Offering Hope and Recovery to Chronic Pain Sufferers

Methadone: Treating Bipolar disease and Migraine

Most of the people who are referred to me for the treatment of chronic pain also suffer some form of phychiatric illness. In Understanding Chronic Pain, I explore this relationship because it helps us understand just what chronic pain really is. I also develop the thesis that aggressive treatment of the psychiatric disorder can diminish and sometimes even cure the pain. Thus, my enthusiam for the treatment of pain with psychiatric drugs. Only recently have I taken the opportunity to look at the issue the other way around. That is, what happens to psychiatric disease when I treat the pain? My hesitancy in pursing this has been my reluctance to use opiate therapy if it could be avoided. However, within the past year I have seen incredible, almost unbelievable results with opiate therapy in the treatment of bipolar (manic depressive) disorder.

Belinda was 42 years old and suffered that form of migraine known as cluster headaches. The pain would strike her about her eye and last for an hour or so. It would then abate spontaneously, only to recur several times during the day, especially at night. The name cluster headache derives from the fact that in most people the headaches cluster in time, appearing repetitively for a month or so.  Then they go away only to return months later. Belinda wasn't so lucky. She had that form of the affliction known as chronic cluster headaches, and for two years she had not known a day without several hours of pain. She had not responded to the usual drugs to arrest migraines, nor to any of the several drugs used to prevent migraine or cluster. She denied to me that she felt depressed, but acknowledged that " this thing is getting me down." Troubled not only by her headaches , she also had a teenaged son with unstable bipolar disease, and that was as much a stressor as her headaches.

I began my treatment with the drugs Nortriptyline and Clonazepam, neither of which she had taken before. They are, in my opinion, preeminent in the treatment of most forms of chronic pain, and she did respond, at least partially.She occasionally went a few days without a headache, and she and I considered that quite a positive.

Several weeks into her treatment, she told me something that alarmed me. She said for the first time that she felt depressed and sad, and that her emotions were on a roller coaster. I prescribed the antidepressant Lexapro. I took a call from her husband a few days later, telling me that she had become suicidal and was admitted to a psychiatric hospital. I saw her a few days following her discharge and she told me she had been diagnosed with bipolar disease and treated with the mood stabilizers Lamictal and Keppra. Nonetheless, her moods were still shifting and her headaches had returned full force. At least she wasn't suicidal, she told me. I elected to prescribe the opiate Methadone, beginning at the rather low dose of 10 mg every 8 hours.

It's still hard for me to believe what I saw when she returned two weeks later. She was smiling. She told me her moods were no longer shifting as they had before and that her headaches were much relieved. She still had one when she woke up each morning, but it was quite tolerable.

I was thrilled. I wrote her another prescription for the Methadone, telling her she could go up to 2 pills every 8 hours if she felt it was necessary. She returned at the appointed time to tell me that she had not increased her dose and she had attended her son's graduation from high school. Sitting on the third row in the front, she realized that she had made a mistake, because the school band, but a few feet away, was about to perform. She expected the worst, knowing that bright lights and loud sounds would precipitate a headache. Astonishingly, it didn't bother her at all.

We've been into it for several months now and Belinda continues to do well, suffering only a morning headache which soon abates. She remains on the Nortriptyline,Clonazepam, Lamictal and Keppra, doing vastly better than when we started.

I'll explore the curious opiate Methadone as we go along. I will advise you that there are sound physiologic and pharmacologic reasons for her to have responded the way she did. Methadone, I believe, will turn out to be one of the best treatments there is for the painful bipolar.

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robertcochran Posts: 7

Jennifer
Reply #43 on : Wed April 11, 2012, 10:20:52

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Most State Boards would frown on opiate Rx for BP but perfectly legal if Rx is for pain. You might find a pain clinic as opposed to a meth clinic that will prescribe meth. You say control with meth was good but incomplete re cravings for other drugs. I wonder if the dose was hi enough. Bob Cochran

jennifer Posts: 40

methadone for bipolar
Reply #42 on : Tue April 03, 2012, 11:44:46

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i am 31, bipolar, i have pain issues and am an ex addict...i was on a mmt for 4 yrs but found it difficult to stay clean from other drugs while there so i left, i was at my best while on methadone: no pain, better mood/emotional stability, i had energy to get normal everyday things done(which at times while on no meds seems impossible) i guess my question is, do you know if Doctors are allowed to perscribe Methadone for bipolar? I'm wondering because i fear relapse, i try dealing with my pain and bipolar symptoms but it is difficult, and i dont want to return to the clinic where it seed everyone was doing some other drug...

