Use of methadone as an alternative to morphine for chronic pain management: a noninferiority retrospective observational study

Barros, Guilherme Antônio Moreira de; Baradelli, Ricardo; Rodrigues, Debora Garcia; Toffoletto, Odaly; Domingues, Flávia Seullner; Gayoso, Maísa Vitória; Lopes, Alexandre H.; Afiune, Jorge Barros; Guimarães, Gabriel Magalhães Nunes

doi:10.1097/pr9.0000000000000979

Cited by 2 publications

(1 citation statement)

References 42 publications

(78 reference statements)

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“…Furthermore, methadone may treat various manifestations of pain, including nociceptive pain, neuropathic pain, and nociplastic pain. 14 When methadone is prescribed for opioid use disorder, federal law mandates that only an opioid-treatment program certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) can dispense methadone. 15 When administering methadone for an indication of pain, either acute or chronic pain, certification by SAMHSA is not needed, and guidelines are not clearly defined on the level of training or expertise that is warranted of the prescribing physician.…”

Section: Promentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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Enhanced recovery after surgery (ERAS) protocols are standardized and designed to provide superior analgesia, reduce opioid consumption, improve patient recovery, and reduce hospital length of stay. Yet, moderate-to-severe postsurgical pain continues to afflict over 40% of patients and remains a major priority for anesthesia research. Methadone administration in the perioperative setting may reduce postoperative pain scores and have opioid-sparing effects, which may be beneficial for enhanced recovery. Methadone possesses a multimodal profile consisting of µ-opioid agonism, N-methyl-d-aspartate (NMDA) receptor antagonism, and reuptake inhibition of serotonin and norepinephrine. Furthermore, it may attenuate the development of chronic postsurgical pain. However, caution is advised with perioperative use of methadone in specific high-risk patient populations and surgical settings. Methadone's wide pharmacokinetic variability, opioid-related adverse effects, and potential negative impact on cost-effectiveness may also limit its use in the perioperative setting. In this PRO-CON commentary article, the authors debate whether methadone should be incorporated in ERAS protocols to provide superior analgesia with no increased risks.

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Section: Promentioning

confidence: 99%