Methadone

I have not had personal experience with it, but I saw what my friend went through, and I'm a hospital pharmacist.

My friend had stage IV pancreatic cancer (the worst stage) at initial diagnosis.  The oncologist was giving her Oxycontin and oxycodone for break through pain, after morphine and percocet didn't really help.

I was going with her to many of her onc visits.  They often asked her if she was having pain,  she said yes, but they weren't asking her about her pain score.  About 3 months after her diagnosis, I heard them FINALLY asking about her pain score.  You can imagine my response when she calmly said, "Today my pain score is a 7(out of 10).  That's lower than its been the last 3months."

She went to see the palliative care doc.  The palliative care doc put her on methadone.

There is a type of pain called 'neurogenic'.  Nerves are involved.  'Regular' opiates (morphine, dilaudid, percocet, oxycodone, etc) don't tend to treat this kind of pain. The doc said the types of pain relievers that help for neurogenic pain are methadone (its dirt cheap too), gabapentin, Lyrica, and (possibly) Darvocet.  She also put my friend on low dose amitriptyline (Elavil) for pain relief.

She FINALLY got pain relief.  I think she started out at 2.5mg three times a day.  You have to start out slow because it takes a while to get the maximum pain relief, so they may not want to adjust pain doses for a week or so.   At her maximum (at about 6months), I think she was on about 30 mg  methadone three times a day.  I was so happy she finally got pain relief.

She was on methadone until she died, about 6 months later. (They lowered her dose because she didn't need it.  She was probably getting liver involvement with her cancer, and she may not have been metabolizing it like she did before.)  When she couldn't swallow tablets, they changed her to oral liquid.  I kept on asking her if she was in pain, and  she said no.

This palliative care doc uses methadone ALL the time in the hospital.  Methadone may have a stigma because they use it for heroin addicts, but its a good pain killer, and I think its one of the cheapest big time narcotics for chronic pain.  You do need to titrate the dose slowly.  It does accumulate.  Of course, like any opiate, you may eventually need a bigger dose to get the same kind of effect.  It will cause constipation, like all the opiates do. Methadone may or may not be appropriate for your circumstances.

I am so happy that my friend didn't have to spend her last 6 months in pain. This palliative care doc was an angel on earth. I'm so glad my friend had methadone.

Edited to add: You do NOT have to be on hospice to get methadone.  The reason why they use it for heroin addicts is that you are less likely to get a 'high' from it.  That's because it has a long onset and relatively slow elimination. After seeing my friend (she was a nurse), I would recommend trying it for chronic pain, especially for neuropathic pain.

@Methusala: I'm sorry to hear about your pain. As a chronic pain sufferer myself, I can relate to the situation of being leery to try other medications while dealing with the frustration of not getting relief from current meds.

@leaf: Thank you so much for sharing that story. I appreciate your input from the patient, caregiver, and pharmacist perspectives.

@Ladyg2172: I'm sorry for your situation. I am also Triple Negative and have suspected fibromyalgia that my oncologist believes was brought on by chemo. Whether methadone will work for you has nothing to do with your having Triple Negative breast cancer. Not having estrogen or progesterone receptors or an abundance of Her2 is not the same thing as whether your pain will respond to a particular drug. Being TN means you won't get hormonal therapy such as Tamoxifen or the Aromitase Inhibitors, nor will you get a biological therapy targeted for Her2 such as Herceptin, Perjeta, or Kadcycla. Fibromyalgia is typically neuropathic pain as leaf explained and as such, certain drugs will work better for it than others. I have never taken methadone, but it's good to know how effective it can be. 

Best of luck to everyone!