Methadone: Opioid of Choice for Treatment of Persistent Pain in the Elderly

Abstract

The undertreatment of persistent pain is a worldwide dilemma. Studies show that one in five adults are living with inadequately treated moderate-to-severe persistent pain. One of the major barriers to the appropriate assessment and treatment of persistent pain is a ‘knowledge gap’. This gap affects healthcare providers, policy makers, patients and their families in their understanding of the magnitude and importance of this problem and available options for treatment. The impact of this knowledge gap is compounded by the lack of available and affordable opioid analgesics. Of the few long-acting opioids available to treat persistent pain, methadone has been available for the longest time and is dramatically less expensive than the others. Yet, methadone has been used minimally in treating persistent pain. Clinical studies assessing its efficacy, tolerability and safety have been few and inadequate. From the perspective of a clinician who, for 30 years, has extensively used methadone to treat pain, this article addresses the use of methadone in the treatment of persistent pain in the elderly. It discusses the factors that have led to the drug being understudied and underprescribed and lays out a rationale for why it should be considered the opioid of choice for the treatment of all types of persistent pain.