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Methadone and Pain Doctors/Clinics
LadyofHouston posted:
I have posted several discussions on this subject and I don't seem to be getting a response.

Back in 2000, I was suffering terribly with migrain headaches and my primary Doctor put me in 30 mg of Oxycontin a day and 5/350 PPercocette for BT. Everything was going well and my headaches were down to a "dull roar" and then after several years, my Doctor decided he did not want to prescribe anymore narcotics for me. I was really kind of ignorant to the Pain Pill World and I simply just said OK and went home. Four days later I was sooo sick that my husband had to take me to the ER. The Dr I saw in ER sent me to an addiction rehab clinic that he owned. One day later, he approached my at the rehab stating that he felt I should go on Methadone and I would no longer be in any more pain or withdrawals. Well of course I said Yes. That was in 2000.

In 2002, I was in a bad car accident and hit from the left side of my car and was thrown around quite a bit and had bad pain in my back for years. I was taking 170 mgs of Methadone a day and between that and aspirin, I was keeping it under control.

I am now almost 62 (in May), and I have moved several times due to my husband's work. Each time I moved, the methadone clinic brought my dose down considerably. In 2005, my Dr told me I had Degenerative Arthritis of the Spine and the pain was getting worse all the time. The last move was to Orlando, FL and I was on 120 mgs of Methadone in October 2011.

The pain in my back got so bad, I could no longer stand it and I went to a pain management clinic. I was told that as long as I was on Methadone, he would NOT put me on any opiates. Sooo, I began to take my self down. My methadone clinic would not let me come down as often as I wanted so I did it myself. I was taking pills that were scored and I could break apart. I am now on 60 mgs of Methadone and trying to hang in there with the pain. It is terrible. I went back to my Pain Dr and told him I was on 60 mgs of Methadone and asked if he could please, please give me something for the pain. I can no longer live my life in a normal manner. My husband has to do all the chores in the house; I can't bend, pick up, lift, pull and I can barely walk anymore. The Pain Dr said NO, not until you are off the Methadone. It will take me probably 6 more months to get down from 60 to 0 mgs. He wanted me to have an MRI, even though he had my old records. Well when I got there, through questioning and from my records from my past Drs., the MRI place said I could not have an MRI because I have stents and some type of surgical material that they are not sure if it is a scissors, gauze or whatever. They said it could hurt me real bad if I had an MRI. They took X-rays and couldn't tell what was going on so they just thought I just shouldn't gamble on it and make a decision NOT to have the MRI.

The Pain Dr also wants to give me epidural shots in my spine and I am terribly afraid of that. Can't the Dr just give me some type of pain pill? Everyone I read about in WebMD is taking all kinds of pain pills and I can't even get one!! Also the further down I go on the Methadone the more pain I am in. One of the reasons I also want off the Methadone is the cost. The price is $105 a week, every week!

So I guess my question is, can a person not take Methadone and an opiate at the same time. I just want someone to try one thing at a time. I spend hours during the day and night crying with the pain and that is not the way to live.

Can someone help me and maybe give me a suggestion as to where to go in Orlando, FL for help? Thank you for any help you can give me.
Anon_1421 responded:
The rules of webmd are that no one can recommend a doctor in a specific area-sorry. On your other question-my best friend who has a severely messed up back is on Methadone with Hydrocodone (an opioid) for breakthrough pain, has been for awhile, so it can be done. Don't know why your doctor would insist you get off the methadone first, don't know why he seems to want you to suffer, sounds like he's a sadistic jerk in my humble opinion. You might try calling your insurance and see who they have on their list of providers for pain management. You might also check if there are any physiatrists on your list of providers-they are a special kind of pain management doctor that not only manages pain but looks deeper into the cause of it. As for the epidural shots-if you get them from someone skilled, they are usually not that bad, I have had many of them. If you have them you need to tell the doctor to either knock you out, or make sure you are numbed up really well. You are already in enough pain, you don't need the doctor to add to that. You also need to make sure the doctor uses a fluroscope or some kind of imaging while he does the injections so he can see what he's doing while he's in there-you don't need someone blindly sticking a needle in you. However, for some people they do provide relief, for others they do nothing at all or don't last very long, everyone is different. In my opinion injections are overrated, but that's just me. But if your current doctor only wants to do injections and nothing else, you need to get away from him-some unethical doctors only want to do the injections because of the money they make off them. And steroids can cause some side effects, make sure your doctor fully explains eveything to you before you have them, risks, side effects, etc. also you should take someone with you on your visits, as a witness, and for moral support. Never forget, the doctor works for YOU-you deserve to be treated with respect and dignity. If the doctor is nasty to you or makes you feel uncomfortable, you need to find a different doctor. As for the mri-if you can't have an mri, you should be able to have a cat scan, and I am not surprised the doctor wants more current images to see whats going on with you now. Hope this helps, hope you get relief, good luck.
annette030 responded:
170 mg. a day of methadone is a huge dose. It is hard to believe a doctor increased your dose that much in just two years! Anything over about 60 mgs. a day is considered a high dose by most healthcare professionals. I happily take methadone and also oxycodone for breakthrough pain, but would not accept that high a dose of methadone from anyone. We are about the same age.

