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My mom has MS and fractured her hip 3 years ago (bone is basically dissolved now), is in a nursing home, and the last two years has been in a lot of pain. For about a year, all her old Dr would do was give her a fentanyl patch, Norco and neurotin for pain. She now has a new Dr who wants to try new things. The Dr has put her on Cymbalta and removed one of three doses of Neurotin (it made my mom very confused) and she just swapped the Norco for oxycodone. So now my mom has the fentanyl patch, cymbalta, oxycodone and afternoon and evening dose of neurotin. Her pain is finally manageable now, but now she’s very forgetful. This week the Dr wants to up cymbalta to 30mg and in a few weeks swap oxycodone with methadone. I’ve read horror stories as well as wonderful stories of methadone. I’m honestly a little nervous of her on this and if future Drs will keep allowing her to take it and withdrawals if she ever needs to go off. Does anyone have experience with this and can offer me advice or should I put my trust in the Dr?


A little of my mom’s background is about 1 1/2 years ago my moms old nurse practitioner almost killed my mom with a new mix and increase of meds she gave her so I have been very cautious about everything. Something needs to be done and this new Dr seems very knowledgeable and wants to help. It’s hard for me to trust and I just want what’s best for my mom.

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I've had 4 back surgeries and have had chronic pain in my legs and back for years. At one point I was given methadone for pain. I moved to Washington state from Nevada and my new doctor stopped prescribing it for me cold turkey. I went through horrible withdrawals for about a week. Methadone worked great for my pain. It was the sudden stop that was the problem for me. It did cause quite a bit of drowsiness as well. My moms pain management doctor won't prescribe it for her because it could cause respitory failure and she already has had respiratory failure several times. I've never heard it prescribed along with fentanyl but I'm not a doctor. Those are two very powerful drugs. Just use caution if she does take it.
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Jasmina Aug 2018
I'm sorry you had to go thru that hell. That doc should be reported! 1st do no harm. He treated you like a druggy addict looking for a high.
He should have said I won't prescribe that, but you can go -to this doc, or here etc to get off of it. I recommend this drug for your pain.
He shouldn't have let you go off of it cold turkey. That could be dangerous! You didn't have to suffer like that. I just looked it up and it said that you shouldn't do it alone, but under doc supervision, Going cold turkey makes symptoms worse. The drug can stay in your body for a few weeks, and 1 dose can stay in your body up to a day later. Other drugs can be prescribed to ease withdrawal symptoms.
Find another doc bc this guy doesn't care for his patients. I'd still report him. You were on the med for legit reasons. And find a caring doc.
The web site didn't say much about prescribing it for pain. Perhaps there,are better drugs now than when it was 1st introduced back in the 70s.
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Hospice put my Mom on Methadone for back pain. It worked well. After she broke her other hip and went into a NH the doctor there took her off it, although she was in a lot of pain without it. It also helped her picking disorder, as once off it she started picking again. When she went back on hospice care they put her back on it, she was on a low dose , and it helped with the the pain and the picking. It really helped my Mom, made her pain bearable. Good luck with your Mom I have been there?
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Why methadone? That is typically used for someone who is addicted due to substance abuse.
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How about checking with your pharmacist? Perhaps they can give some input. I would go in when they are not busy.
I'm also wondering do docs prescribe the new wonder drug marijuana? In patch, pill form or some type that the high has been taken out. I hear that does wonders. Maybe that is too new. Unless you bought the card and have access to the shops that sell it. Perhaps our nursing homes are behind the times with that.
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SKGCarepartner Aug 2018
Hi Jasmina! I have tried everything. Some drugs work for a few years, then stop. Some didn't work at all. Some stopped working and then, after a few years doing something else, started working again. My doctor now gives me a prescription for 30 Oxycodone, just so I know there is something that will help if nothing else does and it becomes unbearable. This happens so rarely that I still have plenty left of the script she gave me three years ago. It's kind of just a security blanket. But she knows me well enough to know that I wouldn't abuse it, and I bring the bottle in every once in a while to show her that I'm still good.
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As others have said, everyone reacts differently to every drug. Prescribers need to be watchful and prepared to re-think their care plans if the results aren't satisfactory. You've gotten a lot of good information about methadone. I would just add that, for me, it was not a good fit. Back in the days when doctors were told that narcotics were safe, if potentially addictive, they gave them out indiscriminately. I've suffered from migraines since I was 5 --maybe even younger. My doctor had given me percodan to use as needed. But then she suggested we try methadone because it would keep me on an even medication level --no dips and rises that can trigger rebound. She was a wonderful doctor and I trusted her implicitly. Unfortunately, she was wrong about this drug for me. I suffered from hot flashes, difficulty urinating, and I became chemically dependent (the term the medical profession uses to differentiate between patients' dependency on a drug and people who use it just to get high). It's true, having quit cigarettes and seeing friends go off alcohol and/or narcotics, I'd say methadone is right up there as a highly difficult drug to quit --which I did myself, on my own. It is possible and reasonable, however, to wean patients off it slowly and, even when they are down to what are supposedly "sub-therapeutic doses" patients can still get good doctors to prescribe syrups with a tiny bit of methadone in it to get past that final push. Depending on your mother's age and life expectancy, this might not really be important anyway.

