Methadone for chronic non-cancer pain in adults

Abstract

BackgroundMethadone belongs to a class of analgesics known as opioids, that are considered the cornerstone of therapy for moderate-to-severe pain due to life-threatening illnesses; however, their use in chronic non-cancer pain (CNCP) is controversial. Methadone has many characteristics that di erentiate it from other opioids, which suggests that it may have a di erent e icacy and safety profile. ObjectivesTo assess the analgesic e ectiveness and safety of methadone in the treatment of CNCP. Search methodsWe identified both randomized controlled trials (RCTs) and non-randomized studies of methadone use in chronic pain by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2011, issue 11, MEDLINE (1950 to November 2011), and EMBASE (1980 to November 2011, together with reference lists of retrieved papers and reviews. Selection criteriaWe included RCTs with pain assessment as either the primary or secondary outcome. Quasi-randomized studies, cohorts and case-control trials were also considered for inclusion because we suspected that the beneficial and harmful e ects of methadone in CNCP may not be adequately addressed in RCTs. Data collection and analysisTwo review authors independently extracted e icacy and adverse event data and assessed risk of bias. Main resultsWe included two RCTs and one non-randomized study, involving a total of 181 participants. Both RCTs were cross-over studies, one involving 19 participants with diverse neuropathic pain syndromes, the other involving 76 participants with postherpetic neuralgia. Study phases were 20 days and approximately eight weeks, respectively. The non-randomized study retrospectively evaluated 86 outpatients over an average of 8.8 ± 6.3 months.One RCT reported average pain intensity and pain relief, and found statistically significant improvements versus placebo for both outcomes, with 10 mg and 20 mg daily doses of methadone. The second RCT reported di erences in pain reduction between methadone and morphine and found morphine to be statistically superior. The non-randomized study found that in patients initially prescribed methadone it was Methadone for chronic non-cancer pain in adults (Review)

Neuropathic pain and SCI: Identification and treatment strategies in the 21st century

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