Oral Methadone for Chronic Noncancer Pain

Sandoval, Juan A.; Furlan, Andrea D.; Mailis, Angela

doi:10.1097/01.ajp.0000146165.15529.50

Cited by 40 publications

(4 citation statements)

References 58 publications

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“…The effectiveness of the most commonly prescribed opioids for CNCP, including codeine, morphine, oxycodone and tramadol, has been evaluated in several systematic reviews (10)(11)(12)(16)(17)(18)(19)(20)(21)(22). The most common kinds of CNCP represented in these reviews were low back pain, osteoarthritis, and neuropathic pain.…”

Section: Effectiveness Of Opioids For Relieving Pain and Improving Fu...mentioning

confidence: 99%

Use and Misuse of Opioids in Chronic Pain

2018

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The prescribing of opioid analgesics for pain management-particularly for management of chronic noncancer pain (CNCP)-has increased more than fourfold in the United States since the mid-1990s. Yet there is mounting evidence that opioids have only limited effectiveness in the management of CNCP, and the increased availability of prescribed opioids has contributed to upsurges in opioid-related addiction cases and overdose deaths. These concerns have led to critical revisiting and modification of prior pain management practices (e.g., guidelines from the Centers for Disease Control and Prevention), but the much-needed changes in clinical practice will be facilitated by a better understanding of the pharmacology and behavioral effects of opioids that underlie both their therapeutic effects (analgesia) and their adverse effects (addiction and overdose). With these goals in mind, this review first presents an overview of the contemporary problems associated with opioid management of CNCP and the related public health issues of opioid diversion, overdose, and addiction. It then discusses the pharmacology underlying the therapeutic and main adverse effects of opioids and its implications for clinical management of CNCP within the framework of recent clinical guidelines for prescribing opioids in the management of CNCP.

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Section: Effectiveness Of Opioids For Relieving Pain and Improving Fu...mentioning

confidence: 99%

Use and Misuse of Opioids in Chronic Pain

2018

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“…Methadone has traditionally been used in the management of opioid dependence. However, there is increasing interest in the repurposing of methadone as a cost-efficient treatment for neuropathic pain [6,7]. Morley, et al [8] reported the efficacy of oral methadone for the management of neuropathic pain in a double-blind randomized controlled crossover trial.…”

Section: Introductionmentioning

confidence: 99%

Preparation, Characterization and Dermal Delivery of Methadone

Kung¹,

Sil

Hadgraft³

et al. 2019

Pharmaceutics

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The use of methadone for the management of pain has received great interest in recent years. Currently, oral and intravenous formulations are available for clinical use. Dermal delivery represents an attractive alternative route of administration for this drug as it is associated with comparatively fewer side effects. The first stage of the work was the preparation of methadone free base as this form of the drug is expected to permeate the skin to a greater extent than the hydrochloride salt. Subsequently the molecule was characterized with Nuclear Magnetic Resonance (NMR) and thermal analysis, the distribution coefficient was determined and solubility studies were conducted in a range of solvents. In vitro permeation and mass balance studies were conducted under finite dose conditions (5 μL/cm2) in porcine skin. The results confirmed the more favorable penetration of methadone free base compared with the salt. The highest cumulative amount of methadone (41 ± 5 μg/cm2) permeated from d-limonene (LIM). Ethyl oleate (EO), Transcutol® P (TC) and octyl salicylate (OSAL) also appear to be promising candidate components of dermal formulations for methadone base. Future work will focus on further formulation optimization with the objective of progressing to evaluation of prototype dosage forms in clinical trials.

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“…This syndrome is thought to be under-recognized, but is probably becoming more prevalent because of an increase in the use of narcotics for chronic nonmalignant painful disorders in United States (4,6, 10), and the paradoxical development of increased pain in those chronically taking opiates associated with maladaptive behaviors (11, 12). However, to our knowledge, there are no epidemiological data on the prevalence of NBS in the US community or elsewhere.…”

Section: Introductionmentioning

confidence: 99%

Opioid Bowel Dysfunction and Narcotic Bowel Syndrome: A Population-Based Study

et al. 2009

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OBJECTIVES Opioid prescription use is increasing. Narcotic bowel syndrome (NBS) refers to chronic abdominal pain aggravated by narcotic use. Despite increasing narcotic use, NBS may be under-recognized. The aim of this study was to assess whether gastrointestinal (GI) symptoms in the community are associated with chronic narcotic use and estimate the likely prevalence of NBS. METHODS Validated self-report GI symptom questionnaires were mailed to 4,898 randomly selected people in the community. The medical charts of all respondents were reviewed to identify participants who had used narcotics and to determine whether they were taking an opioid for > 5 weeks for the treatment of chronic pain (malignant or nonmalignant). NBS was defined as abdominal pain developing in those taking chronic narcotics. The associations between GI symptoms and chronic narcotics use were assessed using logistic regression analysis. RESULTS A total of 2,913 respondents returned a completed questionnaire (overall response rate 59%, mean age 62, 52% female); 117 participants (4.1%, 95% confidence interval (CI): 3.3, 4.5) were taking narcotics. Five participants (0.17%; 95% CI: 0.06, 0.40%) met the criteria for NBS. Participants using narcotics had an increased use of laxatives (17 vs. 8% in those not using narcotics, P < 0.05). GI symptom reporting was more common in participants on narcotics, although the adjusted (for age, gender, somatic symptom complaints, and use of laxatives) odds ratios (ORs) were significantly increased only for frequent abdominal pain and stool frequency. CONCLUSIONS NBS may be relatively uncommon. Those on narcotics report additional GI symptoms (abdominal pain and stool frequency) and use more laxatives.

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Oral Methadone for Chronic Noncancer Pain

Cited by 40 publications

References 58 publications

Use and Misuse of Opioids in Chronic Pain

Use and Misuse of Opioids in Chronic Pain

Preparation, Characterization and Dermal Delivery of Methadone

Opioid Bowel Dysfunction and Narcotic Bowel Syndrome: A Population-Based Study

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