Breakthrough Pain Meds plus Methadone

[methadonian]

I have been on MMT for several years now but in the past 6 months I have had a back injury that is causing me a lot of pain. I ruptured a disc in my lower back that is also pressing on my sciatic nerve. It feels like I've gotten a charlie horse in my leg that just won't let up. So now I am taking methadone for chronic pain as well as maitenance. Before any of this back trouble happened I was taking 90mg a day but since gonig to a pain management doctor he has lowered it to 70mg a day........go figure. I've already brought this up in this forum once but since then there have been some developements. Now this Doctor is offering me pain meds for breakthrough pain. He sort of softened his psition once he found out I was wanting to switch doctors.

My problem is that I can't seem to figure what is gonna actually breakthrough 70 mg of methadone. I gotta pretty high tolerance now. I mean I could do a monstrous shot of some decent heroin and hardly feel it. What's this doctor gonna give me that's gonna be strong enough to work? I had this same problem when I was admitted to the emergency room when all of this started. The emergency doctor kept giving me increasing shot's of dilaudid with no effect. I told her about the 90mg of methadone but she could'nt seem to figure out what to give me without the possibility of killing/ODing me. She ended up admitting me to the hospital and hooking me up to all sorts of monitor's and pumping me full of valium. That seemed to get the pain under control. The muscules in my left leg were spasming pretty bad and she said that valium was one of the best muscle relaxants there is.

I can't see my pain doctor prescribing me any valium to take on top of my methadone. Under controlled situations, like in a hospital setting, they will because they can monitor your respitory/heart rate. Besides most of the people out there that are dying because of methadone are dying because they are combining it with some other CNS depressant and any benzo is a bad thing to take on top of methadone.

[panda]

i cant say what your doctor SHOULD give you but, my uncle was scripted 12 10mg methadones a day(120mg). his doctor only gave him vicodin es for bt pain!

he had bad pain also, they screwed up on surgery to remove 3 toes. at mmt they had him on a 290mg dose. he was a big guy 6'5 320.

i say this because i don't want you to get your hopes up to much, and get let down. being as you were on mmt, they might be afraid to give you something good.

best of luck though. and to answer you're question. i think your best bets would be 4-8mg dillies, opana ir, 15-30mg oxy ir, or maybe even fent pops or that new bucal fent. although fent+ methadone might be to much...

[AndiPandi]

I'm on methadone for pain and getting 15 mg oxy ir for breakthrough. My doc just started me on this and I'm not liking it. Mainly because I'm not getting much relief. I, too, can't see them doing valium, but you never know. I was on valium in the hospital for spasms, but since being home I take baclofen during the day and zanaflex at night.

[nick]

How often do you take your methadone?

[methadonian]

Originally Posted by nick

How often do you take your methadone?

I'me suppose to be taking it 2 or 3 times a day but I'me so used to taking it just once a day that's what I've been doing. Also on the last week of the month I take less and this helps keep my tolerance in check somewhat.

[roxi*stardust]

Methadone technically does not "block" other opiates. It binds tighter and longer to the opioid receptors in the brain than most other opiates/opioids do. This doesn't mean that other opiate/opioid medications don't work when you are on methadone, it only means you won't, in many cases, feel the euphoria from these medications. That doesn't mean they are not working on your pain. While it is true you may require a higher does than an opiate naive patient or even one who has not been treated for long periods with Methadone it does not mean that no break through medication will work or that you will require ridiculously high doses for b/t pain.

There are a ton of articles published you can research with a quick Google search then explain how Methadone works and why adding a b/t medication actually adds to the analgesic effect of Methadone.

For decades, methadone has also been used as an analgesic, and interest in the drug as a treatment for pain has been increasing because of recent evidence that the commercially available racemic mixture includes an isomer that does not bind to opioid receptors, but is an antagonist at the n-methyl-D-aspartate (NMDA) receptor. By blocking this receptor, this d-isomer could potentially yield analgesia by a mechanism that potentiates that produced by binding of the l-isomer to the opioid receptor. Moreover, NMDA-receptor antagonism reverses opioid tolerance, and this effect may explain the unexpectedly high analgesic potency of methadone when it is administered to patients who are receiving another mu agonist drug.

[panda]

^^ that is what my uncles doctor told him. he will not get the euphoria, but will still get the pain relief.

i think your best bet is try whatever he gives you, pay attention to the pain and not the high. if it don't work, let him know.

[upstate_007]

Originally Posted by roxi*stardust

Methadone technically does not "block" other opiates. It binds tighter and longer to the opioid receptors in the brain than most other opiates/opioids do. This doesn't mean that other opiate/opioid medications don't work when you are on methadone, it only means you won't, in many cases, feel the euphoria from these medications. That doesn't mean they are not working on your pain. While it is true you may require a higher does than an opiate naive patient or even one who has not been treated for long periods with Methadone it does not mean that no break through medication will work or that you will require ridiculously high doses for b/t pain.