I've been caring for my husband, who is in pain 24/7, for the last dozen years. You both have my sympathy and warm hopes that this new concoction will really help.
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Jasmina Aug 2018
This is kinda off topic but I suffer from migraines too. I was told docs would never prescribe the meds you are given for migraines. There are pills, nose sprays, and self administered shots that can be taken for migraines. I was shocked to read you were prescribed those.
I have been quizzed when going to new docs. They want to make sure I'm not a druggie looking for pain meds.
Of course this is my experience. I'm just so surprised you were given those meds. Perhaps botox for migraines would work for you? I've been tempted, but I don't have 15-20 a month. Hope that med works for you. Mine doesn't always work. Good luck.
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Every chronic pain patient has different needs. What works for one may not work for another. What one kid abuses may be a lifesaver to someone in pain. I would think that your doctor has thoroughly thought through your Mother’s history and thinks this is the best option. Ask him to start at a low dose to see how it goes. He can always titrate it up if needed. Your Mom deserves to be as free from pain as possible, by whichever drug gets her there.
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Ebeach:

There are alternatives to drugs or alternatives that can help to reduce a high dose of prescription pain drugs to a safer level.

Here is a link to an article from AARP that discusses this issue:

aarp.org/health/alternative-medicine/info-11-2008/drug_free_remedies_chronic_pain.html

From the link: “While acute pain appears in areas of the brain that are connected to tissue damage, chronic pain lives in other areas of the brain—the prefrontal cortex and limbic system, which the brain uses for memories, especially emotional ones,” Rossman says. In some cases “the pain lives on long past the time when the body tissues have healed.”
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I am in the exact same position this week. Mom is on Fentynol 100 mcg and Ocycontine 10mg. Last week, they introduced her to 5 mg of methadone. It was horrible and we are now taking her off. She slept constantly and when she was awake, she was delusional. She may have appeared to be lucid, but she was not. (At one point she was talking about my sister.... I do not have any sisters. I believe she thought I was her sister.) She also had more pain than before and a loss of strenth. After 8 days, hospice decided she may have "adverse" side effects and took her off. I flushed all of the remaining pills last night to get them out of the house!

If you choose to try methadone, start with a very small dose like 5 mg. The pharmacy may not carry it and may have to order it. Watch her for a few days and make your decision. Keep in close contact with the doctors about anything you notice. Your mother may be fine, but it is well worth keeping a close eye on things.
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It's NEVER wrong to question any medications or to question the attending physician!
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No one should be in constant pain for the type of condition your mother has. The prognosis for recovery isn’t very hopeful. If she’s in her sixties you position is understandable. If she’s in her eighties it seems excessive. Either way, she should be free from pain.
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The fact that this doctor is weaning off one med, trying to reduce others is a good thing. It sounds like the doctor is actually trying to relieve pain rather than just write a prescription.
It was described to me this way by the CNA that helped care for my Husband while he was on Hospice, the body that NEEDS morphine (or in this case methadone) will use it and react differently to it than a person that takes it to "abuse" it.
It sounds like this doctor is actually trying to manage pain and not just drug her.
I would go with the changes, give it a while to work. It will not happen overnight.
I think given your Moms condition, her level of pain and her life now addiction would be the least of the problems. As I said a lot about my Dad while he was undergoing treatments for cancer....they should have let him have what he needed for pain, if they can cure the cancer then we can worry about addiction.
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I don’t care what the books or the internet say. My junkie nephew says it’s a LOT harder to kick methadone. And believe me, I’ve seen him HIGH on it! Just like on black tar heroine he gets all wound up then suddenly nods off. He says the government uses it because they can control the dosing and that helps them “control” the junkies. They talk about a drug called “suboxen” to withdraw.
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SKGCarepartner Aug 2018
My husband, who is chemically dependent on narcotics because of chronic, incurable pain conditions, opted for Suboxone. It doesn't help his joint pain, but it has made a world of difference for his IBS-related pain, which had superseded all his other pain. It was developed to help addicts get off drugs, but it is a class of narcotic itself.
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According to my online reading methadone works differently from other opioids and is particularly effective in some patients with neuropathic pain from MS, I imagine your mother has a fairly involved and forward thinking doctor if s/he is willing to prescribe it.
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Methadone is an opioid or narcotic. It's often used to wean people addicted to other narcotics off of them because, unlike other narcotics, there is no "high" connected to it. It binds to opioid receptors in the brain just like all other narcotics but you won't feel "stoned" from it. You are, in essence, still addicted to narcotics but won't have the mental fog from taking it.

