Did that hyperbolic subject line attract your attention? Recently, I
was prescribed methadone for intractable nerve pain. It has been a
Godsend. But, there is a problem. It causes sleep disturbances; I wake
up every one hour to 90 minutes. Is anyone familiar with methadone and
sleep problems?
Thank you, 
Yesmam

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Request for Question Clarification by techtor-ga on 20 Sep 2003 13:22 PDT

I wonder what you're looking for, a solution to your problem or just
anything about the side effects of Methadone? I've started looking
around the Internet for possible clues, but I do wonder what you're
really after. Of course, what I say here could not be taken as
qualified medical advice.

---

Clarification of Question by yesmam-ga on 20 Sep 2003 18:15 PDT

"I wonder what you're looking for, a solution to your problem or just
anything about the side effects of Methadone?"

Yes, I am curious about methadone for myself. Of course, I know that
whatever your answer is would not be construed as medical advice.
When I searched the internet, I couldn't find anything and when you go
to message boards, the people were rather incoherent, perhaps because
they're people using it as a heroin substitute. A change in medication
would never be changed by anyone but my pain doctor.

Hello - thanks for asking your question.  
  
Although I am an internal medicine physician, please see your primary
care physician for specific questions regarding any individual cases –
please do not use Google Answers as a substitute for medical advice.
I will be happy to answer factual medical questions. 

Regarding the side effects of methadone - there are many.  Here is a
list taken from the Drug Information Handbook:
"ADVERSE REACTIONS — Frequency not defined. 

Cardiovascular: Bradycardia, peripheral vasodilation, cardiac arrest,
syncope, faintness

Central nervous system: Euphoria, dysphoria, headache, insomnia,
agitation, disorientation, drowsiness, dizziness, lightheadedness,
sedation

Dermatologic: Pruritus, urticaria, rash 

Endocrine & metabolic: Decreased libido 

Gastrointestinal: Nausea, vomiting, constipation, anorexia, stomach
cramps, xerostomia, biliary tract spasm

Genitourinary: Urinary retention or hesitancy, antidiuretic effect,
impotence

Neuromuscular & skeletal: Weakness 

Ocular: Miosis, visual disturbances 

Respiratory: Respiratory depression, respiratory arrest 

Miscellaneous: Physical and psychological dependence" (1)

As you can see, insomnia is a documented side effect of methadone. 

Regarding the use of methadone in the treatment of pain - this has
been used successfully by many pain specialists.  The advantage of
methadone is that it has a long half-life (i.e. it stays in the body
longer).  Regarding the treatment of neuropathic pain - such as the
pain you describe - methadone is effective in treating this:

"Methadone and levorphanol have long half-lives (22 and 16 hours,
respectively), and may be used in place of sustained-release
preparations for baseline opioid requirements . . . In addition,
research studies suggest that methadone, perhaps by antagonizing
N-methyl d-aspartate (NMDA) receptors in the dorsal horn of the spinal
cord, could be uniquely effective in controlling neuropathic pain and
preventing opioid tolerance." (2)

I stress that this answer is not intended as and does not substitute
for medical advice - please see your personal physician for further  
evaluation of your individual case.  
       
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.     
           
Thanks,            
Kevin, M.D.   
  
Search strategy:    
No internet search engine was used in this answer.  All sources are
from physician-written and peer-reviewed sources.   
 
Bibliography:
1) Lacy.  Methadone.  Drug Information Handbook, 2003.
2) Hough et al.  Pharmacologic therapy of cancer pain.  UptoDate,
2003.

Dear Dr. Kevin-Thanks for your considerate answer. My disease is
multiple sclerosis and I understand that some medical schools still
teach that MS doesn't cause pain. About 1/2 of MS patients will
experience occasional sensory problems, and I've only come across
perhaps 5 or 6 people with constant grueling and intractable
neuropathy. I am one of the unlucky ones. Most neurologists try
anti-convulsant medication, but some have no luck with them.
As you know, narcotics are very controversial, but my take is when
they come up with a medication to treat "central" pain, the doctor
will wean me off of methadone, but in the meantime, I am considering
part-time work or volunteering for the first time in 14 years. It has
"saved" my life and wish that more conservative members of the medical
community refer patients to pain specialists because we have had our
lives turned around. It's been a miracle.
Thanks again,
Yesmam

Thank you for your kind comments and tip.  

Good luck,
Kevin, M.D.

