At what point will a pain-management doc put a patient on metadone to manage severe pain?

Oh my goodness, Jane, you ARE a mess!  I tried the methadone for a few weeks and didn't like the feeling at all...I felt druggy and tired all the time and it affected my voice (I am a teacher by day, and I sing at night with a band...so that was no good!).  Under my pain doc's instructions, I cut back little by little with NO adverse sice affects.  I was freaking about becoming addicted...but I got off pretty easily.  S/he needs to give you lower doses so that you can cut down slowly till you are off.  Maybe a new doctor is in order?  I have fibro, rheumatoid arthritis, severe IBS, three buldging discs w/ herniation in C4-C-7...and a myriad other complaints...argh.  I pray that you find some relief, but I would definitely try to find another pain mgmnt specialist.  Good luck!  You may chat with me any time!

Holly

Hi Jane:

I'm on Methadone, and the most important thing my doctor did when I was started on it was to start on the lowest possible dose and build up very slowly so that I could be on the smallest effective amount for my condition.  Usually, methadone is a last resource drug due to the high risk for addiction and/or overdose....overdose doesn't show up right away because of the length of time the drug stays in the body and it can be several days before you know your levels are too high.  After a year and a half I am now finally up to what we feel is my optimum dose, which is a 10 mg tablet 3 times a day.  My starting dose was 2.5 mg twice a day and it wasn't increased the first time for almost 3 months. 

Secondly, stopping the medication cold turkey like that can be very stressful, not to mention dangerous.  My suggestion, if it's possible, is to seek out a new doctor who isn't so aggressive with pushing the drugs and is willing to go other routes as well.  I go to a psychiatrist monthly at the insistence of my pain management doc to make sure that I'm not starting to show any signs of overdose or addiction.

Please don't let this bad experience taint your view of pain management doctors.  I have been to three and this third one is the best I've met.  They all have their own attitudes regarding chronic pain, prejudices against certain patients, and, believe it or not, there are conscientious and kind pain management docs out there.  I would start looking for one now if I were you.

I'm sorry you had such a bad first experience.  My first pain doc was arrogant and dismissed me for being in too much pain at first to make all my appointments with an hour and a half drive to get to his office.  Now I'm 30 minutes from my doc and she treats me someone with dignity and deserving of respect.

I wish you good searching.

Trisha in Missouri

I have actually been given methadone with a catapres patch to come off another medication.  I was in a severe accident about 4.5 years ago and sufferred several injuries so one of my docs put me on a Duragesic patch, which is much stronger than morphine.  So in order to come off the Duragesic patch that I had been on for about 7 months (which was insane, by the way) I was on the methadone and catapress patch for two weeks to help with withdraws and my pain until the other meds were out of my system so they could start me on a new medicine. I'm not going to lie...it was a grueling two weeks, but as I said, Duragesic is much stronger than morphine and I was on a very high dosage. 

Anyway, I have probably been on every pain narcotic out there in the past 5 years due to my auto accident.  In turn, my tolerance for them is ridiculous unfortunately...for me and my pain.  Therefore, I actually started hurting more than I did when I originally got into my accident.  I kept asking my doctor what was wrong with me and what was happenning.  My doctor I had been with for four years continued to run more and more MRI's, EEG's, Cat Scans, etc.. that only showed the same results as the first ones, as well as minor additional problems like dual carpal tunnell, pinched nerve, two more bulging/herniated discs, etc..; yet nothing to explain the way I felt (I know that sounds like it would explain it, but that wasn't much more than I already had, believe it or not).  My existing injuries compared to the things they found and weren't reasonable explanation for the way I had felt for so long.  They continued to do different injections of all sorts, some they had already done without any results in the past and some new ones that were different but for the same thing.  I finally went to a different doctor and he explained that after being on the Ocxycontin for so long that it made my body ultra-sensitive to pretty much anything, everything and nothing.

I spoke to the new doctor about admitting myself to a hospital or something similar to detox my body of the Ocxycotin to see if that would help, and then go from there.  He said that would be a good idea.  At least then I could find out exactly where my pain was coming from, because at that point it was every single inch of my body.  I have had fibromyalgia for 15 years and I knew that this was not just FM.  I admitted myself for a week to have help detoxing.  Then I saw a pain management doctor that specializing in pain management and addiction.  I chose this type of pain management doctor for a couple of reasons. 

After feeling the way I did for so long that fourth year...I know I never, ever want to feel that way again!  Two, I lost a lot of faith and trust that I had in my previous doctor because they allowed me to get to that point where my body felt the way it did and did nothing about it except continue to write the same prescription and increase the strength, as well as do unnecessary procedure on me that were expenssive (whether I had insurance or not).  I think its extremely unethical! Thirdly, pain management doctor who specialize in PM and addiction really manage controlling pain medication and know many many ways and alternatives to treat chronic pain without narcotics.  And if you do require narcotic they will give them to you, but they make sure you come way before their paycheck does by making sure you are taking care of and your pain AND meds are managed. 

As far as getting off of methadone, you can either do it yourself by whienning yourself off....which no, it isn't the easiet way and you should definitely have someone there with you for safety reasons, but it is definitely possible.  Or, find a doctor who prescribes Suboxone in your area.  Its a pain medication that you can NOT build up a tolerance to no matter how long you take it.  The only thing is that there are not very many doctors in each city/town that prescribe it, and then each doctor can only have 50 patients in their practice/office that they are allowed to prescribe it to at a time.  Its a very controlled substance.  That is the same thing they give you in a hospital to take when they detox you to help with your withdraws symptoms and your pain.

I am still talking it and I stopped taking Oxycontin 9 months ago. 

YOu can find a doctor in your area by looking on wwww.suboxone.com

Hope this helps.  Sorry for the long response!