Methadone in pain uncontrolled by morphine

Morley, J. S.; Watt, J. W. G.; Wells, J. C. D.; Miles, John B.; Finnegan, MJ; Leng, G.

doi:10.1016/0140-6736(93)92228-l

Cited by 124 publications

(44 citation statements)

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“…Methadone's NMDA receptor antagonistic activity 17 in addition to the well known clinical phenomenon of incomplete cross-tolerance to the effects of various opioids may explain this marked improvement also observed by other authors when rotating to methadone from opioids other than fentanyl. 4,10,11 Our study confirms that methadone when used via intravenous PCA after appropriate conversion parameters is safe and can be drastically effective for the relief of pain refractory to fentanyl.…”

Section: Discussionsupporting

confidence: 64%

“…6 Several reports have underscored the efficacy of methadone in the treatment of cancer pain, especially for pain refractory to high doses of other opioids. 4,[7][8][9][10] The main concern when using methadone for the treatment of pain is its long and unpredictable half-life and associated risk of delayed overdose, 11,12 unless careful and individualized dose titration is undertaken. Methadone is a synthetic opioid that differs from other opioids because of its long half-life, N-methyl-D-aspartate (NMDA) receptor antagonist activity, and lack of known active metabolites.…”

mentioning

confidence: 99%

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Intravenous methadone in the management of chronic cancer pain

Santiago-Palma

Khojainova

Kornick

et al. 2001

Cancer

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We review contemporary research on perceptual‐cognitive expertise in sport and consider implications for those working in the field of applied cognitive psychology. We identify the important perceptual‐cognitive skills that facilitate anticipation in sport and illustrate how these skills interact in a dynamic manner during performance. We also highlight our current understanding of how these skills are acquired and consider the extent to which the underlying processes are specific to a particular domain and role within that domain. Next, we briefly review recent attempts to facilitate the acquisition of perceptual‐cognitive expertise using simulation training coupled with instruction and feedback on task performance. Finally, we discuss how research on elite athletes can help inform applied cognitive psychologists who are interested in capturing and enhancing perceptual‐cognitive expertise across various domains. Copyright © 2010 John Wiley & Sons, Ltd.

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Section: Discussionsupporting

confidence: 64%

mentioning

confidence: 99%

Intravenous methadone in the management of chronic cancer pain

Santiago-Palma

Khojainova

Kornick

et al. 2001

Cancer

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“…Coadministration of morphine with MK-801, a noncompetitive NMDA receptor antagonist, has been shown to prevent morphine tolerance in several animal models. 10 Methadone, a potent NMDA antagonist, restores opioid responsiveness in patients whose pain ceases to be controlled by morphine or diamorphine. 11 Patients with persistent pain and adverse effects due to opioids (e.g., intravenous morphine and hydromorphone) have achieved excellent pain relief without significant adverse effects at doses of intravenous methadone much lower than those suggested by opioid conversion charts.…”

Section: Opioid Tolerancementioning

confidence: 99%

Rotating Methadone to Other Opioids: A Lesson in the Mechanisms of Opioid Tolerance and Opioid-Induced Pain

Prommer

2006

Journal of Palliative Medicine

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“…eine Reduktion unerwünschter Nebenwirkungen erzielt werden. Insbesondere Methadon scheint hier aufgrund der höheren Affinität zum µ-Rezeptor und der antagonistischen Wirkung am NMDARezeptor Vorteile aufzuweisen [15,94]. Nach der Umstellung auf ein anderes Opioid sollte mit 50% der errechneten Äquivalenzdosis begonnen und je nach Bedarf rasch hochtitriert werden, da die Äquivalenzdosen aufgrund der Aktivierung pronozizeptiver Systeme individuell stark variieren können [41].…”

Section: Opioidrotationunclassified

Opioid-induzierte Hyperalgesie

Koppert

2004

Der Anaesthesist

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Opioids are the drugs of choice for the treatment of moderate to severe acute and chronic pain. However, clinical evidence suggests that opioids can elicit increased sensitivity to noxious stimuli suggesting that administration of opioids can activate both pain inhibitory and pain facilitatory systems. Acute receptor desensitization via uncoupling of the receptor from G-proteins, up-regulation of the cAMP pathway, activation of the N-methyl-D-aspartate (NMDA) receptor system, as well as descending facilitation, have been proposed as potential mechanisms underlying opioid-induced hyperalgesia. Numerous reports exist demonstrating that opioid-induced hyperalgesia is observed both in animal and human experimental models. Brief exposures to micro-receptor agonists induce long-lasting hyperalgesic effects for days, which might by reflected by clinical observations that large doses of intraoperative micro-receptor agonists increased postoperative pain and morphine consumption. Furthermore, the prolonged use of opioids in patients often requires increasing doses and may be accompanied by the development of abnormal pain. Successful strategies that may decrease or prevent opioid-induced hyperalgesia include the concomitant administration of drugs like NMDA-antagonists, alpha(2)-agonists, or non-steroidal anti-inflammatory drugs (NSAIDs), opioid rotation or combinations of opioids with different receptor selectivity.

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Methadone in pain uncontrolled by morphine

Cited by 124 publications

References 0 publications

Intravenous methadone in the management of chronic cancer pain

Intravenous methadone in the management of chronic cancer pain

Rotating Methadone to Other Opioids: A Lesson in the Mechanisms of Opioid Tolerance and Opioid-Induced Pain

Opioid-induzierte Hyperalgesie

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