Methadone Users

Spiticus · Post by **Spiticus** » Sat Feb 21, 2009 5:06 am

What do you guys do when you need pain medication for something other than RLS? If you have substantial pain elsewhere, but the methadone obviously doesn't help since you're already used to it, what would you tell a doctor, or what have you done in the past? Since we take methadone on a regular basis, do we have to "rough it" with other pain or will a doctor prescribe more methadone for a short period of time?

I'm just curious if that ever comes up for me.

Neco · Post by **Neco** » Sat Feb 21, 2009 5:14 am

THe only experience I have is with dental work.. I've had several root canals, and several teeth pulled, and generally I let them know what medication I'm on, and they don't seem to be too stingy about giving me some Tylenol #3 or Hydrocodone.

I have heard that some doctors suggest that you simply increase the dose of methadone to help cover the extra pain.. I think something like 10% but don't really remember that much.

Post by **ViewsAskew** » Sat Feb 21, 2009 8:27 am

I haven't had it come up yet...no question that the methadone doesn't do much to help me with minor pain, though.

Maybe Josh will be around in the next few days and have an answer from a pharmacist perspective.

SquirmingSusan · Post by **SquirmingSusan** » Sat Feb 21, 2009 11:14 am

My pain doctor said that when I have surgery or other acute pain, that the surgeon should prescribe something in addition to the methadone to handle the increased pain. But then I've had other doctors refuse to prescribe the additional meds, because I'm a patient at a pain clinic. :roll:

So I've just taken an extra methadone for a couple days to cover the pain, and my pain doctor is OK with that. I think Josh has said we're supposed to increase the methadone by something like 1/3. It's always best to ask the doctor on this one!

Neco · Post by **Neco** » Sat Feb 21, 2009 2:14 pm

That's a load of crap.. All those doctors have to do is get in touch with your doctor at the pain clinic and get permission to prescribe.. They're just being lazy probably..

I suppose the next time you need surgery you can ask if they will call the doctor and speak to them, or a note from him, on official letterhead will be enough to ease their concerns..

When I was in the E.R all the doctor had to do was call my doctor and get a yes or no, because I signed a narcotics contract with him. They don't even ask at the Dental Clinic, just ask me what I would like them to prescribe.

Helen518 · Post by **Helen518** » Mon Feb 23, 2009 12:50 am

I have found that tylenol helps my back problem (lumbar disc). But also hydrococone helped.

I have two questions.
1. if you have to have anesthesia - IV sedation or general anesthesia - can they do that when you are on methadone?
2. the recommended dose for RLS is 5-20 mg of methadone, right? But will they go above that if a patient is still suffering at 20 mg?

Post by **ViewsAskew** » Mon Feb 23, 2009 1:17 am

I can only answer about the dosing: he recommended dose used to be up to 30 mg (total all day).

I just looked and the Clinical Management of RLS book says the same (albeit in a different way- max dose 5 to 10 mg, every 8 hours)

I know that they will go above 20 based on the above. I know of one case where they went above 30 for and RLSer. It turned out, however, that she also had a misdiagnosed disorder that was mimicking the RLS, so the methadone at the higher dose didn't work completely. But, the doc did try it.

Helen518 · Post by **Helen518** » Mon Feb 23, 2009 1:40 am

Well, that's good to know. My neurologist has said to me , " you're on a really low dose. I've seen people on 200 mg/day" but he hasn't said what disorders these people had.
Is the ceiling based on demonstration that greater doses don't make a difference?
What was the disorder that was mimicking the RLS if you don't mind my asking?
I'm having a bad day again, and I think it might be because I started the hormone injections, or because I am nervous. It is now 48 hours since my first injection.

Post by **ViewsAskew** » Mon Feb 23, 2009 3:23 am

I think it's because that's the dosing they've found that works...but I don't know.

The other disorder...I also can't remember that. She was a member here and she came back about a year after she tried everything and nothing worked. She said they'd finally figured it out and told us what it was. I'll see if I can find it.

SquirmingSusan · Post by **SquirmingSusan** » Mon Feb 23, 2009 6:57 am

Helen518 wrote:I have found that tylenol helps my back problem (lumbar disc). But also hydrococone helped.

I have two questions.
1. if you have to have anesthesia - IV sedation or general anesthesia - can they do that when you are on methadone?
2. the recommended dose for RLS is 5-20 mg of methadone, right? But will they go above that if a patient is still suffering at 20 mg?

