Intravenous Methadone for Perioperative and Chronic Cancer Pain: A Review of the Literature

Mercadante, Sebastiano

doi:10.1007/s40265-023-01876-7

Cited by 5 publications

(7 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Methadone also modulates pain stimulus propagation to limit the development of hyperalgesia and mitigate opioid tolerance. 5,12 Renal and hepatic impairment do not affect methadone clearance with about 50% of methadone and its metabolites excreted by the intestines and 50% excreted unchanged by the kidneys. 13 However useful, these pharmacologic properties can also limit its utility.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…In this way, methadone provides potent analgesia which is bolstered by a long half‐life that mimics the duration of action of extended‐release opioids while simultaneously conferring neuropathic pain relief through non‐competitive NMDA antagonism. Methadone also modulates pain stimulus propagation to limit the development of hyperalgesia and mitigate opioid tolerance 5,12 . Renal and hepatic impairment do not affect methadone clearance with about 50% of methadone and its metabolites excreted by the intestines and 50% excreted unchanged by the kidneys 13 .…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…Specifically, the Australian and New Zealand College of Anesthetists and Faculty of Pain Medicine (ANZCA & FCM) have discouraged breakthrough use of methadone, which is considered a slow‐release opioid due to lack of evidence‐based consensus data on its' feasibility and dose titration 8 . Of the various studies that have examined IV methadone, almost all have suggested single intraoperative doses may produce more effective pain control and may lower postoperative opioid requirements without more adverse effects when compared to comparator opioids such as morphine 5,24,25 . Anecdotally, outside of the operating room and post‐anesthetics recovery units, orders for breakthrough doses of methadone (either IV, subcutaneous or intramuscular) are a rarity, and subsequently, administration can be a cause for concern.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…In addition, methadone exhibits a long duration of effect which has seen its use for the management of chronic opioid dependence in the community. These pathways additionally have been demonstrated to be effective in the treatment of acute and chronic cancer pain, with a growing number of studies reporting on their use for this purpose, in some cases even as the first‐line agent 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…These pathways additionally have been demonstrated to be effective in the treatment of acute and chronic cancer pain, with a growing number of studies reporting on their use for this purpose, in some cases even as the first-line agent. 5,6 There has been consideration of the potential for methadone as an analgesic within the postoperative period, particularly for patients with complex analgesia requirements. 7 Despite this, methadone is highly regulated, with no current evidence base to inform the development of appropriate guidelines and frameworks to guide its use outside that of opioid replacement therapy and leaves methadone an underused medication in pain medicine.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Intravenous methadone in the management of acute postoperative pain in a chronic cancer pain patient: A case report and review of the literature

Le,

Hua

2023

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageThe current landscape of literature highlights that there is insufficient well‐powered and robust evidence to support the integration of intravenous methadone into current guidelines and frameworks in supporting the pain management of cancer patient with complex pain syndromes. However, there is preliminary evidence, both from the literature as well as this case study that highlights intravenous methadone may be efficaciously and safety used for the management of postoperative pain in cancer patients with chronic pain undergoing operative management. Further research is required to fully elucidate key considerations of integrating this medication into clinical practice including consideration into dosing, opioid conversion, tolerance, and safety.AbstractMethadone is a broad‐spectrum analgesic with long duration of effect. Its multimodal mechanism of action, such as through effects on mu‐opioid receptor and presynaptic N‐methyl‐D‐aspartate receptors, has led to its current use in the management of opioid dependence in the community and in palliative care. These properties however make methadone appealing in the management of postoperative pain, particularly for patients with complex analgesic requirements. We report on an interesting case whereby intravenous methadone was effectively used for postoperative analgesia in a 56‐year‐old female with complex chronic pain secondary to a mucinous pelvic neoplasm of unclear primary who underwent palliative resection. Further, we review the literature surrounding usage of methadone in this setting to understand current challenges and barriers to implementation of methadone as an analgesia option for chronic pain patients following surgery. To do this, a case report and literature review was conducted in accordance to the CARE case report guidelines. The patient provided written consent for the de‐identification and use of their medical information and data for the generation and publication of this case report. Our case report and literature review demonstrate there remains significant heterogeneity, unfamiliarity, and scarce use of intravenous methadone in the perioperative and postoperative space in the management of patients with complex pain regimens such as chronic cancer pain patients. Despite this, our case report and literature review highlight as a broad analgesic, intravenous methadone warrants consideration following more rigorous research and development of safe use guidelines into its use for this purpose.

show abstract

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Discussion and Literature Reviewmentioning

confidence: 99%