Dr. took me off methadone and put me on mrophine only???

[Romans8:28]

PLEASE BEAR WITH ME!My first pain doctor had me on 15mg of methadone 3x a day, plus 15 mg (I cut them in half).oxycodone for break through pain. On that level my IC was great best in years but my kidney stone pain was not good. (The last pain doctor dropped, me long frustrating story..., I couldn't function on Effexor, went off and had withdrawls. he gave me comprazine and I wound up in the ER with a bad reaction..., when my husband question the ER thing he just dropped me. Wasn't a good doctor anyway!) It was amazing though my URo and my pharmacist supported me!! My URO even talked to the new pain doc.

Now the problem: my new pain doc. is an anathesiologist (sp). He told me the med/s the first doctor had me on fight for the same brain receptors so cause each other not to work as well...(The pharmacist also confirmed this!, therefore he started me on 60mg of morphine 2 x a day and gave me 15mg. of morphine i can take up to every 4 hours for break through pain. Now if I take the 15mg every 4 hours I am OK, (using all my other coping tools too,) but if I don't my bladder pain is off the charts! I may just be in a flare??? (My son in the service just got sent on another mission and is scheduled to go to Iraq and truthfully I am handling it right now!)


What I need to know is if any of you are on the long acting morphine etc. How much do you take? At the level I am taking I am really concerned I don't even like taking pain meds. so I try and try not to take it but the pain is bad?? Even with my rescues etc. I really NEED to order the new ICN mag. and book and definately plan too asap..., but in the mean time could use some advice? The other option he gave me was to go just to the methadone but the problems with that is when I am passing a stone, the methadone doesn't touch it??? If you take methadone (which really helps my bladder), what do you do for bad days or pain for like a stone (I have soo many(?????


Thanks for your help!!

Shelly

Thanks in advance for you input!

[Sarojini]

When I was on MS-Contin (long-acting morphine), I took 30 mg, three times a day. I tried taking 60mg twice a day but it was just too long between doses, so even though the total dose was less, I did better with the three per day regimen.

Now I use methadone, and I much prefer it. I use Percocet for breakthrough, too.

Frankly, if he's worried about competition for receptors, then I'm not sure why he gave you long acting AND short acting morphine -- according to his logic, this combination would cause the exact same problem, if not worse.

ALL of the narcotics use the opioid receptors in the brain -- along those lines, there is always going to be some "fighting." BUT, there are plenty of opioid receptors in the brain. Using two opiates will not negate the effects of the drugs; in fact they tend to work synergistically. Think about it -- you take breakthrough medication when your long-acting is starting to wear off. That means your receptors are getting empty, so you take a pill to fill them up temporarily until you can take your next long acting dose. It works, right?

If the drugs were fighting, then the whole premise of breakthrough medication would be bunk, but it's not.

I'd do some reading on pain management methods on your own and then discuss the fact that the new regimen is not working for you with the doctor. This time, since you've read up beforehand, you should be able to understand what he's saying and challenge him if necessary. And to me it sounds necessary.

[Romans8:28]

Thanks Jen!! I think what he told me was that the oxycondone and methadone use the "same" brain receptor??? This doctor only does pain management. I have to admit though I was much better on the methadone
etc. I like it better with the percocet too but they said they definately don't prescribe percocet!!! They are equiped to do alot of things though like trigger point injections etc. that my other pain doctor (an Internal Med. Doc.) couldn't etc.

I know you have gotten those I think, for fibro, but did they ever help your IC etc.?

Is all this info. in the new book and ICN mag. out or are there other's you recommend that I read??

Thanka again Jen, I may have to call him before my months is up but need to be well educated and prepared ahead of time!!! I ca't afford to lose this one!!

Shelly

[Sarojini]

Okay. There are many different subtypes of opioid receptors in the brain. They are named after Greek letters (mu, kappa, sigma, etc). Most traditional narcotics, like morphine and oxycodone (Percocet), bind to just the mu opioid receptor, which is why your doctor is partially right... they do bind to the same receptor. However, what I am trying to say is there are enough mu receptors in the brain and spinal cord to go around -- there is no "fighting" for receptor space because at the doses of drug prescribed, there's enough space for everyone. Which is where your doctor is wrong.

Also, since morphine binds to the mu receptor, giving morphine with morphine breakthrough runs into exactly the same so-called "problem" your doctor is trying to avoid, which is why I think he is, um, I hate to say it, either scientifically uninformed or twisting things around to suit what he wants to prescribe.

Now, methadone is nice because while it binds to the mu receptor, it also binds to the kappa receptor and possibly tickles the sigma receptor as well. Because of the multi-receptor action, methadone produces superior pain relief in many people (but not everyone since body chemistry is different). So, in another stab at your doctor, even if you give Percocet with methadone, you can still get a good effect -- even if you were able to give a high enough dose of methadone and Percocet (without killing the person) to fill all the mu receptors, you'd still have action through the kappa receptor as well.