Yes, they can do surgery when you are on methadone. It's just one of many variables the anesthesiologists get paid to figure out. Just make sure they know of all the meds you're on before they put you under. I had minor surgery a year ago December, and they gave me what they call "MAC" anesthesia. It's a lighter version of general anesthesia. It was the best sleep I'd had in years, and I felt great all day. :wink:

As for the dosage it takes to control your RLS - a good doctor will just adjust the dosage to what it takes to work for you.

Is the methadone working for you in general? Perhaps the hormones are aggravating your RLS. Hormones can do that. And then there are those days when nothing seems to work. But hopefully those days will become more and more rare as you find a dose that works.

Post by **ViewsAskew** » Mon Feb 23, 2009 8:20 am

Per the hormones, it's often been assumed that hormones were an aggravating factor because many more women have RLS than men. In addition, it's worse for many women during pregnancy and around their monthly cycles.

But, a new study implicated estrogen as the problem. Can't remember the exact result, but I posted it in the research thread on RLS.

My point is simply that with the hormones they are giving you, it definitely could make the RLS worse.

Post by **ViewsAskew** » Mon Feb 23, 2009 8:57 am

It took awhile, but I finally found the post of what the associated condition was and about the two being confused. She posted it in Oct of 2007 and hasn't been back for an update in quite awhile. I will add it to the sticky so I can find it again.

Here is what they person said:

"In the time I've been away, I've had many struggles. I found out through extensive testing including QST and autonomic systems testing that I have a small fiber neuropathy in addition to the RLS. This causes aching, burning pain and tingling. Some stinging. I also have fasiculations from the motor part of it and some weakness. Autonomic system seems to be normal which is good. As usual, my neurologist has no answers for me as far as the prognosis, and simply said, "You will suffer with this for many, many years". I want answers as to how long this will last and if the nerves will ever be normal again.

I feel that the neuropathy sets off the RLS. I had finally found treatment that gave me partial relief from the RLS and when the neuropathy got bad it really kicked the RLS off again. I don't know what to do. All the treatments for neuropathy make Restless Leg worse. Let me tell you, the folks with neuropathy are in a boat similar to ours- it's chronic, progressive, and there are no treatments that work for everyone, and even partial relief is hard won if achieved at all. However, having both I will say that RLS is worse- for me at least, as the neuropathy hasn't progressed to debilitating pain whereas the RLS has been completely debilitating."

Helen518 · Post by **Helen518** » Mon Feb 23, 2009 4:07 pm

Aargh. You know what is funny - I asked my neurologist if the patients he treated that became pregnant reported increase in symptoms during pregnancy and he said no, he did not remember them reporting this. But the common report among women is that it does. In the first 18 hours, I felt fine.

I hope I'm not completely crazy for doing this! I'm doing pretty well today, except when I get nervous, like now, after being reminded about hormones and worsening.

So, if I feel I need to increase the meds, I call the doctor and ask- that's all there is to it, I guess.

Neco · Post by **Neco** » Mon Feb 23, 2009 5:13 pm

Just to throw out random info..

I don't know what disorder would possibly have someone taking 200mg/day of Methadone, but the only thing that really pops into my mind is if this other patient was an addict in a program. Doses in the 100mg+ range are not at all uncommon for heroin addicts as they have a super high tolerance to opiates, heroin being one of the strongest drugs on the planet. I think it was originally researched as a post surgical painkiller, but not 100% sure, my memory is kind of fuzzy on that area.

I sometimes worry about how high I will be allowed to take my doses as well, although I am doing very well in the 15-20mg range for the time being, I still have difficult days and don't want to be stuck within a dose range that may eventually do nothing. I've resolved not to ask for unnecessary increases at the hint of a little discomfort like in the past, so its been a bit of a challenge at times to adjust. But I'm hoping that my effort to milk each increase for all I can will earn me a little more trust when I do ask for an increase. It's all anyone can really do in our cases.

Helen518 · Post by **Helen518** » Mon Feb 23, 2009 5:54 pm

Well, I understand what you mean, Zach. But right now, I need reassurance that I'm going to be reasonably comfortable for the next 9 months on this medication if the IVF works. If the IVF doesn't work, then I have other choices in terms of neurontin, and anxiety meds. Since I haven't stabilized on a dose yet, really, I thought it would be reasonble to consider an increase. I called the neuro and left a message saying that the fertility injections seemed to be aggravating my symptoms and would it be OK to increase. Maybe that will ease my mind and maybe I will relax a bit and won't even need it.