Management of chronic neuropathic pain with methadone: a review of 13 cases

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Clin J Pain. 2005 Jul-Aug;21(4):364-9.

Management of chronic neuropathic pain with methadone: a review of 13

cases.

Altier N, Dion D, Boulanger A, Choiniere M.

Centre des Grands Brules, Hotel-Dieu du Centre Hospitalier de

l'Universite de Montreal, Montreal, Quebec, Canada.

The synthetic opioid methadone has generated much interest in recent

years among clinicians involved in the management of intractable

chronic cancer pain. Its use as an analgesic is starting to extend to

the treatment of noncancer pain, particularly neuropathic pain.

Unfortunately, the evidence for its use in the management of

neuropathic pain is limited to a few case studies.

We examined retrospectively during a 12-month study period the

clinical response of all 13 patients at our pain clinic who were

prescribed methadone in an attempt to control neuropathic pain

resistant to conventional analgesics. A questionnaire was also

administered to the 9 patients who continued to take methadone at 12

months posttreatment.

A total of 4 patients (31%) discontinued it by the end of the 12-

month study period. Patients discontinued methadone due to the

absence of pain relief and due to various intractable, undesirable

side effects.

Somnolence was the most common adverse effect reported, followed by

nausea, constipation, and vomiting. All patients took coanalgesics

(eg, amitriptyline, gabapentin) or other analgesics (eg, morphine,

nonsteroidal anti-inflammatory drugs) during methadone treatment to

control pain. The 9 patients who continued to take methadone at 12

months reported experiencing on average 43% pain relief (range 0-

80%), 47% improvement in quality of life (range 0-100%), and 30%

improvement in quality of sleep (range 0-60%).

Methadone was effective at relieving pain and ameliorating quality of

life and sleep in 62% of patients. These findings suggest that

methadone can offer an acceptable success rate for the treatment of

neuropathic pain. Prospective randomized, placebo-controlled studies

are now needed to examine more rigorously the benefits of methadone

for this type of pain.