Chronic Pain and Withdrawels

[nubbin1954]

I have been in pain management for over 15 years and on 40mg of methadone.  Dr. thought it was affecting my heart so he switched me to dilaudid 4mg every 8 hours.  2 days later I was in full blown withdrawels.  After about 3 weeks I began to think I might live, Dr. kept telling me I shouldn't be having withdrawels.  The dilaudid only lasted 2-3 hours, if I waited 8 hours I was hurting so bad the medicine was'nt doing me any good, besides it just was'nt enough.  Next visit Dr. put me on 25mg fentanyl patch w/1 loratab 10 per day for break through pain.  It's been 3 months and I swear I'm still having methadone withdrawels, runny nose,sneezing, leg aches and my ambian don't work anymore.  I only get 2-3 hours sleep at a time.  I'm worn out!  I don't think the fentanyl patch is doing anything, the only time I feel better is when I take my 1 a day loratab that lasts about 2-3 hours.  What can I do to make Dr. understand that its not enough and that I feel like crap.  He thinks I should'nt be having withdrawels.  HELP

[namnam46]

Hi nubbin,

Thank you for clarifying the Lortab.  :)

With this being said, it means you are terribly under-medicated.  As Jaybay said, you really need to find a Doctor that can medicate you properly!!!   This is a travesty that your Doctor has done to you. Your Fentanyl definitely needs to have the dosage raised to be comparable to the Methadone that you were on.  Hopefully, you will get help soon.

I hope you will start looking around quickly for a new PM Doctor!!

Best of luck and please continue to keep us updated as to how you are doing.........Sherry

[nurseaudrea]

With the symptoms you describes they are classic withdrawal symptoms. It is a long time to be in acute withdrawal but with that being said, methadone has a very long half life. It takes a very long time for it to get out of your system, months. I am not at all surprised you are still having problems, especially seeing how you were on it for the length of time you stated. The doses of the other meds the doctor put you were just not adequate. It seems he would of known that. The doses he put you on were the doses you would put someone going from Vicodin to Long acting meds, not the other way around. It sounds like he is not well versed in pain management meds and how to rotate meds very well. I would really question his ability and seek another opinion rather than to suffer like you have been. I am really sorry you have had to suffer like this. I know the torture you have been through. I took myself off methadone after I had my daughter in 2005. I thought I could do it on my own and do it rather quickly. I weaned off in 10 days because that is all the meds I had left. I did not want to have to go back to my pain management doctor and the OB was the one who took over my care and was not going to be giving me the meds anymore. Well suffice to say when I went in with major withdrawals even though I had weaned I was a huge mess. They thought I was crazy for not saying anything. I had suffered silently for about two weeks. I had awful symptoms. My daughter was in the NICU so thank God I did not have to take care of her during that time. Anyway they gave me more meds and told me not to do that again. I was given a better taper plan and tapered off in about 4 weeks with a successful plan the following time. I still had some withdrawals but they were more manageable and did not last near as long. From what I remember the worst lasted about 4 days with the horrible body aches and head splitting open head ache. I thought my head was going to explode from the base of my neck. This time I did have my daughter. I took her to my mom' s and layed in a fetal position for about three days until the worst was over. I did not sleep for about 4 days either.

With you being on Fentanyl it should not be so bad, that is what is so confusing. It could be because you could be going through a secondary withdrawal. Methadone gets into your body different than other opiods and stays in your fat. When you go into withdrawal it starts to leach out and when it is all used up what is left in the fat finally comes out and that is when the secondary withdrawal happens. That's why it can take months.  

Another weird thing that can happen is when you take other opiods it can block the effects of the Methadone that is still in your system making your withdrawal even worse.  Unfortunately too many pain management doctors don't know these things. You have to do your research.

Hopefully this helps.

[nubbin1954]

Thank you for clarifing the Lortab dose for me. I did mean one (1) 10mg Lortab per day plus the 25mcg fentanyl patch.  Am I still suffering from methadone withdrawals after the 3 weeks of hell I went through switching from methadone @ 40mg per day to dilaudid @ 4mg three times per day?  Then from dilaudid to patch and one Lortab 10mg?  It's been 3 months and I still feel like crap.

