Fentanyl to Methadone adjustments

[gazebo1]

Would appreciate any folks who actually have changed from fentanyl to methadone for chronic pain management comment on the experience and effectiveness.

Very briefly;  I have a messed up spine from car crash years ago and will need either fusion, implant drug pump or stimulator within months for spinal stenosis that has not been resolved with conventional treatments, X-stop, P.T., acupuncture, etc.  Pain is unbearable without opiate drugs. Been on 75mcg fent patch for over two years with 4 mg hydromorphone for break-through  pain episodes. Recently become tolerant to fent and docs feel moving to methadone would be best course of treatment.  Have studied some and know that conversion can be tricky and is less toxic to liver (have stage 2 cirrhosis), so hoping it will be the right decision.

Will it be a rough ride, up down, during change, will methadone be as effective helping pain and what different side effects can I expect.  I now have plenty nausea, fatigue and usual restlessness on all the opiates.  But, as stated earlier I will have surgery within 8 months and so just need to be able to tolerate the pain now.  Anyone who has switched over with helpful comments would be appreciated.  Thanks.

[gazebo1]

Wishing you get relief soon - sounds horrible.  Keep your spirit and be kind to those around you and they may be more attentive and take time to be concerned.  I used to fight the nurses and docs, then just tried to relate my needs more peacefully and they reacted with compassion.  Good luck.

[Sharka]

I went through 3 years o "finding what works" for my pain. Dr tried all different combos. Stong ones. I found one that helped . not to long ago I got to feeling better so I asked to be taken off. I was in SEvere pain again. I am back on it. The on ly thing is the constipation, but prunes work well for me(  cold) I hate them otherwise.
ANYWAY, I am on methadone 10mg 2xday. dilauid4mg 2xday, neurotion600mg3xday, feldene,20mg 2xday, robaxin,3xday, and klonopin, 1mg at night. The feldene is an anti inflammitory and workd great for me. The Robaxin is a muscle relaxer that does good. Neurotion I take for my nerve damage. but the como of the methadone and dilauild is what ended up helping me the best,out of all others tried over the years. The only problem now is, When my pain gets over the top, My body is so  high tolerant to pain that nothing helps me.I am in the hospital now, due to severe pain in my rught lower abdomnal area. My regular meds didn't help this one, so here I am. Stuck with needles and getting higher doses of thr dilauid, as need.
I just wanted to say to you that, everyone's body reacts different to medicines. I do hope you the best. As for me, methadone and dilauild is my end result of what helps me. (along with other meds),,,Good luck!

[gazebo1]

Big concern for me is that my liver is already compromised but has been stable the past 2 years, so docs are trying to limit how toxic some meds are (can't take neurontin or lyrica meds at all) - so going higher on fent is not good.  Pain doc says methadone has a long half life and passes through feces not kidney/urine and less stress on liver.  So my real question is how effective will methadone be after a 75 fent patch-hydromorphone 4mg combo and have others had experience switching, dosage conversion suggestions and such.  Thanks!  

[Sharka]

Hi,
I was on 75mg fentenol patch for awhile. It stoped working on me, so the doctor switched me to methadone. I had no side effects from methadone. If I am right, are you taking it twice a day? Do you have a medicine for breakthrough pain between the methadone dose? Methadone is a long acting med. ususally it last up to 12 hours. I myself am on 10mg methadone 2xday. and dilauid for breakthrough(4mg). I take the methadone in the morning and at bed time. I take the others at lunch and dinner.( I am bad abot not taking my dilauid though I trying to get better.
I had my doctor take me off the methadone after a year, because I thought I would be okay without it. I was taken off slowly. Now my pain is horrable, I am in the hospital now even. He put me back on it. I did noticed that I lost a bit of weight, but I am not sure if that was from methadone. I know when I was off of it, I gained weight quickly. If ou have been on the fentenol patch, you should be okay with methadone. You body will tell you what mg workd best for you. Good luck sweetheart.

[geminigirl1963]

I did do a switch from the fentanyl patches (50 mcg) to methadone, but found the methadone didn't help my pain at all.

[Reddtop]

I've had two back procedures, a laminectomy and a spinal fusion. I was put on Methodone two years ago because other opiates didn't seem to help. I take 120mg's a day. The only problem I've had with Methodone, is that it blocks out all other pain drugs. I was given 100Mg Fentanyl patches three months ago to help with extra pain, they did nothing. Now I was given Oxycodone, 30 mg tablets, the strongest they make of that type. They don't do anything either. It seem's the only pain killer that will work is more Methodone. I tried it, it did work, but there's a limit how much you can take, and how much they'll give you. If I keep taking more, then that will stop working too.
So I'm stuck still looking for something that can work with the Methodone.
Having the back surgery was still better then not. I couldn't walk the pain was so bad. The laminectomy and fusion helped  that, but I guess I'm just stuck with having a nerve flare up once a month or so. Good luck!

[Mollyrae]

Hello Gazebo:

I haven't tried the Methadone either but I do use the Fentanyl Patch. I have been using it for about 2 years myself. I started on the 75mcg patch and a year later was increased to 100mch every 48hrs. This adjustment worked very well.

Have you chatted with your Doctor about possibly increasing the Patch?
I feel that this would be your best move.

Also, have you thought about a different breakthrough med? Different meds can have different effects depending on the person.

I would hate to see you go through the possible switch and all the discomfort that comes along with that just to find that the Methadone isn't for you. The Fentanyl was working and I feel that an adjustment might be the trick.......

I wish I had further advise for you. Please take care and good luck.
Mollyrae

[sandee1818]

I have never been on the Fentanyl but have tried Methadone and it was not for me.
I do not know the conversion rate but I am sure your doctor does and will most likely start you off on a relatively low dose and work up to the dosage you need to control your pain. Anytime you change medications you may feel differently but you will start to feel better after awhile of being on the new medication.
The weekends are very slow here so you will get some other responses it just may take a little while.
If the nausea and fatigue are very bothersome your doctor can prescibe medications to help you with these side effects.
I know your looking forward to having the surgery and having your pain cease or at least lessened a great deal but remember this will take time. I hope you will keep us updated and please know we are here for you and will help all we can:)