Re: Phil and methadone dosages

[Guest guest]

Faye A wrote:

> Phil, I have RSD...Definately A whole lot of neuropathic pain. It

> seems to do about the best for me of any I have tried. I am on quite

> a high dosage though. I take 40mg. 4X a day. I would like to know

> from other people on this what ranges of doses others take. Do you

> take methadone for your neuro pain and have you had the doctor say

> why you have this kind of pain?

>

Wow...160mg of methadone a day does seem like a lot. To me, at least.

I have never tried methadone, at least not yet.

I know exactly why I have neuropathic pain. I had surgery on my left

foot in Oct 1999 to fix a torn posterior tibial tendon. The problem had

started a year and a half earlier, but all of the " conservative "

therapies didn't work. Orthotics, ultrasound, you name it.

By the time we decided to operate, my arch had completely collapsed and

I could barely walk. My surgeon did an excellent job putting all the

bones into their correct positions. People tell me I still walk with a

limp, but I'm not really aware of it. But the surgery severely damaged

the lateral branch of the posterior tibial nerve, and the sural nerve to

a lesser extent. The distribution of the lateral plantar nerve (the

little toe and adjoining area of the foot) has been totally numb and

quite painful ever since. Exactly two years later we did another surgery

to decompress the nerve, but I'm afraid it only made the problem worse.

Pain medications help somewhat, but I'm so tired of side effects that

I'm going to investigate both spinal stimulation and implanted spinal

pumps. I've held off on these options so far because they seem rather

drastic and invasive, but I understand it's fairly easy to conduct tests

to see how effective they're likely to be before I commit to anything.

The basic idea of a spinal pump seems very attractive, namely keeping

the pain medication in the spinal cord and away from the rest of the

body, especially the gut and brain.

Phil

[Guest guest]

Amen. The further I can stay from anything invasive the better!

Chris

Broaders

STOP THE PAIN!

www.rsdresearch.com

chris@...

[Guest guest]

Herring wrote:

> Phil,

>

> Just a bit curious here--you would try methadone before a pump

> wouldn't you? I do hope so, as a pump would be just another way for

> bacteria to enter the body and the further I personally can stay awy

> from hospitals and bacteria the happier I am and I also think I'm

> probably healthier also.

I'm open to all reasonable suggestions. The main reason I'd be

interested in a pump is to get the benefit of opioid analgesia in the

spinal cord while minimizing the side effects in the rest of my body,

especially my brain and my gut. I know that you can't totally avoid side

effects in this way, but they can be greatly reduced. I understand the

risk of possible infection, but this is done often enough that I'm sure

the protocols to avoid infection are reasonably effective.

I'm also looking at spinal stimulators. They're supposed to work well

for one-sided peripheral neuropathies. They have the advantage of

running longer than pumps without maintenance, of being less susceptible

to infection, and of totally avoiding drug side effects and the hassles

of handling highly controlled drugs.

Phil

[Guest guest]

wrote:

> Amen. The further I can stay from anything invasive the better!

I hear you. But I'm also mindful of an important lesson I learned from

our late cat, Hal.

As far as we can tell, Hal had a heartworm infection. This causes

chronic coughing and other lung problems when the worms die,

disintegrate and lodge in the lungs. Our vet put him on fairly large

doses of oral prednisolone, a corticosteroid much like cortisone. This

helped a lot, but the coughing didn't stop completely. But the steroid

induced diabetes that required daily insulin shots. He went hypogycemic

at least once after we administered insulin that turned out to be too

potent.

He also developed a serious bacterial infection which may also have been

the fault of the steroid therapy (corticosteroids suppress the immune

response.) After barely surviving that, the vet switched him to Flovent,

an inhaled steroid that stays in the lungs. The results were like magic;

his cough nearly disappeared. And because we discontinued the oral

steroid, so did his diabetes.

Sadly, we lost Hal six months later after he was injured in a fight and

developed another infection that wouldn't go away. But I still learned

an important lesson from him: if you have a medical problem that

responds to a drug and the problem is localized to one part of the body,

it is preferable, if at all possible, to apply a limited amount of the

drug directly to the problem instead of flooding the whole body with it.

That's exactly the idea behind spinal opioid therapy: to put the

morphine or whatever directly into the spinal cord where you want it and

keep away from the rest of the body where it causes all those annoying

side effects.

I have pretty good reason to believe that the relief I get from opioids

for my foot pain is indeed due to their action on my spinal cord. Many,

many times I've taken a short-acting opioid like Vicodin or Norco and

felt the effects on my brain within 15-20 minutes. But the pain relief

usually won't kick in for an hour or more. And when the drug wears off,

the pain often stays low for some time after I first notice withdrawal

symptoms. My theory is that it takes that much time for an oral opioid

to diffuse into the cerebral-spinal fluid and reach my spinal cord. A

morphine pump would put it there much more directly and minimize the

amount that reaches my brain (causing dependence and drowsiness) and my

gut (where it causes constipation and bowel dysfunction).

It'll be a hard decision, but I'm determined to investigate all the

alternatives because I'm just not very happy with constantly having to

choose between pain relief and side effects.

Phil