There are a ton of articles published you can research with a quick Google search then explain how Methadone works and why adding a b/t medication actually adds to the analgesic effect of Methadone.

That is really cool. And probably quite useful to me in the near future. Thanks Roxi!

[Anthropioid]

I know someone who is in almost the exact same situation as yourself. He is prescribed 5mg oxy ir's and can take up to 4 of them 3 times a day for BT pain, and he is also on 70mgs of methadone. He has told me that the euphoria of the oxy's no longer seem apparent but the pain does go away.
So you may just need a slightly higher dose of BT pain medication.

I also have a family member with sever sciatica and compressed disks. After trying a slew of narcotics that were only minimally effective, her doctor switched her over to gabapentin (neurontin) combined with amyltryptaline (Elavil) at night. It's not a narcotic, but it does wonders for her nerve pain, and has been the only combination that has truly reduced her suffering on a dailly basis.

I know that gabapentin really works for some and not others, but if you can't get the relief you need you might consider asking your doc to put you on a low dose in combination with your methadone.

[insaneike]

First off if you don't want to read through my lil story from my exp with a similar situation skip down to the last paragraph. May be a bit long but the morning opis are coming on and I just getsta talking...

Well I was in the same situation after my toler got fucked and the docs wouldn't give me a high enough dose of fent patches to help me, but now all is well(for the most part anyway) as far as my pain meds go. I had a lumbar fusion and discectomy on L5-S1 discs for slipped and herniated discs, fucked nerves, ect. couple years ago, all in all surgery went very bad, made me way worse, and now I'm disabled and in very bad pain all the time, pain is constant now, with excruciating pain that flares up randomly very frequently. Way worse than before surgery.

So after the 25mcg/hr fent patches with 30mg roxis stopped giving relief, SWIM had no choice but to start using anything and everything available. I didn't, but SWIM was forced to purchasing demerol and oxycodone from online sources very frequently, purchasing all the roxis a friend got scripted, and even couple stamps when needed. Someone was spending fucking $1400-1900 a month on just the illicit opis! Just to get decent pain relief! Being the person someone is/was it was pissing them off spending so much on drugs and not even getting so much as a buzz! Spending all their money to just feel normal and make their life half way livable because the pain. After like 2 years of this someone started going to a methadone clinic aswell ontop of all the online and illicit opis, seeing as they could get 120-160mg of m'done a day for just $350 a month!

So after many diff pain clinics and Dr. visits someone found a understand and good/REAL! pain dr(with much help from a counselor at the 'done clinic)! So this Dr. takes over the methadone from the clinic, but lowers dose to just 100mg a day. And raises someones fentanyl patches to 50mcg/hr ones, ten per month, along with the roxicodone 15mg, 90 a month. While this wasn't giving someone too much releif, it helped a hell of a lot, compared to what someone was getting. After about 1.5yrs of seeing this decent pain Dr. and trials of diff meds, the Dr. gave someone ten 50mcg/hr and five 12mcg/hr fent patch/month, 30mg roxicodone 4x/day, and 100mg m'done/day. Now someone finally has adequate pain relief for the first time since he was 19y/o and is building a strong and very trusting relationship with their pain Dr. Hopefully gets the amount/dose of meds someone really needs soon..

But to give what little input to your thread that I can, for me fentanyl and methadone are truly godsends for bad chronic pain! No amounts of hydromorph, oxycodo, morphine, or demerol gave me shit for relief compared to fentanyl and/or methadone. Now for me, I never noticed the methadone block the fentanyl or oxycodone much at all, not the fent one bit... So I've always got good pain releiuf from all opis actually(fent, oxy, dem, hydromorph) while on methadone(currently 100-160mg/day). Now it does kind of 'block' or more so lesson the effectiveness of said opis, but for me it has never blocked the analgesic effects, if it did it was nothing really noticeable. And with the fent, the m'done never even blocked the recreational or analgesic effects of it, even at 200mg of 'done... but with the other opis like demerol, oxycodone, and hydromorphone I noticed the 'done started to lessen their effectiveness at about 90-110mg. The recreational effects that is, not the analgesic(pain relief) effects. So you should still get pain relief from other opis while on the methadone.. for the avg. person the 'done doesn't start minimizing the effects of other opis until about 80-100mg it seems, and it shouldn't really lessen the analgesic effects of other opis too much, if at all at 70mg of m'done. So while it may block some of the recreational effects it shouldn't block the analgesic effects man, so you should be good. So just try fent, oxycod, hydromorph, dem, morph, whatever the Dr. thinks will work best for you and see how it goes. From my exp the Fentanyl and Methadone combo is the hands down best medication for pain relief there is. Especially for patients who need multiple doses of opis per day for severe chronic pain. and for a little extra the roxis/oxycodone deff adds a bit of extra relief, 120mg oxy/day isn't much more relief really but it's deff noticeable and the m'done doesn't block it all at 100-160mg.

