methadone for chronic bad pain

[railroaded]

Is it a good idea to replace high doses of oxycontin, that you have tolerated for years, no highs, pain relief, but still quite a bit of pain, for methadone, forever?  My dack surgeon says the switch will kill me and would have to be done in the hospital over a long period, and even then, he refuses to even entertain the idea, and he has been my back dr. for15 yrs. (I had 2 back surgeries in 1995 abd 1996 and no relief after last surgery, except I could walk again. Now the cost of my oxcontin has made my insurance company badger , or try to badger, me into taking high doses of methadone, with no end in sight.  I am refusung for many reason, my daughter is a methadone addict and heroin addict, but it is more than that.  The insurance dr. touts methadone as being as good as sliced bread.  I have researched a lot, since the same dr. tried this 2 years ago and came to the conclusion i was NOT a candidate for methadone.  I guess the insurance company didn't realize they sent me back to the same dr, but I find myself fighting him all over. Does anyone really know the true harmful effects of massive (I will need) doses of methadone over years and years, well until death?

[railroaded]

Thanks for writing1  I don't know how i missed your post earlier than today.  Am going to check on the site you mentioned, right now I am completely out of my meds, even though the INSURANCE Dr. wrote me a prescription for Fentanyl patches, (another thing I've ALREADY tried and didn't work!), but NOW, at 5:00 FRIDAY they tell me they didn't O.K. it and will have to wait until MONDAY!  I t is so typical, but don't you know..."Just go to the E.R. if the pain gets bad!  Are they kidding!  I already have a drawerful of the lose dose Vicodin they would prescribe, and they NEVER give you anything that really works, BECAUSE YOU ARE A DRUG ADDICT for being normally ON your pain meds!  I have dealt with the E.R. Drs. so many times that I literally wouldn't bother!  To sit there for 4 hrs. for 8 Vicodin!  NO THANKS!  I told the pain Management Dr. whats going on, no meds, weekend, and he was HIRED byn the insurance company!  I think even HE couldn't believe it!  Obviously the real pain hasn't kicked in since i am on the computer!  Will fill you in on the outcome. (Oh, by the way, the PHARMACIST didn't like the new switch of meds so have a pretty good idea it wasn't asked for approval for 2 DAYS!  I turned it in 2 days ago! I am going to drive to the pharmacy, and hope for a miracle (kidding!), but he did give me a ton of oxycodone for breakthrough pain, I told him I would no doubt go through the entire months worth this weekend!  I am on 800 mg. of oxycontin a day, and  used to be on more, lowered it because MORE doesn't work better.  Now, yes I did say that amount, and it has been approved by every Dr. I've seen due to the nerve damage and other problems, now arthritis, bursitis, rotator cuff, and herniated disks in neck, and my UNDERLYING problem is sciatic pain down my leg and lower back!  If I were a HORSE......Talk to you later.  p.s., have NEVER felt a tinge of high off any of the meds, kind of incredible, really.  It is one of the main things they gauge your pain level by...They take blood tests to determine how much medication you are actually absorbing, and I have been seeing my Doctor for 15+ yr, every 4 weeks, and he has NEVER seen a sign of impairment. I guess that's why they approve so much, it is really expensive. My last surgery didn't help my pain much, but it did allow me to walk, which I wasn't BEFORE last back surgery.

[femmy29]

I am not on the side with the insurance dr.  The only thing that I agreed with the insurance dr. about was that the methadone would lower your blood pressure as all opioids lower blood pressure to some extent.  What I don't agree with the insurance dr. about is his desire to push you to methadone because of the risk of QT interval prolongation that I discussed earlier and you confirmed that was indeed the concern that your regular dr. has with you taking methadone as the risk of this irregular heart rhythm goes up as the dose of methadone increases.

It seems that there is something about the morphine that didn't work for you.  Did you not have adequate pain relief on the morphine?  

I hope you will download the .pdf report via the link that I provided in my last post and look at the cost comparisons of the different opioids on the market today.  Ask your regular doctor about what other inexpensive meds in the report that he thinks would be a good fit for you other than the oxycontin.  Bring your regular dr.'s recommendation and the bestbuy report to your insurance dr. and have a discussion with him about other inexpensive medications other than methadone that you can take for your pain.  Also, have your regular doctor write up a medical report documenting his reasons for not prescribing methadone as treatment for your chronic pain and bring this documentation to your appointment with your insurance dr.

I agree it is an uphill battle but don't give up and please keep us posted.

femmy

[djjondoe]

Jeez I hate to hear what you are going threw. I have been taking Oxycontin also. I started taking them when I still had a job that covered most of the cost but now I have been having to buy them them a online pharmacy. I was asking somebody else about switching also and was told to stay with the Oxycontin that I have been taking. Good luck to you

[railroaded]

Thanks so much for mentioning the QT Intervals, it was exactly what my Doctor wrote on his report to the insurance company!  Along with other things!  Thanks, all who responded, I REALLY mean it!

[Dee1956]

Again I am so very sorry for what you are going through.  My husband went through a similar problem and I can completely empathize
It is so unfair for the insurance company to have more say than your own doctor.

[railroaded]

Oh, forgot to mention, tried the morphine, both long lasting and other, the epidurals and looked up a site that someone suggested about QT Intervals, which I also asked my REGULAR Dr. about.  He said that IS the reason it would be so dangerous for me and although my regular Dr. has some Methadone patients, none that need the amount of pain control I need to move, and he says even those patients need additional pain meds, since the Methadone amount would be to high to control.  I thank GOD that I have a Dr. that is behind me, but it is still an uphill battle!

