Health Organization for Pudendal Education

I found this post very helpful as I am going to consult a pain management specialist in the near future.

http://nosleepingdogs.wordpress.com/200 ... l-account/

I only scanned the article but am glad to see somebody is out there giving realistic information about methadone. I had a 10 year career as a nurse in the prison system, and came to hate the stuff with a passion. If a heroin addict was arrested, we would keep them under observation for 72 hours and treat them per a protocol, and they would go through hard withdrawl and be done. The people we admitted on methadone would suffer the agony of WEEKS of painful withdrawl. This is due to the long half life of the drug. People are not told this: if they have an addiction problem , they are told switching to methadone is a positive choice; and if they have chronic pain, they are often put on it flippantly without a discussion of the associated issues such as tolerance and withdrawl.
Everyone, only agree to methadone as a last resort, and do serious research ahead of time. This blog would be a good place to start; thanks Judith.
To prevent offense to anyone on Methdadone - I do want to say it is appropriate in some cases when a patient is fully informed, and has made a slow withdrawl plan with the Doc in advance to avoid being "cut off". I take valium regularly and am aware I will have to wean off as benzodiazepine withdrawl is no walk in the park either. Key is an informed choice.

Ya, I'm on very low dose MS Contin, 15 mg twice a day her majesty ( you're Kate, right ? ) and have good control on it twice a day with some vicodin now and then for breakthrough pain, however I was considering Methadone as I cont. to hear that it is becoming the standard of care for long-term chronic pain. So, as an RN too... I've been thinking about it, but I just don't want to go that route. I once tried to do cold turkey off MS Contin, it was not fun ( but now the posts are in the bowels of the old site- and some were very entertaining rants 9 days into it) cuz I thought maybe my PN was good enough that I didn't need any. But, it was obvious from nerve pain that I still needed it, but what was discouraging was that after 9 days, I still had the terrible symptoms of opiate withdrawal- so obviously I have a physical dependance on it as well. Working in the prison system, did they make people just suffer through the withdrawal, and did some never ever get past it ?
Just curious.....

Judtih

We had supportive treatment for safety, like Q4h BP's with hypertensive meds as needed, seizure meds if they began coarse tremors, and also some things to increase comfort like anti-diarrheal and other G-I meds and a very short course of librium. Mostly they just suffered through it though. And big shout out to everyone, stay out of trouble: Due to hoarding & selling of meds, many jail & prison facilities DO NOT continue to supply you with narcotics taken for legitimate pain, and some even have a total no controlled substance policy - so the people who had to withdraw in some of these facilities were pain patients, not junkies...Don't get arrested!

Oh, I just noticed you asked "did some never get past it" - do you mean did we kill people, or were they in withdrawl for the entire stay?
No, we never killed anyone - people in a severe state were sent to the hospital and I actually never saw anyone that severe from withdrawl except one woman with alcohol DT's...her charges were minor and the system did not want to pay her medical bills, so they released her on her own recognizance pending court hearing, to go drink again, for real.
Methadone withdrawl is so protracted that we did have some people released for one reason or another before they ever finished the withdrawl process...
So there are those cases of release before they "got past it", but I have never seen anyone die from withdrawl. Mainly, I have heard death from narc withdrawl only happens WITHOUT medical supervision - generally due to dehydration if somebody tries to do it without help and is too out of it to take in fluids, or can't keep them down. Alcohol DT's can be more dangerous, and I do believe the woman who was released due to her DT's might have died if we had kept her, and might not even have made it with hospital care. The stats I have heard for severe DT's is 20% death rate without treatment, and 3% death rate with treatment. The narc withdrawl death stats are almost entirely due to lack of treatment.

What I was wondering is if they got any medical intevention, like meds to ease the withdrawal, or were they forced to endure the withdrawal. but, you answered that.

I have been told by two pain management doctors that methadone is particularly effective for nerve damage pain. So this is confusing for sure. I have taken methadone and I think it helped quite a bit but I found that the sweating was horrid. I am currently trying a low dose of Opana and I get very nauseated on it.

Yes a single dose of methadone to break a severe pain cycle is reasonable. It is the regular use that causes not only dependence but tolerance - That is, with regular use it can take a higher and higher dose to be effective and evantually can become ineffective...however at that point it is a very difficult med to get off of; the physical dependence is extreme and the withdrawl syndrome prolonged.

In talking with Pt's in San Franciso who work with some academic pain management dr.s they believe the standard of care for chronic pain is methadone. Some dr.s have biases, but it seems that methadone is being considered more and more as the standard over morphine and other drugs. It is easy to dose and titrate to get the best effect. The problem is finding that dr. who will choose to use narcotics at all. Some want to do some procedures and no meds.
Cora

It seems like if you are still in the early stages of diagnosis and treatment for PNE you may want to avoid methadone and stick with some of the drugs that are easier to get off of. But, if your other treatment options have failed and you have basically consigned yourself to pain management through medication, what I have read about methadone is that it's one of the more effective narcs for neuropathic pain and many people can be very functional on it long term. But I'm not speaking from experience -- just from the literature I've read about it.