Drug Methadone

Question by : Seeking advice for a more effective painkiller?
I am approximately 4 months into treatment for a Herniated L5 disc. From what I’ve been told by my PCP after getting an MRI is that my disc is bulging directly into my S1 nerve root and leaking fluid on to it. which has been excruciatingly painful in both my lower back and all the way down my right leg. The pain is relentless, I am in pain just about 24 hours a day 7 days a weeks. There is a very small window in which my pain even slightly subsides and thats when I’m laying down with an icepack on my back. So of course I spend as much time as possible icing the spot looking for even slight relief. After my Dr got back the results of my MRI, she prescribed me 60 mg of methadone a day and up to 6 hydrocodone 7.5/325mg daily for “breakthrough pain”. Within 3 days I went back to her to tell her that the methadone was doing absolutely nothing to help with my pain and If I took 2 of the hydrocodone at a time they would give me barely 45 minutes of very very minimal relief. I explained to her that I did not want to be taking that many pills a day just for a very small amount of relief and suggested we try something different. This time she prescribed me Fentanyl patches 50 mcg and more hydrocodone. She explained to me that the Fentanyl patches would provide good pain relief for up to 72 hours, and so I would not need to use the hydrocodone as often even though it was barely doing anything but at the same time doing the most out of anything I had been prescribed. I am on my second Fentanyl patch at this point and up to this point it has done zero to releve any pain. To me it feels no different than if I had simply stuck a piece fo scotch tape to my skin. After it was first prescribed I did a good amount of research on the Fentanyl patch. Many people of the forums I read stated the patch simply did not stick to the skin very well, and in not properly adhering to the persons skin the patch virtually becomes ineffective. After reading up on these potential problems I made sure I was much more careful and thorough when applying the second patch. That was yesterday and I have still not gotten a minute of relief from this patch which is supposed to be very effective. I have Dr friend who is currently not praticing, he suggested I ask my PCP about Dilaudid. Doc told me Dilaudid is very strong and is not a long acting drug and she didn’t seem to keen on prescribing it. Does anyone know of any medications out there that would help me be more comfortable until I have my surgery which will hopefully help me put this whole nightmare behind me ???

Best answer:

Answer by Hal Lancer
First of all for what it’s worth, I’m really sorry you’re having this kind of pain, and I hope you can get some better relief soon.

Here’s a chart ranking the strength of pain relievers. Go towards the bottom:
http://www.vaughns-1-pagers.com/medicine/painkiller-comparison.htm

As you can see, as prescription opiates go, hydrocodone is mid-level. But she already bumped you up to the highest level local pain reliever, Fentanyl, and it’s having no effect. Dilaudid (hydromorphone) is slightly stronger than Fentanyl, but your doctor may be right, in that (like a strong dose of hydrocodone), it may also only give you very short-term relief and may not be the answer either.

All of these drugs–even hydrocodone–can create a lot of other problems for you when used 24/7 for more than a few weeks. (That’s why she emphasized “breakthrough.”) Tolerance and addiction can lead to worsening pain and other social and medical problems. The stronger the medication, and the more and longer it’s used, the greater the risk.

Pharmaceuticals don’t seem to be doing it for you, but if you’re going to continue to go that route, you may need to be doing it with a pain management doctor rather than a primary care doctor. For one thing, doctors (especially primary care doctors) are under increasing pressure to limit use of narcotics because of the problems they lead to. This along with concern about tolerance and addiction issues may explain part of her reluctance to try Dilaudid.

I hope you can get into surgery soon. It’s a roll of the dice, but given your lack of response to narcotics, the odds may be better for you in that direction.

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