadone is a big decision. Good for you that you are getting on the internet to learn about this so you can make an informed decision.

 

[spacejunk]

^ top post

 

[wezface]

Agreed. Very nicely covered, Dave. Listen to that guy.

 

[crzydiamond]

In the dosages of methadone you would be given for pain, those scary side effects like death and not breathing , etc , really are t applicable.

Most of the "horror stories" are by ppl who came off cold turkey or suddenly. As far as someday getting off, a proper taper is almost not even noticed. I am speaking from personal experience

Two things in favor-- the long lasting methadone avoids the peak and valley plasma saturation that comes with a short acting immediate release opiate. You'll have a more stable amount of medication in your blood

Other thing--tolerance to methadone alone does not go up anywhere near as much as it does to say, oxy or heroin. People can remain stable on methadone for years at the same dose

Don't be afraid to try it based on those side effects. That's not going to happen to you with the lower doses you get on pain management. Opiate maintenance doses are a lot higher and once a day. For pain it's usually a lot lower and every six hours.

 

[Rybee]

1. Most pain specialists are functionally retarded.
2. Don't use short-acting opiates for chronic pain.
3. Methadone is the ideal agent for chronic pain.
4. Don't use short-acting opiates for breakthrough pain. Works for cancer, not for neuropathic pain of spinal origin. Short-acting opiates promote tolerance, and they are cross tolerant with methadone. Meaning, if you keep taking immediate-release oxycodone along with your methadone, you will have to increase both the oxy and the methadone over time, and once you get up to 200mg of methadone per day your retarded pain doctor is going to freak out, accuse you of being a drug addict or dealer, and cut you off.
5. Don't stop the nortrip. Theoretically MTD could work all by itself but it works way way better with a central alpha agonist. Desipramine is better if you can get it but there's not a darn thing wrong with nortrip

Going on methadone is a big decision. Good for you that you are getting on the internet to learn about this so you can make an informed decision.

Thanks very much for the reply. I'm still waiting for my Methadone referral to be motioned so I'll call the doctor on Monday to see what's up with that. I'll reply to your points if that's okay?

1) Haha, yeah I tend to agree. I've been pushed from pillar to post with different doctors and have felt incredibly frustrated with the lack of care. I ended up paying to see a private consultant who is actually an anaesthetist by trade, but does pain management on the side. He's been so hopeful and understanding in my treatment. Not once has he ever whipped out the judgemental accusations or made me feel like a drug seeker. The Nortriptyline he put me on has been working great and helped me lower my opiate use. Some of the horror stories I read on BL with regards to pain management doctors just makes me sick to the stomach. The negligence/ignorance is astounding.

2) I agree, and I got so fed up of administering Oxycodone every 4 hours. The pre-planning it takes, the horrible feeling when you miss a few doses etc... just got too much to me. Whilst having a clear out I found some MS Contin that I was using last year (~100x50mg tablets and ~100x20mg) and I've gone back to taking them. The ease of taking one 50mg when I wake up and one 20mg before sleep has has had my pain under control much better, and has also stopped the acute withdrawal symptoms - and whilst I considered that, it made me want to switch to Methadone even more.

3) So I hear more and more, the more I look at it. My consultant said that opiates are typically quite anti-climatic for neuropathic pain. A big dose of Oxycodone for someone with a broken arm usually works wonders, but that same dose for spinal nerve pain just doesn't cut it. I can't quote him exactly, but he did explain to me why Methadone is far, far superior to other opiates in treating neuropathic pain. My life's pretty miserable and limited at the moment so the thought that Methadone has the potential to be revolutionary in terms of pain relief, when compared to Morphine or Oxycodone, does give me something to hold on to.

4) I actually didn't know this - so thanks for the heads up. Now this is one thing that I am worried about. I always thought that I'd be supervised whilst I start Methadone and then once I found my dose (lets just say 50mg for argument sake) and then I'd use Oxycodone for breakthrough pain. As opposed to taking a bit more than needed, such as 75mg Methadone (again, for arguments sake) then I wouldn't need to use breakthrough pain. But how do I manage on a lower dose of Methadone without breakthrough pain meds, or contrariwise, how do I settle on a higher dose of Methadone and make sure I keep a low tolerance and start sneaking up the dose to keep my pain under control. Should I supplement it with something like MS Contin, as opposed to IR Oxycodone? What would you suggest? I'm sure they'll discuss this with me but I'd like to be informed before this happens, so I don't get done over.

5) I've had to withdraw from the Nortriptyline unfortunately. It's made me so groggy throughout the day, even on a small dose such as 25mg. On 75mg it pretty much comatose'd me and I would sleep through my VERY loud alarm every morning. I lowered down to 50, then to 25 but unless I am physically woken up, I sink into a 12 hour sleep every day. I'm considering going back to Dosulepin or Doxepin. Desipramine I have heard of, but only for the treatment of depression. I wasn't aware that it shared neuropathic pain reducing abilities, so that's another option to read up on.

I really appreciate you taking the time to reply by the way buddy. To say I'm 'nervous' about changing Methadone, which I envision to be an irreversible stairway to hell is an understatement. But I know I can reap so many benefits in terms of pain relief if I'm well informed and manage the doses well. So thanks for keeping me reassured.

 

[Euphorogenesis]

If like you say you manage your doses and ensure you have a script till kingdom come you'll be far better off on methadone.