Methadone

Hi Karen and Marion,

I cannot view the guidelines unfortunately. She takes long acting oxy q8h with oxy 20mg IR q2-4h Prn. She also takes gabapentin q8h. I’m not really sure why they are pushing for methadone other than her oxy IR requirements have doubled but the logical reason for this would be disease progression resulting in higher requirements and possible tolerance. Her CT scan has shown disease recurrence. I asked for them to adjust her long acting oxy instead but they wanted to switch to methadone and steroids. I’m not doing that since she is started treatment soon and the side effect profile for methadone (specially QT prolongation in setting of poor PO intake and electrolyte imbalance and antiemetic use) is concerning. And the 21 day course of steroids would be more useful during her radiation treatment.

Her current pain meds bring her to a 6-7/10 however this is also because she is hesitant to take her break through as needed bc of fear of ‘addiction’. This is despite us telling her repeatedly that she has more than a valid reason for pain medication. When she takes them as needed, she is around 3 to 4 or 4 to 5. She has not tried the fentanyl patch and they didn’t seem keen on trying that when I asked about it in the past. I’m at a loss bc they are pushing for methadone and we haven’t exhausted the other options yet. Her pain, I believe is more visceral and neuropathic in nature. Do you think we should consider adding on the fentanyl patch to her long acting oxy regimen. And keep her breakthrough of course.

Regards,
Fay