[railroaded]

Oh No, the INSURANCE Dr. is PUSHING the Methadone, and he doesn't care about the heart history.  It is my orthopedic surgeon, who I have seen every 4 wks, since 1995 that is totally against it!  He knows ALL my health history, and he was very concerned after my last appt (last week) that the INSURANCE Dr. was pushing methadone AGAIN!  I have had colitis, and he says that because it was from unknown causes, usually vasculitis, since it is a blood clot that obstructed 3 ft. of my colon 2 yrs. ago, he should be concerned about that too. The support is from my regular Dr, NOT the INSURANCE Dr.!  He wants to cut me off everything that costs money!  I will fight it!

[femmy29]

You have my sincerest condolences on the loss of your son to cancer.  I can't imagine how hard that was for you going through it and how hard it is on you still today.  Your blood pressure levels make complete sense given the emotional and physical pain you have been through and are still going through.  

Based on the cardiovascular problems involving your heart, I agree that methadone is not a good approach for you.  I agree with the doctor who is representing your insurance co. that the methadone will indeed reduce your blood pressure but it is also possible that the methadone can cause a deadly heart arrythmia.  

How much Oxycontin are you taking currently to manage your pain?  Have you talked with them about switching you to generic MS Contin (Morphine Sulfate Extended Release) instead of methadone?  Morphine is a blood vessel dialator which lowers blood pressure and reduces strain on the heart.  Morphine is a first line medication that paramedics use on victims of a heart attack to reduce the pain and lower their blood pressure which helps the heart not have to work as hard.  My blood pressure was the most controlled when I was being treated with Morphine.  Morphine is an inexpensive medication that is just a little more in cost than methadone is.  There is a great website that compares the costs of various opioid medications both generic and brand name.  The costs for both methadone and generic morphine ER are included in this report.  The Consumer BestBuy report is at:

http://www.consumerreports.org/health/best-buy-drugs/opioids.htm

There is a link that you can click on to download the full report.  Consider providing this to your insurance company for consideration of using generic morphine ER instead of methadone.

Now that I am on fentanyl, my blood pressure is slightly above 140/90 during certain times of the day on a consistent basis.  On the morphine, my blood pressure was always under 140/90.  I also take two different blood pressure medications to control it.  Are you still on blood pressure medications?  If so, have you considered talking with your doctor about increasing the strength of the blood pressure medications?  Your blood pressure being that high (190/100) for extended periods of time is not good.  

Please keep us posted.  Take care.

femmy

[railroaded]

i just read read your post, thanks for responding.  My insurance company is Partnership health, and because I have been permanetly disabled, and not married, this is what is available to me.  I will fight the decision, and they CANNOT force medicine down your throat, but they can do other things, like stopping the meds you have been on, I know because they tried to give me a partial, and I had to explain to the new insurance dr., it wasn't going to hold me over for 3 days more!  He DID give me this months prescription, but I see him next week!  LORD HELP ME!

[railroaded]

Thanks for responding, just checked e-mails.  Yes I have high bloo pressure, actually since my thirties, which I atributed to stress because mt son was dying of leukemia, over a 5 yr period.  After he died, my blood pressure stayed as high, and i fought taking blood pressure medicine for yrs, until it reached 190/100 or so on a routine dr. visit.  I still thought it could be from constant pain, but gave in the next month when it stayed pretty high.  Have been on blood pressure meds for about 3= yrs.  Have heart disease in the family, my dad very early, he has since died.  I have had heart palpitations for years, since mt 20's, and they know I have mitralve valve prolapse, but that is so common.  It doesn't seem to concern the insurance dr.  My input sheet listed my blood pressure meds, and he did say methadone would bring my blood pressure down, but didn't even talk about the fact I am on meds NOW.  I seriously feel like the stress is causing a nervous breakdown, and I KNOW my pain has gone up, along with the constant muscle spasms.  It seems the insurance dr. wrote his doctorate on trigger points and is red hot to put his theories into practiv=ce on me.  He is insisting I may become pain-free with his help.  I KNOW that isn't going to happen.  I was so sore after his appt.  I could barely move the next day.  He had me doing contortions, I guess to see if my pain was real.  IT IS!  After seeing I had lost my reflexes in my foot from nerve damage to my back, I guess he believed me.  NOT to mention the huge report he sent the insurance company less than 2 years ago saying I was NOT a candidate for Methadone.  Seriously, I believe the insurance company didn't realize they sent me BACK to be evaluated by the same DOCTOR!  Am not sure if the previous report, which my regular dr. has, could, in itself justify my refusing to go on with this treatment.Don't get me wrong, I am adamant about refusing methadone, but I am so sick and tired of the harrasment.  I am seriously afraid they will cut me off from anything, and I will be unable to walk or take care of my 9 yr. old grandson, it is so hard already.

[Dee1956]

I am so sorry your insurance company is in charge of your health.  It is not right and only your doctor can decide what you need.  Is it possible for your doctor to explain to them why you need the oxycontin?  Do you mind if I ask what type of ins you have so that I never get it?  Also there are types of insurance where you can go to who ever is the over site and complain to them
So sorry
Dee

[becca61]

NO, NO NO!  I was in your position about ten years ago and agreed to try methadone for a month.  It did not relieve my pain as well and made ME quite ill.  Personally, I highly DO NOT recommend this for you or anyone in chronic pain. Trust YOUR doctor and YOUR gut feeling.  The insurance companies don't get to treat patients and that ins. doc is being paid by them to tout that stuff.  I hated it on several levels.  Good luck and "STAND YOUR GROUND"  (YEP, I DO live in Florida)