Abstract
Purpose
To report the successful long-term use of methadone and tramadol in treating low back pain in a marine police officer.
Principal findings
The patient sustained a work-related injury having fallen down stairs while on duty in 1990. After multiple operations for a prolapsed L5/S 1 intervertebral disk, he was first seen at our pain clinic in 1994. Numerous systemic medications, invasive procedures, physiotherapy and psychotherapy were used to treat his pain, but without sustained effect.
Methadone was started in late 1995 and tramadol in 2000. The current maintenance doses are methadone 20 mg and tramadol 200 mg, both twice daily. Apart from some initial disruption, the patient was soon able to return to full time work. Regular performance reports from his supervisors have always been excellent.
Conclusion
The use of methadone in this police officer with chronic low back pain has been very successful despite the demanding nature of his job. The controversy surrounding, and further suggestions regarding long-term use of opioid therapy for nonmalignant pain are discussed.
Résumé
Objectif
Rendre compte de l’usage prolongé efficace de méthadone et de tramadol comme traitement des douleurs lombaires chez un officer de la police maritime.
Constatations principales
Le patient a subi un accident du travail en 1990 en tombant dans un escalier. Après de multiples opérations pour un prolapsus discal à L5/S1, il s’est présenté à notre service antidouleur en 1994. De nombreux médicaments à action générale, des interventions effractives, de la physiothérapie et de la psychothérapie ont été utilisés sans produire d’effet analgésique durable. La méthadone a été prescrite à la fin de 1995 et le tramadol en 2000. Les doses de maintien courantes sont de 20 mg de méthadone et de 200 mg de tramadol, à prendre deux fois par jour. Mis à part une interruption initiale, le patient est bientôt retourné au travail à temps complet. Les rapports réguliers sur le rendement produits par ses superviseurs ont toujours été excellents.
Conclusion
Lusage de méthadone chez un officier de police présentant des douleurs lombaires chroniques s’est révélé très efficace malgré la nature exigeante de son travail. La controverse entourant l’usage prolongé d’opioïdes pour des douleurs bénignes et des suggestions supplémentaires sont examinées.
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Mak, P.H.K., Tsui, S.L. & Jacobus Ng, K.F. Long-term therapy of chronic non-malignant pain with potent opioids in an active police officer. Can J Anesth 49, 575–578 (2002). https://doi.org/10.1007/BF03017384
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DOI: https://doi.org/10.1007/BF03017384