Methadone is a long acting opioid, so it might be inadvisable to take another long acting opioid with it, something short acting is usually added to it on an as needed basis. Most medical literature supports only using one long acting opioid at a time. Can't the doctor switch you over to a different opioid? Or does he consider your present dose too high for that? Maybe you should get a second opinion from another doctor?

I have had severe migraines and done my own research, opiate are generally not recommended for migraines because they can cause rebound type headaches. Menopause helped mine some, has it helped yours? When I first got them at age 35, they gave me opiates for them, as more research and newer meds came out, the doctors gradually stopped prescribing opiates and switched over to other meds. I had as good pain control as I did with the opiates.

Pain is a very scary thing, please do your own research as well as listening to your doctors.

Take care, Annette
Peter Abaci, MD responded:
I know that being able to manage your pain better is really important to you, but I think you also want to do it in a safe manner. Here are some things to think about to help you understand why your situation is challenging:

You have been on high dose methadone in the recent past, and there are safety concerns with methadone use including a steep rise in accidental deaths over the last decade. One of the reasons attributed to this is the mixing of methadone with other pain medications and.

Over the years, changes can take place within the central nervous system with prolonged opioid use, including methadone. In some cases, this can lead to a tolerance or resistance to the effects of opioids in your system. As a result, they now may be less therapeutic and create a need to take much higher doses to try to get a response.

If you have cardiac problems, then I suggest you work closely with your cardiologist when making any medication changes. You don't want to put more stress on your heart than what it can handle.

Lastly, it would be helpful to think of pain management as much more than medication management. There are a whole host of options out there from more traditional treatments to complimentary alternative approaches that you can discuss with your doctor. I know this isn't easy, but hang in there and try to work with your doctors to come up with a healthy plan.
LadyofHouston replied to annette030's response:
Thank you so much for your advice. The 170 Mgs were from 2000 through 2009. We moved to Memphis and the Methadone clinic brought me down to 120 mgs. I was on 120mgs until 1/16/2012 when I dropped to 100 mgs and have been dropping down since then and I am now on 50mgs. and I am planning on going down to "ZIP"!!

The Pain Doctor is fully aware that I am going down on my dose. He thought I could drop 20 mgs every 3 days and I refused. I know how I am...I would feel the withdrawal and go back up. Going as slow as I am, has made it much easier. When I get down to 5 mgs, I am going to try and do the "Thompson Recipie (sp?). I think that is what it is called...something to help me get off all together.

I definitely do notice the pain is a lot more severe now...I can barely walk and I cry out in pain A LOT!!! It really upsets my husband and he as well as me, can not understand why I can't get something for pain.

No, menopause did not help in fact it seemed to get worse. However, when I went on the methadone they almost stopped all together...they are coming back now though. I am allergic to Immetrix. I had my first shot in a hospital ER in 1995, and was told by the ER Doc to NEVER take that RX again or anything that has that formula in it, that my reactions would only get worse.

I will definitely look for another Doctor for pain. I am seeing a Phychiatrist for my panic attacks but I have not told him about my methadone situation however, I did tell him I have Degenerative Arthritis of the spine. He politely said, "Oh, that's too bad, I'll bet that really hurts!" Ya Think?!? The last Psychiatrist I went to here in Orlando, I told her about the Methadone and the pain...she had her secretary call me the next day and told me she can not offer me any help...that she does not feel comfortable working with someone on methadone. I will keep my mouth shut from now on!

The pain Doctor has not mentioned a cat scan...I just figured they were unable to tell what was going on in my back with a cat scan...I guess they can though...that is a relief!

I will get a hold of my Insurance Company and see who they recomment and hopefully I get get some relief. One more question. I have read in a lot of newspaper ads for Pain Doctors and they want a recent you think a Cat Scan would be as reliable as an MRI? Most all of those clinics do not take insurance...does that make the place a scam if they only take cash?

Thanks again for your help and I will write again as soon as I have a change in my "Doctoring" situation!!

I hope all is well with you and yours.
LadyofHouston replied to Anon_1421's response:
Thanks for your response...I feel much better after reading what you had to say about the Doctor working for me! Treating me with a little respect would also be nice.

I decided to not go the epidural path. I had a bad reaction to a cortizone shot in my back when I hurt it playing golf in the 80's and it didn't help anyway!

