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Suggest Treatment For Burning Sensation In Stomach After Weaning Off Methadone

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Posted on Mon, 20 Oct 2014
Question: I have come off methadone in May 2014 that was prescribed for me for ten yrs for my back pain. Ever since then a burning sensation in my stomach area and prickling pains in my chest area have developed. I take Prilosec for heartburn, but I have been dealing with this for about a month now. I am weak and have a dizzy feeling when I stand after a while. God Bless.
doctor
Answered by Dr. Dr. Matt Wachsman (43 minutes later)
Brief Answer:
The physical and the mental

Detailed Answer:
Congratulations on coming off the most dangerous narcotic (proportion of those with fatal overdose versus total on it is highest for methadone Prescribed for Pain; addiction centers treat younger, healthier people and watch them DAILY... and they die from heroin not the methadone!).
We're thinking it's the methadone. and you should first make sure about that with a standard simple physical and routine blood tests.
Liver/lung/kidney trouble. weight loss with low blood pressure. Stomach irritation with or without bleeding and/or anemia. would be pretty obvious things that could be the whole issue.
back to the methadone
While the textbooks don't say much about it, my addict friends assure me there is a late stage withdrawal from methadone. Muscle relaxers (of the safe variety, NOT soma/carisoprodol) have been helpful in most, also might try anti-epileptics that have pain reducing properties (gabapentin, and pregabalin).

Anti-depressants with both pain reducing and nerve damping down properties (AMITRYPTALINE) would be my first choice.... oh.. .it also calms down the digestive tract. Obviously, since it hits all the issues, it's the top choice.

But then, there's the psychological possibilities. Addiction/coming off narcotics (especially methadone!) produce a lot of psychological effects: panic attacks and depression. Chemical imbalances are the most treatable forms of depression and any of the SSRI's would be quite helpful; amitryptiline also works, but it is a less effective anti-depressant (but still working on the majority) than newer agents. On the addicts I see, this is less true and psychological interventions are the main thing. Cognitive behavioral therapy is a good start (an intervention in which you identify the thoughts/feelings/assumptions behind your situation and examine them). There are online versions of it. But, it needs to go up another dimension. If I were recommending it for you here's where I'd go with it.
1) don't do it; start with getting any illness ruled out. Then continue with treating the symptoms... basically do all the first section.
2) assuming you aren't mostly fixed up by the first section, you'd know you don't have serious physical or mental issues going on. This is an essential first step.
Then, read up on methadone addiction and consider whether where you are now isn't totally superior to where you were going!
3) In this POSITIVE FRAMEWORK (again, essential) look at the symptoms again in the positive framework. Begin exercise. Feel worse! But, the pain of the exercise within a positive framework, damps down all the other symptoms. It forces you to mentally and physically get used to them and they fade. a lot.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Dr. Matt Wachsman (4 hours later)
Thank you Dr. Wachsman for my answer. Last week I had a physical, all labs and stool sample etc..... done and they came back good. I was also tested for stomach bacterial infections and there were none. I have a past history of bleeding ulcers so do you recommend that I go see a gastro Dr in the near future if my symptoms worsen? The problem is that it takes 2 months here in Fl to get an appointment to see a gastro Dr. I am taking Gabapentin, 40mg Prilosec, Cymbalta and blood pressure medicine. I guess I am being a little worried about stomach ulcers because I do not want to go through that pain again. You have been very helpful and God Bless you Sir!!
doctor
Answered by Dr. Dr. Matt Wachsman (33 hours later)
Brief Answer:
tests are pretty good....

Detailed Answer:
Ok, if iron level good, and stools heme negative (on 3 tests) then not likely to have a problem from ulcers down to hemorrhoids (and polyps unlikely too!). Then.... it's incredibly common to have stomach issues that are minor and often motility related and with an entirely negative on all tests including EGD. Prilosec still helps even when there is nothing like a stomach ulcer.
And... what I often have my patients do, is if there is both a very real issue for a specialist, AND a very real possibility that things will get better and not need one, is to make the appointment but be ready to cancel it ! (and in the meantime, getting evaluated for bleeding and if no bleeding and symptoms gone.. then.... not much is going to come from the gastro visit).
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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Suggest Treatment For Burning Sensation In Stomach After Weaning Off Methadone

Brief Answer: The physical and the mental Detailed Answer: Congratulations on coming off the most dangerous narcotic (proportion of those with fatal overdose versus total on it is highest for methadone Prescribed for Pain; addiction centers treat younger, healthier people and watch them DAILY... and they die from heroin not the methadone!). We're thinking it's the methadone. and you should first make sure about that with a standard simple physical and routine blood tests. Liver/lung/kidney trouble. weight loss with low blood pressure. Stomach irritation with or without bleeding and/or anemia. would be pretty obvious things that could be the whole issue. back to the methadone While the textbooks don't say much about it, my addict friends assure me there is a late stage withdrawal from methadone. Muscle relaxers (of the safe variety, NOT soma/carisoprodol) have been helpful in most, also might try anti-epileptics that have pain reducing properties (gabapentin, and pregabalin). Anti-depressants with both pain reducing and nerve damping down properties (AMITRYPTALINE) would be my first choice.... oh.. .it also calms down the digestive tract. Obviously, since it hits all the issues, it's the top choice. But then, there's the psychological possibilities. Addiction/coming off narcotics (especially methadone!) produce a lot of psychological effects: panic attacks and depression. Chemical imbalances are the most treatable forms of depression and any of the SSRI's would be quite helpful; amitryptiline also works, but it is a less effective anti-depressant (but still working on the majority) than newer agents. On the addicts I see, this is less true and psychological interventions are the main thing. Cognitive behavioral therapy is a good start (an intervention in which you identify the thoughts/feelings/assumptions behind your situation and examine them). There are online versions of it. But, it needs to go up another dimension. If I were recommending it for you here's where I'd go with it. 1) don't do it; start with getting any illness ruled out. Then continue with treating the symptoms... basically do all the first section. 2) assuming you aren't mostly fixed up by the first section, you'd know you don't have serious physical or mental issues going on. This is an essential first step. Then, read up on methadone addiction and consider whether where you are now isn't totally superior to where you were going! 3) In this POSITIVE FRAMEWORK (again, essential) look at the symptoms again in the positive framework. Begin exercise. Feel worse! But, the pain of the exercise within a positive framework, damps down all the other symptoms. It forces you to mentally and physically get used to them and they fade. a lot.