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February 23, 2010 7:03 PM Subscribe
I have a herniated disc (L4-L5) with lower-back pain. I have developed sciatic pain in the last few years.
I have been taking vicodin for a few years and now the doctor has prescribed methadone. What can I expect?
I have been battling with lower back pain for years and it has progressed to sciatic pain. I have been getting treatments such as facet joint injections (limited or no success) and radiofrequency rhizotomy (better success).
Vicodin is now an every day thing (Think: "House"). I have graduated all the way from two of the 5/750s a day at the beginning to four or five the 7.5/375s a day now.
The doctor said that he wanted to prescribe a drug for continuous chronic pain maintenance; when he found out that our health insurance is about to expire, he changed his mind from [whatever drug, he did not say] to "another drug which is much cheaper." This "other drug" is methadone. Note that the prescription is written for three 5mg pills a day but he instructed me to start with two a day and consult with him before going on to three a day.
What can I expect from the use of methadone in this context? Is withdrawal a problem? Is continuous or long term use a "no fun" proposition?
[TMI filter] I am familiar with the effects on the digestive system. The vicodin has me taking softeners and fiber like never before.
[The usual disclaimer holds true: You Are Not A Doctor. You Are Not My Doctor.]
I have been battling with lower back pain for years and it has progressed to sciatic pain. I have been getting treatments such as facet joint injections (limited or no success) and radiofrequency rhizotomy (better success).
Vicodin is now an every day thing (Think: "House"). I have graduated all the way from two of the 5/750s a day at the beginning to four or five the 7.5/375s a day now.
The doctor said that he wanted to prescribe a drug for continuous chronic pain maintenance; when he found out that our health insurance is about to expire, he changed his mind from [whatever drug, he did not say] to "another drug which is much cheaper." This "other drug" is methadone. Note that the prescription is written for three 5mg pills a day but he instructed me to start with two a day and consult with him before going on to three a day.
What can I expect from the use of methadone in this context? Is withdrawal a problem? Is continuous or long term use a "no fun" proposition?
[TMI filter] I am familiar with the effects on the digestive system. The vicodin has me taking softeners and fiber like never before.
[The usual disclaimer holds true: You Are Not A Doctor. You Are Not My Doctor.]
IANAMD. Just wondered if you have ever considered going to a chiropractor. Thirty years ago a doctor said I had a herniated disc. Numb legs, pain shooting down legs, etc. He was talking about surgery. I went to a chiropractor, at first several times a week, then once a week, then every other week. No medicine or surgery was needed and the pain was gone after the first couple of treatments, the other treatments got the spine in order so it wouldn't come back. Occasionally, through the years, there has been flair-ups, but a trip or two to the chiropractor would take care of it.
A friend said her father was flat on his back for months. Men carried him into a chiropractors and he walked out. They really work.
Back pain is rough. Hope you get to feeling better.
posted by srbrunson at 7:42 PM on February 23, 2010
A friend said her father was flat on his back for months. Men carried him into a chiropractors and he walked out. They really work.
Back pain is rough. Hope you get to feeling better.
posted by srbrunson at 7:42 PM on February 23, 2010
OK, I don't know about taking methadone for the pain, but:
My husband's got something similar (not sure about the precise vertebrae, but I know it's at least one herniated disc in his lower back), and this sounds kind of weird. Have you and the doctor discussed other options? (Not sure how this plays out vis a vis the insurance.) For example, have you discussed
--epidural steroid injections
--steroid packs (methylprednisolone is what Mr. leahwrenn has taken when the pain gets bad enough to radiate down his leg)
--physical therapy
--surgery
Mr. leahwrenn takes Mobic for daily pain maintenance (used to take Vioxx, which apparently worked great until he got a pulmonary embolism)---certainly he's never taken anything as strong as vicodin, much less methadone.
(I guess what I'm really asking is, have you considered a second opinion?)
posted by leahwrenn at 8:07 PM on February 23, 2010
My husband's got something similar (not sure about the precise vertebrae, but I know it's at least one herniated disc in his lower back), and this sounds kind of weird. Have you and the doctor discussed other options? (Not sure how this plays out vis a vis the insurance.) For example, have you discussed
--epidural steroid injections
--steroid packs (methylprednisolone is what Mr. leahwrenn has taken when the pain gets bad enough to radiate down his leg)
--physical therapy
--surgery
Mr. leahwrenn takes Mobic for daily pain maintenance (used to take Vioxx, which apparently worked great until he got a pulmonary embolism)---certainly he's never taken anything as strong as vicodin, much less methadone.