I am going to contact my insurance company and see if I can start all over on this arthritus thing! Thank you so much for your kind made me feel a lot better!

Have a good one and I hope you are free of pain...always and forever!
LadyofHouston replied to Peter Abaci, MD's response:
Dr Peter, Thanks for your kind words. I can truly understand what you said about the opioids. That has never happened to me but I can understand how it could.

I am really happy that I am coming down on my methadone but not very happy with the associating pain in my back and legs that come with it!

I will try to find another Dr to help me in the situation. Thank you so very much for your input I appreciate your advice.
annette030 replied to LadyofHouston's response:
I am sorry I misunderstood your post. It said you began seeing an ER doctor's rehab clinic and they started you on methadone in 2000, and in 2002 you were taking 170 mg. a day of methadone at the time of your accident. At least that is how I understood it.

Just take it slowly on the taper off of methadone. My husband went off of it twice in his lifetime, once after cancer treatment, and once after a hip replacement. He had no withdrawal at all, I think it is primarily the slowness of the taper that affects the withdrawals.

Why haven't you told your psychiatrist about the methadone? He probably asked you to list all your medications at some time, how can he treat you properly if he is unaware of all that is going on with you? You need to keep looking for the right doctor, one who is comfortable treating all of you.

My family practice doc that I was seeing many years ago told me that menopause will either help, hurt, or not affect migraines at all. 33% in each group, so just wait and see, he said. For me it got a bit better.

I don't use the triptan type drugs at all anymore, too expensive. I use reglan 10 mg. with aspirin 975 mg. or ibuprofen 800 mg. Or I use compazine 10 mg. by mouth. The first gives me improvement about 85% of the time, and I add the compazine if necessary. I had rad a medical study about using IV compazine in the ER for migraines, (not just for nausea) and asked my doctor if I could try it at home. First I used rectal suppositories then went to pills. Cheap and easy, effective too.

I have had both CT scans and MRIs of my head and spine. Neither can diagnose pain, only show structural changes in the body.

I personally consider any clinic that does not accept insurance or Medicare to be questionable, and would not go to one that only accepted cash.

Best of luck to you. I hope you are feeling better soon.

Take care, Annette
LadyofHouston replied to annette030's response:
No, I am sorry! I did say I was up to 170mgs in 2 are was a lot in such a short amount of time; I guess I never thought of it that way.

I haven't told my Psych Dr about my Methadone because the first one I went to here in Orlando called the next day and said she could not treat me because of the methadone so I decided to just keep my mouth shut...not that I feel very good about doing that...maybe later on down the road I can mention it to him.

I also have compazine and it does help with the migrains and also I am beginning to be in so much pain in my back that I get sick to my stomach; then I take a compazine and it helps some; not with the pain but with the nausea.

I went down to 50 mgs yesterday and before the end of the early evening I had to take 10 mgs more I was soooo twitchy and nauseated. I guess I took that last 10mg drop too soon!
I do realize that a cat scan and MRI can't tell if you are in pain but I was hoping that the cat scan could do just as well as an MRI in showing the Degenerative Arthritis of the Spine when all of the Docs ask for an MRI. I was just told there is too much metal in my body to safely do an MRI which really scares me!

I truly appreciate all of the great things you have to say and I will keep in touch as things develope. God Bless and have a great week
TDXSP08 replied to LadyofHouston's response:
Anyplace that does not accept insurance and wants cash 98% of the time is a "Pill Mill" and you definitely do not want the services of a Pill Mill , cash to get in the door for a Prescription of whatever your med of choice is and then out to a Pharmacy that they own or co-own to pay cash for your drug of choice from the happy doctor who will see you again next time you want more--it looks really bad on your Medical Records and real Doc's will turn you away for it, so do not do it for your own good Please. And hiding the fact you use methadone from your Doctor is a bad thing, I have local doctors who would not lift a finger to treat my chronic pain so i have drive 325 miles to get to a Pain Management Doctor who will write me scripts for the meds i take and my way of getting back is i tell them what i'm taking but i do not allow them access to medical records ,Doctors names or any dialog between my doctors here in po dunk and the big city and it drives them crazy, and i remind them you said you did not see a need for the opiates i take and refused to prescribe them when my PCP left the area yet i took all of your records to the " City " to a Pain management specialist and she reviewed them for 10 days before she saw me and when she did she apologized that the doctors in my town could be so stupid the need for them was well documented in my records i had tried everything on the pain pyramid and stuck with some stuff for as long as it worked until finally i ended up on opiates and then these doctors looked at met like trash so they only get what i give but Medication dosage and what not should be told to everyone for YOUR OWN HEALTH AND SAFETY.
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
ctbeth replied to LadyofHouston's response:

Not disclosing (to your psychiatrist) that you are taking a controlled substance is a bad idea on so many levels.