[nurseaudrea]

If you read his thread agian you will understand he is saying it is one Lortab 10 mg  a day. He says he only gets one a day and it lasts only 2 to 3 hours. I can't imagine why this doctor only allows you to take it once a day, that is really odd. And yes, I agree, with Jaybay, 25mcg is a very low dose compared to 40 mg of Methadone. I can't believe your doctor does not know this. He needs to up your dose of Fentanyl. Have you asked for an increase in the Lortab as well for maybe three times a day? Usually when it is for bt it is for three to four times a day.

[Jaybay]

Good grief!  I'm not at all surprised you're having withdrawal symptoms.  Every change your doctor made to your medication was in a huge downward direction.  I can't begin to understand what he's thinking to believe you shouldn't experience withdrawal with that kind of reduction.

Methadone withdrawal is the gift that keeps on giving where detox is concerned because it has such a long half-life.  I'm also not surprised you're still having symptoms.  Insomnia is typical and nothing but time will cure it.  You might as well forget about the ambien because it won't help.  Rebound pain is also a symptom - Increased pain from your original problem as well as pain all over your body.   Again, time is the only cure and it's different for everyone.  Anxiety and restless leg syndrome can be dealt with temporarily by soaking in a hot bath with epsom salts.  The magnesium is important when you're in withdrawal as is staying hydrated and maintaining excellent nutrition.  Detox does a real number on your body in unexpected ways and it needs all the help it can get.

I seriously question your doctor's actions and even his knowledge of opiate therapy.  I also agree with Sherry that you're taking a truck load of tylenol with 10 lortab a day. Lortab usually contains 500 mg of tylenol, which puts you at 5 grams a day.  The FDA limit is 4 grams and the brand name manufacturer, Johnson & Johnson, recently lowered their recommended daily dose to 3 grams due to liver toxicity.  Unless your doctor has a medical reason for lowering your dose so drastically and changing medications so radically and quickly, his actions make absolutely no sense.  In your shoes I'd be looking for a different doctor or at least a second opinion on your current therapy.

[namnam46]

Hi nubbin1954,

First, I want to welcome you to the PM (Pain Management) Forum and let you know that we are glad you found this Forum. We are all CP (Chronic Pain) Patients that help each other with our own expertise and experiences that we have developed through our own CP Issues.

I'm sorry that you are experiencing all of these withdrawal symptoms from the Methadone!! I don't know if I'm reading this correctly but have you been on the Methadone for all 15 of those years?  If you have and at that dose then it will take you quite awhile to get over it.  I have a feeling that you need a stronger patch than 25 mcg's.  That's really not very strong. This might be part of you problem.  Remember we are not Doctor's on here, only CP (Chronic Pain) Patients like you!!

Did I also read it correctly that he has you on 10 Lortab's a day?????  What strength are they?  If this is true that is way too much Acetaminophen for you to be taking!!!!  It will ruin your liver.  Please check this out with your Doctor.  I'm very concerned about that, IF I read your post correctly.  You said he gave you 25 mcg (it's not mg) Fentanyl Patch w/1 lortab 10 per day for break through pain.  The reason that the Fentanyl is mcg is because Fentanyl is 80 times stronger than Morphine.  It is dispersed by the micro-gram instead of by milligrams because of this.  A 25 mcg patch would be approximately equal to 100 to 120 Lortab's a day but without the Acetaminophen. I learned this from one of our member's, Jaybay, who is very versed in the Fentanyl Patch.  I'm, also, on the Patch, 87 mcg's every 48 hours as it doesn't work for me the extra 24 hours. A lot of people need to change it after 2 days instead of 3.  However, your Doctor should be the one to give you this advice.  It's no wonder that you are having this problem as your pain probably isn't being covered either.

Please go back and talk with your Doctor and have a heart-to-heart with him and hopefully he will listen to you.

I wish you the very best and hope that you will keep us informed on what you find out and how you are doing.........Sherry