one of the greatest, and least well known, benefits of methadone -- along with the fact that it has methods of action present in nearly no other pain medication except for Levorphanol, which is very rare -- is that it can flatten the tolerance curve over time. in short, a given dosage of methadone will continue to work for much longer than a given dosage of a "traditional" opiate.
this is because methadone is an NMDA Antagonist, something which almost no other opiate does except Levorphanol. You can get this effect with other opiates by taking DXM (dextromethorphan, the main ingredient in cough syrup, Nyquil/Dayquil, etc) in moderate dosages every day with your pain medicine. But of course, be sure that none of your other medications conflict with the DXM before taking it -- ask your doc, disclaimer etc etc.
methadone can also control pain that is not adequately controlled by any other opiate. however, there is much debate as to whether it really continues to relieve pain long term or if it only prevents WD symptoms, and pain is actually felt almost unmodified. Many patients taking methadone for addiction treatment claim that they receive no pain relief from it, but that is a complex issue.
In my case, I worry that my hydromorphone (dilaudid) breakthrough medication may not be working well enough due to the blocking effect of my high methadone dosage. Only fentanyl is known for being able to "punch through" the blocking effect due to its extremely high affinity for opiate receptors and the very low dosages required to have an effect.
I would very much like to try Levorphanol as a BT medication alongside methadone, for its NMDA Antagonism, longest action of any non-time-released opiate other than methadone, and nearly Fentanyl-like affinity for receptors, low dosages, etc.....
Conditions: Reactive Arthralgia/Reactive Constellation, Chronic Pelvic Pain Syndrome, Sacroiliitis, Costochondritis, widespread Tendonitis, severe back pain & spasms with numerous spinal problems, barely able to type anymore due to severe full-body runaway inflammation, and on and on. Typical daily pain levels exceed 8.5(!)
Medications: Methadone, Dilaudid, Oxycodone, Marinol, Cesamet, Lidocaine Patches, Flexeril, Zanaflex, Soma, Desipramine; many herbs & supplements.
Previous medications: Oxycontin, Opana, Fentanyl patches, Kadian, Avinza, MS Contin, Lortab, OxyIR, Baclofen, Testosterone (oral, patches, gel), Cymbalta, Lyrica, Neurontin, Amitryptyline, every NSAID known to man, Prednisone....and many, MANY more.