Methadone in Pain Management: A Systematic Review

Hanna, Verina; Senderovich, Helen

doi:10.1016/j.jpain.2020.04.004

Cited by 23 publications

(17 citation statements)

References 47 publications

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“…In addition to mu-opioid receptor agonism, methadone’s complex mechanism includes NMDA-receptor antagonism and inhibition of serotonin and norepinephrine uptake in the central nervous system. These actions confer benefit in the treatment of chronic neuropathic pain and may also inhibit surgical stress and central sensitization, thus reducing the risks of opioid-related hyperalgesia, tolerance, and persistent postoperative pain [ 335 , 336 , 337 , 339 , 342 , 343 ]. Appropriate monitoring and communication across transitions of care is important when the anesthetist administers methadone intraoperatively.…”

Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Pain Management and Opioid Stewardship Across The Periopementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…Recognition of methadone's mortality risks and the minimal evidence for benefit in patient analgesia [23] has emphasized its inappropriate status as the first-line drug of choice for chronic pain management, influencing several states to remove methadone from their preferred drug lists [10]. However, its role as maintenance therapy for OUD remains paramount in reducing the morbidity of the opioid epidemic.…”

Section: Discussionmentioning

confidence: 99%

Methadone Prescribing for Pain Management in Pennsylvania per the Prescription Drug Monitoring Program, 2016–2020

Adalbert¹,

Varshney²,

Hom³

et al. 2022

Cureus

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IntroductionMethadone is a schedule II opioid traditionally used to treat opioid use disorder (OUD) and chronic pain. However, following the identification of its contribution to opioid overdose deaths, methadone has become less commonly used for chronic pain indications. In Pennsylvania (PA), prescribers are required to report methadone prescriptions written for pain indications to the prescription drug monitoring program (PDMP), which is an electronic database that enhances the tracking and reporting of prescription data. The primary objective of our study was to describe the geographic methadone prescribing trends recorded by the PA PDMP in order to report methadone's current use for only pain indications. MethodsState-and county-level methadone prescription data summaries recorded by the PA PDMP for each calendar quarter from August 2016 through March 2020 were collected from the PA Department of Health. The metric reported per quarter consisted of the total number of methadone prescriptions dispensed for pain indications unrelated to OUD. ResultsA total of 341,949 methadone prescriptions were dispensed in PA from the third quarter (Q3) of 2016 to the first quarter (Q1) of 2020 (range = 1106) with an overall 38.7% decrease in methadone prescriptions and a change in the rate of 85.97 per 100,000 population. The counties with the five highest prescription totals were Philadelphia, Allegheny, Bucks, Montgomery, and York (range = 46,969), and the counties with the five highest rates per 100,000 were Montour, Green, Columbia, Northumberland, and Forest (range = 964). ConclusionsMethadone prescribing for pain management unrelated to OUD has decreased in PA from 2016 to 2020 per the PA PDMP. However, it is still prescribed in appreciable amounts for pain management. Further studies are required to understand the prescribing rationale and potential areas for harm reduction interventions.

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“…Methadone, like buprenorphine, is primarily used as medication for opioid use disorders but also for cancer pain and in palliative care because of its long half‐life and noneuphoric opioid effects at therapeutic doses 71 . Methadone is primarily administered orally once daily in opioid treatment programs, sometimes referred to as methadone clinics, as a liquid to reduce diversion and increase adherence.…”

Section: Prescription Opioidsmentioning

confidence: 99%

Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids

Vearrier

Grundmann

2021

The Journal of Clinical Pharma

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Opioids were the most common drug class resulting in overdose deaths in the United States in 2019. Widespread clinical use of prescription opioids for moderate to severe pain contributed to the ongoing opioid epidemic with the subsequent emergence of fentanyl‐laced heroin. More potent analogues of fentanyl and structurally diverse opioid receptor agonists such as AH‐7921 and MT‐45 are fueling an increasingly diverse illicit opioid supply. Overdose from synthetic opioids with high binding affinities may not respond to a typical naloxone dose, thereby rendering autoinjectors less effective, requiring higher antagonist doses or resulting in a confusing clinical picture for health care providers. Nonscheduled opioid drugs such as loperamide and dextromethorphan are associated with dependence and risk of overdose as easier access makes them attractive to opioid users. Despite a common opioid‐mediated pathway, several opioids present with unique pharmacodynamic properties leading to acute toxicity and dependence development. Pharmacokinetic considerations involve half‐life of the parent opioid and its metabolites as well as resulting toxicity, as is established for tramadol, codeine, and oxycodone. Pharmacokinetic considerations, toxicities, and treatment approaches for notable opioids are reviewed.

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Methadone in Pain Management: A Systematic Review

Cited by 23 publications

References 47 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Methadone Prescribing for Pain Management in Pennsylvania per the Prescription Drug Monitoring Program, 2016–2020

Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids

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