Methadone Uses

Question by rockondon_djs: my dr gave me methadone but wont prescribe fentanyl limb pain?
so is fentanyl work that good?ive lost a leg in a accident my doc gave my mom fentanyl for a little hole in her leg but wont
prescribe it for a missing leg pain.is it to addictive?im on methadone but im in pain now and dont feel much relief?

Best answer:

Answer by Bite Me.
Methadone is mainly used for treatment of heroin addiction. Doctors wont prescribe pain killers to people with addictive personalities because good pain killers are schedule II, considered a high potential for addiction.

So if your on methedone, most people will assume it is for heroin, and wont risk a chance of a new addiction.

Also some pain killers are derived from opiates, heroin is derived from opium. Very similar.

I dont know anything about fentanyl, i recommend searching it online. I also only trust and use Mosby’s Nursing Drug Reference, which covers the chance of addiction and the schedule. You can find it at a book store and just look up the drug, no need to buy it.

Answer by US_DR_JD
Generally, there is no reason to select Fentanyl Patches over oral methadone for pain management.

When patients are sent to a clinic for chronic pain management, addiction is usually not the primary issue which is the deciding factor in selecting the medication. If a patient has a history of alcohol or drug abuse, and psychological addiction, then concern about the psychological issues related to the medications, and control of the medications becomes the primary priority. However, if a patient has a pain condition, which is expected to be severe and chronic, then having a physical dependence to a medication which they will most likely take for the remainder of their life, is not a significant factor. Very few pain medicine specialist will withold certain medications from patients who have a bonifide reason for pain.

Given that, methadone cost approximately $ 30 a month for a patient taking 90 mg per day. Comparatively, many Fentanyl patch patients will have a pharmacy bill of over $ 600 per month for a similar level of pain control. Sometimes the insurance coverage will determine which medications can be covered.

Fentanyl in the long acting patches as well as the Actiq transmucosal instant release lozenges are very good forms of pain control, but many patients can be adequately controlled on methadone. If your pain is not controlled, keep track of your pain. Is it constantly uncontrolled, or is it only break thru pain. This will determine the proper adjustments you need.

In general, once you are at an adequate dose, methadone will provide as coverage for your pain which is as complete as the fentanyl.

Discuss these issues with your physician. If the problem is pain control, then the medication you are on may just need adjusting. If you have some other problem, then there may be a reason for changing medications.

As a note, pain medicine providers are constantly asked for a new or different medication, by patients who are looking for a psychological benefit. They have a tendency to be wary of patients who are too specific about any particular medication, as this is a common drug seeking behavior.

I hope your pain is controlled soon.

EDIT: To respond to a comment by Chas. Methadone has a long half-life, so the physical dependence issues are greater. However, there is no physical manifestation of the methadone which can cause insomnia for the extended period he relates. I do not doubt he had sleep problems, but they are not related to the physical properties of methadone. Most patients who take methadone for pain control, have no psychological issues (less than 10%) however, those who were heroin addicts often do have residual psychological factors.

The physical withdrawal symptoms can be minimized with proper management, and while never fun, are much less horrible with proper management. I use a significant amount of psychological, as well as nutritional and physical therapty in withdrawing patients from the medication, and the effects are decreased. I learned these methods, as I was on methadone for 4 years following an injury which left me disabled and in long term pain. I have now withdrawn, and the withdrawals took about 15 days, though I was able to sleep every night with non-medication sleep support. I also now use non-medication pain control methods, and use them frequently for my patients.

Work with your physician, they understand the effects of the medications, much better than it may seem in a few minutes in clinic.

Also regarding the FDA warnings regarding deaths, it is always due to patients who are taking too high a dose. By the same token, more people die in the US of gastric bleeding from NSAIDS like Motrin than die from AIDS, death is possible if any medication is used improperly.

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