Someone recommended that you see a physiatrists which is a physical medicine specialist-not to be confused with psychiatrist.

This is what I just don't understand:

". I went back to my Pain Dr and told him I was on 60 mgs of Methadone and asked if he could please, please give me something for the pain"

Methadone IS "something for the pain."

Perhaps your MD can explain why he/ she wants you to discontinue methadone, and discuss your treatment plan with you. It may be good to write a list of questions to discuss with your MD soon as possible.

I agree with TDX about the cash for meds.
Sounds like a very bad way to manage your pain.
Pill mills can not be a good thing.
Run like the devil is chasing you!
annette030 replied to LadyofHouston's response:
Please tell your psychiatrist about the methadone sooner rather than later.

Try discussing with your doctor tapering more slowly, maybe try 5 mg. a day per week, rather than 10 mg. at one time
Or switch to short acting opiates and take them on an as needed basis. Methadone is not meant to be taken as needed to manage withdrawal symptoms. You take it on a set schedule as prescribed.

Take care, Annette
LadyofHouston replied to annette030's response:
Dear annette030,

I am not taking methadone on a "as needed basis", I am simply trying to discontinue the use by dropping down every few weeks. I am going to a methadone clinic for the methadone and they know I am trying to get off the methadone. There are 2 reasons I am trying to get off the methadone, #1 is the high cost of $105 per week at the clinic; they do not give me the proper information for me to file with my insurance company and at least some of my money back and it is up to them, they do not HAVE to give me that info.. #2, the pain Dr I am seeing will not give me any pain pills for breakthrough or anything else until I am off all of the methadone. After reading all of everyones comments, I do now understand much better about methadone being an opiate in itself and it IS used for pain by regular Doctors. It is very hard to get a job when you are on methadone...there is a lot of explaining to do and it has a bad name; people always think of a heroin addictand I don't like that at all. I have gotten many jobs while on methadone and they excepted the explanation But I am just not comfortable going through all the drama. Even though the methadone has helped some with the pain, even at 170 mgs of methadone, it didn't take my pain away. My other Dr, 4 years ago, knew I was on methadone and gave me hydrocodone for break through and I managed with that. Also my back is degenerative spinal arthritis so it is getting worse all of the time and harder to control the pain.

Now that several people have mentioned it...why does me Dr want me off the methadone so badly?? I will look for another Dr today. It does not have to be a Pain Dr but here in Orlando, regular Docs can not prescribe opiates at all! At least that is what the one Dr I went to told me.

I am just so tired of being in pain and there are soooo many people who are like pain!!

Thanks again for your understanding and wonderful advice from all of you.... Take Care and God Bless
LadyofHouston replied to ctbeth's response:
I do realize now as I am coming down on my methadone that yes it is "something for the pain", however, I no longer want to go to a meth clinic. I would rather a pain Dr or any Dr just give me the methadone by pill ( or however the Drs give it to you) and something for the breakthrough pain. 60 mgs of methadone is not enough to help with the pain...I am nearly out of my mind with pain...I almost can't stand it anymore!! When I have tried to discuss my treatment plan with him he only wants to do epidurals and I can't imagine putting a needle into my spine or anywhere near my spine.

I won't do the "cash for meds"; I didn't think it sounded quite koesher...

I guess when I asked for "something for the pain", I should have said something more or something different because this is NOT working.

Thanks for your suggestions, I really appreciate them. Take care and God Bless.
annette030 replied to LadyofHouston's response:
When you take less methadone and get withdrawals and then take 10 mg. more as you said in your previous post, that sounds like "as needed" to me.

I pay about $7/ month for my methadone RX at the pharmacy, the total cost to the insurance company is less than $30 per month. It sounds to me like you go to a methadone clinic that is primarily used by opiate addicts for maintenance???

Employers are not allowed to ask you what health problems you have by law, and if you must take a drug abuse screening test prior to being employed the RX meds you are on should be confidential and not given to the employer either. The medical people just compare them to what came back on the screening test to make sure you have a RX for that med.

If at 170 mg. a day the methadone did not get rid of your pain, then my guess would be that opioids are not going to work for you. You might need to find a different medication or treatment plan for your problems. Your doctor probably wants you off of it because it does not work for you. He has to be able to justify using it, and if it doesn't work for your pain, he can't do that.

It is nuts if regular doctors are not allowed to prescribe
opiates at all, I think the person who told you that did not know what he was talking about. Call the state board of medical licensing in Florida and they can tell you what the laws are there about pain meds. I have a friend in Polk County, Florida, and she gets opiates from her regular family doctor.

Don't assume from your diagnosis that you will have pain, not all folks with DDD have any pain, let alone severe pain.

Take care, Annette

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