Long term pain medicine use to manage chronic pain

[Robo27]

Hello, I am new to the forum but not new to the pain management system. Just a quick and brief over view of my history. I have had both shoulders operated on, nose reconstructed, I have broke my neck and lower back, after 2 surgeries on each end of my spine, my neck-cervical spine and lumbar spine are now constructed with titanium rods and screws, each section contains approximately 8 inches of hardware and cause severe chronic pain. I have been on pain meds starting back in 1999. After each work related injury surgery would follow and medications. My point to all of this that I have been to good PM Drs and to very poor PM Drs, I wa s recently changed from ER meds to methadone with 30mg of IR oxycodone 1-2 every 4-6 hours as needed for break through pain, I have been on the meds for so long that my body has built up a tolerance to the meds and they are no longer effective, I by know means want to increase the amount and/or strength of the medication. Anyone in a similar situation, successful changes, etc???

[philnoir]

I don't understand if methadone is a new medication or if you've been on methadone a long time and are now feeling that the medication is no longer working.

Please clarify.

Methadone is an excellent pain medication, when used skillfully, at correct doses to provide analgesia. However, the equal analgesic tables for methadone have been changed in recent years and are now very conservative.

What is your daily dose of methadone? What was your previous baseline opioid and daily dose? Is methadone a new medication?

[Tuckamore]

hi Robo,

Welcome to our Pain Management Forum. You have certainly had more than your share of spinal surgeries and pain. I'm sorry you've had to experience both.

There is some clinical evidence that tolerance to analgesia is less with Methadone compared to other opioids; this may be due to its activity at the NMDA receptor.

Just to clarify, Methadone does not contain Naloxone, the substance which is an opiod antagonist. However Methadone does block the "high" and prevents the intense euphoric rush of opiate drugs. Opiates will still be effective and are RX with Methadone.

It is Suboxone (a controlled substance) that not only contains buprenorphine for pain it also contains the opioid antagonist Naloxone.

Tolerance can be an issue in long term opiate use, at least that's the popular belief. I also think that our pain/condition often worsens and therefore we require more opiates. It can be difficult to sort through the difference - but a good PMP or PCP will do so.

Some PMP believe in rotating opiates to avoid some of this tolerance. Some prefer to RX the same LA and SA opiate - meaning if they RX OxyContin (LA) they will RX Oxycodone (SA). The thinking is your tolerance builds only on that one opiate - down the road they'll RX something completely different.

If you've just been changed to Methadone. Is that a new LA opiate for you?  If so, it may just not be as effective as other LA meds may be. Our systems are different and don't always respond to meds the same. If you must stay on the Methadone (per PMP) it may be beneficial to change the IR med.

Have you tried any non-opiate procedures? If your pain is not well controlled be sure to inform your PMP and request a change. I hope he'll work with you to reduce your pain levels.

I'm so sorry you find yourself in this situation - chronic pain is difficult enough and brings so many challenges! Please keep in touch. I hope you'll be active in our community. I find distraction helps my pain. I'll look forward to hearing from you,

Good Luck and Take Care,
~Tuck

[Sunnygrl2015]

Hi, my me is Tracey. Your problem could also be also that the methadone is blocking the breakthrough pain med. I have been on methadone for that reason. (Because I have severe pain but was also  addicted to pain meds, opiates.) The methadone blocks all opiates so it's a waste of my time and money to even try any longer. You should do a little research on methadone. I'm surprised your doctor gave you an opiate breakthrough pain med while on methadone. (Maybe you need to change that med to something non opiate.) It's worth a shot! Good luck!