Hope you find something that helps man, I know how it is being in pain and trouble trying to put together a combo that works well. and as far as the valium goes, there are lots of pain Dr.s who script it as a muscle relaxer in combo with opis, I know someone who gets methadone and oxycodo with diazepam from his pain Dr. even. and met many ppl who are on methadone from a pain clinic and benzos. So don't give up on getting valium scripted with your done and other opis man.

later

[upstate_007]

Originally Posted by insaneike

for me fentanyl and methadone are truly godsends for bad chronic pain!

Absolutely! If I were looking to get high they would not be my first choice. But for stable and effective pain control they are the shit.

[insaneike]

Originally Posted by upstate_007

Absolutely! If I were looking to get high they would not be my first choice. But for stable and effective pain control they are the shit.

For me Fentanyl and Methadone combo is my hands down opi of choice, for getting high and for my pain. Fentanyl is the best opioid there is to me, for both recreational and analgesic effects. Smoking fent gives so much more of a rush and euphoria than smoking good dope or shooting morphine or oxycodone. I've never shot dope so can't compare that. Now IV fent is god... like a space-age opioid or something lol. Puts hydromorphone to shame. I've never hd oxymorphone in any form so can't compare to it. but for me fent is the hands down ebst opi for getting high, and deff for pain relief.
Now in an oral or transdermal form fentanyl is still very good and pretty euphoric but it's not better than smoking or snorting good dope(heroin) or IV dilaudid, demerol, morphine, ect. esp if you have a low toler oral or transdermal fent will probably be more so sedating than euphoric. That is how it was for me anyway, but once my toler was fucked oral, intranasal, and even transdermal fent gave a very good high and good euphoria, much better than oral/intranasal m'done, oxycodo, dem, morph, ect.

Sorry if I was getting off topic but I just wanted to add my exp and thoughts on the recreational effects of said opis.

later

[methadonian]

Thanks for all the reply's from everyone. My appointment with my pain dr is on the 12th and I'll post back and let everyone know what happened. I don't wanna be too forward with the guy and start suggesting all sorts of narcotic's. I'll just let the doc be the doc for now. All I can do is let him know what works and what does'nt.

[Dhedmo]

Like Ike, I was going to suggest fentanyl, but with a question.

I have never been on MMT, so this might be a ridiculous question, but couldn't you just stop taking the done with a high enough dosage of fentanyl? Could this not be a back door out of the liquid handcuffs? I've wondered about this in the past, and I'm curious what anyone might have to say on that.

(Oh, but don't think a fent kick is easy. Oh, no.)

Unlike Ike, however, I can't recommend smoking fent. The Cadillac Rush aside (okay, that's a Big Aside), you do two very bad things smoking fent: bump tolerance off the charts and risk the Eternal Keyboard Faceplant in osomanyways.

Here's the other side to that: Using the patch transdermally, by withholding the fentanyl until you...just...can't...stand...it anymore, you can actually maintain a pretty solid euphoria a third or more of the time, and solid pain relief (except when you're stretching to keep tolerance).

The virtues of low tolerance are impossible to overstate.
But, at this point, the biggest thing is to be pain-free. Good luck.

[methadonian]

Well, I went to see my pain doc yesterday but decided to turn down his offer of breakthrough pain meds for the time being. My methadone has been working pretty good for me lately and I've gotten a dosing regimen down that allows me to slowly lower my dose/tolerance the last week of every month before I go back to the pain clinic. That way I get a little euphoria all over again everytime I refill my script.

I figure "why mess with something if it's working"? If I start taking additional opiates I might end up on that yoyo cycle of feeling well, then sick, then well again. Years ago I used to intentionally keep my MMT dose low just so I could continue to shoot dope without the worry of dope sickness wearing me down. I used to think that I was so friggin smart by doing that. Little did I know back then that all I was doing was creating a bigger and bigger habit without the enjoyment along the way.

The way I see it, if your gonna shoot dope..........then shoot dope. But if your gonna get on a methadone clinic just to try to stave off dope sickness in between fixes then all your gonna end up doing is build a bigger habit and when you do get the chance to do some decent dope your not gonna feel it as well and all the while that little squirell monkey you started off with is gonna end up a giant methadone & dope craving gorilla.........screw that.

I take methadone for 2 reasons.........chronic pain as well as maintenance. Plus by turning down additional narcotics for my pain I feel like I've honestly reached a turning point in my recovery. I'me getting older and am getting too tired of going down the same old path that always landed me in a jail cell somewhere........fuk it.