Low Dose Methadone for Chronic Pain?

[ishmael]

Hi All,

I believe I've read on here that at least one person is taking lowdose methadone for their chronic pain. I've been doing some research and it seems ld methadone can be very effective for my particular case (brachial plexus avulsion/traumatic amutation of arm/phantom limb pain). My questions are 1) for those who are taking it, for what conditions and how effective is it? and 2) how would/did you approach your doctor concerning this? Or was it the doctors idea? Any help/info would be gratefully appreciated!!

[gazbg]

i take 100 mg of methadone for addiction treatment, but i dont find it helps my back pain (buldging dic and arthritis) or knee pain ( arthritis) in any noticeable way. but i know people at the clinic who have had great success with pain management with methadone.

[RedBaron]

i take 100 mg of methadone for addiction treatment, but i dont find it helps my back pain (buldging dic and arthritis) or knee pain ( arthritis) in any noticeable way. but i know people at the clinic who have had great success with pain management with methadone.

I wish I got 100mg of methadone for a bulging dic(k).

Jk, but you might not be able to feel it because there's always going to be some level of pain there. Methadone has such a long duration of action that the slow come up makes it hard to notice that an opiate is present.

[alumni]

Methadone is a very effective medication for controlling chronic pain and many pain management physicians are now using it as an ER treatment instead of other drugs like OxyContin and MS-Contin. It is often prescribed in 10mg doses 1-3 times/day.
Its abuse and diversion profile is less problematic and it is quite inexpensive compared to these other prescription narcotic painkillers.
Its dosing must be carefully titrated by your doctor since it does have a risk initially for accidental overdose. There is also an adverse reaction potential with other medications such as benzodiazepines but hopefully your physician will explain all of this before beginning treatment. It is very important that you take it only as prescribed.
You could simply discuss with your doctor that you have read medical information about successful use of this drug for chronic pain and ask his opinion.

[ishmael]

Good article:

Use of Methadone for the Treatment of Diabetic Neuropathy

see paragraph 2: "Bergmans et al. (6) concluded that methadone may be of particular value in the treatment of phantom limb pain and advocated for controlled clinical trials to verify their observations."

[Coheed]

I take 70mg methadone daily and honestly it does absolutely nothing for my back or any other pain for that matter. I would say the only advantage of using methadone for pain is its long half life but it has so many cons compared with other opoids that I wouldn't reccomend it.

From what I hear methadone is used for pain as a complete last resort after pretty much every other pain med has failed.

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Also the mixture of benzos and methadone can be fatal, I would stay away. Some people swear suboxone works good for pain but I dunno.

[ishmael]

@alumni , may I humbly ask how one goes about finding the type of PM clinic you describe? I have no faith in my new doctor (just a GP), who I am seeing for only the third time tomorrow. <whine> And I just can't take another round of gabapentin, tri-cyclics, etc.. </whine>

[alumni]

@alumni , may I humbly ask how one goes about finding the type of PM clinic you describe? I have no faith in my new doctor (just a GP), who I am seeing for only the third time tomorrow. <whine> And I just can't take another round of gabapentin, tri-cyclics, etc.. </whine>

You're describing a typical situation these days regarding a GP treating chronic pain.
Explain your current lack of pain control to your doctor and ask for a referral to a pain management specialist that uses multiple treatment options including medication.
That's the best advice I can offer.

[gazbg]

Methadone is a very effective medication for controlling chronic pain and many pain management physicians are now using it as an ER treatment instead of other drugs like OxyContin and MS-Contin. It is often prescribed in 10mg doses 1-3 times/day.
Its abuse and diversion profile is less problematic and it is quite inexpensive compared to these other prescription narcotic painkillers.
Its dosing must be carefully titrated by your doctor since it does have a risk initially for accidental overdose. There is also an adverse reaction potential with other medications such as benzodiazepines but hopefully your physician will explain all of this before beginning treatment. It is very important that you take it only as prescribed.
You could simply discuss with your doctor that you have read medical information about successful use of this drug for chronic pain and ask his opinion.

theres actually quite a big diversion rate, around here anyway, a dose of 40 mg goes for about 60 bucks on average here and the higher doses go for even more. i know alot of people that buy and sell methadone.

[JoeyButtafuoco]

My last PM doc had 75% of methadone as an ER. I think it is the best painkiller I have ever tried. It really dulls the pain to a 1-2 on the chart.

The bad news is the side effects. Extreme bloating (i look pregnant) and lethargy. The bloating was so extreme in the stomach area it was painful.

My diet is healthly as I am one of those health food nuts so constipation (which i hear is brutal on meth) never bothered me

I started at out 30 3X a day, I really wish this med worked for me as is one of the best in pm.

[alumni]

theres actually quite a big diversion rate, around here anyway, a dose of 40 mg goes for about 60 bucks on average here and the higher doses go for even more. i know alot of people that buy and sell methadone.

Here in the US, 40mg+ methadone dosage units are used almost exclusively for treatment of narcotic addiction at licensed methadone maintenance clinics. Their distribution and prescription is therefore neither approved nor available for pain management use because of strict DEA regulations.
The vast majority of the diversion you are referring to, at least in the US (I don't know where you are living), would thus be coming from this source rather than from patients being treated by their doctors for chronic pain conditions.
That's the reason why I mentioned the reduced diversion risk profile for methadone when used as a treatment by pain management specialists.

