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Methadone and Neurontin

Posted by Terri on 5/18/03 at 20:03 (119214)

I posted a while ago and got some great responses from you guys, so I thought I would try again.
When I posted before I told you that I had just been diagnosed with TTS. My doctor sent me to pain management. The pain management doctor looked at my feet and asked me some questions and decided that he thought I had the start of RSD. He wanted me to look it up on the internet. Well I looked it up and I DON'T HAVE THAT, OK? It is too scarey to think about. But I decided to try and do what he wanted me to do. He told me to take Methadone four times aday. And Neurontin at night. Well the Methadone I was very leary of, didn't like the idea at all. Neurontin on the other hand, I thought would be ok since you guys recommended that. Well I tried the Methadone and it made me sick. Even very small doses of it. Maybe it was in my head, but I didn't like the way it made me feel, so I refused to take it, plus I dont' want to get addticted to anything. The Neurontin was started at a small dose of 100mg and then he wanted me to up the dose to 900mg gradually. I got to 500mg and I woke up extremely dizzy. I couldn't walk. I was bouncing off the walls, then I got a massive bloody nose and started feeling better. Has anyone else experienced this problem? Makes me scared to try it again in that high a dose and I know that that is a small dose of Neurontin. I know he wants to get me up to 2400mg a day. I started taking 300mg again to see how I do. I would love any feedback. Thanks, Terri

Re: Methadone and Neurontin

Pam S. on 5/18/03 at 20:18 (119218)

Terri:
I will tell you my experience with Neurontin. I happen to be very sensitive to medications so my doc. advised me to take it very slowly. I started at l00 mg. and it has taken me almost two years to build up to 400. I could probably take more but i have not. My burning is a little worse these days so I might take l00 mg early in the evening the the 400 at bedtime. Do not be afraid to play around with it like that or to ask your doctor about that.

Sounds like you may be sensitive also. I know that one of the side effects of Neurontin is dizziness. If you cut back on the dose you will probably be ok. It would be too bad for you to miss out on the benefits of this drug because you took too much to soon. I really noticed benefits with the burning pain at 400 for a long time now. Probably I should up it a little more now.

I really feel the drug is safe. I have gotten many medical opinions about this. I also take a low dose of an anti-depressant called lexapro and klonopin because I have a sleep disorder called restless leg syndrome. The lexapro has helped alot with my pain and fatigue. Since I am on those meds also I just hesitate to take more Neurontin but I dr. likes it alot for pain. They are also finding it helpful for migraines.

Re: Methadone and Neurontin

Terri on 5/19/03 at 08:45 (119256)

Thanks Pam, I am taking 300mg right now, and will keep it at that for a while. I have only been doing this for the past 2 days, so we will see. So many people seem to like this Neurontin, that I really want to give it a fair chance. I am curious, has anyone ever had a doctor give you methadone for nerve pain? I looked on the internet and nowhere can I find methadone being perscribed for this. Thanks, Terri

Re: Methadone and Neurontin

Carmen H on 5/19/03 at 08:52 (119260)

Terri~

If your doctor thinks you have the start of RSD I would listen to him and make sure you stay on top it until it is confirmed you don't have it.
Too many doctors MISS the diagnosis of RSD in the early stages and this is when it is most treatable IF you catch it early.
So get another opinion ASAP but don't rule it out yet...especially if he suspects this.
Just a suggestion...

Re: Methadone and Neurontin

Pam S. on 5/19/03 at 09:08 (119261)

Terri:
I know nothing about methadone. Some people also take Elavil for nerve pain. The side effects of that were too much for me. I felt so sleepy in the am I could hardly drive my daughter to school. I am a big one for cutting pills in half and taking it slowly. I never even knew I could DO that until someone told me.

I hope you get some relief from the Neurontin. It has a longer half life so the benefit can carry over until the the next morning in a good way. You will sleep better because of the pain relief too.

Feel well and I hope you have a great week!

Re: Methadone and Neurontin

Pam S. on 5/19/03 at 09:26 (119264)

Terri:
That is good advice from Carmen. I know how frustrating it is going to drs., appts, waiting but maybe you should get a second opinion and be sure to rule out RSD. Don't you usually have swelling with that? I also think the skin is VERY sensitive to touch. Anyone an expert here?

I do not want to give you advice if I am not sure about RSD. I went to a pain clinic once and that was what that dr. said to me about RSD. My feet did not APPEAR to show those symptoms. I am not sure how they difinitely diagnose RSD. Maybe someone will post who knows more???

Re: Methadone and Neurontin

Carmen H on 5/19/03 at 09:45 (119271)

Do a search on RSD on this site nad you will get all the information you need.

Re: Methadone and Neurontin

BrianG on 5/19/03 at 18:51 (119322)

Hi Terry,

Actually Methadone is probably the best narcotic for chronic nerve pain. If you go to a search engine, like Google.com and type in 'methadone for pain' you'll get over 1,500 hits. I cut and pasted one of the 1st I came to.

