For those on Methadone for chronic pain: What medications work for you for breakthrough pain?

I am currently on this quest with my own pain management Dr. I've been on Methadone 90 mgs 3 x day. I've been on various breakthrough medications, all of which have failed to work at all: vicadin, percocet, Morphine, oxycodone, tramadol, etc... But nothing has worked so far.

I've been reading up and I'm finding that Fentanyl (spelling?) works the best with Methadone because Methadone blocks opiate receptors, but there is something about the make up of Fentanyl or Fentanol that works with Methadone.

Good luck if you find one that works!

~Shawnie

Correction, 90 mg per day total. 30 mg 3 times per day, I"m sorry for the previous error. ")

My pain specialist (the dr. that does my procedures, not the dr. that prescribes my pain meds) will not keep me as a patient if I continue on the Fentora. He says it never was intended for chronic pain patients, just for cancer patients. Ridiculous, but that's the way it is, and I need him - he helps.

oh ok i thought it was someone doing it out of sight, sorry didnt mean to be rude

Thanks Christine - I always appreciate your answers! My doctor says there is a federal regulation prohibiting him from prescribing more than 90 mgs of Methadone for a chronic pain patient. I posted this question before, but didn't find out anything. So, I can't go any higher on the Methadone. I've been using Actiq/Fentora now for 8 years, and have been using 56 of the Fentora per month, along with the Methadone, for 2 1/2 months, and haven't had any problems with it - I've been very careful to space it out to 4 hours, and not use more than 3 in one day. Thanks for your concern - you are always looking out for us like a mother hen! Take care Christine!

Mother Hen, huh? Ok. I'll take that as a compliment! I wasn't sure if you were used to the fentora or not. But since your system is adjusted well, you'll probably need a stronger oxycodone than the standard 10mg. What about maybe 8mg dilaudid? Really your doc is the pro and sounds like he's been taking good care of your pain so far. It's just that fentora is a hard drug to match in the breakthrough pain control department. Be sure and write down any and all possible meds to discuss with him.
Best wishes and hope it goes well!

Thank you Peterws9 - I see it is the equivalent of U.S. Kadian or Avinza. I will have to look into it further - I appreciate the advice. Since I wrote this question I have gone down on the Methadone from 90 mg to 70 mg/day, so that gives me a little wiggle room - I could increase it back up for a surgery (which is what I really need the breakthrough meds for now. The oxycodone just isn't doing much - even at 22.5mg. It takes a few 30 mg to make any difference and no way will my dr prescribe that much. Sure is tough when you're at the highest dose of things and still need more help. How I wish I could get off this stuff! Regards -

Thanks Heather. I've been on Methadone at the 70mg dose since March and take Oxycodone 22.5 mg (1 and 1/2 of a 15 mg tablet) once, occasionally twice a day for breakthrough pain. I have used the Fentora while on vacation - it made the trip possible. The oxycodone doesn't help much, I must say. I've been on Amitrytptaline 25 mg prn since spring - I find if i take one of those along with a Flexeril 10 mg it helps just as much as the 22.5 mg Oxycodone does. I don't know what to make of it, I'm just glad that it helps. I really don't like being on Methadone - the incredible! sweating and I find that I am SO hot if the temperature is over 70 degrees - even inside the house. And I sure don't like this dose of Oxycodone not making much of a difference. I have an upcoming surgery and my doctor has prescribed a box of the Fentora - I think that's the only thing that is going to touch the pain. Methadone just won't let any other pain killers through! Thanks for you comment.