Pain management is a top priority at Our Lady of Peace Residential and Community Hospice. The medications we use are designed to interact with different receptors in the body, and our medical staff and pharmacist work together to suppress pain, based on the individual needs of each patient.
Morphine, Fentanyl, Dilaudid, Norco, and Hydrocodone are frequently recognized medications. They work on the Mu Receptor, so they work well for acute kinds of pain. However, we often run into neuropathic pain that comes with cancer in the head, neck, abdomen, and bone metastases where the nerves are being infiltrated. The pain is similar to sciatica pain with a pinched nerve and inflammation in your back. It’s caused by a disk pressing on your sciatic nerve, and as a result, you perceive pain going down your leg. About 40% of the time, morphine-like drugs work to ease this kind of pain, but patients have to take a lot more of it. And, there’s a high percentage of people who don’t get relief, but they get the side effects of becoming more sedated, and constipated. This is why we use small doses of methadone instead to relieve neuropathic pain, and it’s very effective.
Methadone was developed in the 1950’s and is used to treat opioid addiction, and help people stay off heroin. People in these programs are getting 100-125mg a day which is a significantly higher dose than we administer. By administering 30mg or less per day, depending on a person’s system, Methadone works to combat neuropathic pain. Dr. William Downing treats patients at Our Lady of Peace and he says, “I’ve had patients who have been on high doses of morphine-like drugs, 150-200mg without relief, and I put them on 20mg of Methadone and their pain is totally controlled. Methadone doesn’t cause addiction in our setting. It is an effective drug for controlling awful neuropathic pain.”
It’s common for patients and families to be concerned about Methadone at first because of its use as an addictive street drug with negative impact, but because we use a much lower dose, it is safe. “Methadone is a different type of drug. It’s what I call a ‘twofer,’ says Dr. Downing. It works on the Mu Receptor, but also the ANP receptor, which is the neuropathic pain stimulator, and if we block it, patients get much better pain relief. This is why we choose Methadone.
Another drug we use is Ketamine, a drug that is used in hospitals for anesthesia. “We use it in low doses, so it’s safe to use here,” says Dr. Downing. “Ketamine works predominantly on the ANP Receptor, so we may add it to get even more control over neuropathic pain. It’s also effective in treating depression. We’ve had patients at OLP who have been incredibly depressed and not talking, and with a single dose of ketamine, their depression is relieved in just a couple days.”
It’s critical for patients and families to understand the purpose of the medications we choose, and why we combine them to combat pain. We want to work together to provide the highest quality of life while patients and their families are in our care.