Methadone in the Treatment of Neuropathic Pain

Gagnon, Bruno; Al-Mahrezi, Abdulaziz; Schreier, Gil

doi:10.1155/2003/236718

Cited by 78 publications

(54 citation statements)

References 56 publications

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“…93 However, its long half-life (24-36 hours) necessitates extremely careful dose titration. 94 Two small RCTs of methadone demonstrated benefit in managing neuropathic pain, 95,96 and open-label experience suggests promise in a wide variety of neuropathic pain conditions. 97 …”

mentioning

confidence: 99%

Neuropathic pain: a practical guide for the clinician

Gilron

Watson²,

Cahill³

et al. 2006

Canadian Medical Association Journal

379

275

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confidence: 99%

Neuropathic pain: a practical guide for the clinician

Gilron

Watson²,

Cahill³

et al. 2006

Canadian Medical Association Journal

379

275

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“…NMDA antagonism is also believed to atenuate tolerance [12][13][14][15][16]. These combined mechanisms are the cause of its eicacy in chronic and neuropathic pain [17].…”

Section: Dual or Multimechanism Opioidsmentioning

confidence: 99%

Pharmacotherapy of Chronic Pain

Vázquez¹,

Fagiolino²

2017

Pain Relief - From Analgesics to Alternative Therapies

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In the past two decades, many preclinical works have been carried out assisting in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. Chronic pain involves multiple pathophysiological mechanisms with peripheral and central components. This research in basic and clinical research has greatly expanded the options for analgesic pharmacotherapy. This chapter gives information regarding the major classes of medication used to assist in the management of chronic pain, including nonopioids analgesics such as NSAIDs and acetaminophen, opioids analgesics, antidepressants and anticonvulsants and an emerging area as the ield of cannabinoids is. Importantly, chronic pain treatment encompasses multiple agents to take advantage of synergistic mechanism of actions, but drug-drug interactions have to be taken into account in order to avoid lack of eicacy or toxicity.

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“…Because of incomplete cross tolerance with conventional µ-opioid agonists, methadone may control pain better in patients who have become tolerant to other opioids (13). Due to the additional NMDA antagonist action, methadone may be more effective in neuropathic pain and there is preliminary evidence to support this (10). Also, the additional monoaminergic action may mean that methadone is more effective in chronic noncancer pain, whether it be neuropathic or not, and there is preliminary evidence to support this as well (18).…”

Section: Clinical Aspectsmentioning

confidence: 99%

“…Accumulating evidence has identified a number of advantages of methadone over other opioids for the treatment of chronic pain, including agonist action at both µ and δ opioid receptors (2,3), N-methyl-D-aspartate (NMDA) antagonist activity (4)(5)(6)(7)(8)(9) and the ability to inhibit the reuptake of monoamines (6). This, in addition to the pharmacoeconomic issues related to the very low cost of the widely available generic hydrochloride methadone powder (10,11), have led to increased interest in the use of methadone for the treatment of cancer pain (10)(11)(12)(13)(14)(15) and, more recently, neuropathic (16,17) and chronic noncancer pain (18). However, methadone exhibits significant interindividual variation in pharmacokinetics and it is important for clinicians to be aware of this so that patients are not exposed to unnecessary risk.…”

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confidence: 99%

A Review of the Use of Methadone for the Treatment of Chronic Noncancer Pain

Lynch

2005

Pain Research and Management

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Methadone, although having been available for approximately half a century, is now receiving increasing attention in the management of chronic pain. This is due to recent research showing that methadone exhibits at least three different mechanisms of action including potent opioid agonism, N-methyl-D-aspartate antagonism and monoaminergic effects. This, along with methadone's excellent oral and rectal absorption, high bioavailability, long duration of action and low cost, make it a very attractive option for the treatment of chronic pain. The disadvantages of significant interindividual variation in pharmacokinetics, graduated dose equivalency ratios based on prerotation opioid dose when switching from another opioid, and the requirement for special exemption for prescribing methadone make it more complicated to use. The present review is intended to educate physicians interested in adding methadone to their armamentarium for assisting patients with moderate to severe pain.Key Words: Chronic pain; Methadone; Pharmacotherapy Une analyse de l'utilisation de la méthadone dans le traitement des douleurs non cancéreuses chroniques La méthadone, bien qu'elle soit disponible depuis environ un demi-siècle, attire plus d'attention dans la prise en charge des douleurs chroniques. Cet intérêt découle de recherches récentes selon lesquelles la méthadone comporte au moins trois mécanismes d'action différents, y compris un puissant agonisme des opiacés, un antagonisme N-méthyl-D-aspartate et des effets monoaminergiques. Ce phénomène, allié à l'excellente absorption orale et rectale de la méthadone, à sa biodisponibilité élevée, à sa longue durée d'action et à son faible coût, le rend très attrayant dans le traitement des douleurs chroniques. Les inconvénients d'une variation pharmacocinétique interindividuelle marquée, des ratios d'équivalence de doses graduées fondés sur la dose d'opiacés de prérotation au moment de changer d'opiacé et le besoin d'une exemption spéciale pour prescrire de la méthadone en compliquent l'utilisation. La présente étude vise à informer les médecins intéressés à ajouter la méthadone à leur panoplie pour aider les patients ayant des douleurs modérées à graves.

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Methadone in the Treatment of Neuropathic Pain

Abstract: Methadone at relatively low doses seems to be useful in the treatment of neuropathic pain.

Cited by 78 publications

References 56 publications

Neuropathic pain: a practical guide for the clinician

Neuropathic pain: a practical guide for the clinician

Pharmacotherapy of Chronic Pain

A Review of the Use of Methadone for the Treatment of Chronic Noncancer Pain

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