from Methadone to pain management?

[spooky1]

Hello,

I am new to the forums so I apologize if this is in the wrong topic area.

I am currently on 50mg for MMT daily. I recently had an MRI, which revealed several herniated discs in the lumbar and sacral regions. Both are extremely painful, and is the reason I began taking opioids in the first place. My family doctor has referred me to pain management. Now, I am unsure as to what I'm going to say to the pain doctor. I am currently dosing out of the methadone clinic, as I'm tired of paying $13.00 a day.

Is this an unusual thing for pain management physicians to see?

Will he not take my pain seriously because I've had dependence issues in the past?

Assuming he prescribes pain meds, I intend to just stop going to the clinic immediately. Should this be a problem?

Any advice/information/similar stories would be greatly appreciated!

Thanks!

EDIT: My family doctor is actually quitting medicine as he is losing his medical license. So, by time I will get in to see the pain physician, he will no longer be open. However, he does not prescribe the methadone. He suggested I go there to treat the vicodin addiction and get pain relief. Since then, I've had the MRI and he no longer thinks I'm full of shit about the pain. I'm just really confused of what to expect from the pain management guy. Thanks!

 

[laCster]

why did you get on methadone in the first place?? it is not totally unheard of people getting off suboxone or methadone to pain clinics, but if your opiate addiction lead you to methadone in the first place, just know it will be twice as hard not to get addicted mentally again

 

[morphonorconic]

50mg of methadone daily is a substantial dose- it doesn't alleviate your pain or just not completely? Do you really think that a traditional opioid will be your best option?

The fact that you are on MMT will almost certainly factor into a doctor's approach to treating you. But it's difficult to say how they will view your situation. You're going to require a large dose of whatever opioid you switch to, as your tolerance is high from prolonged methadone usage. Due to your history, they may be apprehensive about prescribing large doses of the commonly abused opioids usually associated with pain management clinics.

IMO, the best option would be to continue the methadone once under the supervision of the pain clinic, but titrate the dose to a level that effectively relieves your pain. That way the temptation to abuse will essentially be removed from the equation.

 

[spooky1]

Thank you both for the quick reply!

I initially began methadone as my family doctor basically did not believe I had pain - he suggested I go to the methadone clinic and treat my assumed addiction. I agreed, because it was the only way I would get any relief at all. I eventually pestered him until he ordered an MRI, which he was shocked to see that my spine had moderate to severe herniations in 3 locations. He then referred me to the PM, believing I could benefit from the specialist I suppose.

I was originally on 80mg of methadone a day, but have effectively dosed down to the 50mg. It does relieve my pain initially when I dose, but I find it wears off after 10-12 hours, and I find myself writhing in pain watching the clock waiting for 5 am to roll around.

I understand the concerns regarding readdiction issues, but honestly it is a chance I am willing to take at this time as I feel the pain is unbearable. Its not that methadone doesn't work, I'm just tired of paying out the a$$ for it. $13.00 a day compared to less than $5.00 a month (I have good insurance thru my employer, I'm an EMT for a public ems service). I've faced enough stigma relating to drug abuse from physicians in the past, and I guess I'm really concerned he will look at me like some kind of scammer or something. I just want to be out of pain. If he can do that with a weaker medication I'm all for it. I know he's the specialist and I of course am willing to try whatever he wants. I just hope we can find something that works.

Thanks again for your replies!

Dave

 

[helium-4]

you should def go to pain management. Even if you stick to methadone, you'll recieve pills instead of getting the juice which you only dose once a day. I recieve methadone from my neurologist and dose it multiple times a day (I'm scripted 10mg three times a day). This will help give you relief over the whole day.

Also, methadone prescriptions are cheap as shit for a month worth of pills. It is one of the cheapest pain meds out there.

