Abstract
Purpose
Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to accumulation and toxicity. In the present study we report that clinically effective analgesic doses of methadone, given either epidurally or orally, can be used safely for prolonged treatment in hospitalized patients.
Clinical features
Over a five-year period we administered methadone at Hadassah Hospital in Jerusalem to 3,954 in-patients with severe pain, 12% of whom were younger than 17 yr. Satisfactory pain relief was recorded in more than 85% of the patients. None of the patients treated with oral methadone developed serious side effects. Three patients, treated with epidural methadone (0.09%), developed a clinically significant respiratory depression. In all three cases, epidural pump failure or pump misprogramming resulted in methadone overdose. None of the children or adults treated with methadone developed addiction during hospitalization.
Conclusion
Based on its analgesic properties and marked safety profile, we suggest that methadone could be added to the analgesic armamentarium of in-hospital health-care providers. Moreover, methadone could serve as the opioid of first choice in some inpatient populations.
Résumé
Objectif
La méthadone est toujours considérée comme un opioïde mineur dans ies cas de douieurs intenses. Elle est rarement prescrite aux patients hospitalisés. Cette situation est sans doute reliée à sa longue demi-vie plasmatique qui peut entraîner accumulation et toxicité. Nous montrons ici que des doses anaigésiques efficaces de méthadone, administrées par voie épidurale ou orale, peuvent être utilisées sans danger comme traitement prolongé de patients hospitalisés.
Eléments cliniques
Pendant cinq ans, nous avons administré de !a méthadone pour douleurs intenses à 3 954 patients hospitalisés au Hadassah Hospital de Jérusaiem. Parmi eux, 12 % avaient moins de 17 ans. L’analgésie a été satisfaisante chez plus de 85 % des patients. Aucun effet secondaire important n’a été rapporté avec l’usage de la méthadone orale. Trols patients traités avec la méthadone épidurale (0,09 %) ont subi une dépression respiratoire significative. Une défaillance de la pompe épidurale ou une erreur de programmation avaient alors provoqué des surdoses de méthadone. Aucun enfant ou adulte traité avec la méthadone n’est devenu dépendant du médicament pendant l’hospitalisation.
Conclusion
Étant donné ses propriétés analgésiques et son remarquable profil d’lnnocuité, nous croyons que la méthadone pourrait s’ajouter à l’arsenal thérapeutique des patients hospitalisés. Elle peut aussi servir d’opioïde de premier choix chez certains patients hospitalisés.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Schechter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am 1989; 36: 781–94.
Abbott FV, Gray-Donald K, Sewitch MJ, Johnston CC, Edgar L, Jeans ME. The prevalence of pain in hospitalized patients and resolution over six months. Pain 1992; 50: 15–28.
Donovan M, Dillon P, McGuire L. Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain 1987; 30: 69–78.
Owen H, McMillan V, Rogowski D. Postoperative pain therapy: a survey of patients’ expectations and their experiences. Pain 1990; 41: 303–7.
Fainsinger R, Schoeller T, Bruera E. Methadone in the management of cancer pain: a review. Pain 1993; 52: 137–47.
Inturrisi CE, Colburn WA, Kaiko RF, Houde RW, Foley KM. Pharmacokinetics and pharmacodynamics of methadone in patients with chronic pain. Clin Pharmacol Ther 1987; 41: 392–401.
Gourlay GK, Willis RJ, Lamberty J. A double-blind comparison of the efficacy of methadone and morphine in postoperative pain control. Anesthesiology 1986; 64: 322–7.
Berde CB, Beyer JE, Bournaki MC, Levin CR, Sethna NF. Comparison of morphine and methadone for prevention of postoperative pain in 3-to-7 year-old children. J Pediatr 1991; 119(Pt 1): 136–41.
Wang JM, Knarr DC, Raj PP, Denson D. Continuous epidural methadone for the management of postoperative pain after lower abdominal surgery. Reg Anesth 1992; 17: 26–8.
Ripamonti C, Zecca E, Bruera E. An update on the clinical use of methadone for cancer pain. Pain 1997; 70: 109–15.
Ettinger DS, Vitale PJ, Trump DL. Important clinical pharmacologic considerations in the use of methadone in cancer patients. Cancer Treat Rep 1979; 63: 457–9.
Hunt G, Bruera E. Respiratory depression in a patient receiving oral methadone for cancer pain. J Pain Symptom Manage 1995; 10: 401–4.
Oneschuk D, Bruera E. Respiratory depression during methadone rotation in a patient with advanced cancer. J Palliat Care 2000; 16: 50–4.
Olsen Gd, Wendel HA, Livermore JD, Leger RM, Lynn RK, Gerber N Clinical effect and pharmacokinetics of racemic methadone and its optical isomers. Clin Pharmacol Ther 1977; 21: 147–57.
Evron S, Samueloff A, Simon A, Drenger B, Magora F. Urinary function during epidural analgesia with methadone and morphine in post-cesarean section patients. Pain 1985; 23: 135–44.
Shir Y, Eimerl D, Magora F, Damm D, Schulte-Monting J, Chrubasik J. Plasma concentrations of methadone during postoperative patient-controlled extradural analgesia. Br J Anaesth 1990; 65: 204–9.
Shir Y, Yehuda Ben DB, Polliack A, Magora F. Prolonged continuous epidural methadone analgesia in the treatment of back and pelvic pain due to multiple myeloma. Pain Clin 1987; 1: 255–8.
Shir Y, Shenkman Z, Shavelson V, Davidson EM, Rosen G. Oral methadone for the treatment of severe pain in hospitalized children: a report of five cases. Clin J Pain 1998; 14: 350–3.
Sawe J, Hansen J, Ginman C, et al. Patient-controlled dose regimen of methadone for chronic cancer pain. BMJ 1981; 282: 771–3.
Paalzow L, Nilsson L, Stenberg P. Pharmacokinetic basis for optimal methadone treatment of pain in cancer patients. Acta Anaesthesiol Scand Suppl 1982; 74: 55–8.
Payne R, Lnturrisi CE. CSF distribution of morphine, methadone and sucrose after intrathecal injection. Life Sci 1985; 37: 1137–44.
Gourlay GK, Cherry DA, Cousins MJ. A comparative study of the efficacy and pharmacokinetics of oral methadone and morphine in the treatment of severe pain in patients with cancer. Pain 1986; 25: 297–312.
Martinson LM, Nixon S, Geis D, YaDeau R, Nesbit M, Kersey J. Nursing care in childhood cancer: methadone. Am J Nurs 1982; 82: 432–5.
Miser AW, Miser JS. The use of oral methadone to control moderate and severe pain in children and young adults with malignancy. Clin J Pain 1986; 1: 243–8.
Gorman AL, Elliott KJ, Lnturrisi CE. The d- and 1-isomers of methadone bind to the non-competitive site on the N-methyl-D-aspartate (NMDA) receptor in rat forebrain and spinal cord. Neurosci Lett 1997; 223: 5–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shir, Y., Rosen, G., Zeldin, A. et al. Methadone is safe for treating hospitalized patients with severe pain. Can J Anesth 48, 1109–1113 (2001). https://doi.org/10.1007/BF03020377
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03020377