(I guess what I'm really asking is, have you considered a second opinion?)
posted by leahwrenn at 8:07 PM on February 23, 2010
just a disclamer: i'm not a doctor!
You're already using chronic opiates. If you were to quit the Vicodin now you would definitely go into withdrawal, so don't think it will be a new thing with methadone.
There are several problems with using Vicodin long term: the Tylenol in it (the 325 part of 7.5/325) is not great for your liver, especially if you take too much, or almost too much. also it just doesn't last that long.
Methadone lasts way longer, and the slow decrease in the levels in your body will make withdrawal less severe if you were to stop. This also means that using it is less likely to cause more serious addiction problems. It's generally considered good practice to switch people to methadone when it becomes clear that they're going to need opiates for the long haul. The major problem is the stigma- since it's associated with heroin addicts, but it's just another opiate drug like morphine or oxycontin.
Chronic back pain is tough- the medical establishment really doesn't have good ways of treating it. A lot of studies have shown that surgery doesn't help much. Some people find that certain kind of antidepressants really help with chronic pain, so that might be something to talk to your doctor about. Other then that, the more effective therapies tend to be about learning to live with the pain and function despite it.
Good luck!
posted by genmonster at 8:49 PM on February 23, 2010
You're already using chronic opiates. If you were to quit the Vicodin now you would definitely go into withdrawal, so don't think it will be a new thing with methadone.
There are several problems with using Vicodin long term: the Tylenol in it (the 325 part of 7.5/325) is not great for your liver, especially if you take too much, or almost too much. also it just doesn't last that long.
Methadone lasts way longer, and the slow decrease in the levels in your body will make withdrawal less severe if you were to stop. This also means that using it is less likely to cause more serious addiction problems. It's generally considered good practice to switch people to methadone when it becomes clear that they're going to need opiates for the long haul. The major problem is the stigma- since it's associated with heroin addicts, but it's just another opiate drug like morphine or oxycontin.
Chronic back pain is tough- the medical establishment really doesn't have good ways of treating it. A lot of studies have shown that surgery doesn't help much. Some people find that certain kind of antidepressants really help with chronic pain, so that might be something to talk to your doctor about. Other then that, the more effective therapies tend to be about learning to live with the pain and function despite it.
Good luck!
posted by genmonster at 8:49 PM on February 23, 2010
I would also suggest that a second opinion from someone would be a good idea. I'd try flat-out quackery before methadone personally. I expect you have better options available - a chiropractor is statistically unlikely to kill you. Or talk to another doctor or an osteopath.
posted by GuyZero at 8:51 PM on February 23, 2010
posted by GuyZero at 8:51 PM on February 23, 2010
I had a spinal fusion at the L4-L5 level. I know the pain you are in. It sucks. I have been pain free for 5 years now since the fusion. But, prior to the fusion after a lamanectomy and discectomy (Spelling could be way off on those) I took vikes 3 to 4 a day for a long period of time. I never switched to methadone, but I suspect like any other opiate, you will build a tolerance and need more for the same result. I found that two things worked to get me off the vikes. THe first time, I tapered off after the pain in my back had subsided. The second time I was on them, I stopped cold turkey two days after my fusion. I had so many other issues at that point that stopping was not what I was focused on. I had severe muscle spasms so was taking Soma which put me to sleep and got my mind off the missing pain meds.
Seems to me your choices are worry about addiction and withdrawal or live with severe pain. Or try other medical options. Surgery worked for me all three times. THe first one lasted 20 years, the second 5 and the third is 5 going on 25 hopefully. I went to numerous chiropractors which resulted in some very short term relief. Maybe a week at a time. I tried prolonged bedrest and physical therapy. Quite frankly, what works for me may not work for you and vice versa. I think it worth getting other opinions if you are in that much pain. Unlikely that any will worsen the situation; more likely that it will be a waste of time.
For me, heal with steel. Have the operation. I would take the medication to relieve the pain until you find a more permanent solution. For the pain I was in, withdrawal seemed like a better option and more easily dealt with than being in so much pain I could not function in my daily life.
Good luck.
posted by JohnnyGunn at 9:04 PM on February 23, 2010
Seems to me your choices are worry about addiction and withdrawal or live with severe pain. Or try other medical options. Surgery worked for me all three times. THe first one lasted 20 years, the second 5 and the third is 5 going on 25 hopefully. I went to numerous chiropractors which resulted in some very short term relief. Maybe a week at a time. I tried prolonged bedrest and physical therapy. Quite frankly, what works for me may not work for you and vice versa. I think it worth getting other opinions if you are in that much pain. Unlikely that any will worsen the situation; more likely that it will be a waste of time.