 

[Swimmingdancer]

The fact that you are on methadone will factor into how you are treated, but even if they end up just wanting to keep you on the methadone they may give you a pain management regimen instead of an opioid dependence regimen, as Cloudy mentioned. Maybe they can give you some non-opioid treatments as well. We can't know what your particular PM doctor will do of course. It's best to just be completely honest with the doctor and go from there. It's certainly not unusual for someone to end up on methadone maintenance because they were self-medicating their pain that wasn't getting taken seriously at the time. Your MRI results will be helpful in proving that you have legit pain. You don't really have anything to lose from seeing a PM doctor, right?

Also, methadone prescriptions are cheap as shit for a month worth of pills. It is one of the cheapest pain meds out there.

I just want to point out that price very different in different places and situations (why you're prescribed it/your condition, your insurance, how often you have to pick it up, etc) - we don't even know where the OP lives. We don't do specific price discussion, but it's possible that getting it prescribed for pain as opposed to for opioid addiction could be cheaper. You (the OP) could talk to the doctor about your financial concerns.

 

[spooky1]

Thanks for your help guys! I basically gather that I should be as honest as possible and not be afraid to bring up any concerns. I sincerely appreciate all of the advice!

 

[helium-4]

I just want to point out that price very different in different places and situations (why you're prescribed it/your condition, your insurance, how often you have to pick it up, etc) - we don't even know where the OP lives. We don't do specific price discussion, but it's possible that getting it prescribed for pain as opposed to for opioid addiction could be cheaper. You (the OP) could talk to the doctor about your financial concerns.

It's generally accepted in the pharmacy community that methadone is one of the cheapest (if not the cheapest) opioid painkiller available at least in the USA (so if outside of the US, I am less certain, but still know its seen relatively cheap through out most countries). Of course different pharmacies will have different costs (they might not vary that largely, especially when on the cheaper spectrum) per quantity of pills prescribed (not included deductions from insurance or local pharmacy savings), but still remain pretty similar from pharmacy to pharmacy - note I'm talking about generics, as brand name drugs will be much more expensive. Even with out insurance being prescribed say 30mg a day like I am, the costs wont likely exceed 20-30 dollars. When including insurance, the price will generally be cheap but will depend on your plan. Your plan may say have a deductible giving you little to no insurance payment for the drug until you meet the deductible, or decrease the closer you reach the deductable. With the deductible met, it's often 0-10 dollars for a script. Prices change during the year, or years, but methadone has stayed with a rating of $ out of $$$ in many pain management articles (something like fentanyl patches would be a $$$, higher formulations of oxycodone than 5 or 10mg oxy/APAP would be a $$, hydromorphone a $$, morphine a $ or $$). You'll notice that ER drugs (often not available in brand name for a lot of opioid pain killers) will cost more money than IR drugs. A good thing about opioids like methadone is that it has a very long half-life (24+ hr), and a long period of therapeutic effect (8-16 hours of analgesic relief), so it in ways functions similarly in pain management as ER drugs of forexample oxycodone or morphine.

 

[Swimmingdancer]

^Not everyone lives in the US was my point . Here in Canada, for example, methadone pills are very expensive (liquid methadone prescribed for opioid dependence is cheap though aside from pharmacy fees which are outrageous and are charged on a per-pickup basis). Anyway the OP now has a location listed for themselves which is in the US, so yes it's likely relatively inexpensive for them

 

[pillboxskid]

I would,nt worry about the pain managment dr thinking your a scammer.He has to act accordingly to what he see,s on your MRI scan buddie!.I can see how the use of methadone and the temptation to become re adicted to regular opiates must be driving you crazy. But at the end of the day if you put your argument across correctly with the back up of your MRI scan<no punt intended lol> and just put your cards on the table and say im willing to take what you feel will help my pain i just want to be pain free then the drs obliged to prescribe you what he feels will help your condition i would have presumed so buddie. O and dont beat yourself up over being in pain its not your fault hope it gos well!!!

 

[Dr Rxpert]

my pm dr. is very understanding, he prescribes 3x30mg IR oxycodone and 2x10mg methadone for extended pain relief and i dont get that withdrawal feeling and dont have to dose near as often. my advice is go ahead, you are paying for his services and im sure he wants to keep patients.