Good luck
BrianG

PRESCRIBING METHADONE FOR P
AINBy: David J. Wilmont, M.D.painmanagement@do
c
PRESCRIBING METHADONE FOR PAIN
By: David J. Wilmont, M.D.
(email removed)
Of all the strong narcotic analgesics in our formulary used to treat severe or  intractable pain, methadone (Dolophine, Lilly) is surrounded by a mystique perhaps greater than any other agonist medication available for use legally. Unlike other powerful opiates or opioids, like meperidine (Demerol,) morphine sulfate, fentanyl (Duragesic transdermal system,) oxycodone (Percocet, Percodan, OxyContin) or hydromorphone (Dilaudid,) methadone has been singled out as the only acceptable opioid for use in detoxification from narcotic addiction.  Methadone is also the only narcotic approved in the United States for use in maintenance programs designed to treat opiate or opioid dependent individuals. Within these programs, most often heroin (or other narcotic) addicts are given single daily dosages of a form of methadone called Methadose.  The purpose here is to prevent the addict from going through a withdrawal or abstinence syndrome upon cessation of use of his or her narcotic drug of preference. This is done in federally licensed NTP's (or Narcotic Treatment Programs) located virtually everywhere in the nation.
 
Like it or not, accept it or not, a powerful stigma has been attached to methadone as a result of its status as the only legally approved drug for management of  opiate and/or opioid addiction.  Methadone also happens to be a superb and most efficacious medication for treatment of intractable pain.  And here is where a figurative line begins to blur.  It is a commonly accepted fact that different people respond differently to one medication over another, despite the fact that two or more drugs may be generally regarded as effective analgesics for use in cancer or other severe pain which presents as difficult to control.  Hence, it should be no surprise that for some, no drug is superior to methadone in medication resistant cases of pain management.
 
Only a few years ago, private practice physicians were either outright prohibited, or simply discouraged from prescribing methadone in the course of their medical practice for the purpose of managing or relieving pain and associated suffering within their patients so unfortunate as to be plagued with this horrific  malady.  Laws in this regard varied from state-to-state, further complicating the issue. And doctors had no real choice but to order some 'second best' medication for these patients. It would be impossible now to calculate or even estimate just how much needless suffering resulted from the presence and enforcement of these laws, delineated to 'protect' us.
 
Today, circumstances have changed, although to what degree remains a matter of much discord and debate.  It is now legal throughout the United States for any licensed medical doctor to prescribe methadone for any patient deemed to require  it.  However, the system which governs this prescribing is still replete with complexities.  For example, let us cite, in everyday language, the plethora of requirements faced by a General Practitioner devoted to providing comfort and increased quality of life for a patient suffering with severe pain. Our mythic patient in this context clearly responds best to methadone;  not at all an unusual factor, rather one routinely encountered in pain management. Our doctor must, as a precursor to treatment, begin by demonstrating, in writing, why methadone would be preferable to any other very potent narcotic agonist.  By its very nature, this is a volatile declaration, extremely vulnerable to debate.  So in order for our physician to undertake his preferred course of therapy, he or she must be well prepared to defend this decision should some highly zealous drug enforcement personnel elect to vehemently disagree.  This is the sort of thing that can cause a license to practice medicine to be suspended or revoked. Or at the least, it can be a position phenomenally expensive to defend.  In all likelihood, the best evidence our practitioner will have that methadone indeed should be used as opposed to another strong opiate will be, quite singularly, the testimonial of the suffering patient.
 
One 'brighter side,' albeit to a geographically-dependent, potentially dim side as well -- is the advent of medical operations devoted exclusively to the practice of pain management.  This can mean 'problem solved' for patients living in large metropolitan areas.  Ah, but if you suffer with severe pain (and most assuredly if it's from a cause other than cancer,  the whole nightmare begins anew for those in rural areas.
 
So what is the promulgating factor, the driving force behind this didactic governmental edict?  The primary concern of the Drug Enforcement Administration with regard to methadone is diversion -- e.g. large scale, illegal reappropriation of supplies from legitimate channels to the black market.  This whole-hearted bureaucratic mindset emerges not because there truly exists a large, great and danger-ridden diversion issue with methadone.  In truth and conversely, methadone is not the hyperfocal supertarget of misuse many would have you believe.  Because methadone blocks, at opiate receptors in the brain, other narcotics from being even close to fully and normally effective was in great part the reason it was chosen as the detox and maintenance drug of choice.  For this very same reason, seasoned narcotic addicts do not particularly care for it. Certainly methadone can and is a drug subject to misuse, and its control status on Schedule II is appropriate.  However, for purposes akin to 'getting high,' devoted druggies would quickly and readily cleave onto virtually any other very potent narcotic pursuant to the realization of that endeavor.
 
The remaining question?  Whom, just exactly whom is left to most likely suffer from the benefits of laws governing the use and distribution of methadone?  If you're a severe pain sufferer who obtains superior analgesic effects from methadone, you are.

Re: Methadone and Neurontin

Paula A on 5/26/03 at 20:10 (119979)

Terri,

Carmen gave you very good advice the greater the success with RSD depend how early you get started on the treatments. Did you have a triple phase bone scan to confirm RSD? Does your foot have hypersentivity to hot or cold. Does your foot skin color change? Burny sensation to you skin? Neurontin is appropriate for RSD although I've not heard of the methadone. There is also a physical therapy treatment with a STD machine that has been very successful. You need to rule out or confirm that you do have RSD soon. Also, taking neurontin is a very gradual process until you accumulate to its side effects eventialy they disappear.

Re: Methadone and Neurontin

Terri on 5/27/03 at 20:26 (120074)

Hi Paula,
I really don't think that I have RSD. I didn't have any test for this. I am not even sure why the doctor thought this. The skin color changes with the change of temperature or if it is hanging down. Other than that it doesn't change. It is not super sensitive to touch. My foot does burn but I feel it is a burning from the inside not the outside. I really feel that I just have Tarsal Tunnel. I was told that the methadone helps with nerve pain. That is why I am trying it. I am on a very low dose. The neurontin did not agree with me, but I went down on the dose and am trying it again at a lower dose. Terri