For me, heal with steel. Have the operation. I would take the medication to relieve the pain until you find a more permanent solution. For the pain I was in, withdrawal seemed like a better option and more easily dealt with than being in so much pain I could not function in my daily life.
Good luck.
posted by JohnnyGunn at 9:04 PM on February 23, 2010
Methadone is a reasonable opiate option for pain management. It's long-acting, and is often prescribed, in my experience, for pain. It is still primarily used as a treatment for opiate addiction, but that's not what you would be using it for here. If you're going to be using opiates as a part of your pain management approach, methadone is definitely one of the cheapest options, and pretty standard.
Here's a pdf of a booklet on methadone written primarily for people taking it for opiate addiction, but it's got a fair amount of useful information in it about what to expect.
The main caution I would add is to be very careful about the dosing. In part because of the long-acting nature of it, it can be easy to take a higher dose than you mean to. Know how to recognize an opiate overdose and what to do for it. Ask your doctor for naloxone. (Memail me if you want more info.)
posted by gingerbeer at 10:05 PM on February 23, 2010 [1 favorite]
Here's a pdf of a booklet on methadone written primarily for people taking it for opiate addiction, but it's got a fair amount of useful information in it about what to expect.
The main caution I would add is to be very careful about the dosing. In part because of the long-acting nature of it, it can be easy to take a higher dose than you mean to. Know how to recognize an opiate overdose and what to do for it. Ask your doctor for naloxone. (Memail me if you want more info.)
posted by gingerbeer at 10:05 PM on February 23, 2010 [1 favorite]
Your symptoms describe precisely what I went through. Medication merely relieved the symptoms, while masking the wrong movements I was making and which made everything progressively worse until the day I simply couldn't get out of bed, despite 4 Percodans a day. Some friends loaded me screaming onto their pickup and took me to a chiropractor. I had no idea at that time what a chiropractor was, but I was ready to try anything rather than lay there and die of the pain. He solved it - slow (about 3 weeks until I could feel a definite improvement) but sure. A year later, another chiro (I had meanwhile moved to a different continent) told me I didn't need to come in any more, I could go and ride a motorbike or a horse or ski or whatever I wanted, he was through with me. I'm still pain-free (almost 30 years later) and need just a brief maintenance visit once a year or so. Just like srbrunson said upthread.
IANAD, IANAC. I just offer a personal experience for what it's worth. Every case is obviously different. A chiropractor may check you and tell you it's not something s/he can treat. But please invest in one visit - you might have the total success I did, and it's worth a try.
Good luck - I remember vividly what you're going through.
posted by aqsakal at 11:45 PM on February 23, 2010
IANAD, IANAC. I just offer a personal experience for what it's worth. Every case is obviously different. A chiropractor may check you and tell you it's not something s/he can treat. But please invest in one visit - you might have the total success I did, and it's worth a try.
Good luck - I remember vividly what you're going through.
posted by aqsakal at 11:45 PM on February 23, 2010
I've been on narcotics for sciatica but not for as long as you have, and I don't remember if they had me on methadone or not. I do remember horse sized pills of percocet. With those differences in our situation, once I was out of the sciatic pain, I wanted to taper down naturally anyway, and I was strongly motivated to be able to drive again. The doctors said was that addiction only occurs when you take the pain killers for fun, rather than pain. One thing I didn't recognize at the time is how I was in a fog from the drugs. Had I been able to think clearly, and had I known how easy it was to kick the drugs once the pain was gone, I wouldn't have been so worried about it.
Please let me warn you. Because of similar threads to this one one, before we knew what was going on, I did go to a chiropractor. He made things worse. The absolute most painful day I had was the 24 hours after I saw him. I could barely walk out of his office, and the next morning, when I tried to stand up out of bed, I fell. I can't explain how he took the most excruciating pain I've ever had and made it worse, but he did. Knowing what I now know about what was wrong with my back, he could have paralyzed me for life. Please be very, very careful. Have you had the MRI to see the extent of the bulge?
