Fears re: laparoscopy and methadone

[playethic]

I have a first laparoscopy coming up in under two weeks.

I am on methadone. It's the only pain medication that I've been on that doesn't have an 'immediate release' dose (or alternate medication) that can be taken for severe breakthrough pain. I'm scared about the post-procedure laparoscopy pain, and whether they'll be able to give me anything to cope with the additional operation pain (because of this history that adding anything for severe breakthrough pain isn't permitted with methadone.)

In January, I was booked for bladder fulguration/dilation that was halted as I was being rolled into the OR because the urologist was concerned that the post-procedure pain would be so high (when added to the severe bladder pain that's being treated with opiates) as to be completely unbearable. I'm also scared of them doing what they did before - cancelling the laparoscopy at the very last minute, because no plan is in place to deal with the extra pain. I've been on the laparoscopy waitlist for close to four months, I can't risk them stopping another procedure en route to OR.

I did address this concern with the ob-gyno's office both in person and by phone, but they just said medications would be discussed with the anesthetist prior to the operation. I did do this last time, and the anasthetist OK'd the surgery but it was stopped en route to the OR anyway. I need some strategies to prevent that happening again, and I also need a strategy to make sure I'm not in post-operation torture-level agony but not allowed to take anything additional for it.

I'm interested to hear from anyone else who's on methadone and has had an operation/procedure like a laparoscopy, and what doctors gave them for additional pain.

I'm scared enough that I'm wondering if I should transition back to morphine starting ASAP, so that I have an IR backup for post-op. pain. I would consult with GPs before doing this of course, but it would be helpful to hear from anyone with any similar experiences.

[MamaZ]

I've had two laparoscopies. The first one I had significant post-op pain and I'm not sure what I took for it, if anything. I was pretty uncomfortable for a few days. With my second, my doctor suggested adding some lidocaine to my diaphragm before he sewed me up. This greatly reduced gas buildup (result of them blowing up your abdomen) that gets stuck and causes awful shoulder pain post-op. My one big issue with the second lap was that I couldn't pee afterwards and had to drive really super far to go get cath'd because I was in SERIOUS pain. That was no fun. But other than that, I didn't feel bad with the second surgery because of the lidocaine.

[sailawaygrl]

I take methadone and am not given anything for breakthru pain but I am pretty sure that in a hospital setting there is something, IF NEEDED they can give you. I have had a lap while on the methadone and I was fine. I don't even remember if I needed anything extra. I was uncomfortable but not in agony.

I hope things work out for you. I know I wouldn't be happy if they stopped my surgery on the way to the OR. Maybe you should make sure the anesthesiologist and the Dr speak prior to the surgery this time.

Sandra

[gapeach]

Hi there! First off, I have to say that I think that is terrible that they cancelled your surgery like that! Talk about waiting until the last minute! I would have been incredibly upset if it were me, for sure! Surely if the doctors had put their heads together they could have come up with a plan for your post-op pain issues, that's just crazy in my opinion.

I don't understand what the issue is really. Why are they telling you nothing else is permitted with methadone for any breakthrough pain? I take methadone with oxycodone for my breakthrough pain on a daily basis! I was taking methadone (and had been for a while) when I had my hysterectomy and my doctor didn't have any problems prescribing me extra post-op meds. I was given mepergan (demerol with phenergan) and then oxycodone while still taking the methadone. The post-op pain is usually worse than just regular break-through pain, and lots of pain patients who take methadone regularly but have any acute pain for any reason, have to take something to deal with it along with the methadone. Are all the docs including the anesthesia person saying that nothing else is given if a patient is already on methadone, or is it just one certain doc saying this?

I know that it is safe to take other narcotics with methadone because lots of people including me do so. I have been told that it is not advised to take methadone along with benzo's, like xanax, but other pain meds are used for break-through pain.

[playethic]

Post-op pain management, when already on opiates 24/7

That's interesting, & puzzling, that others can get help for breakthrough pain if they're on methadone. Thank you.

I don't get to talk or meet with the gynecologist doing the surgery ( I met her once for 5 minutes in January or February, then her receptionist called with the surgery date).

I don't get to talk to or meet with the anesthesiologist until a day or so before the surgery - they phone me and tell me when.

So it has not been possible to have these discussions. I tried to call the gynecologist's office to explain my concern and wanting to be proactive about a plan, but receptionist said it can't be dealt with prior to that anesthesiologist consult.

The methadone is prescribed by a pharmacologist - he is the one who said that I can't be prescribed anything for breakthrough pain, that I can only take the naproxen. On my behalf my GP asked for an earlier meeting with the pharmacologist because of the intensity of the breakthrough pain, he told her he isn't going to agree to give me anything else and so wasn't willing to meet with me within a week or two of her request. I have a long-ago-booked app't. with him on April 29. He told her that we are free to request a 2nd opinion (kind of an empty comment where I live - we have already got a request in for a pain specialist, but here the waiting list for that is very long --- up to a year).

(That situation is also complicated in that the pharmacologist wants to hand my file back to the GP for her to prescribe, and she is not willing to, is not comfortable with it with her expertise level, not willing to prescribe opiates and the hassles with government auditing involved).

[gapeach]

I don't I like that they are not willing to discuss anything with you any sooner than the day or so before surgery. Being informed of your options, and informed about the surgery and any possible complications before or after it, and how your pain care is going to be managed is pretty important, in my opinion. Especially because of what happened last time you were supposed to have surgery! As the patient, you have every right to have your questions and needs addressed so that you can decide what is best for you to do!

The pharmacologist has already decided that he will not give you anything else and is telling you and your GP that you can get a second opinion if you don't like what he is saying. That doesn't sound like the person I would want in charge of my pain management

Are they not wanting to prescribe a short-acting pain med as a breakthrough med for you on a regular basis, or just during the post-op/recovery process? If it's the latter, there should be no issue with giving you something extra for the post-surgery pain which will only last for a certain amount of time and then it should go away. If it's an issue of him not wanting to prescribe a true breakthrough med to be used on a regular/daily basis, then it may be time to search for a new pharmacologist or GP that is more willing to work with you and your needs.

Unfortunately, there are more and more doctors, GP or Pain Management, etc. who just won't prescribe many of the meds available for chronic pain patients. The "War on Drugs" seems to be becoming a war on pain meds, pain patients, and any doctors who Rx them. Many docs don't want any part of it, which leads people like us into having to fight for our needs to be met.

[playethic]

Responses

Yes, I too think he isn't the person any more who I want in charge of my pain management. The problem here is alternatives.

Re: 'then it may be time to search for a new pharmacologist or GP that is more willing to work with you and your needs', I've been doing this but either have been declined on the referrals I've researched (wait lists too long? i don't know) or no response, which I'm told means I'm sub-waiting list, which means the wait will be many months and as much as a year. I researched and asked for those referrals. I'm told via GP now that there are no other options.

I"m in so much pain that I just can't do the research and phone calls and clear thinking to fight any more.