[gazbg]

Here in the US, 40mg+ methadone dosage units are used almost exclusively for treatment of narcotic addiction at licensed methadone maintenance clinics. Their distribution and prescription is therefore neither approved nor available for pain management use because of strict DEA regulations.
The vast majority of the diversion you are referring to, at least in the US (I don't know where you are living), would thus be coming from this source rather than from patients being treated by their doctors for chronic pain conditions.
That's the reason why I mentioned the reduced diversion risk profile for methadone when used as a treatment by pain management specialists.

thats true, it would mostly be coming from addiction treatment patients. but im sure some of it comes from pain patients, even a small dose can get alot of people really high lol

[ishmael]

Bumping, for any fellow travelers who might be interested, or have experiences/info to share.

[mark129395]

I have been on methadone twice before and it worked great for any back pain. I also know some people who are prescribed it for pain. It lasts a very long time to which is a plus if you have chronic pain. Although it is used mostly for addiction treatment there is also many people who use it for pain. May work for you might not depends on the person.

[Lynx4]

I go to pain management and I take Methadone as my ER medicine, oxyIRs as my breakthrough medicine, klonopin for anxiety and muscle spasms and Lyrica when I can tolerate it. Oh, and promethazine because I have a lot of nausea from any narcotic medicine.

I take 10mgs 4x a day. It was not a last ditch effort, it was the first medicine he tried on me. I took just Methadone for about the first 5 months or so before he slowly added in the oxy. The klonopin was added about 10 months ago and was also slowly titrated to make sure I didn't accidentally OD from the methadone and klonopin. I've had no increases in the Methadone since I started seeing him, and it works great for me.

I have left leg radiculopathy verified by an EMG that found two large nerve sections that didn't respond appropriately to stimuli. I also have a bulging disc pushing on those nerve roots and I have very painful shoulder/neck pain.

I too look like I'm pregnant which is very upsetting, but I was with another pain clinic for 4 years and they used a lot of different ER meds on me and I found that methadone was the best for me because I can't feel it but it does its job.

Alumni is right that no pain clinic prescribes the 40 mg methadone wafers or pills. It's always 10mgs and usually at 3 -4 times a day.

I don't know what else I could add to the conversation. It works for me, it lowers the pain so that I don't notice my back and left leg problem except when cleaning house and that's when I use my breakthrough meds.

Your family doctor wouldn't prescribe methadone, especially if you've only seen him 3 times. He might give you a month's worth of hydrocodone or oxycodone, but you're going to need a PM clinic for methadone, and even then the clinic you choose may use morphine ER or other ER meds instead. My first clinic changed my ER meds every 6 months or so, which was quite maddening. I constantly felt off balance and not quite in this world.

I believe my doctor did it right my starting with methadone, waiting until I complained to add the breakthrough meds, and then added the klonopin when I just couldn't take the constant feeling like I was shaking inside and I never wanted to leave the house because I felt like people could see that I was shaking and it felt like my skin didn't fit right, if that makes any sense.

As for getting high on 10mgs? It's just my opinion but I believe most people would be incredibly disappointed if they thought a small dose could get them high. I've never taken a 40mg dose like they use at clinics but I know one person who is currently going to a clinic and he said he could feel a warm sensation for an hour or so and then he just felt less pain. He is uninsured and is actually using the clinic to help with his chronic pain. He borrowed drugs from a friend so they'd show up in his urine and he'd get accepted. He's in his mid 20's and no doctor would help him, even though he has proof of his pain so he felt this was his only choice. He looks much healthier now and his color is back so I guess it's working for him.

[ishmael]

Thank you, @Lynx4 , EXREMELY helpful. I've been fighting this battle for 40+ years, and have only ever found 2 doctors who "got it". Unfortunately, they are both long gone. I am not going into my appt today with any positive expectations, but the battle will be rejoined.
@Lynx4 , and if I have to do what your friend did, I will.

[chell55]

My primary care doctor started me on the lowest dose methadone for chronic pain a number of years ago. It was a good pain medication but made me sweat awful and itch like crazy. Had a hard time getting off of it. Doctor switched me to morphine and 6 norco for bk pain.

That was the good days. My doctor left and her pain patients couldn't find care. I now go to pain management.

[newman1282]

I believe the methadone has no pain killing affects. i was on the methadone for about three years it pretty much numbs you from the brain down most people who seen me said i looked like the lights were on but no one was home you know that kind of thing but to answer the question no it really doesnt help pain that much and there usually isnt a low dose to use for pain because you always need more and when you do not have it you are one sick sick puppy.

[ishmael]

I believe the methadone has no pain killing affects. i was on the methadone for about three years it pretty much numbs you from the brain down most people who seen me said i looked like the lights were on but no one was home you know that kind of thing but to answer the question no it really doesnt help pain that much and there usually isnt a low dose to use for pain because you always need more and when you do not have it you are one sick sick puppy.

May I ask why were you on methadone? Was it prescribed to treat your pain? And if not to personal, may I ask what is/was the cause for the pain?

[mikey420]

I hear methadone withdrawal can be absolutely brutal...small dose if you can!

And best of luck to you.