And I'm amazed you've lived with this for years. If you're afraid of surgery, please know that it's not always awful. I didn't get implants - they just removed the bulge that was pressing on my spinal cord. It was six weeks to hobble back to work. They weren't a fun six weeks, but they beat sciatica. Three months later, I did an 8.5 mile hike. I'm never going to move furniture by myself again, and I still have back pain from the other herniated disc but you know what? I can walk and I'm not on narcotics. The surgeon told me if we waited more than a day or two after my doctor sent me to the ER, I'd be in diapers and a wheelchair for the rest of my life.
posted by arabelladragon at 7:08 AM on February 24, 2010
Please let me warn you. Because of similar threads to this one one, before we knew what was going on, I did go to a chiropractor. He made things worse. The absolute most painful day I had was the 24 hours after I saw him. I could barely walk out of his office, and the next morning, when I tried to stand up out of bed, I fell. I can't explain how he took the most excruciating pain I've ever had and made it worse, but he did. Knowing what I now know about what was wrong with my back, he could have paralyzed me for life. Please be very, very careful. Have you had the MRI to see the extent of the bulge?
And I'm amazed you've lived with this for years. If you're afraid of surgery, please know that it's not always awful. I didn't get implants - they just removed the bulge that was pressing on my spinal cord. It was six weeks to hobble back to work. They weren't a fun six weeks, but they beat sciatica. Three months later, I did an 8.5 mile hike. I'm never going to move furniture by myself again, and I still have back pain from the other herniated disc but you know what? I can walk and I'm not on narcotics. The surgeon told me if we waited more than a day or two after my doctor sent me to the ER, I'd be in diapers and a wheelchair for the rest of my life.
posted by arabelladragon at 7:08 AM on February 24, 2010
IANAD, but this is closely related to my research field. If you aren't already being treated through one, I would recommend going to a pain clinic. The interventions that you've described all seem reasonable for someone with your problems, but only a specialist with detailed access to your medical history will be able to tell if everything that should have been done for you has, in fact, been done. There are also several classes of drugs (Lyrica, antidepressants) that are not opiates, and have been useful to some patients with back pain. You need to be seeing a specialist in pain medicine, if you aren't already.
Continuous opiate use isn't a fun proposition, but it's more fun than excruciating pain. Plus, as others have pointed out, it's what you're already doing. I don't think that you're likely to see any substantively different side effects from methadone than you're already getting from the Vicodin. (Doc was probably going to give you fentanyl and then switched to methadone for financial reasons.) However, this article suggests that it's trickier to get the dose just right for methadone as opposed to morphine or fentanyl. Additionally, all opiates slow breathing (respiratory depression). With methadone, respiratory depression starts later than pain relief, and lasts longer than pain relief. So you need to be very careful not to overdose.
As for a chiropractor, I would definitely talk to your doctor BEFORE seeing a chiropractor (or really, before trying any other alternative treatment modalities). Some people find chiropractors really helpful (for example, I love my chiropractor to pieces), but we can't know your precise medical situation and it could be that there are extremely good reasons for you not to have your spine manipulated.
I'm sorry that you are suffering from this condition and that we haven't come up with any good ways to fix it. Hopefully someday we'll come up with good treatments for chronic pain.
posted by kataclysm at 12:13 PM on February 24, 2010
Continuous opiate use isn't a fun proposition, but it's more fun than excruciating pain. Plus, as others have pointed out, it's what you're already doing. I don't think that you're likely to see any substantively different side effects from methadone than you're already getting from the Vicodin. (Doc was probably going to give you fentanyl and then switched to methadone for financial reasons.) However, this article suggests that it's trickier to get the dose just right for methadone as opposed to morphine or fentanyl. Additionally, all opiates slow breathing (respiratory depression). With methadone, respiratory depression starts later than pain relief, and lasts longer than pain relief. So you need to be very careful not to overdose.
As for a chiropractor, I would definitely talk to your doctor BEFORE seeing a chiropractor (or really, before trying any other alternative treatment modalities). Some people find chiropractors really helpful (for example, I love my chiropractor to pieces), but we can't know your precise medical situation and it could be that there are extremely good reasons for you not to have your spine manipulated.
I'm sorry that you are suffering from this condition and that we haven't come up with any good ways to fix it. Hopefully someday we'll come up with good treatments for chronic pain.
posted by kataclysm at 12:13 PM on February 24, 2010
L5-S1 herniation here. Ask your doctor about Nortriptyline. I was given it when I had my sciatica to help with the pain. It did make a difference for me and worked better than the Percocets I was popping. Helps with sleeping too.
What really fixed me was the lami/disco. One night in the hospital and I was home the next day, back to work in a month. No more pills.
posted by banshee at 1:26 PM on February 24, 2010
What really fixed me was the lami/disco. One night in the hospital and I was home the next day, back to work in a month. No more pills.
posted by banshee at 1:26 PM on February 24, 2010
This thread is closed to new comments.
posted by Salvor Hardin at 7:14 PM on February 23, 2010