Pain management

[JustVisiting23]

Dear Friends:

I am currently taking 20mg Methadone daily for RLS and will have painful hand surgery soon. Because Methadone blunts effects of opioids I am concerned about pain management. Any ideas how best to handle? Thank you.

[SueJohnson]

I'm not aware that methadone blunts effects of opioids. I think you are confusing it with buprenorphine.

For your surgery tell your doctors and anesthesiologists about your RLS and its symptoms and that you need your medicine and ask if there will be any drug interactions from what they will give you. Naloxone can affect anesthesia so tell them if taking. Also talk with the patient representative ahead of time. Tell them not to give you any sedating antihistamines or sedating anti-nausea medications. Instead insist they use Zofran (ondansetron) for anti-nausea. You can download the Medical Alert Card that you can show your doctors, that tells them about the condition and what will happen after surgery and what medicines to avoid at rlshelp.org/ although you will need to join the RLS foundation. An international membership is $40, but they have some good information on it and you get their monthly magazine. However the safe antidepressants listed on medical alert card are not antidepressants: Lamotrigine, Carbamazepine, Oxcarbazepine. Also there is a 2 page handout "Surgery and RLS: Patient Guide" on the RLS Foundation website which is very helpful. Also "Hospitalization Checklist for the Patient with RLS"

[JustVisiting23 in reply to SueJohnson]

Hi Sue:

Thank you for your guidance. Yes, I've been a member of the RLS Foundation for a number of years, and always provide their literature to my medical providers. I have noticed that when I have had to use opioids such as Percocet for acute injury-related pain (most recently, fell off a ladder. My balance has been adversely impacted by Methadone), while on Methadone, that the analgesic effects are far less than prior to my daily Methadone. I have seen a few research articles which note this phenomenon, but the study participants are those using Methadone for opioid abuse vs. RLS, so the patient populations are quite different and thus the applicability to RLS patients is less vigorous. However, based on my experience, I am concerned that pain management might be challenging. Hoping those who are on methadone and have had surgery can chime in with their experience in this regard. Thanks.

[Merny5]

Sue provided some good advice. DO download the documents from the RLS foundation and give it to the anesthesiologist. A year ago I had a shoulder replacement and had the same concerns. I was told that the methadone blocks the effects of the opioids. Because I was taking methadone my surgeon would not handle my “pain management”. I had to go to a pain clinic prior to surgery. I had unbearable pain while in the hospital!!! Evidently there was a lack of communication between the hospital and the doc from the clinic because I did not get the pain medication that I was told that I would get. In addition to the severe pain, they gave me the methadone way too late that night and I walked the floors the entire night. It was an absolute hellish night! As soon as got home, the pain clinic doctor gave me the script that I needed and I finally had relief. I took my regular methadone dose in addition to the other prescribed opioid and it helped with the pain. So I would suggest be prepared and have someone to advocate for you while you are in the hospital. Good luck and let us know how you do.

[JustVisiting23 in reply to Merny5]

Thank you for this information regarding your experience. I am coordinating with my movement specialist as she will prescribe pain meds. However, before I meet with her, I am hoping to hear from this group what medications in specific were found to have been beneficial for post surgical pain. Regarding RLS foundation- I always provide their recommendations to both the surgeon and anesthesiologist prior to surgery. The foundation is a wonderful resource.

[Merny5]

I was prescribed 10 mg oxycodone/ Acetaminophen every six hours and it really helped. The pain without it was horrible! Icing really helped as well.

[JustVisiting23 in reply to Merny5]

Thank you for taking the time to respond. Best Wishes.