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Health Forum    Pain & Pain Management
Health Discussion Forum

 Shoulder blade pain......?
My 42 yr old husband has had shoulder blade pain for 2 days now and it is radiating to his front chest and he has trouble lifting his arm up and complains of having pain in his chest when he breathes ...

 I have a dull ache in the middle of my chest right between my breast and no doctors can figure it out??
It comes out of no where...it does not burn. It just aches off and on through the day....

 I feel as though I need to crack my big toe and I can't. It isn't painful, just irritating. What can I do?

 Waking up with a stiff back?
For the past few days I have had a stiff/sore back whenever I first get up in the morning. Once I get moving it goes away
I have tried flipping the mattress and it hasn't helped. My husband&...

 Big worrys about my mums medication?
Hey well to get this question started, my mum was born with a bent spine and 3-4 slipped disks, obviously as time passed shes become more and more in pain.

she was supposed to have a type ...

 Opinions on Chiropractors...?
Whats the consensus on chiropractors? Do you think they are reliable or quacks?
Are they ever effective or do they make it where you always have to go back for relief?
I have heard both ...

 How do painkillers know where you are hurting?
On adverts it always says they go straight to the source of pain. How do they know?! Lol!...

 disability income?
Does anyone know anything about disability benefits? My mom is permanently disabled and gets a disability check.... Everyone that we have bumped into that draws disabilit draws at least $200.00 more ...

 Abdominal pain on my right side.?

Last night I started to get some pain in my right abdomen, just in from my hip bone. It started out as a dull pain, and hurt a lot more if I was sitting or if my legs were up. I ...

 best constipation relief?
i can't poop and i've taken laxatives and fiber. helppppppppppp!!!!...

 Does your cellphone ever hurt your head?
My cellphone sometimes gives my head a sharp pain actually all the time so i have to use speaker phone all the time. Does anyone know why it would do that and has it happened toyou? Its not the phone ...

 Is it normal to feel hung over after a dose of hydrocodone wears off or is something else wrong with me?

Additional Details
Yeah I woke up at 4 AM this morning thinking I was gonna barf....

 PLEASE HELP, in so much pain!?
I went to Austria on a ski trip just over a month ago and came down with Gastroenteritis which caused me to have appendicitis i had it removed there and haven't felt quite right since.I don'...

 how to get rid of a stomach ache quickly?
i've got a terrible stomach ache, i've tried all that i can think of:

drink water
went to the toilet
kept my legs higher then my stomach
layed down on my stomach<...

 Why my shoulder (Ball & Socket) joint paining as unbearable since two months and also fore-arm since one mont?
The ball and socket joint of the shoulder is paining very much and unbearable. I am not able to do any thing with this hand. Even I can not hold the cell phone for more than 10 minutes. Due to this I ...

 Leg really sore near the bone?
A few days ago I woke up with my leg (below the knee) really sore. I ignored it but now it just keeps getting worse, and the pain has spread up to my knee. It almost feels like the bone is bruised. I ...

 Spine degeneration - what next?
I'm 33 and self employed. About 2 years ago I began having a slight pain down my left leg. A year later a MRI showed that I have degeneration in levels L2 to S1, the worst being L5/S1. Now in ...

 Does flexeril help during menstrual cramps?
Did it help anyone who took it?...

 fishbone got stuck in my throat?

last night I ate fish for dinner, then some stupid fishbone somehow got stuck in my throat. I tried swallowing balls of rice and bread and banana but I can still feel it there.<...

 Please help now, got a major migrane atm?
I know, you are going to say the computer won't help and i know, i'm just wanting to be on for 5 minutes whilst someone gives me help.

The pain is shooting from all different ...

How long does liquid methadone have to stay in your stomach to make sure your body absorbs it?
I just recently started on Methadone as treatment for prescription pain pill addiction. Every morning I go into the clinic, drink 50 MG of liquid methadone. The stuff makes me pretty nauseous but until this morning, I've been able to hold it down for hours before getting sick. This morning, I took my dose, and left the building without waiting. I believe it stayed down for about 20 minutes. My fear is that my body might not have absorbed it and that I'll be sick before tomorrow morning. Does anyone know, for a fact, how long it takes for the body to absorb it, fully?

It takes between 30-60 minutes for most medications to be absorbed. However, lying down slows down the absorption of the medication.

Methadone, a potent opioid agonist, has many characteristics that make it useful for the treatment of pain when continuous opioid analgesia is indicated. Although available for decades, its use has gained renewed interest due to its low cost and potential activity in neuropathic pain syndromes. Unlike morphine, methadone is a racemic mix; one stereoisomer acts as a NMDA receptor antagonist, the other is a mu-agonist opioid. The NMDA mechanism plays an important role in the prevention of opioid tolerance, potentiation of opioid effects, and efficacy for neuropathic pain syndromes, although this latter impression is largely anecdotal.
Any clinician with a Schedule II DEA license can prescribe methadone for pain; a special license is only required to prescribe methadone for the treatment of addiction. In some jurisdictions, it is necessary to apply the words "for pain" on the prescription.

Methadone is highly lipophilic with rapid GI absorption and onset of action. It has a large initial volume of distribution with slow tissue release. Oral bioavailability is high, ~ 80%. Unlike morphine there are no active metabolites; biotransformation to an active drug is not required. The major route of metabolism is hepatic with significant fecal excretion; renal excretion can be enhanced by urine acidification (pH <6.0).

Methadone is a highly lipophilic drug that is rapidly absorbed with extensive tissue distribution.2 Unlike morphine sulfate, methadone has no active metabolites and hepatic metabolism has no significant effect on methadone concentrations, clearance, or clinical disposition.3 It is predominantly excreted in the feces; however, acidification of the urine will increase renal excretion. It has a prolonged and variable elimination phase with a plasma half-life that ranges between 4.2 hours and 190.0 hours, depending on the literature that is reviewed.2,4-6

The mean plasma half-life of methadone is probably 15 to 60 hours,4 though even this range is extremely variable and dependent on single versus multiple dosing, individual adipose stores, and protein binding. This wide variation in half-life contributes to methadone's potential for toxic accumulation and has created difficulty with appropriately and easily dosing this medication.

Methadone has a rapid onset of action, with analgesic effects occurring within 30 to 60 minutes and an analgesic peak between 2.5 and 4.0 hours.

Its oral bioavailability, though variable, generally exceeds 80%. It binds with mu, delta and to a lesser extent kappa opioid receptor sites.

Unlike morphine, no dose adjustment is needed in patients with renal failure since there are no active metabolites. Methadone is available in tablet, liquid and injectable forms; oral preparations can be used rectally. Parenteral routes include IV bolus dosing or continuous infusion.
Unlike morphine, hydromorphone or oxycodone, methadone has an extended terminal half-life, up to 190 hours. This half-life does not match the observed duration of analgesia (6-12 hours) after steady state is reached.

This long half-life can lead to increased risk for sedation and respiratory depression, especially in the elderly or with rapid dose adjustments. Rapid titration guidelines for other opioids do not apply to methadone. An important property of methadone is that its apparent potency, compared to other opioids, varies with the patient's current exposure to other opioids.

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