renee g villarreal Posts: 40

need help any info
Reply #41 on : Fri March 30, 2012, 21:01:59

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ever sense i was 17 i had ovarian cysts the get the size of a orange and i also get several cysts all over i have endometriosis pancritis i have i also have back problem i got in car accident at the age of 16 my neck sholders and lower back with all this going on in in constant pain im 29 yrs old i finally got a doctor to pescibe me methodoze for my chronic pain it woked the best i was able to have a good quallity of life i was close to my last straw i was getting it from sacrid heart untill i could get insurance if i would have the dr was a set to treat my chronic pain this was several years ago im in so much pain i can bearly cook clean the way dr's are getting in spokane they think everyone is out to use pain meds the wrong way i have no appatite when they had me on methadone it made me feel like the pain wasn't controlling me anymore i want my life back please if theres anyway for numbers to call whatever you can do i will be thank full im sick of being in bed all day cause pain

robertcochran Posts: 7

Methadone.
Reply #40 on : Thu November 03, 2011, 11:03:07

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Lisa, I suggest you keep trying to find a doc who is willing to prescribe methadone. Maybe even a methadone clinic. If it's any comfort , more and more docs are recognizing the benefits of methadone both for pain and emotional illness. Good luck! Bob Cochran

Lisa Hicks Posts: 40

Methadone Helped My Chronic Pain
Reply #39 on : Tue October 25, 2011, 13:11:22

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I have chronic pain in my back and hip. Methadone was the only med that helped me have a life. Due to financial reasons I had to stop going to my Pain Clinic two years ago. Since then I've had no life I can't even make the bed or walk from one end of the house to the other without PAIN! Going to the store and standing in the checkout line is misery. Recently went back to a Pain Clinic they will not put me on methadone again, since I turned to alchohol for pain relief. Methadone gave me a quality of life I need back. I was able to work part time, go to school, participate in life. Since being off it my life has gone drastically down hill as I have searched for relief from constant pain I have every minute of my life and am judged for needing my meds.

robertcochran Posts: 7

Re: Methadone: Treating Bipolar disease and Migraine
Reply #38 on : Mon October 10, 2011, 12:19:19

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Melanie
Yours is a common problem,You know which drug cures but can't find M.D.
to prescribe. One hopeful note more and more pain docs are recognizing the
benefits of Methadone in the Bipolar. Have you told any pain docs of your
experience? They might be able to help.
Good Luck
Bob Cochran

melanie rossi Posts: 40

the methadone miracle
Reply #37 on : Sat October 08, 2011, 20:17:00

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For the past year r so I've been taking methadone periodically to relieve pain from migraines. Much like the above article I suffer from chronic migraines that last for 2-3 days/week AND bipolar disorder. My boyfriend takes methadone for an opiate addiction but spares some for me. For more than one reason, I wish I could get my own presciption. Howver, I don't have insurance and worry that if I tell this to a doctor they might presume that I'm an addict too. I whole heartedly believe that methadone not only alleviates the pain caused by migraines, it relieves the depression caused by them too. Any ideas on how I should go about getting my own script for migraines?

Anonymous Posts: 40

Bipolar Disorder and Methadone treatment
Reply #36 on : Wed September 28, 2011, 21:19:41

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I have a friend who suffers from Bipolar Disorder. He has been without his medications for three months and as a result has been suffering from severe mood swings, anxiety and nervous tics. He has been unable to sleep and was complaining of severe pain in his body due to the inability to sit still and/or relax. It has been difficult to get him back on his normal medications because of wait times and medical insurance issues. He tried methadone as a possible treatment just to see if it would help until he could get his medications. To our GREAT SURPRISE IT WORKED!!!! For the first time in days he was able to control his constant urge to be moving and actually claimed to "feel normal again." I wonder what the result would be for others suffering from bipolar disorder. A study needs to be done and this option should definitely be investigated further!!

Terri Posts: 40

Bi-polar treatment-Chronic pain
Reply #35 on : Fri September 09, 2011, 11:02:29

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Dr. Cochrane I'm sorry to be such a bother to you, the as couple of weeks I've had bi-polar depression and have been in bed since the 26th of Aug.your wonderful staff has been really wonderful with all my crying and frantic phone calls. But today I feel good again, and I realized that mentally I can not return to work where I work, the job is super demanding, fast paced, and non stop, there are days I don't take lunch or breaks because I am the one there all the time. I can not continue to work there not only because of my chronic pain, migranes that they seem to bring on and my organizational skills are going to get me in trouble. I really need to take some time off (not in the bed like I have been) but just get away and get myself together, to everyone outthere methadone has changed my life I was constantly thinking about death and my past and I even started seeing pictures of things that had happened in my life inside my head, but methadone took that away. Thank you Dr. Cochrane you really saved my life because thinking about dieying evry day was not healthy for sure. I would recommedn Dr. Cochrane to anyone having these types of issues he really knows what he is doing and I just adore him, I just hope he can forgive my past outbursts, but I promise next time we see each other it will be a very positive change. And that's all thanks to Dr. Cochrane. Sincerly Terri

Last Edit: October 04, 2011, 06:10:45 by robertcochran  

Tim Baldwin MD, ABAM Posts: 40

treatment of bipolar disease with opiates
Reply #34 on : Tue August 09, 2011, 19:27:11

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Opiates were reported in the european medical journals in 1964 as the preferred treatment for "manic depressive disorder". Currently research is being done to develop a kappa receptor blocker with no effect on other opiate receptor which would be helpful for not only Bipolar Disorder but other psychiatric disorders.




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