Per Drugs.com website; "You should not use methadone if you have severe asthma or breathing problems, or a blockage in your stomach or intestines. Methadone may cause a life-threatening heart rhythm disorder. Call your doctor at once if you have a headache with chest pain and severe dizziness, and fast or pounding heartbeats.
Some medicines can interact with methadone and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications."

Like any narcotic, it has the potential to cause a dependence on it and can be "habit forming." That really is beside the point for your Mom. She will need life long pain treatment because of her chronic conditions.

If she will need to stop taking it, I can't imagine any doctor NOT knowing that she will need to be weaned off it, because it is a narcotic. That will take a long time. She also will need to be medicated for pain during her withdrawal, so a delicate balance of adding a different narcotic while weaning her off Methadone.

From American Addiction Centers website; ;
"The drug’s half-life is about 24-36 hours on average, but some of the drug can stay in the body for up to 5 days after the last dose. Stored in the liver and even other body tissues, it is eliminated at different rates depending on the individual. The faster methadone is metabolized, the more tolerant a person is. "
(HolidayEnd-Never heard of a drug with a half life of a YEAR. Even marijuana only lasts from 13-90 days.)

From www.bpac.org.nz keyword: methadone;
Example of methadone titration
Week 1
2.5 mg twice daily
Week 2
5 mg twice daily
Week 3
7.5 mg twice daily
Week 4
10 mg twice daily
Week 5
10 mg three times daily or 15mg twice daily
Week 6
20 mg twice daily
or 10 mg four times daily

Hope this info was helpful.
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You didn’t mention how old your mom is or what, besides MS and hip pain, is wrong with her health. I’m wondering this in relation to the methadone.

As a newly graduated registered nurse I had an older male patient, 70 years old approximately, who was shaking so badly his hospital bed was clattering. I couldn’t imagine what was wrong. We hadn’t been taught about drug addiction in nursing school (1980) or what withdrawal looked like.

According to the patient’s chart and what he told me, he’d been on METHADONE for a good number of years, to treat rheumatoid arthritis. A doctor had decided this man didn’t need methadone, so he was in about day three of WITHDRAWAL. I made a call to the patient’s prescribing doctor, who ordered he be given his methadone. It was written in his chart.

I read about methadone in my nursing drug book. Methadone has a half-life of over a year. That means it takes over a year for even part of the methadone to leave the body if the methadone is curtailed. That results in a HELL of a withdrawal. So ideally, methadone is for life. It WILL relieve pain though.

So I’m sure you’ve heard of how our current US government is conducting a hysterical ‘war against opiates’, resulting in many elderly chronic pain sufferers to do just that, SUFFER. This is a time when a patient can’t be complacent about the medications they take, because the doctor could cut them off for very little reason.

I urge you to read up on methadone online. Then knowing methadone is for life, your mom and you need to decide if the benefits (pain relief) outweigh the drawbacks (big time addiction!). If you decide pain relief is the most important thing (I’d lean toward that for my mom) be aware that the methadone could be discontinued abruptly. And a horrendous withdrawal would begin.

Other opiates could help (Dilaudid, morphine, even a high dose of Norco) but I imagine new doc is thinking about how methadone’s relief from pain lasts longer than the other drugs, just like withdrawal from them is short.

My own mother has the hip joint that collapsed onto itself, causing mobility problems and pain. Her doctor has only given her Ultram but she claims it makes her pain bearable. So I’m not interfering now but if her pain worsened I’d ask the doctor for Norco for her relief.

Expect mom to be sedated, but know she’s not suffering. Good luck to you and your mom.
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Isthisrealyreal Aug 2018
That is the very reason the government is in a hysterical war against opioids.

Addiction and dependency are not the same. Addiction is a behavioral issue. Obviously there will be a dependency because of the nature of these drugs but it does not mean mom will become an addict.
I would think a nurse would know the difference and not use a scare tactic. And quite frankly, quality trumps quantity, every time for me.
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Do your own online research about drug interactions and side effects.

Talk to the doctor about your concerns and verify how she would be winged off if ever.

I think that mom being pain free is worth it to trust this doctor after you talk about your concerns.
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