As for trigger point injections, yes, I got them. They were great. I got them in my neck and shoulders, and in my butt muscles and hip muscles to relieve PFD, which in turn seemed to help the IC pain. I do recommend them for both PFD and fibro/myofascial pain syndrome -- but they're really not for IC per se.

If you are planning on getting them, however, make sure your doc has done a lot of them and is well trained -- hitting a blood vessel with a lidocaine mixture is dangerous because it has cardiac effects, so especially in the pelvic area, he must be very careful. He also must know how many he can safely give without producing lidocaine toxicity.

As for reading about pain mechanisms and treatment, you can start on the ICN by reading everything Dr. Daniel Brookoff has provided. Then, use Google to find information about opioid receptors and their function. Wikipedia has a decent opioid receptor section (http://en.wikipedia.org/wiki/Opioid_receptor). You can also Google each drug you wish to read about. For basic pharmacology of the drugs, http://www.rxlist.com is good.

You will need to go beyond the ICN eventually if you want to delve into all of this. As for the new pain book from the ICN, it does not really have too much science in it -- it does describe drugs very simplistically but focuses largely on self-care and obtaining better pain control. It's a great book, but it's not a science book.

[Romans8:28]

Jen,
Thanks for taking time to give me such a long detail explaination it really helped a lot! I already printed out and have been reading an interview with Dr. Brookoff, and found this helpful. (He sai that the oxcodone is good choice for the same reasons you did the methadone, that it actually hits a couple of pain receptors too the mu and the kappa.) I will follow your advice and take some info. with me, just hope the new doctor handles it well.

Anyway thanks again, Jen at least I understand what is going on in my body!

Shelly

[Romans8:28]

Thanks again, just in the little amount of time I've had today I've learned soo much!!!

It also makes so much more sense why multi-drug and approach therapies work best for IC patients. Different types of meds effect different brain recpetors! I was amazed to even learn that the histaimine recpetors also effect smooth muscle contractions and hormone release. I wonder if that is not part of why antihistimine meds help us too!

Thanks again!
Shelly

[Romans8:28]

Jen,
Again i want to thank you and give you and update!
I did all the research like you said! Then on my first visit with my new GP he just looked at my records and said why did he take you off the methadone?
he told me to tell the pain doctor he wanted me on the methadone.

OK so took all the info. including the fact the the morphine does not touch ther brain receptors that cause visceral pain that is alot of our IC issues.

The pain doctor refused to listen and only wanted to give me more morphine..., anyway i left on a good note, talked to the GP and he was so against the direction the pain doctor was taking, he took over my pain meds.

So I am finally back on the methadone/oxyxocodone and waitng for the methadone to again build up to where it works well..., seems like i am taking so much break through meds. today. (Just got back on the methadone yesterday!)

Thanks again!
SHelly

[Sarojini]

Good, I'm glad you are back on the combo that works for you.

Morphine DOES work for visceral pain, actually, but that's okay... it's neither here nor there.

You're back on your preferred regimen -- and you've gotten rid of that doc who seemed a bit uninformed for a specialist.

[Romans8:28]

Actually i got that info, form the ICN Special report on pain,pg.25. in it Dr. Brookoff mentions that oxyxodone hits a couple different receptors, the mu as well as the kappa. he states "kappa opiod receptors for visceral pain??/

From the many articles I read after this post. I read on some testing they did on brain receptors and mice, it appeared that morphine only hits the mu receptor???? So this was how I got that impression!

All I know is seemed as if all we were doing is throwing more and more morphine at the problem with little results in my IC??? Plus I pay out of pocket and it is 5x higher!!! I also learned form the same article pg.26 not only does methadone seem to work better the longer you take it and it appears to reverse opiod tolerance...

Now I am just counting the days till the methadone is built back up and the IC pain is back under control! Just started back yesterday!!..., one good thing i got out of this, is my husband allowed me to become a subscriber, and I was then able to also get the Special Report!!!

Anwyway thanks again!

Shelly

[Sarojini]

Yeah, there were a few papers a while back (one in the journal Gut in 1998 and one in the British Journal of Pharmacology in 2004) that suggested that stimulating kappa receptors may be slightly more specific for visceral pain, which is why he said that... and it is probably true, which is why many ICers get excellent relief from methadone, oxycodone, etc.

However, stimulating the other receptors can also reduce visceral pain, and that is easily shown by each and every person on these boards who gets relief from MS-Contin (morphine) or Vicodin or whatever else... which, as I said, as Dr. Brookoff said, and now as you've found on your own, binds just to the "mu" type of opioid receptor.

Like most things in biology, this is not an "all or nothing" thing -- the kappa receptor isn't "only" for visceral pain, and the mu receptor isn't "only" for other types of pain. You sense pain through many different types of nerves and receptors, and you ease pain by stimulating many different types of nerves and receptors; pathways intersect and separate with incredible complexity, and as a former boss said to me once, "All or nothing is just as dangerous a bet in the brain as it is in cards."