Is my husband’s methadone prescription causing more harm than good? What are our options for managing his chronic pain and potential overdose risks? How can we navigate the challenges of finding appropriate pain relief in a changing medical landscape? #ChronicPain #Methadone #OverdoseRisk #PainManagement #MedicalOptions
Your husband is in a very difficult situation for a few reasons
He obviously has some very severe injuries that impacted his overall quality of life. Yes, the narcotics he’s been on have helped his quality of life; however, being a long-term narcotics leads to many issues, including tolerance and opioid induced hyperalgesia. Basically meaning he has little to no pain tolerance since his pain receptors have been bathing in narcotics for so long.
It also seems difficult as your prescribing physicians keep leaving practice.
This last physician that you have talked about, seems like he doesn’t have a great bedside manner; however, I do believe his goal to wean off of narcotics is not a bad choice. If your husband could wean off narcotics and attempt other pain modalities, it may lead to a better life in the long run. I do think this doctor was inappropriate with how he spoke to you when your husband missed the appointment. But to play devils advocate, prescribing narcotics is not a joke and missing appointments are red flags in our book.
In my opinion, you should find a new pain management physician/practice. I think the goal of weaning off of narcotics is a good one, your husband may benefit from something such as ketamine therapy. The modalities have significantly improved over the last few years and living a life without narcotics may be possible.
It’s unfortunate, but with the opioid epidemic, physicians should be very selective and safe while prescribing narcotics.
Hello OP. I read your post and I am sorry for what you are going through. I am not in US so I cannot relate to your situation which I find quite unsettling since it’s seems partly driven by opiophobia due to this “opioids epidemic” which a very “hot” topic in your country. I think that a good pain clinic shouldn’t be afraid of prescribing opioids to a FBSS patient that didn’t respond to spinal cord stimulation. Methadone is a great drug for chronic pain therapy in FBSS where a neuropathic component is very likely to be involved. However it is one of the most difficult opioid to manage due to very long half-life, dependence on liver and renal function, multiple drug interactions and QTc prolongation (which is a EKG parameter that can lead to serious arrhythmias) and it requires a very strong surveillance by the pain physician. Reversal of overdose for example often requires IV continuous infusion of naloxone since the duration of the antidote is just a fraction of the duration of the methadone. It’s difficult to balance the cons and benefits of this drug but I think that since it worked pretty well it’s worth another try with increased surveillance and better patient education. However the message I want you to understand is that your husband is a chronic severe pain patient on opioids, and that doesn’t make him an addict in any possible way. He can suffer well known side effects from these drugs including tolerance and dependence but dependence is NOT addiction, at least in the way it’s commonly interpreted.