First, I am not a Doctor. My son has been on Methadone for 17 months.

How do you feel in the morning, just before your dose and while
waiting for it to take effect?

Do you feel antsy? cold? shivery?, goosebumps? sweaty?

What I'm suggesting is that you might need a bit higher dose of
Methadone to get you through the night.  Methadone, as you know, is
highly addictive, and simply because you are taking it for pain
doesn't mean you won't have symptoms of withdrawl if your daily dose
is not high enough for your personal metabolism. Sleep disturbances
are a symptom of withdrawl. When couipled with any

It is *possible* that another 5-10mgs would get you through the night.

Please consider discussing this possibility with your Doctor.  You can
request a small increase to see if it helps, and if not, you can go
back to your lower dose.

~~Cynthia

Hi Cynthia-`Since asking Dr. Kevin` the question, my body has really
become accustomed to this amount of methadone. I sleep well at night
and don't have stomach pain any more.

Do you feel antsy? cold? shivery?, goosebumps? sweaty?

No, I'm not on that high of an amount that that would happen. In
December,I will be having surgery and assume that I will not be able
to take methadone the morning of surgery. I'll have to ask my doctor
what is done, because of anesthesia.

After a certain amount of time, I know that my amount will have to go
up, or I'll have to take Oxycontin, because as of now, there is no
cure for MS neuropathy.

I hope that your son is finding relief with methadone.

Best,
Yesmam

Hi again yesmam,

I am relieved you are sleeping better than before. Based on my
experience with my son, I felt compelled to make contact with you,
regardless of the fact that I am not qualified to give medical advice,
or medical opinions.

Although I gave no hint of this before, above, I cannot stress to you
loudly enough that the use of Methadone is a double edged sword. Make
no mistake: by choosing to use methadone for the relief of pain, you
are, in essence and practice, using a HIGHLY addictive drug. ----> You
are now addicted to Methadone. <----  As you recover from your
debilitation, please don't lose sight of this fact.

Methadone IS a miracle for those that REQUIRE it. However, please
recognize that you are in the "honeymoon" period in usage of the drug.
You see virtually no wrong with it's usage, and in fact, you are
nearing the point of being a Methadone proponet.

Mark these words:  --There will come a time, albeit a long while, when
those that love you will come to you with a wide assortment of
questions in regards to your behavior, seemingly unrelated to
Methadone -to you, and they will question your Methadone usage, as the
cause of what they see as "wrong."

You MUST REALIZE (put this bee in your bonnett) ...that you will be in
denial, and will <<subconsciously>> try to protect your Methadone
<<supply>>, as any addict would.  What this really means is that every
fiber in your Methadone saturated body will give you every logical,
rational, available reason <<they will all make sense to you>>, as to
why it's not the drug causing the undesired behavior.

You see, there is very little difference between a *recovering heroin
addict* and a *pain patient* on methadone, because at that point: not
on heroin and not in pain, --BOTH are now _Methadone_Addicts_, their
original reason for usage is moot.

I have monitored my son's behavior on Methadone, he lives with me,
AND, I have a close friend with MS on Methadone. I have seen this
firsthand from both sides.

I am FOR Methadone, although you after reading the above you may have
a hard time believing that...  I just hate to see anyone in the
honeymoon period going in --wide eyed and happy, knowing what I know
now.

Remember: IT'S A DOUBLE EDGED SWORD. Sometimes Opiate addicts exhibit
addictive behavior that is dangerous to the themselves _and_ those
nearby.  They become dulled and oblivious to certain realities of day
to day living. They can become careless with cigarettes, stoves,
driving, pets, security, they forget things --and DENY all the former,
...and a lot of other things I am not remembering at this moment.

Your family and friends will come to you, eventually, with questions,
Listen to them. When you respond to them, listen closely to your
reply. You will naturally deny, defend.

My mission here is to cause you to remember this warning, coming from
a Methadone supporter. NEVER FORGET.

I can even feel you saying to yourself that you feel SO MUCH BETTER,
that NONE of these things apply to you...

JUST REMEMBER THIS POST, is all I ask.

I want you to know that I am here. I understand what you are
experiencing. I understand what your friends will eventually wonder,
because I have wondered myself, researched, and found answers.  Use
me, or anyone at Google Answers that is familiar with the drug, --as a
sounding board to keep yourself in check.

Again, Good luck to you and God Bless, I CARE.
~~Cynthia